Preventive measures and lifestyle habits against exertional heat illness in radiation decontamination workers.

PubMed

Endo, Shota; Kakamu, Takeyasu; Sato, Sei; Hidaka, Tomoo; Kumagai, Tomohiro; Nakano, Shinichi; Koyama, Kikuo; Fukushima, Tetsuhito

2017-09-28

The aim of this study was to reveal the current state of preventive measures and lifestyle habits against heat illness in radiation decontamination workers and to examine whether young radiation decontamination workers take less preventive measures and have worse lifestyle habits than the elder workers. This was a cross-sectional study. Self-administered questionnaires were sent to 1,505 radiation decontamination workers in Fukushima, Japan. Five hundred fifty-eight men who replied and answered all questions were included in the statistical analysis. The questionnaire included age, duration of decontamination work, previous occupation, lifestyle habit, and preventive measures for heat illness. We classified age of the respondents into five groups: <30, 30-39, 40-49, 50-59, and ≥60 years and defined the workers under 30 years of age as young workers. Logistic regression analysis was used to reveal the factors associated with each lifestyle habit and preventive measures. In comparison with young workers, 50-59-year-old workers were significantly associated with refraining from drinking alcohol. Workers 40 years of age or older were significantly associated with cooling their bodies with refrigerant. Furthermore, 30-39-year-old workers and 40-49-year-old workers were significantly associated with adequate consumption of water compared to young workers. The results of our study suggests that young decontamination workers are more likely to have worse lifestyle habits and take insufficient preventive measures for heat illness. This may be the cause of higher incidence of heat illness among young workers.

Susceptibility to exertional heat illness and hospitalisation risk in UK military personnel

PubMed Central

Stacey, Michael J; Parsons, Iain T; Woods, David R; Taylor, Peter N; Ross, David; J Brett, Stephen

2015-01-01

Background Susceptibility to exertional heat illness (EHI) is considered multifactorial in nature. The aims of this study were to (1) review traditional susceptibility factors identified in cases of EHI and (2) determine how they are related to risk of hospitalisation. Methods Review of an electronic database of EHI reported in the British Army between 1 September 2007 and 31 December 2014. Cases were categorised by demographic, situational and susceptibility variables. Univariate and multivariate logistic regression was performed for the OR for hospitalisation by risk factor. Results 361 reports were included in the analysis. 33.5% of cases occurred in hot climates, 34.6% in temperate climates during summer months and 31.9% in temperate climates outside of summer months. Traditional susceptibility factors were reported in 193 but entirely absent from 168 cases. 137 cases (38.0%) were admitted to hospital. Adjusted OR for hospitalisation was lower for recruits (OR 0.42, 95% CI 0.18 to 0.99, p<0.05) and for personnel wearing occlusive dress (OR 0.56, 95% CI 0.34 to 0.93, p<0.05) or unacclimatised to heat (OR 0.31, 95% CI 0.15 to 0.66, p<0.01). Conclusions The global, year-round threat of EHI is highlighted. Absence of susceptibility factors in nearly half of reports highlights the challenge of identifying EHI-prone individuals. Paradoxical association of traditional susceptibility factors with reduced hospitalisation risk may reflect the contemporary contexts in which severe EHI occurs. These findings also suggest a need for better evidence to inform guidelines that aim to prevent severe EHI concurrent to reducing overall morbidity. PMID:27900138

Heat Illness

MedlinePlus

... dangerous levels and you can develop a heat illness. Most heat illnesses happen when you stay out ... in high heat can also lead to heat illness. Older adults, young children, and those who are ...

Preventive measures and lifestyle habits against exertional heat illness in radiation decontamination workers

PubMed Central

Endo, Shota; Kakamu, Takeyasu; Sato, Sei; Hidaka, Tomoo; Kumagai, Tomohiro; Nakano, Shinichi; Koyama, Kikuo; Fukushima, Tetsuhito

2017-01-01

Objectives: The aim of this study was to reveal the current state of preventive measures and lifestyle habits against heat illness in radiation decontamination workers and to examine whether young radiation decontamination workers take less preventive measures and have worse lifestyle habits than the elder workers. Methods: This was a cross-sectional study. Self-administered questionnaires were sent to 1,505 radiation decontamination workers in Fukushima, Japan. Five hundred fifty-eight men who replied and answered all questions were included in the statistical analysis. The questionnaire included age, duration of decontamination work, previous occupation, lifestyle habit, and preventive measures for heat illness. We classified age of the respondents into five groups: <30, 30-39, 40-49, 50-59, and ≥60 years and defined the workers under 30 years of age as young workers. Logistic regression analysis was used to reveal the factors associated with each lifestyle habit and preventive measures. Results: In comparison with young workers, 50-59-year-old workers were significantly associated with refraining from drinking alcohol. Workers 40 years of age or older were significantly associated with cooling their bodies with refrigerant. Furthermore, 30-39-year-old workers and 40-49-year-old workers were significantly associated with adequate consumption of water compared to young workers. Conclusion: The results of our study suggests that young decontamination workers are more likely to have worse lifestyle habits and take insufficient preventive measures for heat illness. This may be the cause of higher incidence of heat illness among young workers. PMID:28794393

Epidemiology of Exertional Heat Illnesses in Youth, High School, and College Football.

PubMed

Yeargin, Susan W; Kerr, Zachary Y; Casa, Douglas J; Djoko, Aristarque; Hayden, Ross; Parsons, John T; Dompier, Thomas P

2016-08-01

Data on exertional heat illness (EHI) in youth football are limited and have not been compared across competition levels. This study describes the epidemiology of EHI events in youth, high school (HS), and college football in the 2012-2014 seasons. One hundred and eighteen youth teams (players age 5-14 yr), 96 HS programs (~14-18 yr), and 34 college programs (~18-23 yr) participated. During games and practices, athletic trainers recorded EHI events and athlete exposures (AE), defined as one athlete participating in one game/practice. We calculated the number of reported EHI by time in season, game/practice, and need for emergency transportation. EHI rates, risk, included rate ratios (IRR), and risk ratios (RR) with 95% confidence intervals (CI) were calculated in 2015. EHI rates for youth, HS, and college football were 1.82, 0.57, and 1.67/10,000 AE, respectively. Rates were highest during the preseason (youth: 2.76; HS: 1.47; college: 3.66/10,000 AE). Game rates were higher than practice rates in youth (4.04 vs 1.22/10,000 AE; IRR = 3.31; 95% CI, 1.75-6.26) and college (4.42 vs 1.38/10,000 AE; IRR = 3.21; 95% CI, 2.00-5.16); the practice rate was higher than the game rate in HS (0.63 vs 0.27/10,000 AE; IRR = 2.33; 95% CI, 1.01-5.38). The EHI risk was higher in college (0.9%) than in youth (0.6%; RR = 1.59; 95% CI, 1.06-2.37) and HS (0.5%; RR = 2.01; 95% CI, 1.43-2.81). Common EHI events included heat cramps (youth: 15.8%; HS: 28.6%; college: 45.6%), heat exhaustion (youth: 42.1%; HS: 32.9%; college: 20.0%), and dehydration (youth: 31.6%; HS: 28.6%; college: 28.9%). EHI risk was low. Higher preseason football EHI rates across levels emphasize developing and continually modifying preseason heat acclimatization policies. Lower EHI rates in HS games and youth practices may be attributable to night events, suggesting the importance of modifying/canceling events based on environmental conditions.

Heat-Related Illnesses

MedlinePlus

... Share this! EmergencyCareForYou » Emergency 101 » Heat-Related Illnesses Heat-Related Illnesses Dr. Glenn Mitchell , Emergency physician at ... about heat cramps and heat stroke and exhaustion. Heat Cramps Symptoms include muscle spasms, usually in the ...

Heat-Related Illnesses

MedlinePlus Videos and Cool Tools

... for signs of heat stroke or exhaustion. Heat Stroke and Exhaustion Symptoms of early heat exhaustion symptoms ... heavy sweating; nausea; and giddiness. Symptoms of heat stroke (late stage of heat illness) include flushed, hot, ...

Exertional heat stroke management strategies in United States high school football.

PubMed

Kerr, Zachary Y; Marshall, Stephen W; Comstock, R Dawn; Casa, Douglas J

2014-01-01

The 5-year period of 2005-2009 saw more exertional heat stroke-related deaths in organized sports than any other 5-year period in the past 35 years. The risk of exertional heat stroke appears highest in football, particularly during the preseason. To estimate the incidence of exertional heat stroke events and assess the utilization of exertional heat stroke management strategies during the 2011 preseason in United States high school football programs. Cross-sectional study; Level of evidence, 3. A self-administered online questionnaire addressing the incidence of exertional heat stroke events and utilization of exertional heat stroke management strategies (eg, removing athlete's football equipment, calling Emergency Medical Services [EMS]) was completed in May to June 2012 by 1142 (18.0%) athletic trainers providing care to high school football athletes during the 2011 preseason. Among all respondents, 20.3% reported treating at least 1 exertional heat stroke event. An average of 0.50 ± 1.37 preseason exertional heat stroke events were treated per program. Athletic trainers responding to exertional heat stroke reported using an average of 6.6 ± 1.8 management strategies. The most common management strategies were low-level therapeutic interventions such as removing the athlete's football equipment (98.2%) and clothing (77.8%) and moving the athlete to a shaded area (91.6%). Few athletic trainers reported active management strategies such as calling EMS (29.3%) or using a rectal thermometer to check core body temperature (0.9%). Athletic trainers in states with mandated preseason heat acclimatization guidelines reported a higher utilization of management strategies such as cooling the athlete through air conditioning (90.1% vs 65.0%, respectively; P < .001), immersion in ice water (63.0% vs 45.4%, respectively; P = .01), or fans (54.3% vs 42.0%, respectively; P = .06) and monitoring the athlete's temperature (60.5% vs 46.2%, respectively; P = .04). Preseason

Exertional heat-related illnesses at the Grand Canyon National Park, 2004-2009.

PubMed

Noe, Rebecca S; Choudhary, Ekta; Cheng-Dobson, Jennifer; Wolkin, Amy F; Newman, Sara B

2013-12-01

The Grand Canyon National Park has approximately 4 million visitors between April and September each year. During this period, outdoor activity such as hiking is potentially hazardous owing to extreme heat, limited shade, and steep, long ascents. Given the high visitation and the public health interest in the effects of extreme heat, this study calculated morbidity rates and described heat-related illness (HRI) among visitors. We conducted a retrospective cross-sectional study from April 1 through September 30, during 2004-2009. From a review of Ranger Emergency Medical Services (EMS) incident report files, we extracted information on those that met the case definition of greater than 1 hour of outdoor heat exposure with an HRI assessment or diagnosis, HRI self-report, or signs or symptoms of HRI without another etiology noted. Visitor and temperature data were obtained from respective official sources. Grand Canyon EMS responded to 474 nonfatal and 6 fatal HRI cases, with the majority (84%) being US residents, 29% from Western states. Of the nonfatal cases, 51% were women, the median age was 43 years (range, 11-83 years), and 18% reported a cardiovascular condition. Clinical HRI assessments included dehydration (25%), heat exhaustion (23%), and suspected hyponatremia (19%). Almost all (90%) were hiking; 40% required helicopter evacuation. The highest HRI rates were seen in May. HRI remains a public health concern at the Grand Canyon. High-risk evacuations and life-threatening conditions were found. Majority were hikers, middle-aged adults, and US residents. These findings support the park's hiker HRI prevention efforts and use of park EMS data to measure HRI. Published by Elsevier Inc.

[Characteristics of elderly heat illness patients in Japan--analysis from Heatstroke STUDY 2010].

PubMed

Miyake, Yasufumi

2013-06-01

Heatstroke Surveillance Committee of the Japanese Association for Acute Medicine (JAAM) collected the clinical data of 1,775 heat illness patients transported into 94 Emergency Medical Centers or Emergency Departments throughout Japan from 1 July to 31 August 2010 (Heatstroke STUDY 2010). Seven hundreds and four elderly patients' data revealed that 541 cases (80%) suffered from classical heatstroke in the ordinary life and the morbidity and mortality were much higher than those of exertional heatstroke patients. Hypertension, diabetes, heart disease and dementia were the risk factors of this disease. Forty nine patients (6.9%) were the victims of classical heatstroke and multiple organ failure include heart failure was the major cause of heat related death in acute phase after admission. No one died in exertional heatstroke group.

Exertional Heat-Related Illnesses at the Grand Canyon National Park, 2004–2009

PubMed Central

Noe, Rebecca S.; Choudhary, Ekta; Cheng-Dobson, Jennifer; Wolkin, Amy F.; Newman, Sara B.

2016-01-01

Background The Grand Canyon National Park has approximately 4 million visitors between April and September each year. During this period, outdoor activity such as hiking is potentially hazardous owing to extreme heat, limited shade, and steep, long ascents. Given the high visitation and the public health interest in the effects of extreme heat, this study calculated morbidity rates and described heat-related illness (HRI) among visitors. Methods We conducted a retrospective cross-sectional study from April 1 through September 30, during 2004–2009. From a review of Ranger Emergency Medical Services (EMS) incident report files, we extracted information on those that met the case definition of greater than 1 hour of outdoor heat exposure with an HRI assessment or diagnosis, HRI self-report, or signs or symptoms of HRI without another etiology noted. Visitor and temperature data were obtained from respective official sources. Results Grand Canyon EMS responded to 474 nonfatal and 6 fatal HRI cases, with the majority (84%) being US residents, 29% from Western states. Of the nonfatal cases, 51% were women, the median age was 43 years (range, 11–83 years), and 18% reported a cardiovascular condition. Clinical HRI assessments included dehydration (25%), heat exhaustion (23%), and suspected hyponatremia (19%). Almost all (90%) were hiking; 40% required helicopter evacuation. The highest HRI rates were seen in May. Conclusions HRI remains a public health concern at the Grand Canyon. High-risk evacuations and life-threatening conditions were found. Majority were hikers, middle-aged adults, and US residents. These findings support the park’s hiker HRI prevention efforts and use of park EMS data to measure HRI. PMID:24119571

Heat-Related Illnesses

DTIC Science & Technology

1988-04-01

factors, thermometry, and fever versus hyper- thernia. ihe review of heat illnesses includes heat "anps, heat edema, heat syncope, heat exhaustiom...clinical situations. For example, fever , the daily circadian rhythm of temperature variation, and the 0.50 C difference in rectal temperature following...thermometry is state of the art. Fever versus Hyperthermia Elevations of body temperature can occur as a result of several different mechanisms. One

American football and fatal exertional heat stroke: a case study of Korey Stringer.

PubMed

Grundstein, Andrew; Knox, John A; Vanos, Jennifer; Cooper, Earl R; Casa, Douglas J

2017-08-01

On August 1, 2001, Korey Stringer, a Pro Bowl offensive tackle for the Minnesota Vikings, became the first and to date the only professional American football player to die from exertional heat stroke (EHS). The death helped raise awareness of the dangers of exertional heat illnesses in athletes and prompted the development of heat safety policies at the professional, collegiate, and interscholastic levels. Despite the public awareness of this death, no published study has examined in detail the circumstances surrounding Stringer's fatal EHS. Using the well-documented details of the case, our study shows that Stringer's fatal EHS was the result of a combination of physiological limitations, organizational and treatment failings, and extreme environmental conditions. The COMfort FormulA (COMFA) energy budget model was used to assess the relative importance of several extrinsic factors on Stringer's EHS, including weather conditions, clothing insulation, and activity levels. We found that Stringer's high-intensity training in relation to the oppressive environmental conditions was the most prominent factor in producing dangerous, uncompensable heat stress conditions and that the full football uniform played a smaller role in influencing Stringer's energy budget. The extreme energy budget levels that led to the fatal EHS would have been avoided according to our modeling through a combination of reduced intensity and lower clothing insulation. Finally, a long delay in providing medical treatment made the EHS fatal. These results highlight the importance of modern heat safety guidelines that provide controls on extrinsic factors, such as the adjustment of duration and intensity of training along with protective equipment modifications based on environmental conditions and the presence of an emergency action plan focused on rapid recognition and immediate on-site aggressive cooling of EHS cases.

American football and fatal exertional heat stroke: a case study of Korey Stringer

NASA Astrophysics Data System (ADS)

Grundstein, Andrew; Knox, John A.; Vanos, Jennifer; Cooper, Earl R.; Casa, Douglas J.

2017-08-01

On August 1, 2001, Korey Stringer, a Pro Bowl offensive tackle for the Minnesota Vikings, became the first and to date the only professional American football player to die from exertional heat stroke (EHS). The death helped raise awareness of the dangers of exertional heat illnesses in athletes and prompted the development of heat safety policies at the professional, collegiate, and interscholastic levels. Despite the public awareness of this death, no published study has examined in detail the circumstances surrounding Stringer's fatal EHS. Using the well-documented details of the case, our study shows that Stringer's fatal EHS was the result of a combination of physiological limitations, organizational and treatment failings, and extreme environmental conditions. The COMfort FormulA (COMFA) energy budget model was used to assess the relative importance of several extrinsic factors on Stringer's EHS, including weather conditions, clothing insulation, and activity levels. We found that Stringer's high-intensity training in relation to the oppressive environmental conditions was the most prominent factor in producing dangerous, uncompensable heat stress conditions and that the full football uniform played a smaller role in influencing Stringer's energy budget. The extreme energy budget levels that led to the fatal EHS would have been avoided according to our modeling through a combination of reduced intensity and lower clothing insulation. Finally, a long delay in providing medical treatment made the EHS fatal. These results highlight the importance of modern heat safety guidelines that provide controls on extrinsic factors, such as the adjustment of duration and intensity of training along with protective equipment modifications based on environmental conditions and the presence of an emergency action plan focused on rapid recognition and immediate on-site aggressive cooling of EHS cases.

Exertional heat illness incidence and on-site medical team preparedness in warm weather

NASA Astrophysics Data System (ADS)

Hosokawa, Yuri; Adams, William M.; Belval, Luke N.; Davis, Robert J.; Huggins, Robert A.; Jardine, John F.; Katch, Rachel K.; Stearns, Rebecca L.; Casa, Douglas J.

2018-03-01

To investigate the influence of estimated wet bulb globe temperature (WBGT) and the International Institute of Race Medicine (IIRM) activity modification guidelines on the incidence of exertional heat stroke (EHS) and heat exhaustion (HEx) and the ability of an on-site medical team to treat those afflicted. Medical records of EHS and HEx patients over a 17-year period from the New Balance Falmouth Road Race were examined. Climatologic data from nearby weather stations were obtained to calculate WBGT with the Australian Bureau of Meteorology (WBGTA) and Liljegren (WBGTL) models. Incidence rate (IR) of EHS, HEx, and combined total of EHS and HEx (COM) were calculated, and linear regression analyses were performed to assess the relationship between IR and WBGTA or WBGTL. One-way ANOVA was performed to compare differences in EHS, HEx, and COM incidence to four alert levels in the IIRM guidelines. Incidence of EHS, HEx, and COM was 2.12, 0.98, and 3.10 cases per 1000 finishers. WBGTA explained 48, 4, and 46% of the variance in EHS, HEx, and COM IR; WBGTL explained 63, 13, and 69% of the variance in EHS, HEx, and COM IR. Main effect of WBGTA and WBGTL on the alert levels were observed in EHS and COM IR (p < 0.05). The cumulative number of EHS patients treated did not exceed the number of cold water immersion tubs available to treat them. EHS IR increased as WBGT and IIRM alert level increased, indicating the need for appropriate risk mitigation strategies and on-site medical treatment.

Physiological responses to the menstrual cycle: implications for the development of heat illness in female athletes.

PubMed

Marsh, Susan A; Jenkins, David G

2002-01-01

Fluctuations in estrogen and progesterone during the menstrual cycle can cause changes in body systems other than the reproductive system. For example, progesterone is involved in the regulation of fluid balance in the renal tubules and innervation of the diaphragm via the phrenic nerve. However, few significant changes in the responses of the cardiovascular and respiratory systems, blood lactate, bodyweight, performance and ratings of perceived exertion are evident across the cycle. Nevertheless, substantial evidence exists to suggest that increased progesterone levels during the luteal phase cause increases in both core and skin temperatures and alter the temperature at which sweating begins during exposure to both ambient and hot environments. As heat illness is characterised by a significant increase in body temperature, it is feasible that an additional increase in core temperature during the luteal phase could place females at an increased risk of developing heat illness during this time. In addition, it is often argued that physiological gender differences such as oxygen consumption, percentage body fat and surface area-to-mass ratio place females at a higher risk of heat illness than males. This review examines various physiological responses to heat exposure during the menstrual cycle at rest and during exercise, and considers whether such changes increase the risk of heat illness in female athletes during a particular phase of the menstrual cycle.

Fatal Exertional Heat Stroke and American Football Players: The Need for Regional Heat-Safety Guidelines.

PubMed

Grundstein, Andrew J; Hosokawa, Yuri; Casa, Douglas J

2018-01-01

  Weather-based activity modification in athletics is an important way to minimize heat illnesses. However, many commonly used heat-safety guidelines include a uniform set of heat-stress thresholds that do not account for geographic differences in acclimatization.   To determine if heat-related fatalities among American football players occurred on days with unusually stressful weather conditions based on the local climate and to assess the need for regional heat-safety guidelines.   Cross-sectional study.   Data from incidents of fatal exertional heat stroke (EHS) in American football players were obtained from the National Center for Catastrophic Sport Injury Research and the Korey Stringer Institute.   Sixty-one American football players at all levels of competition with fatal EHSs from 1980 to 2014.   We used the wet bulb globe temperature (WBGT) and a z-score WBGT standardized to local climate conditions from 1991 to 2010 to assess the absolute and relative magnitudes of heat stress, respectively.   We observed a poleward decrease in exposure WBGTs during fatal EHSs. In milder climates, 80% of cases occurred at above-average WBGTs, and 50% occurred at WBGTs greater than 1 standard deviation from the long-term mean; however, in hotter climates, half of the cases occurred at near average or below average WBGTs.   The combination of lower exposure WBGTs and frequent extreme climatic values in milder climates during fatal EHSs indicates the need for regional activity-modification guidelines with lower, climatically appropriate weather-based thresholds. Established activity-modification guidelines, such as those from the American College of Sports Medicine, work well in the hotter climates, such as the southern United States, where hot and humid weather conditions are common.

Exertional heat illness incidence and on-site medical team preparedness in warm weather.

PubMed

Hosokawa, Yuri; Adams, William M; Belval, Luke N; Davis, Robert J; Huggins, Robert A; Jardine, John F; Katch, Rachel K; Stearns, Rebecca L; Casa, Douglas J

2018-03-29

To investigate the influence of estimated wet bulb globe temperature (WBGT) and the International Institute of Race Medicine (IIRM) activity modification guidelines on the incidence of exertional heat stroke (EHS) and heat exhaustion (HEx) and the ability of an on-site medical team to treat those afflicted. Medical records of EHS and HEx patients over a 17-year period from the New Balance Falmouth Road Race were examined. Climatologic data from nearby weather stations were obtained to calculate WBGT with the Australian Bureau of Meteorology (WBGT A ) and Liljegren (WBGT L ) models. Incidence rate (IR) of EHS, HEx, and combined total of EHS and HEx (COM) were calculated, and linear regression analyses were performed to assess the relationship between IR and WBGT A or WBGT L . One-way ANOVA was performed to compare differences in EHS, HEx, and COM incidence to four alert levels in the IIRM guidelines. Incidence of EHS, HEx, and COM was 2.12, 0.98, and 3.10 cases per 1000 finishers. WBGT A explained 48, 4, and 46% of the variance in EHS, HEx, and COM IR; WBGT L explained 63, 13, and 69% of the variance in EHS, HEx, and COM IR. Main effect of WBGT A and WBGT L on the alert levels were observed in EHS and COM IR (p < 0.05). The cumulative number of EHS patients treated did not exceed the number of cold water immersion tubs available to treat them. EHS IR increased as WBGT and IIRM alert level increased, indicating the need for appropriate risk mitigation strategies and on-site medical treatment.

Heat-related illness in China, summer of 2013

NASA Astrophysics Data System (ADS)

Gu, Shaohua; Huang, Cunrui; Bai, Li; Chu, Cordia; Liu, Qiyong

2016-01-01

Extreme heat events have occurred more frequently in China in recent years, leading to serious impacts on human life and the health care system. To identify the characteristics of individuals with heat-related illnesses in China during the summer of 2013, we collected the data from the Heat-related Illness Surveillance System in Chinese Center for Disease Control and Prevention (China CDC). A total of 5758 cases were reported in the summer of 2013, mostly concentrated in urban areas around the middle and lower reaches of the Yangtze River. We found a difference in age distribution of percentage of deaths from heat-related illness between males and females. Severe cases in males mostly occurred in the age group 45-74 years but in females mostly in the age group over 75. A distributed lag non-linear model had been used to identify population vulnerabilities in Ningbo and Chongqing. The results show that there was a clear positive relationship between maximum temperature and heat-related illness, and the heat effect was nonlinear and could last for 3 days. The elderly and males in the range of 45-64 years old might be the most vulnerable people of heat-related illness in China. We also highlighted some deficiencies of the surveillance system, such that the reported data were not accurate, comprehensive, or timely enough at this stage.

The effects of acclimatization on blood clotting parameters in exertional heat stress.

PubMed

Vesić, Zoran; Vukasinović-Vesić, Milica; Dincić, Dragan; Surbatović, Maja; Radaković, Sonja S

2013-07-01

Exertional heat stress is a common problem in military services. Considering the coagulation abnormalities are of major importance in development of severe heat stroke, we wanted to examine changes in hemostatic parameters in soldiers during exertional heat stress test as well as the effects of a 10-day passive or active acclimatization in a climatic chamber. A total of 40 male soldiers with high aerobic capacity performed exertional heat stress test (EHST) either in cool [20 degrees C, 16 degrees C wet bulb globe temperature (WBGT)], or hot (40 degrees C, 29 degrees C, (WBGT) environment, unacclimatized (U) or after 10 days of passive (P) or active (A) acclimatization. Physiological strain was measured by tympanic temperatures (Tty) and heart rates (HR). Platelet count (PC), antithrombin III (AT), and prothrombin time (PT) were assessed in blood samples collected before and immediately after the EHST. EHST in hot conditions induced physiological heat stress (increase in Tty and HR), with a significant increase in prothrombin time in the groups U and A. Platelet counts were significantly higher after the EHST compared to the basic levels in all the investigated groups, regardless environmental conditions and acclimatization state. Antithrombin levels were not affected by EHST whatsoever. In the trained soldiers, physiological heat stress caused mild changes in some serum parameters of blood clotting such as prothrombin time, while others such as antithrombin levels were not affected. Platelet counts were increased after EHST in all groups. A 10-day passive or active acclimatization in climatic chamber showed no effect on parameters investigated.

Policy statement—Climatic heat stress and exercising children and adolescents.

PubMed

Bergeron, Michael F; Devore, Cynthia; Rice, Stephen G

2011-09-01

Results of new research indicate that, contrary to previous thinking, youth do not have less effective thermoregulatory ability, insufficient cardiovascular capacity, or lower physical exertion tolerance compared with adults during exercise in the heat when adequate hydration is maintained. Accordingly, besides poor hydration status, the primary determinants of reduced performance and exertional heat-illness risk in youth during sports and other physical activities in a hot environment include undue physical exertion, insufficient recovery between repeated exercise bouts or closely scheduled same-day training sessions or rounds of sports competition, and inappropriately wearing clothing, uniforms, and protective equipment that play a role in excessive heat retention. Because these known contributing risk factors are modifiable, exertional heat illness is usually preventable. With appropriate preparation, modifications, and monitoring, most healthy children and adolescents can safely participate in outdoor sports and other physical activities through a wide range of challenging warm to hot climatic conditions.

Gastrointestinal temperature trends in football linemen during physical exertion under heat stress.

PubMed

Coris, Eric E; Mehra, Shabnam; Walz, Stephen M; Duncanson, Robert; Jennings, Jason; Nugent, Dylan; Zwygart, Kira; Pescasio, Michele

2009-06-01

Exertional heat stroke is the third leading cause of death in US athletes. Elevations in core temperature in the digestive tract (TGI) have correlated with core temperature and are possible indicators of those at increased risk of heat stroke. The primary objective was to compare a.m. vs. p.m. TGI variation in collegiate football linemen during intense "two-a-day" preseason practice. A secondary objective was to compare longitudinal TGI in offensive and defensive linemen. Cross-sectional observational study. Division I Intercollegiate Athletics Football Program. TGI was monitored during consecutive preseason sessions. TGI, heat illness, weight changes, environmental stress, and subjective symptoms. Mean TGI were 37.8°C and 38.3°C during a.m. and p.m. practices, respectively. The a.m. practices revealed higher TGI gain (1.8°C) compared to p.m. (1.4°C). The p.m. practices had higher maximum TGI than a.m. practices (39.1°C versus 38.8, P=0.0001). Mean time to maximum temperature (Tmax) was 1 hr and 30 min for a.m. and 1 hr and 22 min for p.m. practices. Offensive linemen trended toward higher mean TGI than defensive players (38.0°C vs. 36.7°C, P = 0.069). The rate of rise in TGI was significantly greater in a.m. practices. A decrease in rate of TGI rise was seen from the first to last a.m. practices of the week (P = 0.004). Significant TGI elevations in asymptomatic athletes are common in extreme heat during football practice. Intense a.m. practices in full gear result in higher net temperature gain and rate of temperature gain than p.m. practices. Offensive linemen trended toward higher TGI than defensive linemen. As players acclimatized, a decrease in the rate of TGI increase was appreciable, particularly in a.m. practices. Appreciating cumulative heat stress and variations in heat stress related to scheduling of practice is critical.

Heat illnesses: a hot topic in the setting of global climate change.

PubMed

Sankoff, Jeffrey

2015-01-01

Heat illnesses affect a large number of people every year and are becoming an increasing cause of pathology as climate change results in increasing global temperatures. This article will review the physiological responses to heat, as well as the pathophysiological processes that result in heat illnesses. The emphasis will be on providing general practitioners (GPs) with an understanding of how to prevent heat illness in their patients and how to predict who is most at risk. Heat illnesses may be thought of as minor or major illnesses, any of which may present to the GP. Consideration must be given to identifying those who need more critical intervention and on when to transfer for higher-level of care.

Work-attributed illness arising from excess heat exposure in Ontario, 2004-2010.

PubMed

Fortune, Melanie K; Mustard, Cameron A; Etches, Jacob J C; Chambers, Andrea G

2013-09-12

To describe the incidence of occupational heat illness in Ontario. Heat illness events were identified in two population-based data sources: work-related emergency department (ED) records and lost time claims for the period 2004-2010 in Ontario, Canada. Incidence rates were calculated using denominator estimates from national labour market surveys and estimates were adjusted for workers' compensation insurance coverage. Proportional morbidity ratios were estimated for industry, occupation and tenure of employment. There were 785 heat illness events identified in the ED encounter records (incidence rate 1.6 per 1,000,000 full-time equivalent (FTE) months) and 612 heat illness events identified in the lost time claim records (incidence rate 1.7 per 1,000,000 FTE months) in the seven-year observation period with peak incidence observed in the summer months. The risk of heat illness was elevated for men, young workers, manual workers and those with shorter employment tenure. A higher proportion of lost time claims attributed to heat illness were observed in the government services, agriculture and construction sectors relative to all lost time claims. Occupational heat illnesses are experienced in Ontario's population and are observed in ED records and lost time claims. The variation of heat illness incidence observed with worker and industry characteristics, and over time, can inform prevention efforts by occupational health services in Ontario.

Heat illness and death among workers - United States, 2012-2013.

PubMed

Arbury, Sheila; Jacklitsch, Brenda; Farquah, Opeyemi; Hodgson, Michael; Lamson, Glenn; Martin, Heather; Profitt, Audrey

2014-08-08

Exposure to heat and hot environments puts workers at risk for heat stress, which can result in heat illnesses and death. This report describes findings from a review of 2012‒2013 Occupational Safety and Health Administration (OSHA) federal enforcement cases (i.e., inspections) resulting in citations under paragraph 5(a)(1), the "general duty clause" of the Occupational Safety and Health Act of 1970. That clause requires that each employer "furnish to each of his employees employment and a place of employment which are free from recognized hazards that are causing or are likely to cause death or serious physical harm to his employees". Because OSHA has not issued a heat standard, it must use 5(a)(1) citations in cases of heat illness or death to enforce employers' obligations to provide a safe and healthy workplace. During the 2-year period reviewed, 20 cases of heat illness or death were cited for federal enforcement under paragraph 5(a)(1) among 18 private employers and two federal agencies. In 13 cases, a worker died from heat exposure, and in seven cases, two or more employees experienced symptoms of heat illness. Most of the affected employees worked outdoors, and all performed heavy or moderate work, as defined by the American Conference of Governmental Industrial Hygienists. Nine of the deaths occurred in the first 3 days of working on the job, four of them occurring on the worker's first day. Heat illness prevention programs at these workplaces were found to be incomplete or absent, and no provision was made for the acclimatization of new workers. Acclimatization is the result of beneficial physiologic adaptations (e.g., increased sweating efficiency and stabilization of circulation) that occur after gradually increased exposure to heat or a hot environment. Whenever a potential exists for workers to be exposed to heat or hot environments, employers should implement heat illness prevention programs (including acclimatization requirements) at their

Characteristics of Heat Illness during Hajj: A Cross-Sectional Study

PubMed Central

El-Bakri, Nahid K.; Almowalld, Wedian O.; Turkistani, Zyad A.; Bugis, Bassam H.; Baseif, Eshraq A.; Melbari, Mohamed H.; AlHarbi, Khaled

2018-01-01

Introduction Data regarding the characteristics and outcomes of heat illness are lacking in the literature. The present study aimed to identify the clinical characteristics, morbidity, management, and mortality associated with heat illness among Hajj participants. Methods A cross-sectional study was conducted during the Hajj in 2016 on patients who presented to emergency departments and were diagnosed with heat exhaustion or heatstroke. Data were collected using a structured collection sheet developed based on the literature. Results A total of 267 patients were recruited. Of these, 80 (29%) and 187 (67.75%) were diagnosed with heatstroke and heat exhaustion, with 6.3% and 0.0% mortality, respectively. The mean age of the patients was 54.0 ± 16 years. Diabetes mellitus was the most common comorbidity among both heatstroke and heat exhaustion patients. The majority of patients had hyperthermia and electrolyte imbalance. Most of the heat illness cases were treated per heat illness guidelines. Conclusions Although authorities are working on research and forming interdisciplinary teams to prevent health problems during the Hajj, the mortality rate from heatstroke is high and the majority of the patients had hyperthermia, varied signs and symptoms, elevated creatinine levels, and electrolyte imbalances. PMID:29662887

Heat Illness: A Handbook for Medical Officers

DTIC Science & Technology

1991-06-03

Recommendations to planning staffs should eii~piliasve theC irportwnce of adequate sleep and food to reduce the likelihood of heat casuaRtift-ýs...experience much greater heat strain in uniforms, such as the BDO, that restrict heat exchange with the environment. Will the recruits have the...the sklf.- to thermoregulate and increase the risk of heat Illness. Lack of sleep and food will reduce thermoregiilatomy capacity. Medical Plannin-a

Females exposed to 24 h of sleep deprivation do not experience greater physiological strain, but do perceive heat illness symptoms more severely, during exercise-heat stress.

PubMed

Relf, Rebecca; Willmott, Ashley; Mee, Jessica; Gibson, Oliver; Saunders, Arron; Hayes, Mark; Maxwell, Neil

2018-02-01

There is limited and inconclusive evidence surrounding the physiological and perceptual responses to heat stress while sleep deprived, especially for females. This study aimed to quantify the effect of 24 h sleep deprivation on physiological strain and perceptual markers of heat-related illness in females. Nine females completed two 30-min heat stress tests (HST) separated by 48 h in 39°C, 41% relative humidity at a metabolic heat production of 10 W · kg -1 . The non-sleep deprived HST was followed by the sleep deprivation (SDHST) trial for all participants during the follicular phase of the menstrual cycle. Physiological and perceptual measures were recorded at 5 min intervals during the HSTs. On the cessation of the HSTs, heat illness symptom index (HISI) was completed. HISI scores increased after sleep deprivation by 28 ± 16 versus 20 ± 16 (P = 0.01). Peak (39.40 ± 0.35°C vs. 39.35 ± 0.33°C) and change in rectal temperature (1.91 ± 0.21 vs. 1.93 ± 0.34°C), and whole body sweat rate (1.08 ± 0.31 vs. 1.15 ± 0.36 L · h -1 ) did not differ (P > 0.05) between tests. No difference was observed in peak, nor rise in: heart rate, mean skin temperature, perceived exertion or thermal sensation during the HSTs. Twenty-four hours sleep deprivation increased perceptual symptoms associated with heat-related illness; however, no thermoregulatory alterations were observed.

Exertional heat stroke in navy and marine personnel: a hot topic.

PubMed

Goforth, Carl W; Kazman, Josh B

2015-02-01

Although exertional heat stroke is considered a preventable condition, this life-threatening emergency affects hundreds of military personnel annually. Because heat stroke is preventable, it is important that Navy critical care nurses rapidly recognize and treat heat stroke casualties. Combined intrinsic and extrinsic risk factors can quickly lead to heat stroke if not recognized by deployed critical care nurses and other first responders. In addition to initial critical care nursing interventions, such as establishing intravenous access, determining body core temperature, and assessing hemodynamic status, aggressive cooling measures should be initiated immediately. The most important determinant in heat stroke outcome is the amount of time that patients sustain hyperthermia. Heat stroke survival approaches 100% when evidence-based cooling guidelines are followed, but mortality from heat stroke is a significant risk when care is delayed. Navy critical care and other military nurses should be aware of targeted assessments and cooling interventions when heat stroke is suspected during military operations. ©2015 American Association of Critical-Care Nurses.

A randomized controlled trial of aspirin and exertional heat stress activation of platelets in firefighters during exertion in thermal protective clothing.

PubMed

Hostler, David; Suyama, Joe; Guyette, Francis X; Moore, Charity G; Pryor, Riana R; Khorana, Priya; McEntire, Serina J; Comer, Diane; Reis, Steven E

2014-01-01

Platelet aggregation is enhanced in firefighters following short bouts of work in thermal protective clothing (TPC). We sought to determine if aspirin therapy before and/or following exertion in TPC prevents platelet activation. In a double-blind, placebo-controlled study, 102 firefighters were randomized to receive daily therapy (81 mg aspirin or placebo) for 14 days before and a single dose (325 mg aspirin or placebo) following exercise in TPC resulting in four potential assignments: aspirin before and after exercise (AA), placebo before and after exercise (PP), aspirin before and placebo after exercise (AP), and placebo before and aspirin after exercise (PA). Platelet closure time (PCT) was measured with a platelet function analyzer before the 2-week treatment, after the 2 week treatment period, immediately after exercise, and 30, 60, and 90 minutes later. Baseline PCT did not differ between groups. PCT changed over time in all four groups (p < 0.001) rising to a median of >300 seconds [IQR 99, 300] in AA and >300 [92, 300] in AP prior to exercise. Following exercise, median PCT decreased to in all groups. Median PCT returned to >300 seconds 30 minutes later in AA and AP and rose to 300 seconds in PA 60 minutes after exercise. Daily aspirin therapy blunts platelet activation during exertional heat stress and single-dose aspirin therapy following exertional heat stress reduces platelet activation within 60 minutes.

Preventing Heat-Related Illness or Death of Outdoor Workers

MedlinePlus

... attention to workers who show signs of heat-related illness „ „ Evaluating work practices continually to reduce ex- ertion and environmental heat stress „ „ Monitoring weather reports daily and reschedul- ing jobs ...

Treatment and prevention of pediatric heat-related illnesses at mass gatherings and special events.

PubMed

Bernardo, Lisa Marie; Crane, Patricia A; Veenema, Tener Goodwin

2006-01-01

Pediatric heat-related illnesses are likely to occur during mass gatherings and special events. Because critical care nurses may be called upon to provide care during such events, education in the recognition, treatment, and prevention of these illnesses is essential. This article describes the pathophysiology of heat-related illnesses and their recognition and treatment at mass gatherings and special events. Interventions to prevent heat-related illnesses at these events are discussed.

Exertional heat stroke and acute liver failure: a late dysfunction

PubMed Central

Carvalho, Ana Sofia; Rodeia, Simão C; Silvestre, Joana; Póvoa, Pedro

2016-01-01

Heat stroke (HS) is defined as a severe elevation of core body temperature along with central nervous system dysfunction. Exertional heat stroke (EHS) with acute liver failure (ALF) is a rare condition. The authors report the case of a 25-year-old man with a history of cognitive enhancers’ intake who developed hyperthermia and neurological impairment while running an outdoor marathon. The patient was cooled and returned to normal body temperature after 6 h. He subsequently developed ALF and was transferred to the intensive care unit. Over-the-counter drug intake may have been related to heat intolerance and contributed to the event. The patient was successfully treated with conservative measures. In the presence of EHS, it is crucial to act promptly with aggressive total body cooling, in order to prevent progression of the clinical syndrome. Liver function must also be monitored, since it can be a late organ dysfunction. PMID:26969359

Promoting Best Practices regarding Exertional Heat Stroke: A Perspective from the Team Physician

ERIC Educational Resources Information Center

Mazerolle, Stephanie M.; Pagnotta, Kelly D.; McDowell, Lindsey; Casa, Douglas J.; Armstrong, Lawrence

2012-01-01

Context: Knowing the team physician's perspective regarding the use of evidence-based practice (EBP) for treatment of exertional heat stroke (EHS) may help increase the number of athletic trainers (ATs) implementing best practices and avoiding the use of improper assessment tools and treatment methods. Objective: To ascertain team physicians'…

Relationships between maximum temperature and heat-related illness across North Carolina, USA.

PubMed

Sugg, Margaret M; Konrad, Charles E; Fuhrmann, Christopher M

2016-05-01

Heat kills more people than any other weather-related event in the USA, resulting in hundreds of fatalities each year. In North Carolina, heat-related illness accounts for over 2,000 yearly emergency department admissions. In this study, data on emergency department (ED) visits for heat-related illness (HRI) were obtained from the North Carolina Disease Event Tracking and Epidemiologic Collection Tool to identify spatiotemporal relationships between temperature and morbidity across six warm seasons (May-September) from 2007 to 2012. Spatiotemporal relationships are explored across different regions (e.g., coastal plain, rural) and demographics (e.g., gender, age) to determine the differential impact of heat stress on populations. This research reveals that most cases of HRI occur on days with climatologically normal temperatures (e.g., 31 to 35 °C); however, HRI rates increase substantially on days with abnormally high daily maximum temperatures (e.g., 31 to 38 °C). HRI ED visits decreased on days with extreme heat (e.g., greater than 38 °C), suggesting that populations are taking preventative measures during extreme heat and therefore mitigating heat-related illness.

Risk characterization of hospitalizations for mental illness and/or behavioral disorders with concurrent heat-related illness

PubMed Central

2017-01-01

Background Many studies have found significant associations between high ambient temperatures and increases in heat-related morbidity and mortality. Several studies have demonstrated that increases in heat-related hospitalizations are elevated among individuals with diagnosed mental illnesses and/or behavioral disorders (MBD). However, there are a limited number of studies regarding risk factors associated with specific mental illnesses that contribute, at least in part, to heat-related illnesses (HRI) in the United States. Objective To identify and characterize individual and environmental risk factors associated with MBD hospitalizations with a concurrent HRI diagnosis. Methods This study uses hospitalization data from the Nationwide Inpatient Sample (2001–2010). Descriptive analyses of primary and secondary diagnoses of MBDs with an HRI were examined. Risk ratios (RR) were calculated from multivariable models to identify risk factors for hospitalizations among patients with mental illnesses and/or behavioral disorders and HRI. Results Nondependent alcohol/drug abuse, dementia, and schizophrenia were among the disorders that were associated with increased frequency of HRI hospitalizations among MBD patients. Increased risk of MBD hospitalizations with HRI was observed for Males (RR, 3.06), African Americans (RR, 1.16), Native Americans (RR, 1.70), uninsured (RR, 1.92), and those 40 years and older, compared to MBD hospitalizations alone. Conclusions Previous studies outside the U.S. have found that dementia and schizophrenia are significant risk factors for HRI hospitalizations. Our results suggest that hospitalizations among substance abusers may also be an important risk factor associated with heat morbidity. Improved understanding of these relative risks could help inform future public health strategies. PMID:29036206

Heart rate variability during exertional heat stress: effects of heat production and treatment.

PubMed

Flouris, Andreas D; Bravi, Andrea; Wright-Beatty, Heather E; Green, Geoffrey; Seely, Andrew J; Kenny, Glen P

2014-04-01

We assessed the efficacy of different treatments (i.e., treatment with ice water immersion vs. natural recovery) and the effect of exercise intensities (i.e., low vs. high) for restoring heart rate variability (HRV) indices during recovery from exertional heat stress (EHS). Nine healthy adults (26 ± 3 years, 174.2 ± 3.8 cm, 74.6 ± 4.3 kg, 17.9 ± 2.8 % body fat, 57 ± 2 mL·kg·(-1) min(-1) peak oxygen uptake) completed four EHS sessions incorporating either walking (4.0-4.5 km·h(-1), 2 % incline) or jogging (~7.0 km·h(-1), 2 % incline) on a treadmill in a hot-dry environment (40 °C, 20-30 % relative humidity) while wearing a non-permeable rain poncho for a slow or fast rate of rectal temperature (T re) increase, respectively. Upon reaching a T re of 39.5 °C, participants recovered until T re returned to 38 °C either passively or with whole-body immersion in 2 °C water. A comprehensive panel of 93 HRV measures were computed from the time, frequency, time-frequency, scale-invariant, entropy and non-linear domains. Exertional heat stress significantly affected 60/93 HRV measures analysed. Analyses during recovery demonstrated that there were no significant differences between HRV measures that had been influenced by EHS at the end of passive recovery vs. whole-body cooling treatment (p > 0.05). Nevertheless, the cooling treatment required statistically significantly less time to reduce T re (p < 0.001). While EHS has a marked effect on autonomic nervous system modulation and whole-body immersion in 2 °C water results in faster cooling, there were no observed differences in restoration of autonomic heart rate modulation as measured by HRV indices with whole-body cold-water immersion compared to passive recovery in thermoneutral conditions.

Professional Preparation regarding the Recognition and Treatment of Exertional Heat Stroke: The Student Perspective

ERIC Educational Resources Information Center

Mazerolle, Stephanie M.; Pagnotta, Kelly D.; Casa, Douglas J.; Armstrong, Lawrence; Maresh, Carl

2011-01-01

Context: Current evidence suggests rectal temperature(T[subscript re] and cold-water immersion (CWI) are the most effective means to diagnose and treat exertional heat stroke (EHS), respectively. Educators, clinicians, and students should be apprised of this evidence to guide their practice. Objective: Investigate what athletic training students…

Estimating the burden of heat illness in England during the 2013 summer heatwave using syndromic surveillance

PubMed Central

Smith, Sue; Elliot, Alex J; Hajat, Shakoor; Bone, Angie; Smith, Gillian E; Kovats, Sari

2016-01-01

Background The burden of heat illness on health systems is not well described in the UK. Although the UK generally experiences mild summers, the frequency and intensity of hot weather is likely to increase due to climate change, particularly in Southern England. We investigated the impact of the moderate heatwave in 2013 on primary care and emergency department (ED) visits using syndromic surveillance data in England. Methods General practitioner in hours (GPIH), GP out of hours (GPOOH) and ED syndromic surveillance systems were used to monitor the health impact of heat/sun stroke symptoms (heat illness). Data were stratified by age group and compared between heatwave and non-heatwave years. Incidence rate ratios were calculated for GPIH heat illness consultations. Results GP consultations and ED attendances for heat illness increased during the heatwave period; GPIH consultations increased across all age groups, but the highest rates were in school children and those aged ≥75 years, with the latter persisting beyond the end of the heatwave. Extrapolating to the English population, we estimated that the number of GPIH consultations for heat illness during the whole summer (May to September) 2013 was 1166 (95% CI 1064 to 1268). This was double the rate observed during non-heatwave years. Conclusions These findings support the monitoring of heat illness (symptoms of heat/sun stroke) as part of the Heatwave Plan for England, but also suggest that specifically monitoring heat illness in children, especially those of school age, would provide additional early warning of, and situation awareness during heatwaves. PMID:26873949

Effectiveness of exercise-heat acclimation for preventing heat illness in the workplace.

PubMed

Yamazaki, Fumio

2013-09-01

The incidence of heat-related illness in the workplace is linked to whether or not workers have acclimated to a hot environment. Heat acclimation improves endurance work performance in the heat and thermal comfort at a given work rate. These improvements are achieved by increased sweating and skin blood flow responses, better fluid balance and cardiovascular stability. As a practical means of acclimatizing the body to heat stress, daily aerobic exercise training is recommended since thermoregulatory capacity and blood volume increase with physical fitness. In workers wearing personal protective suits in hot environments, however, little psychophysiological benefit is received from short-term exercise training and/or heat acclimation because of the ineffectiveness of sweating for heat dissipation and the aggravation of thermal discomfort with the accumulation of sweat within the suit. For a manual laborer who works under uncompensable heat stress, better management of the work rate, the work environment and health is required.

Risk and preventive factors for heat illness in radiation decontamination workers after the Fukushima Daiichi Nuclear Power Plant accident.

PubMed

Kakamu, Takeyasu; Hidaka, Tomoo; Hayakawa, Takehito; Kumagai, Tomohiro; Jinnouchi, Takanobu; Tsuji, Masayoshi; Nakano, Shinichi; Koyama, Kikuo; Fukushima, Tetsuhito

2015-01-01

The aim of this study was to reveal factors related to heat illness in radiation decontamination workers and determine effective preventive measures. A self-administered questionnaire was sent to 1,505 radiation decontamination workers. The questionnaire included age, sex, duration of decontamination work, previous occupation, education provided by employers regarding heat illness, preventive action against heat illness, and subjective symptoms of heat illness during work. We included 528 men, who replied and answered all questions, in the statistical analysis. Subjective symptoms of heat illness were categorized as "no symptoms", "Grade I" and "Grade II" according to severity. A multiple linear regression model was used to determine the factors associated with the severity of heat illness. The mean age of the subjects was 47.6 years old (standard deviation: 13.4). Of the 528 workers, 316 (59.8%) experienced heat illness symptoms (213 at Grade I and 103 at Grade II). The results of the stepwise selection revealed that age, outdoor manual labor, adequate sleep, use of a cool vest, and salt intake were selected as preventive factors, whereas living in a company dormitory or temporary housing, wearing light clothing, and consuming breakfast were selected as risk factors for heat illness. Both working conditions and living environment are associated with heat illness in radiation decontamination workers. Type of housing and sleep are also strongly related to heat illness during work. Employers should consider not only the working conditions of the employee but also the employee's daily living conditions, in order to prevent heat illness.

Risk factors for heat illness among British soldiers in the hot Collective Training Environment

PubMed Central

Moore, Alice C; Stacey, M J; Bailey, K G H; Bunn, R J; Woods, D R; Haworth, K J; Brett, S J; Folkes, S E F

2016-01-01

Background Heat illness is a preventable disorder in military populations. Measures that protect vulnerable individuals and contribute to effective Immediate Treatment may reduce the impact of heat illness, but depend upon adequate understanding and awareness among Commanders and their troops. Objective To assess risk factors for heat illness in British soldiers deployed to the hot Collective Training Environment (CTE) and to explore awareness of Immediate Treatment responses. Methods An anonymous questionnaire was distributed to British soldiers deployed in the hot CTEs of Kenya and Canada. Responses were analysed to determine the prevalence of individual (Intrinsic) and Command-practice (Extrinsic) risk factors for heat illness and the self-reported awareness of key Immediate Treatment priorities (recognition, first aid and casualty evacuation). Results The prevalence of Intrinsic risk factors was relatively low in comparison with Extrinsic risk factors. The majority of respondents were aware of key Immediate Treatment responses. The most frequently reported factors in each domain were increased risk by body composition scoring, inadequate time for heat acclimatisation and insufficient briefing about casualty evacuation. Conclusions Novel data on the distribution and scale of risk factors for heat illness are presented. A collective approach to risk reduction by the accumulation of ‘marginal gains’ is proposed for the UK military. This should focus on limiting Intrinsic risk factors before deployment, reducing Extrinsic factors during training and promoting timely Immediate Treatment responses within the hot CTE. PMID:26036822

Prevention of Organ Injury in Exertional Heat Stroke: Preclinical Evaluation of a New Class of NSAIDs

DTIC Science & Technology

2016-10-01

both sexes ), neurological symptoms and organ injury resembling human EHS. Blood and tissue samples were collected at 0.5 h, 3 h, 24 h 4d,9d and 14d of...associated with adipose tissue. Analyses of metabolic hormones and histology in both sexes suggest transient injury or “stunning” to the pancreas...15. SUBJECT TERMS Sex differences, exertional heat stroke, multi-organ injury, heat stress, metabolic hormones 16. SECURITY CLASSIFICATION OF: U 17

A Functional Return-to-Play Progression After Exertional Heat Stroke in a High School Football Player.

PubMed

Lopez, Rebecca M; Tanner, Patrick; Irani, Sarah; Mularoni, P Patrick

2018-03-01

  To present a functional return-to-play (RTP) progression after exertional heat stroke (EHS) in a 17-year-old high school football defensive end (height = 185 cm, mass = 145.5 kg).   The patient had no pertinent medical history but moved to a warm climate several days before the EHS occurred. After completing an off-season conditioning test (14- × 110-yd [12.6- × 99.0-m] sprints) on a warm afternoon (temperature = approximately 34°C [93°F], relative humidity = 53%), the patient collapsed. An athletic trainer (AT) was called to the field, where he found the patient conscious but exhibiting central nervous system dysfunction. Emergency medical services were summoned and immediately transported the patient to the hospital.   Exertional heat stroke, heat exhaustion, exertional sickling, rhabdomyolysis, and cardiac arrhythmia.   The patient was immediately transported to a hospital, where his oral temperature was 39.6°C (103.3°F). He was transferred to a children's hospital and treated for rhabdomyolysis, transaminitis, and renal failure. He was hospitalized for 11 days. After a physician's clearance once the laboratory results normalized, an RTP progression was completed. The protocol began with light activity and progressed over 3 weeks to full football practice. During activity, an AT monitored the patient's gastrointestinal temperature, heart rate, rating of perceived exertion, fluid consumption, and sweat losses.   Documentation of RTP guidelines for young athletes is lacking. We used a protocol intended for the football setting to ensure the athlete was heat tolerant, had adequate physical fitness, and could safely RTP. Despite his EHS, he recovered fully, with no lasting effects, and successfully returned to compete in the final 5 games of the season.   Using a gradual RTP progression and close monitoring, a high school defensive end successfully returned to football practice and games after EHS. This case demonstrates the feasibility of

Sickle Cell Trait and Fatal Exertional Heat Illness: Implications for Exercise-Related Death of Young Ddults

DTIC Science & Technology

2008-10-22

athletes who utilize ordinary weather reports? Alpha- Thalassemia Protects Against Exertional Mortality with Sickle Cell Trait • 30% of African...Americans have alpha- thalassemia (2-3 alpha genes instead of 4). In those with sickle cell trait the main effect is to lower the Hb S fraction below 36...expected 15 cases with alpha- thalassemia & ប% S • Two cases had Hb S < 36% , implying about a 7.5-fold protection for those with alpha thalassemia

Conjugate gradient heat bath for ill-conditioned actions.

PubMed

Ceriotti, Michele; Bussi, Giovanni; Parrinello, Michele

2007-08-01

We present a method for performing sampling from a Boltzmann distribution of an ill-conditioned quadratic action. This method is based on heat-bath thermalization along a set of conjugate directions, generated via a conjugate-gradient procedure. The resulting scheme outperforms local updates for matrices with very high condition number, since it avoids the slowing down of modes with lower eigenvalue, and has some advantages over the global heat-bath approach, compared to which it is more stable and allows for more freedom in devising case-specific optimizations.

Self-reported post-exertional fatigue in Gulf War veterans: roles of autonomic testing

PubMed Central

Li, Mian; Xu, Changqing; Yao, Wenguo; Mahan, Clare M.; Kang, Han K.; Sandbrink, Friedhelm; Zhai, Ping; Karasik, Pamela A.

2014-01-01

To determine if objective evidence of autonomic dysfunction exists from a group of Gulf War veterans with self-reported post-exertional fatigue, we evaluated 16 Gulf War ill veterans and 12 Gulf War controls. Participants of the ill group had self- reported, unexplained chronic post-exertional fatigue and the illness symptoms had persisted for years until the current clinical study. The controls had no self-reported post-exertional fatigue either at the time of initial survey nor at the time of the current study. We intended to identify clinical autonomic disorders using autonomic and neurophysiologic testing in the clinical context. We compared the autonomic measures between the 2 groups on cardiovascular function at both baseline and head-up tilt, and sudomotor function. We identified 1 participant with orthostatic hypotension, 1 posture orthostatic tachycardia syndrome, 2 distal small fiber neuropathy, and 1 length dependent distal neuropathy affecting both large and small fiber in the ill group; whereas none of above definable diagnoses was noted in the controls. The ill group had a significantly higher baseline heart rate compared to controls. Compound autonomic scoring scale showed a significant higher score (95% CI of mean: 1.72–2.67) among ill group compared to controls (0.58–1.59). We conclude that objective autonomic testing is necessary for the evaluation of self-reported, unexplained post-exertional fatigue among some Gulf War veterans with multi-symptom illnesses. Our observation that ill veterans with self-reported post-exertional fatigue had objective autonomic measures that were worse than controls warrants validation in a larger clinical series. PMID:24431987

Climatic and psychosocial risks of heat illness incidents on construction site.

PubMed

Jia, Yunyan Andrea; Rowlinson, Steve; Ciccarelli, Marina

2016-03-01

The study presented in this paper aims to identify prominent risks leading to heat illness in summer among construction workers that can be prioritised for developing effective interventions. Samples are 216 construction workers' cases at the individual level and 26 construction projects cases at the organisation level. A grounded theory is generated to define the climatic heat and psychosocial risks and the relationships between risks, timing and effectiveness of interventions. The theoretical framework is then used to guide content analysis of 36 individual onsite heat illness cases to identify prominent risks. The results suggest that heat stress risks on construction site are socially constructed and can be effectively managed through elimination at supply chain level, effective engineering control, proactive control of the risks through individual interventions and reactive control through mindful recognition and response to early symptoms. The role of management infrastructure as a base for effective interventions is discussed. Copyright © 2015 Elsevier Ltd and The Ergonomics Society. All rights reserved.

Increased risk of hospital admission for dehydration or heat-related illness after initiation of medicines: a sequence symmetry analysis.

PubMed

Kalisch Ellett, L M; Pratt, N L; Le Blanc, V T; Westaway, K; Roughead, E E

2016-10-01

Although several studies have identified factors which increase the risk of heat-related illness, few have assessed the contribution of medicines. To address this knowledge gap, our study aimed to assess the risk of hospital admission for dehydration or other heat-related illness following initiation of medicines. We conducted a retrospective analysis using prescription event symmetry analysis (PESA) of 6700 veterans with incident hospital admission for dehydration or heat-related illness (ICD-10-AM codes E86, X30, T67), between 1 January 2001 and 30 June 2013. The main outcome measure was first ever hospital admission for dehydration or heat-related illness following initiation of commonly used medicines. A significantly higher risk of incident hospital admission for dehydration or heat-related illness was observed following initiation of anticoagulants, cardiovascular medicines, NSAIDs, antipsychotics, antidepressants and anticholinergic agents. The risk of hospital admission for dehydration or heat-related illness ranged from 1·17 (SSRIs) to 2·79 (ACEI plus diuretic combination product). No significant association was observed between initiation of anticonvulsants, anti-Parkinson's agents, hypnotics, anxiolytics or antihistamines and hospital admission for dehydration or heat-related illness. Many commonly used medicines were found to be associated with increased risk of hospitalization for dehydration or heat-related illness. Initiation of ACE inhibitors in combination with diuretics had the highest risk. Prescribers and patients should be aware of the potential for medicines to be associated with increased risk of dehydration and heat-related illness. © 2016 John Wiley & Sons Ltd.

Without Warning: Worker Deaths From Heat 2014-2016.

PubMed

Roelofs, Cora

2018-01-01

Worker deaths from heat exposure are unlike heat deaths in the general population; workers tend to be outside in variable temperatures and younger than sixty-five years. Climate change will increase the frequency, duration, and variability of hot temperatures. Public health warning systems, such as the Heat Index of the National Weather Service, do not generally account for workers' greater likelihood of exposure to direct sunlight or exertion. Only 28% of the 79 worker heat-related fatalities during 2014-2016 occurred on days when the National Weather Service warning would have included the possibility of fatal heat stroke. Common heat illness prevention advice ignores workers' lack of control over their ability to rest and seek cooler temperatures. Additionally, acclimatization, or phased-in work in the heat, may be less useful given temperature variability under climate change. Workers' vulnerability and context of heat exposure should inform public health surveillance and response to prevent heat illness and death.

Current knowledge, attitudes, and practices of certified athletic trainers regarding recognition and treatment of exertional heat stroke.

PubMed

Mazerolle, Stephanie M; Scruggs, Ian C; Casa, Douglas J; Burton, Laura J; McDermott, Brendon P; Armstrong, Lawrence E; Maresh, Carl M

2010-01-01

Previous research has indicated that despite awareness of the current literature on the recommended prevention and care of exertional heat stroke (EHS), certified athletic trainers (ATs) acknowledge failure to follow those recommendations. To investigate the current knowledge, attitudes, and practices of ATs regarding the recognition and treatment of EHS. Cross-sectional study. Online survey. We obtained a random sample of e-mail addresses for 1000 high school and collegiate ATs and contacted these individuals with invitations to participate. A total of 498 usable responses were received, for a 25% response rate. The survey instrument evaluated ATs' knowledge and actual practice regarding EHS and included 29 closed-ended Likert scale questions (1 = strongly disagree, 7 = strongly agree), 2 closed-ended questions rated on a Likert scale (1 = lowest value, 9 = greatest value), 8 open-ended questions, and 7 demographic questions. We focused on the open-ended and demographic questions. Although most ATs (77.1%) have read the current National Athletic Trainers' Association position statement on heat illness, only 18.6% used rectal thermometers to assess core body temperature to recognize EHS, and 49.7% used cold-water immersion to treat EHS. Athletic trainers perceived rectal thermometers as the most valid temperature assessment device when compared with other assessment devices (P heat. Furthermore, they reported using cooling treatment methods that have inferior cooling rates.

Summer outdoor temperature and occupational heat-related illnesses in Quebec (Canada)

DOE Office of Scientific and Technical Information (OSTI.GOV)

Adam-Poupart, Ariane; Smargiassi, Audrey; Institut national de santé publique du Québec

2014-10-15

Background: Predicted rise in global mean temperature and intensification of heat waves associated with climate change present an increasing challenge for occupational health and safety. Although important scientific knowledge has been gathered on the health effects of heat, very few studies have focused on quantifying the association between outdoor heat and mortality or morbidity among workers. Objective: To quantify the association between occupational heat-related illnesses and exposure to summer outdoor temperatures. Methods: We modeled 259 heat-related illnesses compensated by the Workers' Compensation Board of Quebec between May and September, from 1998 to 2010, with maximum daily summer outdoor temperatures inmore » 16 health regions of Quebec (Canada) using generalized linear models with negative binomial distributions, and estimated the pooled effect sizes for all regions combined, by sex and age groups, and for different time lags with random-effect models for meta-analyses. Results: The mean daily compensation count was 0.13 for all regions of Quebec combined. The relationship between daily counts of compensations and maximum daily temperatures was log-linear; the pooled incidence rate ratio (IRR) of daily heat-related compensations per 1 °C increase in daily maximum temperatures was 1.419 (95% CI 1.326 to 1.520). Associations were similar for men and women and by age groups. Increases in daily maximum temperatures at lags 1 and 2 and for two and three-day lag averages were also associated with increases in daily counts of compensations (IRRs of 1.206 to 1.471 for every 1 °C increase in temperature). Conclusion: This study is the first to quantify the association between occupational heat-related illnesses and exposure to summer temperatures in Canada. The model (risk function) developed in this study could be useful to improve the assessment of future impacts of predicted summer outdoor temperatures on workers and vulnerable groups, particularly in

Heat Exhaustion in a Rat Model: Lithium as a Biochemical Probe.

DTIC Science & Technology

1988-11-08

thought to predispose to heat-induced illness include amount of exertion, prior conditioning, pre-existing cardiovascular disease, diabetes mellitus...results in altered distribution of body water, sodium depletion, potassium wasting, polyuria , and abnormal thermoregulation (2,3,8-17). Each of

Athletic Trainers' Attitudes and Perceptions Regarding Exertional Heat Stroke before and after an Educational Intervention

ERIC Educational Resources Information Center

Schellhase, Kristen Couper; Plant, Jennifer; Mazerolle, Stephanie M.

2017-01-01

Context: Death from exertional heat stroke (EHS) is preventable when evidence-based guidelines are followed. The assessment of core body temperature using rectal thermometry and the treatment of cold-water immersion for EHS has been established as the standard of care; however, rectal thermometry is still controversial. Athletic trainers (ATs) may…

Community Trial on Heat Related-Illness Prevention Behaviors and Knowledge for the Elderly

PubMed Central

Takahashi, Noriko; Nakao, Rieko; Ueda, Kayo; Ono, Masaji; Kondo, Masahide; Honda, Yasushi; Hashizume, Masahiro

2015-01-01

This study aims to explore whether broadcasting heat health warnings (HHWs), to every household and whether the additional home delivery of bottled water labeled with messages will be effective in improving the behaviors and knowledge of elderly people to prevent heat-related illness. A community trial on heat-related-illness-prevention behaviors and knowledge for people aged between 65 and 84 years was conducted in Nagasaki, Japan. Five hundred eight subjects were selected randomly from three groups: heat health warning (HHW), HHW and water delivery (HHW+W), and control groups. Baseline and follow-up questionnaires were conducted in June and September 2012, respectively. Of the 1524 selected subjects, the 1072 that completed both questionnaires were analyzed. The HHW+W group showed improvements in nighttime AC use (p = 0.047), water intake (p = 0.003), cooling body (p = 0.002) and reduced activities in heat (p = 0.047) compared with the control, while the HHW group improved hat or parasol use (p = 0.008). An additional effect of household water delivery was observed in water intake (p = 0.067) and cooling body (p = 0.095) behaviors. HHW and household bottled water delivery improved heat-related-illness-prevention behaviors. The results indicate that home water delivery in addition to a HHW may be needed to raise awareness of the elderly. PMID:25789456

Exertional Rhabdomyolysis in a Collegiate American Football Player After Preventive Cold-Water Immersion: A Case Report

PubMed Central

Kahanov, Leamor; Eberman, Lindsey E.; Wasik, Mitchell; Alvey, Thurman

2012-01-01

Objective: To describe a case of exertional rhabdomyolysis in a collegiate American football player after preventive cold-water immersion. Background: A healthy man (19 years old) participated in full-contact football practice followed by conditioning (2.5 hours). After practice, he entered a coach-mandated post-practice cold-water immersion and had no signs of heat illness before developing leg cramps, for which he presented to the athletic training staff. After 10 minutes of repeated stretching, massage, and replacement of electrolyte-filled fluids, he was transported to the emergency room. Laboratory tests indicated a creatine kinase (CK) level of 2545 IU/L (normal range, 45–260 IU/L), CK-myoglobin fraction of 8.5 ng/mL (normal < 6.7 ng/mL), and CK-myoglobin relative index of 30% (normal range, 25%– 30%). Myoglobin was measured at 499 ng/mL (normal = 80 ng/mL). The attending physician treated the athlete with intravenous fluids. Differential Diagnosis: Exercise-associated muscle cramps, dehydration, exertional rhabdomyolysis. Treatment: The patient was treated with rest and rehydration. One week after the incident, he began biking and swimming. Eighteen days later, the patient continued to demonstrate elevated CK levels (527 IU/L) but described no other symptoms and was allowed to return to football practice as tolerated. Two months after the incident, his CK level remained high (1900 IU/L). Uniqueness: The athlete demonstrated no signs of heat illness upon entering the cold-water immersion but experienced severe leg cramping after immersion, resulting in a diagnosis of exertional rhabdomyolysis. Previously described cases have not linked cold-water immersion with the pathogenesis of rhabdomyolysis. Conclusions: In this football player, CK levels appeared to be a poor indicator of rhabdomyolysis. Our patient demonstrated no other signs of the illness weeks after the incident, yet his elevated CK levels persisted. Cold-water immersion immediately after

Exertional rhabdomyolysis in a collegiate american football player after preventive cold-water immersion: a case report.

PubMed

Kahanov, Leamor; Eberman, Lindsey E; Wasik, Mitchell; Alvey, Thurman

2012-01-01

To describe a case of exertional rhabdomyolysis in a collegiate American football player after preventive coldwater immersion. A healthy man (19 years old) participated in full-contact football practice followed by conditioning (2.5 hours). After practice, he entered a coach-mandated postpractice cold-water immersion and had no signs of heat illness before developing leg cramps, for which he presented to the athletic training staff. After 10 minutes of repeated stretching, massage, and replacement of electrolyte-filled fluids, he was transported to the emergency room. Laboratory tests indicated a creatine kinase (CK) level of 2545 IU/L (normal range, 45-260 IU/L), CK-myoglobin fraction of 8.5 ng/mL (normal < 6.7 ng/mL), and CK-myoglobin relative index of 30% (normal range, 25%-30%). Myoglobin was measured at 499 ng/mL (normal = 80 ng/mL). The attending physician treated the athlete with intravenous fluids. Exercise-associated muscle cramps, dehydration, exertional rhabdomyolysis. The patient was treated with rest and rehydration. One week after the incident, he began biking and swimming. Eighteen days later, the patient continued to demonstrate elevated CK levels (527 IU/L) but described no other symptoms and was allowed to return to football practice as tolerated. Two months after the incident, his CK level remained high (1900 IU/L). The athlete demonstrated no signs of heat illness upon entering the cold-water immersion but experienced severe leg cramping after immersion, resulting in a diagnosis of exertional rhabdomyolysis. Previously described cases have not linked cold-water immersion with the pathogenesis of rhabdomyolysis. In this football player, CK levels appeared to be a poor indicator of rhabdomyolysis. Our patient demonstrated no other signs of the illness weeks after the incident, yet his elevated CK levels persisted. Cold-water immersion immediately after exercise should be monitored by the athletic training staff and may not be appropriate to

Female farmworkers' perceptions of heat-related illness and pregnancy health.

PubMed

Flocks, Joan; Vi Thien Mac, Valerie; Runkle, Jennifer; Tovar-Aguilar, Jose Antonio; Economos, Jeannie; McCauley, Linda A

2013-01-01

Although agricultural workers have elevated risks of heat-related illnesses (HRI), pregnant farmworkers exposed to extreme heat face additional health risk, including poor pregnancy health and birth outcomes. Qualitative data from five focus groups with 35 female Hispanic and Haitian nursery and fernery workers provide details about the women's perceptions of HRI and pregnancy. Participants believe that heat exposure can adversely affect general, pregnancy, and fetal health, yet feel they lack control over workplace conditions and that they lack training about these specific risks. These data are being used to develop culturally appropriate educational materials emphasizing health promoting and protective behaviors during pregnancy.

FEMALE FARMWORKERS’ PERCEPTIONS OF HEAT-RELATED ILLNESS AND PREGNANCY HEALTH

PubMed Central

Flocks, Joan; Mac, Valerie Vi Thien; Runkle, Jennifer; Tovar-Aguilar, Jose Antonio; Economos, Jeannie; McCauley, Linda A.

2017-01-01

While agricultural workers have elevated risks of heat-related illnesses (HRI), pregnant farmworkers exposed to extreme heat face additional health risk, including poor pregnancy health and birth outcomes. Qualitative data from five focus groups with 35 female Hispanic and Haitian nursery and fernery workers provide details about the women’s perceptions of HRI and pregnancy. Participants believe that heat exposure can adversely affect general, pregnancy, and fetal health, yet feel they lack control over workplace conditions and that they lack training about these specific risks. These data are being used to develop culturally appropriate educational materials emphasizing health promoting and protective behaviors during pregnancy. PMID:24125050

The descriptive epidemiology of sports/leisure-related heat illness hospitalisations in New South Wales, Australia.

PubMed

Finch, Caroline F; Boufous, Soufiane

2008-01-01

Sport-related heat illness has not been commonly studied from an epidemiological perspective. This study presents the descriptive epidemiology of sports/leisure-related heat illness hospitalisations in New South Wales, Australia. All in-patient separations from all acute hospitals in NSW during 2001-2004, with an International Classification of Diseases external cause of injury code indicating "exposure to excessive natural heat (X30)" or any ICD-10 diagnosis code in the range: "effects of heat and light (T67.0-T67.9)", were analysed. The sport/leisure relatedness of cases was defined by ICD-10-AM activity codes indicating involvement in sport/leisure activities. Cases of exposure to heat while engaged in sport/leisure were described by gender, year, age, principal diagnosis, type of activity/sport and length of stay. There were 109 hospital separations for exposure to heat while engaging in sport/leisure activity, with the majority occurring during the hottest months. The number of male cases significantly increased over the 4-year period and 45+ -year olds had the largest number of cases. Heat exhaustion was the leading cause of hospital separation (40% of cases). Marathon running, cricket and golf were the activities most commonly associated with heat-related hospitalisation. Ongoing development and refinement of expert position statements regarding heat illnesses need to draw on both epidemiological and physiological evidence to ensure their relevance to all levels of risk from the real world sport training and competition contexts.

A Heat Warning System to Reduce Heat Illness in San Diego County

NASA Astrophysics Data System (ADS)

Tardy, A. O.; Corcus, I.; Guirguis, K.; Gershunov, A.; Basu, R.; Stepanski, B.

2016-12-01

The National Weather Service (NWS) has issued official heat alerts to the public and decision making partners for many years by developing a single criterion or regional criteria from heat indices which combine temperature and humidity. The criteria have typically relied on fixed thresholds and did not consider impact from a particular heat episode, nor did it factor seasonality, population acclimatization, or impacts on the most vulnerable subgroups. In 2013, the NWS San Diego office began modifying their criteria to account for local climatology with much less dependence on humidity or the heat index. These local changes were based on initial findings from the California Department of Public Health, EpiCenter California Injury Data Online system (EPIC), which document heat health impacts. The Scripps Institution of Oceanography (SIO) in collaboration with the California Environmental Protection Agency's Office of Environmental Health Hazard Assessment and the NWS completed a study of hospital visits during heat waves in California showing significant health impacts occurred in the past when no regional heat warning was issued. Therefore, the results supported the need for an exploratory project to implement significant modification of the traditional local criteria. To understand the impacts of heat on community health, medical outcome data were provided by the County of San Diego Emergency Medical Services Branch (EMS), which is provided by the County's Public Health Officer to monitor heat-related illness and injury daily during specific heat episodes. The data were combined with SIO research to inform the modification of local NWS heat criteria and establish trigger points to pilot new procedures for the issuance of heat alerts. Finally, procedures were customized for each of the county health departments in the NWS area of responsibility across extreme southwest California counties in collaboration with their Office of Emergency Services (OES). The

Effectiveness of cold water immersion for treating exertional heat stress when immediate response is not possible.

PubMed

Flouris, A D; Friesen, B J; Carlson, M J; Casa, D J; Kenny, G P

2015-06-01

Immediate treatment with cold water immersion (CWI) is the gold standard for exertional heatstroke. In the field, however, treatment is often delayed due to delayed paramedic response and/or inaccurate diagnosis. We examined the effect of treatment (reduction of rectal temperature to 37.5 °C) delays of 5, 20, and 40 min on core cooling rates in eight exertionally heat-stressed (40.0 °C rectal temperature) individuals. We found that rectal temperature was elevated above baseline (P < 0.05) at the end of all delay periods (5 min: 40.08 ± 0.32; 20 min: 39.92 ± 0.40; 40 min: 39.57 ± 0.29 °C). Mean arterial pressure was reduced (P < 0.05) below baseline (92 ± 1.8 mm Hg) after all delay periods (5 min: 75 ± 2.6; 20 min: 74 ± 1.7; 40 min: 70 ± 2.1 mm Hg; P > 0.05). Rectal core cooling rates were similar among conditions (5 min: 0.20 ± 0.01; 20 min: 0.17 ± 0.02; 40 min: 0.17 ± 0.01 °C/min; P > 0.05). The rectal temperature afterdrop following CWI was similar across conditions (5 min: 35.95; 20 min: 35.61; 40 min: 35.87 °C; P > 0.05). We conclude that the effectiveness of 2 °C CWI as a treatment for exertional heat stress remains high even when applied with a delay of 40 min. Therefore, our results support that CWI is the most appropriate treatment for exertional heatstroke as it is capable of quickly reversing hyperthermia even when treatment is commenced with a significant delay. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Design and construction of Thermoelectric Footwear Heating System for illness feet.

PubMed

Işik, Hakan

2005-12-01

In this study, a Thermoelectric Footwear Heating System is developed to use in cold weather conditions. The temperature is controlled by an analog electronic control system. Thermoelectric module is used to heat the bottom of the foot. A negative temperature coefficient (NTC) temperature sensor is used to sense the temperature and the temperature is controlled by an electronic circuit proportionally. A 3.5 V, 5000 mAh rechargeable battery is used as the power source. The temperature range of the system is between +15 degrees C and +50 degrees C. Developed footwear heating system is tested against various temperature conditions, and offer better results in the case of heating the illness feet.

Case ascertainment of heat illness in the British Army: evidence of under-reporting from analysis of Medical and Command notifications, 2009-2013.

PubMed

Stacey, Michael J; Brett, S; Woods, D; Jackson, S; Ross, D

2016-12-01

Heat illness in the Armed Forces is considered preventable. The UK military relies upon dual Command and Medical reporting for case ascertainment, investigation of serious incidents and improvement of preventive practices and policy. This process could be vulnerable to under-reporting. To establish whether heat illness in the British Army has been under-reported, by reviewing concordance of reporting to the Army Incident Notification Cell (AINC) and the Army Health Unit (AHU) and to characterise the burden of heat illness reported by these means. Analysis of anonymised reporting databases held by the AHU and AINC, for the period 2009-2013. 565 unique cases of heat illness were identified. Annual concordance of reporting ranged from 9.6% to 16.5%. The overall rate was 13.3%. July was the month with the greatest number of heat illness reports (24.4% of total reporting) and the highest concordance rate (30%). Reports of heat illness from the UK (n=343) exceeded overseas notifications (n=221) and showed better concordance (17.1% vs 12.8%). The annual rate of reported heat illness varied widely, being greater in full-time than reservist personnel (87 vs 23 per100 000) and highest in full-time untrained personnel (223 per100 000). The risk of heat illness was global, year-round and showed dynamic local variation. Failure to dual-report casualties impaired case ascertainment of heat illness across Command and Medical chains. Current preventive guidance, as applied in training and on operations, should be critically evaluated to ensure that risk of heat illness is reduced as low as possible. Clear procedures for casualty notification and surveillance are required in support of this and should incorporate communication within and between the two reporting chains. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Case ascertainment of heat illness in the British Army: evidence of under-reporting from analysis of Medical and Command notifications, 2009–2013

PubMed Central

Stacey, Michael J; Brett, S; Woods, D; Jackson, S; Ross, D

2016-01-01

Background Heat illness in the Armed Forces is considered preventable. The UK military relies upon dual Command and Medical reporting for case ascertainment, investigation of serious incidents and improvement of preventive practices and policy. This process could be vulnerable to under-reporting. Objectives To establish whether heat illness in the British Army has been under-reported, by reviewing concordance of reporting to the Army Incident Notification Cell (AINC) and the Army Health Unit (AHU) and to characterise the burden of heat illness reported by these means. Methods Analysis of anonymised reporting databases held by the AHU and AINC, for the period 2009–2013. Results 565 unique cases of heat illness were identified. Annual concordance of reporting ranged from 9.6% to 16.5%. The overall rate was 13.3%. July was the month with the greatest number of heat illness reports (24.4% of total reporting) and the highest concordance rate (30%). Reports of heat illness from the UK (n=343) exceeded overseas notifications (n=221) and showed better concordance (17.1% vs 12.8%). The annual rate of reported heat illness varied widely, being greater in full-time than reservist personnel (87 vs 23 per100 000) and highest in full-time untrained personnel (223 per100 000). Conclusions The risk of heat illness was global, year-round and showed dynamic local variation. Failure to dual-report casualties impaired case ascertainment of heat illness across Command and Medical chains. Current preventive guidance, as applied in training and on operations, should be critically evaluated to ensure that risk of heat illness is reduced as low as possible. Clear procedures for casualty notification and surveillance are required in support of this and should incorporate communication within and between the two reporting chains. PMID:25717054

Heat-related illness in Washington State agriculture and forestry sectors.

PubMed

Spector, June T; Krenz, Jennifer; Rauser, Edmund; Bonauto, David K

2014-08-01

We sought to describe heat-related illness (HRI) in agriculture and forestry workers in Washington State. Demographic and clinical Washington State Fund workers' compensation agriculture and forestry HRI claims data (1995-2009) and Washington Agriculture Heat Rule citations (2009-2012) were accessed and described. Maximum daily temperature (Tmax) and Heat Index (HImax) were estimated by claim date and location using AgWeatherNet's weather station network. There were 84 Washington State Fund agriculture and forestry HRI claims and 60 Heat Rule citations during the study period. HRI claims and citations were most common in crop production and support subsectors. The mean Tmax (HImax) was 95°F (99°F) for outdoor HRI claims. Potential HRI risk factors and HRI-related injuries were documented for some claims. Agriculture and forestry HRI cases are characterized by potential work-related, environmental, and personal risk factors. Further work is needed to elucidate the relationship between heat exposure and occupational injuries. © 2014 Wiley Periodicals, Inc.

Heat-Related Illness in Washington State Agriculture and Forestry Sectors

PubMed Central

Spector, June T.; Krenz, Jennifer; Rauser, Edmund; Bonauto, David K.

2017-01-01

Background We sought to describe heat-related illness (HRI) in agriculture and forestry workers in Washington State. Methods Demographic and clinical Washington State Fund workers’ compensation agriculture and forestry HRI claims data (1995–2009) and Washington Agriculture Heat Rule citations (2009–2012) were accessed and described. Maximum daily temperature (Tmax) and Heat Index (HImax) were estimated by claim date and location using AgWeatherNet’s weather station network. Results There were 84 Washington State Fund agriculture and forestry HRI claims and 60 Heat Rule citations during the study period. HRI claims and citations were most common in crop production and support subsectors. The mean Tmax (HImax) was 95°F (99°F) for outdoor HRI claims. Potential HRI risk factors and HRI-related injuries were documented for some claims. Conclusions Agriculture and forestry HRI cases are characterized by potential work-related, environmental, and personal risk factors. Further work is needed to elucidate the relationship between heat exposure and occupational injuries. PMID:24953344

Medicines can affect thermoregulation and accentuate the risk of dehydration and heat-related illness during hot weather.

PubMed

Westaway, K; Frank, O; Husband, A; McClure, A; Shute, R; Edwards, S; Curtis, J; Rowett, D

2015-08-01

Hot days are increasingly common and are often associated with increased morbidity and mortality, especially in the elderly. Most heat-related illness and heat-related deaths are preventable. Medicines may accentuate the risk of dehydration and heat-related illness, especially in elderly people taking multiple medicines, through the following mechanisms: diuresis and electrolyte imbalance, sedation and cognitive impairment, changed thermoregulation, reduced thirst recognition, reduced sweat production, and hypotension and reduced cardiac output. Commonly used medicines that may significantly increase the risk include diuretics, especially when combined with an angiotensin converting enzyme (ACE) inhibitor or an angiotensin II receptor blocker (ARB), anticholinergics and psychotropics. Initiation of individualized preventive measures prior to the start of the hot weather season, which includes a review of the patient and their medicines to identify thermoregulatory issues, may reduce the risk of heat-related illness or death. © 2015 John Wiley & Sons Ltd.

Preventing heat illness in the anticipated hot climate of the Tokyo 2020 Summer Olympic Games.

PubMed

Kakamu, Takeyasu; Wada, Koji; Smith, Derek R; Endo, Shota; Fukushima, Tetsuhito

2017-09-19

Amid the effects of global warming, Tokyo has become an increasingly hot city, especially during the summertime. To prepare for the upcoming 2020 Summer Olympics and Paralympics in Tokyo, all participants, including the athletes, staff, and spectators, will need to familiarize themselves with Tokyo's hot and humid summer conditions. This paper uses the wet-bulb globe temperature (WBGT) index, which estimates the risk of heat illness, to compare climate conditions of sports events in Tokyo with the conditions of the past three Summer Olympics (held in Rio de Janeiro, London, and Beijing) and to subsequently detail the need for establishing appropriate countermeasures. We compared WBGT results from the past three Summer Olympics with the same time periods in Tokyo during 2016. There was almost no time zone where a low risk of heat illness could be expected during the time frame of the upcoming 2020 Tokyo Olympics. We also found that Tokyo had a higher WBGT than any of those previous host cities and is poorly suited for outdoor sporting events. Combined efforts by the official organizers, government, various related organizations, and the participants will be necessary to deal with these challenging conditions and to allow athletes to perform their best, as well as to prevent heat illnesses among staff and spectators. The sporting committees, as well as the Olympic organizing committee, should consider WBGT measurements in determining the venues and timing of the events to better avoid heat illness and facilitate maximum athletic performance.

Analysis of a Community-based Intervention to Reduce Heat-related Illness during Heat Waves in Licheng, China: a Quasi-experimental Study.

PubMed

Li, Jing; Xu, Xin; Wang, Jun; Zhao, Yun; Song, Xiu Ping; Liu, Zhi Dong; Cao, Li Na; Jiang, Bao Fa; Liu, Qi Yong

2016-11-01

To reduce health-related threats of heat waves, interventions have been implemented in many parts of the world. However, there is a lack of higher-level evidence concerning the intervention efficacy. This study aimed to determine the efficacy of an intervention to reduce the number of heat-related illnesses. A quasi-experimental design was employed by two cross-sectional surveys in the year 2014 and 2015, including 2,240 participants and 2,356 participants, respectively. Each survey was designed to include one control group and one intervention group, which conducted in Licheng, China. A representative sample was selected using a multistage sampling method. Data, collected from questionnaires about heat waves in 2014 and 2015, were analyzed using a difference-in-difference analysis and cost effectiveness analysis. Outcomes included changes in the prevalence of heat-related illnesses and cost-effectiveness variables. Relative to the control participants, the prevalence of heat-related illness in the intervention participants decreased to a greater extent in rural areas than in urban areas (OR=0.495 vs. OR=1.281). Moreover, the cost-effectiveness ratio in the intervention group was less than that in the control group (US$15.06 vs. US$15.69 per participant). Furthermore, to avoid one additional patient, the incremental cost-effectiveness ratio showed that an additional US$14.47 would be needed for the intervention compared to when no intervention was applied. The intervention program may be considered a worthwhile investment for rural areas that are more likely to experience heat waves. Meanwhile, corresponding improving measures should be presented towards urban areas. Future research should examine whether the intervention strategies could be spread out in other domestic or international regions where heat waves are usually experienced. Copyright © 2016 The Editorial Board of Biomedical and Environmental Sciences. Published by China CDC. All rights reserved.

Summertime Acute Heat Illness in U.S. Emergency Departments from 2006 through 2010: Analysis of a Nationally Representative Sample

PubMed Central

Saha, Shubhayu; Luber, George

2014-01-01

Background: Patients with acute heat illness present primarily to emergency departments (EDs), yet little is known regarding these visits. Objective: We aimed to describe acute heat illness visits to U.S. EDs from 2006 through 2010 and identify factors associated with hospital admission or with death in the ED. Methods: We extracted ED case-level data from the Nationwide Emergency Department Sample (NEDS) for 2006–2010, defining cases as ED visits from May through September with any heat illness diagnosis (ICD-9-CM 992.0–992.9). We correlated visit rates and temperature anomalies, analyzed demographics and ED disposition, identified risk factors for adverse outcomes, and examined ED case fatality rates (CFR). Results: There were 326,497 (95% CI: 308,372, 344,658) cases, with 287,875 (88.2%) treated and released, 38,392 (11.8%) admitted, and 230 (0.07%) died in the ED. Heat illness diagnoses were first-listed in 68%. 74.7% had heat exhaustion, 5.4% heat stroke. Visit rates were highly correlated with annual temperature anomalies (Pearson correlation coefficient 0.882, p = 0.005). Treat-and-release rates were highest for younger adults (26.2/100,000/year), whereas hospitalization and death-in-the-ED rates were highest for older adults (6.7 and 0.03/100,000/year, respectively); all rates were highest in rural areas. Heat stroke had an ED CFR of 99.4/10,000 (95% CI: 78.7, 120.1) visits and was diagnosed in 77.0% of deaths. Adjusted odds of hospital admission or death in the ED were higher among elders, males, urban and low-income residents, and those with chronic conditions. Conclusions: Heat illness presented to the ED frequently, with highest rates in rural areas. Case definitions should include all diagnoses. Visit rates were correlated with temperature anomalies. Heat stroke had a high ED CFR. Males, elders, and the chronically ill were at greatest risk of admission or death in the ED. Chronic disease burden exponentially increased this risk. Citation: Hess JJ

Exertional rhabdomyolysis: a clinical review with a focus on genetic influences.

PubMed

Landau, Mark E; Kenney, Kimbra; Deuster, Patricia; Campbell, William

2012-03-01

In this review, the clinical and laboratory features of exertional rhabdomyolysis (ER) are discussed in detail, emphasizing the full clinical spectrum from physiological elevations of serum creatine kinase after exertion to life-threatening rhabdomyolysis with acute kidney injury and associated systemic complications. Laboratory markers used to diagnose both ER and rhabdomyolysis are very sensitive, but not very specific, and imperfectly distinguish "subclinical" or asymptomatic from severe, life-threatening illness. However, genetic factors, both recognized and yet to be discovered, likely influence this diverse clinical spectrum of disease and response to exercise. Genetic mutations causative for McArdle disease, carnitine palmitoyl transferase deficiency 2, myoadenylate deaminase deficiency, and malignant hyperthermia have all been associated with ER. Polymorphic variations in the myosin light chain kinase, α-actin 3, creatine kinase-muscle isoform, angiotensin I-converting enzyme, heat shock protein, and interleukin-6 genes have also been associated with either ER or exercise-induced serum creatine kinase elevations typical of ER. The prognosis for ER is significantly better than that for other etiologies of rhabdomyolysis, but the risk of recurrence after an initial episode is unknown. Guidelines for management are provided.

Is muscle energy production disturbed in exertional heat stroke?

PubMed

Sagui, Emmanuel; Abriat, Amandine; Kozak-Ribbens, Geneviève; Foutrier-Morello, Catherine; Bernard, Monique; Canini, Frédéric; Brosset, Christian; Bendahan, David

2014-03-01

Exertional heat stroke (EHS) is a life-threatening disease that shares some clinical similarities with malignant hyperthermia (MH). By use of (31)Phosphorus magnetic resonance spectroscopy (MRS), EHS patients with MH susceptibility and MH patients shared common metabolic abnormalities. The aim of this study was to determine whether subjects who suffered from an EHS episode had disturbed muscle energetics. This retrospective study was performed within the French database of military subjects that were explored from 2004 to 2010 after they suffered an EHS. All subjects had both in vitro contracture test to determine their MH susceptibility and (31)Phosphorus MRS at 4.7 Tesla to assess muscle energetics by means of MRS score, a composite score corresponding to the sum of metabolic abnormalities recorded during a standardized rest-exercise-recovery protocol. 437 subjects were investigated and 32.5% of them exhibited abnormal MRS score. MRS score did not segregate subjects on demographic, clinical, or biological grounds. No clear correlation could be done between MH status and MRS score. These results did not confirm the potential relationship between calcium homeostasis and muscle energetics previously reported. However, muscle energy production was disturbed in a significant number of EHS subjects. Reprint & Copyright © 2014 Association of Military Surgeons of the U.S.

Heat Stress Illness in a Mechanized Infantry Brigade During Simulated Combat at Fort Irwin

DTIC Science & Technology

1994-05-01

this expanded concept of risk measurement and tracking, at least partly, feasible. Year(s) # heat Primary (Sumncr only) illnesses/10.000/week Activity...operations. Inibntly 28-34, May-June 1992. Clowes, G.H.A., and O’Donnell, T.F. Jr. Current concepts : heat stroke. New England Journal of Medicine 291(11...V.M.. Role of dehydration in heat stress-induced variations in mental performance. Archives of Environmental Healh 43: 15-17, 1988. Halbertstadt, Hans

Fitness, obesity and risk of heat illness among army trainees.

PubMed

Bedno, S A; Urban, N; Boivin, M R; Cowan, D N

2014-09-01

Exertional heat illness (EHI) affects military personnel, athletes and occupational groups such as agricultural workers, despite knowledge of preventive measures. To evaluate EHI diagnoses during US Army basic training and its associations with fitness and body fat on entering military service. From February 2005 to September 2006, US Army recruits at six different military entrance stations took a pre-accession fitness test, including a 5-min step test scored as pass or fail. Subsequent EHI incidence and incidence rate ratios were analysed with reference to subjects' fitness (step test performance) and whether they met (weight qualified [WQ]) or exceeded body fat (EBF) standards. Among the 8621 WQ and 834 EBF male subjects, there were 67 incidents of EHI within 180 days of entering military service. Among WQ subjects, step test failure was significantly associated with EHI (odds ratio [OR] 2.00, 95% confidence interval [CI] 1.13, 3.53). For those passing the step test, the risk of EHI was significantly higher in EBF than in WQ subjects (OR 3.98, 95% CI 2.17, 7.29). Expected ORs for the joint effects of step test failure and EBF classification under additive and multiplicative models were 4.98 and 7.96, respectively. There were too few women to evaluate their data in detail. This study demonstrated that fitness and body fat are independently associated with incident EHI, and the effect of both was substantially higher. Those with low fitness levels and/or obesity should be evaluated further before engaging in intense physical activity, especially in warmer months. Published by Oxford University Press on behalf of the Society of Occupational Medicine 2014.This work is written by (a) US Government employee(s) and is in the public domain in the US.

Neural basis of exertional fatigue in the heat: A review of magnetic resonance imaging methods.

PubMed

Tan, X R; Low, I C C; Stephenson, M C; Soong, T W; Lee, J K W

2018-03-01

The central nervous system, specifically the brain, is implicated in the development of exertional fatigue under a hot environment. Diverse neuroimaging techniques have been used to visualize the brain activity during or after exercise. Notably, the use of magnetic resonance imaging (MRI) has become prevalent due to its excellent spatial resolution and versatility. This review evaluates the significance and limitations of various brain MRI techniques in exercise studies-brain volumetric analysis, functional MRI, functional connectivity MRI, and arterial spin labeling. The review aims to provide a summary on the neural basis of exertional fatigue and proposes future directions for brain MRI studies. A systematic literature search was performed where a total of thirty-seven brain MRI studies associated with exercise, fatigue, or related physiological factors were reviewed. The findings suggest that with moderate dehydration, there is a decrease in total brain volume accompanied with expansion of ventricular volume. With exercise fatigue, there is increased activation of sensorimotor and cognitive brain areas, increased thalamo-insular activation and decreased interhemispheric connectivity in motor cortex. Under passive hyperthermia, there are regional changes in cerebral perfusion, a reduction in local connectivity in functional brain networks and an impairment to executive function. Current literature suggests that the brain structure and function are influenced by exercise, fatigue, and related physiological perturbations. However, there is still a dearth of knowledge and it is hoped that through understanding of MRI advantages and limitations, future studies will shed light on the central origin of exertional fatigue in the heat. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Does Pre-Cooling With Whole-Body Immersion Affect Thermal Sensation or Perceived Exertion?: A Critically-Appraised Topic.

PubMed

Wohlfert, Timothy M; Miller, Kevin C

2018-02-21

Clinical Scenario: Exertional heat stroke (EHS) is a potentially deadly heat illness and poses a significant health risk to athletes; EHS survival rates are near 100% if properly recognized and treated. 1 Whole body cold water immersion (CWI) is the most effective method of lowering body core temperature. 2 Precooling (PC) with CWI before exercise may prevent severe hyperthermia and/or EHS by increasing the body's overall heat-storage capacity. 3 However, PC may also alter athletes' perception of how hot they feel or how hard they are exercising. Consequently, they may be unable to accurately perceive their body core temperature or how hard they are working which may predispose them to severe hyperthermia or EHS. Does PC with whole-body CWI affect thermal sensation (TS) or rating of perceived exertion (RPE) during exercise in the heat? In four studies, 4-7 RPE during exercise ranged from 12 ± 2 to 20 ± 3 with no clinically meaningful differences between PC and control trials. Thermal sensation scores ranged from 2 ± 1 to 8 ± 0.5 in control trials and from 2 ± 1 to 7.5 ± 0.5 during PC trials. Clinical Bottom Line: Precooling did not cause clinically-meaningful differences in RPE or TS during exercise. It is unlikely PC would predispose athletes to EHS by altering perceptions of exercise intensity or body core temperature. Strength of Recommendation: None of the reviewed studies 4-7 (all level 2 studies with PEDro scores ≥5) suggest PC with CWI influences RPE or TS in exercising males.

Survey Instrument Validity Part II: Validation of a Survey Instrument Examining Athletic Trainers' Knowledge and Practice Beliefs Regarding Exertional Heat Stroke

ERIC Educational Resources Information Center

Burton, Laura J.; Mazerolle, Stephanie M.

2011-01-01

Objective: The purpose of this article is to discuss the process of developing and validating an instrument to investigate an athletic trainer's attitudes and behaviors regarding the recognition and treatment of exertional heat stroke. Background: Following up from our initial paper, which discussed the process of survey instrument design and…

Heat emergencies

MedlinePlus

Heatstroke; Heat illness ... who is in good shape can suffer heat illness if warning signs are ignored. The following make ... Heat cramps are the first stage of heat illness. If these symptoms are not treated, it can ...

Thermoregulatory Response to Exercise After Exertional Heat Stroke.

PubMed

Sagui, Emmanuel; Beighau, Sophie; Jouvion, Arnaud; Trichereau, Julie; Cornet, Delphine; Berthelot, René Charles; Canini, Frédéric; Grélot, Laurent

2017-07-01

After one episode of exertional heat stroke (EHS), risk factors must be identified to determine the potential for subsequent episodes. One of these risk factors, core body temperature (T co ) kinetics during strenuous exercise, may be a surrogate marker suggestive of impaired thermoregulation. This study aimed to determine the kinetics of increases in T co among military subjects who had a history of EHS. Forty subjects (38 males, mean age 28.4 ± 4.9 years, mean body mass index 24.9 ± 2.4) who had a history of EHS ran 8 km in full combat gear with continuous monitoring of T co and heart rate. The run was a qualifying event for military service. T co was assessed using an ingestible sensor (Cortemp HQ Inc., Palmetto, Florida). Maximum oxygen uptake (VO 2max ) was measured on the day before the run. The mean performance time for the run was 44.6 ± 6.6 minutes achieved under mild climatic conditions. No neurological impairment was observed. The mean maximum T co was 39.9 ± 0.5°C. On the basis of T co during the last 10 minutes of running, two T co profiles were identified: increased T co (T co increase > 0.5°C) and plateaued T co . Neither profile depended on initial, mid-run, or maximal T co , VO 2max , speed running, body surface area or body fat mass. Subjects who had a history of EHS exhibited different T co profiles at the end of an 8-km run. Laboratory studies will be necessary to identify the mechanisms underlying these profiles; future longitudinal studies can determine whether a T co increase >0.5°C during the last 10 minutes is a risk factor for EHS recurrence. Reprint & Copyright © 2017 Association of Military Surgeons of the U.S.

The effect of firefighter protective garments, self-contained breathing apparatus and exertion in the heat on postural sway.

PubMed

White, Scott C; Hostler, David

2017-08-01

Fire suppression wearing thermal protective clothing (TPC) and self-contained breathing apparatus (SCBA) challenges a firefighter's balance and may explain firefighter falls. Postural control based on force plate centre of pressure (COP) was compared for healthy subjects wearing TPC and SCBA before and after 20 min of heavy physical exertion in hot conditions. Baseline measures with and without TPC and SCBA (two different SCBA cylinder masses) were compared before and after exertion that included elements of fire suppression activities in an environmental chamber. COP excursion and variability increased with exertion for TPC and SCBA conditions compared to non-stressed conditions. The two different cylinder masses had no significant effect. Wearing TPC and SCBA when physically stressed in a hot environment increases postural sway and exacerbates postural control. Subjects compensated for the extra mass and adjusted to control postural sway with the addition of TPC and SCBA, but the stress protocol amplified these adjustments. Practitioner Summary: Firefighters wear thermal protective clothing (TPC) and self-contained breathing apparatus (SCBA) when heat-stressed and fatigued. Wearing TPC and SCBA was found to negatively impact balance when stressed, but not for non-stressed or two different sized SCBA tanks. Simulating fire-ground conditions wearing TPC and SCBA should be considered for improving balance.

Heat-Related Illnesses

MedlinePlus Videos and Cool Tools

... Be Prepared Safe Citizen Day Organize Important Medical Information ER Checklists Preparing for Emergencies Be ready to ... anyone can be affected. Here you will find information about heat cramps and heat stroke and exhaustion. ...

Manual materials handling: the cause of over-exertion injury and illness in industry.

PubMed

Chaffin, D B

1979-01-01

It is reported from various sources that overexertion due to lifting, pushing, pulling, and carrying objects accounts for about 27 percent of all compensable industrial injury and illness in the United States. Resulting strain/sprain injuries account for over 50 percent of workmen's compensation clams in many industries. Almont two-thirds of these involve back pain, with reported compensation and medical payments totaling well over one billion dollars annually in the U.S. An estimated 300,000 plus workers will be affected each year, 5 to 10 percent of whom will have a permanent disability and often will be unemployable. This paper attempts to describe four basic approaches used to study this occupational health problem. In so doing, a concerted effort is made to identifiy the gaps in knowledge which need to be more fully researched. The approaches utilized to understand and control the hazards of manual materials handling are: 1) epidemiological studies of job and worker attributes to identify those that individually and in combination cause musculoskeletal incidents, 2) psychophysical studies to ascertain the volitional tolerance of workers to the stress mitigated by manual materials-handling activities, 3) biomechanical studies of the musculoskeletal system during common exertions required in manual materials-handling activities, and 4) physiological studies of the strain imposed on the cardiovascular system during repeated load-handling activities. The state of knowledge from each of these approaches is summarized briefly, and a case is made that much research is still needed to substantiate the necessary controls to lessen the economic burden and human suffering associated with manual materials-handling acts in industry.

Cost of preventing workplace heat-related illness through worker breaks and the benefit of climate-change mitigation

NASA Astrophysics Data System (ADS)

Takakura, Jun'ya; Fujimori, Shinichiro; Takahashi, Kiyoshi; Hijioka, Yasuaki; Hasegawa, Tomoko; Honda, Yasushi; Masui, Toshihiko

2017-06-01

The exposure of workers to hot environments is expected to increase as a result of climate change. In order to prevent heat-related illness, it is recommended that workers take breaks during working hours. However, this would lead to reductions in worktime and labor productivity. In this study, we estimate the economic cost of heat-related illness prevention through worker breaks associated with climate change under a wide range of climatic and socioeconomic conditions. We calculate the worktime reduction based on the recommendation of work/rest ratio and the estimated future wet bulb glove temperature, which is an index of heat stresses. Corresponding GDP losses (cost of heat-related illness prevention through worker breaks) are estimated using a computable general equilibrium model throughout this century. Under the highest emission scenario, GDP losses in 2100 will range from 2.6 to 4.0% compared to the current climate conditions. On the other hand, GDP losses will be less than 0.5% if the 2.0 °C goal is achieved. The benefit of climate-change mitigation for avoiding worktime loss is comparable to the cost of mitigation (cost of the greenhouse gas emission reduction) under the 2.0 °C goal. The relationship between the cost of heat-related illness prevention through worker breaks and global average temperature rise is approximately linear, and the difference in economic loss between the 1.5 °C goal and the 2.0 °C goal is expected to be approximately 0.3% of global GDP in 2100. Although climate mitigation and socioeconomic development can limit the vulnerable regions and sectors, particularly in developing countries, outdoor work is still expected to be affected. The effectiveness of some adaptation measures such as additional installation of air conditioning devices or shifting the time of day for working are also suggested. In order to reduce the economic impacts, adaptation measures should also be implemented as well as pursing ambitious climate change

Relieving thermal discomfort: Effects of sprayed L-menthol on perception, performance, and time trial cycling in the heat.

PubMed

Barwood, M J; Corbett, J; Thomas, K; Twentyman, P

2015-06-01

L-menthol stimulates cutaneous thermoreceptors and induces cool sensations improving thermal comfort, but has been linked to heat storage responses; this could increase risk of heat illness during self-paced exercise in the heat. Therefore, L-menthol application could lead to a discrepancy between behavioral and autonomic thermoregulatory drivers. Eight male participants volunteered. They were familiarized and then completed two trials in hot conditions (33.5 °C, 33% relative humidity) where their t-shirt was sprayed with CONTROL-SPRAY or MENTHOL-SPRAY after 10 km (i.e., when they were hot and uncomfortable) of a 16.1-km cycling time trial (TT). Thermal perception [thermal sensation (TS) and comfort (TC)], thermal responses [rectal temperature (Trec ), skin temperature (Tskin )], perceived exertion (RPE), heart rate, pacing (power output), and TT completion time were measured. MENTHOL-SPRAY made participants feel cooler and more comfortable and resulted in lower RPE (i.e., less exertion) yet performance was unchanged [TT completion: CONTROL-SPRAY 32.4 (2.9) and MENTHOL-SPRAY 32.7 (3.0) min]. Trec rate of increase was 1.40 (0.60) and 1.45 (0.40) °C/h after CONTROL-SPRAY and MENTHOL-SPRAY application, which were not different. Spraying L-menthol toward the end of self-paced exercise in the heat improved perception, but did not alter performance and did not increase heat illness risk. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Recruitment, Methods, and Descriptive Results of a Physiologic Assessment of Latino Farmworkers: The California Heat Illness Prevention Study.

PubMed

Mitchell, Diane C; Castro, Javier; Armitage, Tracey L; Vega-Arroyo, Alondra J; Moyce, Sally C; Tancredi, Daniel J; Bennett, Deborah H; Jones, James H; Kjellstrom, Tord; Schenker, Marc B

2017-07-01

The California heat illness prevention study (CHIPS) devised methodology and collected physiological data to assess heat related illness (HRI) risk in Latino farmworkers. Bilingual researchers monitored HRI across a workshift, recording core temperature, work rate (metabolic equivalents [METs]), and heart rate at minute intervals. Hydration status was assessed by changes in weight and blood osmolality. Personal data loggers and a weather station measured exposure to heat. Interviewer administered questionnaires were used to collect demographic and occupational information. California farmworkers (n = 588) were assessed. Acceptable quality data was obtained from 80% of participants (core temperature) to 100% of participants (weight change). Workers (8.3%) experienced a core body temperature more than or equal to 38.5 °C and 11.8% experienced dehydration (lost more than 1.5% of body weight). Methodology is presented for the first comprehensive physiological assessment of HRI risk in California farmworkers.

The force exerted by a fireball

DOE Office of Scientific and Technical Information (OSTI.GOV)

Makrinich, G.; Fruchtman, A.

The force exerted by a fireball was deduced both from the change of the equilibrium position of a pendulum and from the change in the pendulum oscillation period. That measured force was found to be several times larger than the force exerted by the ions accelerated across the double layer that is assumed to surround the fireball. The force enhancement that is expected by ion-neutral collisions in the fireball is evaluated to be too small to explain the measured enhanced force. Gas pressure increase, due to gas heating through electron-neutral collisions, as recently suggested [Stenzel et al., J. Appl. Phys.more » 109, 113305 (2011)], is examined as the source for the force enhancement.« less

Hydration and thermal strain during tennis in the heat.

PubMed

Bergeron, Michael F

2014-04-01

Competitive tennis in the heat can prompt substantial sweat losses and extensive consequent body water and electrolyte deficits, as well as a level of thermal strain that considerably challenges a player's physiology, perception of effort, and on-court well-being and performance. Adequate hydration and optimal performance can be notably difficult to maintain when multiple same-day matches are played on successive days in hot weather. Despite the recognised effects of the heat, much more research needs to be carried out to better appreciate the broader scope and full extent of the physiological demands and hydration and thermal strain challenges facing junior and adult players in various environments, venues and competition scenarios. However, certain recommendations of best practices should be emphasised to minimise exertional heat illness risk and improve player safety, well-being and on-court performance.

Interactions of Gut Microbiota, Endotoxemia, Immune Function, and Diet in Exertional Heatstroke

PubMed Central

Lee, Elaine C.; Armstrong, Elizabeth M.

2018-01-01

Exertional heatstroke (EHS) is a medical emergency that cannot be predicted, requires immediate whole-body cooling to reduce elevated internal body temperature, and is influenced by numerous host and environmental factors. Widely accepted predisposing factors (PDF) include prolonged or intense exercise, lack of heat acclimatization, sleep deprivation, dehydration, diet, alcohol abuse, drug use, chronic inflammation, febrile illness, older age, and nonsteroidal anti-inflammatory drug use. The present review links these factors to the human intestinal microbiota (IM) and diet, which previously have not been appreciated as PDF. This review also describes plausible mechanisms by which these PDF lead to EHS: endotoxemia resulting from elevated plasma lipopolysaccharide (i.e., a structural component of the outer membrane of Gram-negative bacteria) and tissue injury from oxygen free radicals. We propose that recognizing the lifestyle and host factors which are influenced by intestine-microbial interactions, and modifying habitual dietary patterns to alter the IM ecosystem, will encourage efficient immune function, optimize the intestinal epithelial barrier, and reduce EHS morbidity and mortality. PMID:29850597

From agricultural fields to urban asphalt: the role of worker education to promote California's heat illness prevention standard.

PubMed

Riley, Kevin; Delp, Linda; Cornelio, Deogracia; Jacobs, Sarah

2012-01-01

This article describes an innovative approach to reach and educate workers and worker advocates about California's outdoor heat illness prevention standard. In 2010, Cal/OSHA initiated a statewide education campaign to reduce heat-related illnesses and fatalities and increase awareness of the standard's requirements. In Southern California, the UCLA Labor Occupational Safety and Health Program (LOSH) focused on three principal strategies of community-based outreach, popular education, and organizational capacity building. Central to the LOSH approach was the integration of health promotores into core program planning and training activities and the expansion of campaign activities to a wide variety of rural and urban workers. We describe each of these strategies and analyze the possibilities and constraints of worker education to support implementation of this standard, particularly given the vulnerabilities of the impacted workforce, the often precarious nature of employment arrangements for these workers, and the resource limitations of Cal/OSHA.

Novel Interventions for Heat/Exercise Induced Sudden Death and Fatigue

DTIC Science & Technology

2013-10-01

mutations associated with enhanced susceptibility to Exertional Heat Stroke (EHS), Exertional Rhabdomyolysis (ER), and Malignant Hyperthermia (MH) by...reduces the probability of a hypermetabolic response in YS mice. 15. SUBJECT TERMS: Exertional Heat Stroke, Exertional Rhabdomyolysis ...and exertional rhabdomyolysis (ER) have been reported in subjects with diagnosis of Malignant Hyperthermia (MH). MH is a life- threatening

Chronic Fatigue Syndrome versus Systemic Exertion Intolerance Disease

PubMed Central

Jason, Leonard A.; Sunnquist, Madison; Brown, Abigail; Newton, Julia L.; Strand, Elin Bolle; Vernon, Suzanne D.

2015-01-01

Background The Institute of Medicine has recommended a change in the name and criteria for Chronic Fatigue Syndrome (CFS), renaming the illness Systemic Exertion Intolerance Disease (SEID). The new SEID case definition requires substantial reductions or impairments in the ability to engage in pre-illness activities, unrefreshing sleep, post-exertional malaise, and either cognitive impairment or orthostatic intolerance. Purpose In the current study, samples were generated through several different methods and were used to compare this new case definition to previous case definitions for CFS, Myalgic Encephalomyelitis (ME-ICC), Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS), as well as a case definition developed through empirical methods. Methods We used a cross-sectional design with samples from tertiary care settings, a biobank sample, and other forums. 796 patients from the US, Great Britain, and Norway completed the DePaul Symptom Questionnaire. Results Findings indicated that the SEID criteria identified 88% of participants in the samples analyzed, which is comparable to the 92% that met the Fukuda criteria. The SEID case definition was compared to a four item empiric criteria, and findings indicated that the four item empiric criteria identified a smaller, more functionally limited and symptomatic group of patients. Conclusion The recently developed SEID criteria appears to identify a group comparable in size to the Fukuda et al. criteria, but a larger group of patients than the Canadian ME/CFS and ME criteria, and selects more patients who have less impairment and fewer symptoms than a four item empiric criteria. PMID:26345409

Update: Exertional rhabdomyolysis, active component, U.S. Armed Forces, 2012-2016.

PubMed

2017-03-01

Among active component service members in 2016, there were 525 incident diagnoses of rhabdomyolysis likely due to physical exertion and/or heat stress ("exertional rhabdomyolysis"). The crude incidence rate in 2016 was 40.7 cases per 100,000 person-years. Annual rates of incident diagnoses of exertional rhabdomyolysis increased 46.2% between 2013 and 2016, with the greatest percentage change occurring between 2014 and 2015. In 2016, relative to their respective counterparts, the highest incidence rates of exertional rhabdomyolysis affected service members who were male; younger than 20 years of age; and black, non-Hispanic. During the surveillance period, annual incidence rates were highest among service members of the Marine Corps, intermediate among those in the Army, and lowest among those in the Air Force and Navy. Most cases of exertional rhabdomyolysis were diagnosed at installations that support basic combat/recruit training or major ground combat units of the Army or the Marine Corps. Medical care providers should consider exertional rhabdomyolysis in the differential diagnosis when service members (particularly recruits) present with muscular pain or swelling, limited range of motion, or the excretion of dark urine (possibly due to myoglobinuria) after strenuous physical activity, particularly in hot, humid weather.

Does biological sex impact intestinal epithelial injury, small intestine permeability, gastrointestinal symptoms and systemic cytokine profile in response to exertional-heat stress?

PubMed

Snipe, Rhiannon M J; Costa, Ricardo J S

2018-05-23

This study aimed to determine the influence of biological sex on intestinal injury, permeability, gastrointestinal symptoms, and systemic cytokine profile in response to exertional-heat stress. Male (n= 13) and eumenorrheic female (n= 11) endurance runners completed 2 h running at 60% V̇O 2max in 35°C. Blood samples were collected pre- and post-exercise and during recovery to determine plasma intestinal fatty-acid binding protein (I-FABP) and systemic cytokine profile. Urinary lactulose:L-rhamnose ratio was used to determine small intestine permeability. I-FABP increased 479% pre- to post-exercise (p< 0.001), with no difference between sexes (p= 0.432). No differences between sexes were observed for small intestine permeability (p= 0.808), gut discomfort, total, upper- and lower-gastrointestinal symptoms. However, males reported significantly higher flatulence (p= 0.049) and abdominal stitch (p= 0.025) compared to females. IL-6, IL-8, IL-10 and IL-1ra increased pre- to post-exercise (p< 0.05), with no difference between sexes. However, IL-1β increased post-exercise in males only, and was higher in males compared to females (p= 0.044). Findings suggest that when females are in the follicular phase of the menstrual cycle, biological sex has no effect on intestinal epithelial injury and permeability, and minimal effect on gastrointestinal symptoms and systemic cytokine profile in response to exertional-heat stress.

[Pathophysiology of heat illness].

PubMed

Aruga, Tohru; Miyake, Yasufumi

2012-06-01

Human core temperature is strictly controlled by mechanism of radiation, conduction, convection, and evaporation from skin surface. Serial hot and humid climate induces dehydration which interferes heat pump-out from the body. Heart dysfunction is the third factor to rise body temperature. Hyperthermia and hypo-perfusion caused by dehydration and heart failure deteriorate specific organ functions, i.e. central nervous system, liver and renal functions and coagulation system. Disseminated intravascular coagulopathy is one of the standard indicators of severity and mortality of heat stroke.

Risk Factors for Heat-Related Illness in Washington Crop Workers.

PubMed

Spector, June T; Krenz, Jennifer; Blank, Kristina N

2015-01-01

Crop workers are at high risk of heat-related illness (HRI) from internal heat generated by heavy physical work, particularly when laboring in hot and humid conditions. The aim of this study was to identify risk factors for HRI symptoms in Washington crop workers using an audio computer-assisted self-interview (A-CASI) instrument that has undergone reliability and validity evaluation. A cross-sectional A-CASI survey of 97 crop workers in Washington State was conducted during the summer of 2013. Potential HRI risk factors in demographic, training, work, hydration, clothing, health, and environmental domains were selected a priori for evaluation. Mixed-effects logistic regression was used to identify risk factors for self-reported symptoms associated with heat strain and HRI (dizziness/light-headedness or heavy sweating) experienced at work in hot conditions. An increase in age was associated with a lower odds of HRI symptoms (odds ratio [OR] = 0.92; 95% confidence interval [CI] = 0.87-0.98). Piece rate compared with hourly payment (OR = 6.20; 95% CI = 1.11-34.54) and needing to walk for more than 3 minutes to get to the toilet, compared with less than 3 minutes (OR = 4.86; 95% CI = 1.18-20.06), were associated with a higher odds of HRI symptoms. In this descriptive study of risk factors for HRI symptoms in Washington crop workers, decreased age (and less work experience), piece rate pay, and longer distance to the toilet were associated with self-reported HRI symptoms. Modifiable workplace factors should be considered in HRI prevention efforts that are evaluated using objective measures in representative working populations.

Effect of aspirin on acute changes in peripheral arterial stiffness and endothelial function following exertional heat stress in firefighters: The factorial group results of the Enhanced Firefighter Rehab Trial.

PubMed

Olafiranye, Oladipupo; Hostler, David; Winger, Daniel G; Wang, Li; Reis, Steven E

2015-06-01

Peripheral arterial stiffness and endothelial function, which are independent predictors of cardiac events, are abnormal in firefighters. We examined the effects of aspirin on peripheral arterial stiffness and endothelial function in firefighters. Fifty-two firefighters were randomized to receive daily 81 mg aspirin or placebo for 14 days before treadmill exercise in thermal protection clothing, and a single dose of 325 mg aspirin or placebo immediately following exertion. Peripheral arterial augmentation index adjusted for a heart rate of 75 (AI75) and reactive hyperemia index (RHI) were determined immediately before, and 30, 60, and 90 minutes after exertion. Low-dose aspirin was associated with lower AI75 (-15.25±9.25 vs -8.08±10.70, p=0.014) but not RHI. On repeated measures analysis, treatment with low-dose aspirin before, but not single-dose aspirin after exertion, was associated with lower AI75 following exertional heat stress (p=0.018). Low-dose aspirin improved peripheral arterial stiffness and wave reflection but not endothelial function in firefighters. © The Author(s) 2015.

Economic Burden of Hospitalizations for Heat-Related Illnesses in the United States, 2001-2010.

PubMed

Schmeltz, Michael T; Petkova, Elisaveta P; Gamble, Janet L

2016-09-08

Understanding how heat waves affect morbidity and mortality, as well as the associated economic costs, is essential for characterizing the human health impacts of extreme heat under a changing climate. Only a handful of studies have examined healthcare costs associated with exposures to high temperatures. This research explores costs associated with hospitalizations for heat-related illness (HRI) in the United States using the 2001 to 2010 Nationwide Inpatient Sample (NIS). Descriptive statistics of patient data for HRI hospitalizations were examined and costs of hospitalizations were reported using the all-payer inpatient cost-to-charge ratio. Costs were examined using a log-gamma model with patient and hospital characteristics included as fixed effects. Adjusted mean costs were then compared across racial groups. The mean costs of HRI hospitalizations were higher among racial/ethnic minorities compared to Whites, who accounted for almost 65% of all HRI hospitalizations. Observed differences in costs based on income, insurance, and gender were also significant. These results suggest that these populations are suffering disproportionately from health inequity, thus, they could shoulder greater disease and financial burdens due to climate change. These findings may have important implications in understanding the economic impact public health planning and interventions will have on preventing hospitalizations related to extreme heat.

Symptoms of respiratory illness in young children and the use of wood-burning stoves for indoor heating

DOE Office of Scientific and Technical Information (OSTI.GOV)

Honicky, R.E.; Osborne, J.S.; Akpom, C.A.

1985-03-01

The occurrence of symptoms of respiratory illness among preschool children living in homes heated by wood-burning stoves was examined by conducting an historical prospective study (n . 62) with an internal control group (matched for age, sex, and town of residence). Exposures of subjects were not significantly different (P greater than .05) with respect to parental smoking, urea-formaldehyde foam insulation, and use of humidifiers. The control group made significantly greater use of gas stoves for cooking whereas the study group made greater use of electric stoves for cooking and of air filters (P less than .05). Only one home usedmore » a kerosene space heater. During the winter of 1982, moderate and severe symptoms in all categories were significantly greater for the study group compared with the control group (P less than .001). These differences could not be accounted for by medical histories (eg, allergies, asthma), demographic or socioeconomic characteristics, or by exposure to sources of indoor air pollution other than wood-burning stoves. Present findings suggest that indoor heating with wood-burning stoves may be a significant etiologic factor in the occurrence of symptoms of respiratory illness in young children.« less

Temporal and spatial variation of heat-related illness using 911 medical dispatch data.

PubMed

Bassil, Kate L; Cole, Donald C; Moineddin, Rahim; Craig, Alan M; Lou, W Y Wendy; Schwartz, Brian; Rea, Elizabeth

2009-07-01

The adverse effect of hot weather on health in urban communities is of increasing public health concern, particularly given trends in climate change. To demonstrate the potential public health applications of monitoring 911 medical dispatch data for heat-related illness (HRI), using historical data for the summer periods (June 1-August 31) during 2002-2005 in Toronto, Ontario, Canada. The temporal distribution of the medical dispatch calls was described in relation to a current early warning system and emergency department data from the National Ambulatory Care Reporting System (NACRS). Geospatial methods were used to map the percentage of heat-related calls in each Toronto neighborhood over the study period. The temporal pattern of 911 calls for HRI was similar, and sometimes peaked earlier, than current heat health warning systems (HHWS). The pattern of calls was similar to NACRS HRI visits, with the exception of 2005 where 911 calls peaked earlier. Areas of the city with a relatively higher burden of HRI included low income inner-city neighborhoods, areas with high rates of street-involved individuals, and areas along the waterfront which include summer outdoor recreational activities. Identifying the temporal trends and geospatial patterns of these important environmental health events has the potential to direct targeted public health interventions to mitigate associated morbidity and mortality.

Risk Factors for Heat-related Illness in U.S. Workers: An OSHA Case Series.

PubMed

Tustin, Aaron W; Cannon, Dawn L; Arbury, Sheila B; Thomas, Richard J; Hodgson, Michael J

2018-05-30

The aim of this study was to describe risk factors for heat-related illness (HRI) in U.S. workers. We reviewed a subset of HRI enforcement investigations conducted by the Occupational Safety and Health Administration (OSHA) from 2011 through 2016. We assessed characteristics of the workers, employers, and events. We stratified cases by severity to assess whether risk factors were more prevalent in fatal HRIs. We analyzed 38 investigations involving 66 HRIs. Many workers had predisposing medical conditions or used predisposing medications. Comorbidities were more prevalent in workers who died. Most (73%) fatal HRIs occurred during the first week on the job. Common clinical findings in heat stroke cases included multiorgan failure, muscle breakdown, and systemic inflammation. Severe HRI is more likely when personal susceptibilities coexist with work-related and environmental risk factors. Almost all HRIs occur when employers do not adhere to preventive guidelines.

Heat strain during military training activities: The dilemma of balancing force protection and operational capability.

PubMed

Hunt, Andrew P; Billing, Daniel C; Patterson, Mark J; Caldwell, Joanne N

2016-01-01

Military activities in hot environments pose 2 competing demands: the requirement to perform realistic training to develop operational capability with the necessity to protect armed forces personnel against heat-related illness. To ascertain whether work duration limits for protection against heat-related illness restrict military activities, this study examined the heat strain and risks of heat-related illness when conducting a military activity above the prescribed work duration limits. Thirty-seven soldiers conducted a march (10 km; ∼5.5 km h -1 ) carrying 41.8 ± 3.6 kg of equipment in 23.1 ± 1.8°C wet-bulb globe temperature. Body core temperature was recorded throughout and upon completion, or withdrawal, participants rated their severity of heat-related symptoms. Twenty-three soldiers completed the march in 107 ± 6.4 min (Completers); 9 were symptomatic for heat exhaustion, withdrawing after 71.6 ± 10.1 min (Symptomatic); and five were removed for body core temperature above 39.0°C (Hyperthermic) after 58.4 ± 4.5 min. Body core temperature was significantly higher in the Hyperthermic (39.03 ± 0.26°C), than Symptomatic (38.34 ± 0.44°C; P = 0.007 ) and Completers (37.94 ± 0.37°C; P<0.001 ) after 50 min. Heat-related symptom severity was significantly higher among Symptomatic (28.4 ± 11.8) compared to Completers (15.0 ± 9.8, P = 0.006 ) and Hyperthermic (13.0 ± 9.6, P = 0.029 ). The force protection provided by work duration limits may be preventing the majority of personnel from conducting activities in hot environments, thereby constraining a commander's mandate to develop an optimised military force. The dissociation between heat-related symptoms and body core temperature elevation suggests that the physiological mechanisms underpinning exhaustion during exertional heat stress should be re-examined to determine the most appropriate physiological criteria for prescribing work duration limits.

Temperature-Related Death and Illness. Chapter 2

NASA Technical Reports Server (NTRS)

Sarofim, Marcus C.; Saha, Shubhayu; Hawkins, Michelle D.; Mills, David M.; Hess, Jeremy; Horton, Radley; Kinney, Patrick; Schwartz, Joel; St. Juliana, Alexis

2016-01-01

Based on present-day sensitivity to heat, an increase of thousands to tens of thousands of premature heat-related deaths in the summer and a decrease of premature cold-related deaths in the winter are projected each year as a result of climate change by the end of the century. Future adaptation will very likely reduce these impacts (see Changing Tolerance to Extreme Heat Finding). The reduction in cold-related deaths is projected to be smaller than the increase in heat-related deaths in most regions. Days that are hotter than usual in the summer or colder than usual in the winter are both associated with increased illness and death. Mortality effects are observed even for small differences from seasonal average temperatures. Because small temperature differences occur much more frequently than large temperature differences, not accounting for the effect of these small differences would lead to underestimating the future impact of climate change. An increase in population tolerance to extreme heat has been observed over time. Changes in this tolerance have been associated with increased use of air conditioning, improved social responses, and or physiological acclimatization, among other factors. Expected future increases in this tolerance will reduce the projected increase in deaths from heat. Older adults and children have a higher risk of dying or becoming ill due to extreme heat. People working outdoors, the socially isolated and economically disadvantaged, those with chronic illnesses, as well as some communities of color, are also especially vulnerable to death or illness.

Heat stress disorders and headache: a case of new daily persistent headache secondary to heat stroke.

PubMed

Di Lorenzo, C; Ambrosini, A; Coppola, G; Pierelli, F

2009-01-01

Headache is considered as a common symptom of heat stress disorders (HSD), but no forms of secondary headache from heat exposure are reported in the International Classification of Headache Disorders-2 Edition (ICHD-II). Heat-stroke (HS) is the HSD most severe condition, it may be divided into two forms: classic (due to a long period environmental heat exposure) and exertional (a severe condition caused by strenuous physical exercises in heat environmental conditions). Here we report the case of a patient who developed a headache clinical picture fulfilling the diagnostic criteria for new daily persistent headache (NDPH), after an exertional HS, and discuss about possible pathophysiological mechanisms and classification aspects of headache induced by heat conditions.

Heat stress disorders and headache: a case of new daily persistent headache secondary to heat stroke

PubMed Central

Di Lorenzo, C; Ambrosini, A; Coppola, G; Pierelli, F

2009-01-01

Headache is considered as a common symptom of heat stress disorders (HSD), but no forms of secondary headache from heat exposure are reported in the International Classification of Headache Disorders-2 Edition (ICHD-II). Heat-stroke (HS) is the HSD most severe condition, it may be divided into two forms: classic (due to a long period environmental heat exposure) and exertional (a severe condition caused by strenuous physical exercises in heat environmental conditions). Here we report the case of a patient who developed a headache clinical picture fulfilling the diagnostic criteria for new daily persistent headache (NDPH), after an exertional HS, and discuss about possible pathophysiological mechanisms and classification aspects of headache induced by heat conditions. PMID:21686677

Levosimendan in Critical Illness: A Literature Review

PubMed Central

Pierrakos, Charalampos; Velissaris, Dimitrios; Franchi, Federico; Muzzi, Luigi; Karanikolas, Menelaos; Scolletta, Sabino

2014-01-01

Levosimendan, the active enantiomer of simendan, is a calcium sensitizer developed for treatment of decompensated heart failure, exerts its effects independently of the beta adrenergic receptor and seems beneficial in cases of severe, intractable heart failure. Levosimendan is usually administered as 24-h infusion, with or without a loading dose, but dosing needs adjustment in patients with severe liver or renal dysfunction. Despite several promising reports, the role of levosimendan in critical illness has not been thoroughly evaluated. Available evidence suggests that levosimendan is a safe treatment option in critically ill patients and may reduce mortality from cardiac failure. However, data from well-designed randomized controlled trials in critically ill patients are needed to validate or refute these preliminary conclusions. This literature review is an attempt to synthesize available evidence on the role and possible benefits of levosimendan in critically ill patients with severe heart failure. PMID:24578748

The induction and decay of heat acclimatisation in trained athletes.

PubMed

Armstrong, L E; Maresh, C M

1991-11-01

Heat acclimatisation/acclimation involves a complex of adaptations which includes decreased heart rate, rectal temperature, perceived exertion as well as increased plasma volume and sweat rate. These adaptations serve to reduce physiological strain, improve an athlete's ability to exercise in a hot environment, and reduce the incidence of some forms of heat illness. Few differences exist in the ability of men and women to acclimatise to heat. Typically, older runners do not perform in the heat as well as younger runners, but physical training can negate differences between these groups. Hormonal adaptations (e.g. aldosterone, vasopressin) during heat acclimatisation encourage fluid-electrolyte retention and cardiovascular stability. Athletes with high maximal aerobic power (VO2max) acclimatise to heat faster (and lose adaptations slower when they are inactive in a cool environment) than athletes with low VO2max values. Physical training in a cool environment improves physiological responses to exercise at high ambient temperatures. In attempting to optimise heat acclimatisation, athletes should maintain fluid-electrolyte balance, exercise at intensities greater than 50% VO2max for 10 to 14 days, and avoid factors (e.g. sleep loss, infectious disease) which are known to reduce heat tolerance. Once acclimatisation has been achieved, inactivity results in a decay of favourable adaptations, after only a few days or weeks.

A Critical Review of OSHA Heat Enforcement Cases: Lessons Learned.

PubMed

Arbury, Sheila; Lindsley, Matthew; Hodgson, Michael

2016-04-01

The aim of the study was to review the Occupational Safety and Health Administration's (OSHA) 2012 to 2013 heat enforcement cases, using identified essential elements of heat illness prevention to evaluate employers' programs and make recommendations to better protect workers from heat illness. (1) Identify essential elements of heat illness prevention; (2) develop data collection tool; and (3) analyze OSHA 2012 to 2013 heat enforcement cases. OSHA's database contains 84 heat enforcement cases in 2012 to 2013. Employer heat illness prevention programs were lacking in essential elements such as providing water and shade; adjusting the work/rest proportion to allow for workload and effective temperature; and acclimatizing and training workers. In this set of investigations, most employers failed to implement common elements of illness prevention programs. Over 80% clearly did not rely on national standard approaches to heat illness prevention.

Perceived exertion. Antecedents and applications.

PubMed

Watt, B; Grove, R

1993-04-01

The field of perceived exertion has largely concerned itself with the problem of identifying the primary antecedents to this psychophysiological phenomenon. A vast literature has evolved addressing this problem, but it is fraught with contradictions. At this stage a comprehensive theory of perceived exertion does not exist. It is generally accepted that perception of exertion is dominated by physiological determinants. Physiological sensory cues have been separated into 2 categories: local factors (sensations from the working muscles and joints), and central factors (sensations from the cardiopulmonary system). Major reviews in this area generally agree that local factors dominate perception of exertion. Recent work in perceived exertion has placed an emphasis on examining the contributing psychological factors. Research into the psychological factors affecting perceived exertion has been highly fragmented with no apparent theoretical framework as a base. At the same time it is clear that an integration of psychological and physiological variables is required to obtain theoretically meaningful knowledge of this multidimensional construct. The assumed dominance of physiological factors has been challenged by the contention that in field situations, in which a variety of social psychological influences operate, psychological determinants of perceived exertion may be vastly more influential than previously estimated. Identification of the primary determinants of perceived exertion and knowledge of how these factors are integrated is vital for a concrete theory of perceived exertion to evolve.

Phosgene Poisoning Caused by the Use of Chemical Paint Removers Containing Methylene Chloride in Ill-Ventilated Rooms Heated by Kerosene Stoves

PubMed Central

Gerritsen, W. B.; Buschmann, C. H.

1960-01-01

Two cases resembling poisoning by phosgene following the use of a paint remover containing methylene chloride in ill-ventilated rooms heated by an oil stove are described. Experiments carried out under similar conditions demonstrated the production of phosgene in toxic concentrations. The potential hazards from non-inflammable solvents are discussed. PMID:13827592

Update: Exertional rhabdomyolysis, active component, U.S. Army, Navy, Air Force, and Marine Corps, 2011-2015.

PubMed

Armed Forces Health Surveillance Branch

2016-03-01

Among active component members of the U.S. Army, Navy, Air Force, and Marine Corps in 2015, there were 456 incident episodes of rhabdomyolysis likely due to physical exertion or heat stress ("exertional rhabdomyolysis"). Annual rates of incident diagnoses of exertional rhabdomyolysis increased 17% between 2014 and 2015. In 2015, the highest incidence rates occurred in service members who were male; younger than 20 years of age; black, non-Hispanic; members of the Marine Corps and Army; recruit trainees; and in combat-specific occupations. Most cases of exertional rhabdomyolysis were diagnosed at installations that support basic combat/recruit training or major ground combat units of the Army or Marine Corps. Medical care providers should consider exertional rhabdomyolysis in the differential diagnosis when service members (particularly recruits) present with muscular pain and swelling, limited range of motion, or the excretion of dark urine (e.g., myoglobinuria) after strenuous physical activity, particularly in hot, humid weather.

Effectiveness of heat and moisture exchangers in preventing ventilator-associated pneumonia in critically ill patients: a meta-analysis.

PubMed

Menegueti, Mayra Gonçalves; Auxiliadora-Martins, Maria; Nunes, Altacílio Aparecido

2014-01-01

Patients may acquire ventilator-associated pneumonia (VAP) by aspirating the condensate that originates in the ventilator circuit upon use of a conventional humidifier. The bacteria that colonize the patients themselves can proliferate in the condensate and then return to the airways and lungs when the patient aspirates this contaminated material. Therefore, the use of HME might contribute to preventing pneumonia and lowering the VAP incidence. The aim of this study was to evaluate how the use of HME impacts the probability of VAP occurrence in critically ill patients. On the basis of the acronym "PICO" (Patient, Intervention, Comparison, Outcome), the question that guided this review was "Do critically ill patients under invasive mechanical ventilation present lower VAP incidence when they use HME as compared with HH?". Two of the authors of this review searched the databases PUBMED/Medline, The Cochrane Library, and Latin-American and Caribbean Literature in Health Sciences, LILACS independently; they used the following keywords: "heat and moisture exchanger", AND "heated humidifier", AND "ventilator-associated pneumonia prevention". This review included papers in the English language published from January 1990 to December 2012. This review included ten studies. Comparison between the use of HME and HH did not reveal any differences in terms of VAP occurrence (OR = 0.998; 95% CI: 0.778-1.281). Together, the ten studies corresponded to a total sample of 1077 and 953 patients in the HME and HH groups, respectively; heterogeneity among the investigations was low (I(2) < 50%). Information about the outcome mortality was available in only eight of the ten studies. The use of HME and HH did not afford different results in terms of mortality (OR = 1.09; 95% CI: 0.864-1.376). The total sample size was 884 and 762 patients, respectively. Heterogeneity among the studies was low (I(2) = 0.0%). Current meta-analysis was not sufficient to definitely exclude an associate

Rasburicase improves hyperuricemia in patients with acute kidney injury secondary to rhabdomyolysis caused by ecstasy intoxication and exertional heat stroke.

PubMed

Lin, Pei-Yi; Lin, Chun-Chen; Liu, Hsi-Che; Lee, Ming-Dar; Lee, Hung-Chang; Ho, Che-Sheng; Chiu, Nan-Chang; Peng, Chun-Chih; Huang, Fu-Yuan; Tsai, Jeng-Daw

2011-11-01

To report the successful use of rasburicase in two children with hyperuricemia secondary to severe rhabdomyolysis. : Case report. Pediatric intensive care unit in a freestanding quaternary hospital. Two pediatric patients with severe rhabdomyolysis and hyperuricemia caused by ecstasy intoxication and exertional heat stroke. Use of a single low dose (6 mg) of rasburicase, a urate oxidase enzyme. Rasburicase was administered on the first and second hospital days with a single low dose of 6 mg (0.086 mg/kg in patient A and 0.092 mg/kg in patient B). Within 24 hrs, the levels of serum uric acid in both patients decreased dramatically, and their creatinine levels decreased and urine output increased concurrently. Continuous improvements in the uric acid levels, creatinine levels, and urine output were noted during hospitalization. Rasburicase seems to be a safe and effective drug for improving hyperuricemia in patients with rhabdomyolysis and renal failure.

Development of a perceptual hyperthermia index to evaluate heat strain during treadmill exercise.

PubMed

Gallagher, Michael; Robertson, Robert J; Goss, Fredric L; Nagle-Stilley, Elizabeth F; Schafer, Mark A; Suyama, Joe; Hostler, David

2012-06-01

Fire suppression and rescue is a physiologically demanding occupation due to extreme external heat as well as the physical and thermal burden of the protective garments. These conditions challenge body temperature homeostasis and results in heat stress. Accurate field assessment of core temperature is complex and unreliable. The present investigation developed a perceptually based hyperthermia metric to measure physiologic exertional heat strain during treadmill exercise. Sixty-five (28.9 ± 6.8 years) female (n = 11) and male (n = 54) firefighters and non-firefighting volunteers participated in four related exertional heat stress investigations performing treadmill exercise in a heated room while wearing thermal protective clothing. Body core temperature, perceived exertion, and thermal sensation were assessed at baseline, 20-mins exercise, and at termination. Perceived exertion increased from baseline (0.24 ± 0.42) to termination (7.43 ± 1.86). Thermal sensation increased from baseline (1.78 ± 0.77) to termination (4.50 ± 0.68). Perceived exertion and thermal sensation were measured concurrently with body core temperature to develop a two-dimensional graphical representation of three exertional heat strain zones representative of a range of mean body core temperature responses such that low risk (green) incorporated 36.0-37.4°C, moderate risk (yellow) incorporated 37.5-37.9°C, and high risk (red) incorporated 38.0 to greater than 40.5°C. The perceptual hyperthermia index (PHI) may provide a quick and easy momentary assessment of the level of risk for exertional heat stress for firefighters engaged in fire suppression that may be beneficial in high-risk environments that threaten the lives of firefighters.

Development of a surveillance case definition for heat-related illness using 911 medical dispatch data.

PubMed

Bassil, Kate L; Cole, Donald C; Moineddin, Rahim; Gournis, Effie; Schwartz, Brian; Craig, Alan M; Lou, W Y Wendy; Rea, Elizabeth

2008-01-01

The adverse effects of hot weather on public health are of increasing concern. A surveillance system using 911 medical dispatch data for the detection of heat-related illness (HRI) could provide new information on the impact of excessive heat on the population. This paper describes how we identified medical dispatch call codes, called "determinants", that could represent HRI events. Approximately 500 medical dispatch determinants were reviewed in focus groups composed of Emergency Medical Services (EMS) paramedics, dispatchers, physicians, and public health epidemiologists. Each group was asked to select those determinants that might adequately represent HRI. Selections were then assessed empirically using correlations with daily mean temperature over the study period (June 1-August 31,2005). The focus groups identified 12 determinant groupings and ranked them according to specificity for HRI. Of these, "Heat/cold exposure" was deemed the most specific. The call determinant groupings with the clearest positive associations with daily mean temperature empirically were "Heat/cold exposure" (Spearman's correlation coefficient (SCC) 0.71, p < 0.0001) and "Unknown problem (man down)" (SCC 0.21, p = 0.04). Within each grouping, the determinant "Unknown status (3rd party caller)" showed significant associations, SCC = 0.34 (p = 0.001) and SCC = 0.22 (p = 0.03) respectively. Clinically-informed expertise and empirical evidence both contributed to identification of a group of 911 medical dispatch call determinants that plausibly represent HRI events. Once evaluated prospectively, these may be used in public health surveillance to better understand environmental health impacts on human populations and inform targeted public health interventions.

Perspectives on Exertional Rhabdomyolysis.

PubMed

Rawson, Eric S; Clarkson, Priscilla M; Tarnopolsky, Mark A

2017-03-01

Exertional (exercise-induced) rhabdomyolysis is a potentially life threatening condition that has been the subject of research, intense discussion, and media attention. The causes of rhabdomyolysis are numerous and can include direct muscle injury, unaccustomed exercise, ischemia, extreme temperatures, electrolyte abnormalities, endocrinologic conditions, genetic disorders, autoimmune disorders, infections, drugs, toxins, and venoms. The objective of this article is to review the literature on exertional rhabdomyolysis, identify precipitating factors, and examine the role of the dietary supplement creatine monohydrate. PubMed and SPORTDiscus databases were searched using the terms rhabdomyolysis, muscle damage, creatine, creatine supplementation, creatine monohydrate, and phosphocreatine. Additionally, the references of papers identified through this search were examined for relevant studies. A meta-analysis was not performed. Although the prevalence of rhabdomyolysis is low, instances still occur where exercise is improperly prescribed or used as punishment, or incomplete medical history is taken, and exertional rhabdomyolysis occurs. Creatine monohydrate does not appear to be a precipitating factor for exertional rhabdomyolysis. Healthcare professionals should be able to recognize the basic signs of exertional rhabdomyolysis so prompt treatment can be administered. For the risk of rhabdomyolysis to remain low, exercise testing and prescription must be properly conducted based on professional standards.

Youth Sports Safety Statistics

MedlinePlus

... are at the highest risk of suffering exertional heat illness requiring treatment in U.S. hospital emergency rooms. 21  31 high school football players died of heat stroke complications between 1995 and 2009. 22  64. ...

Water Replacement Schedules in Heat Stress

ERIC Educational Resources Information Center

Londeree, Ben R.; and others

1969-01-01

Although early ingestion of cold water appears to lead to greater relief from heat stress during physical exertion than late ingestion, this difference is reduced toward the end of an hour's work in high heat and humidity. (CK)

Exercise challenge in Gulf War Illness reveals two subgroups with altered brain structure and function.

PubMed

Rayhan, Rakib U; Stevens, Benson W; Raksit, Megna P; Ripple, Joshua A; Timbol, Christian R; Adewuyi, Oluwatoyin; VanMeter, John W; Baraniuk, James N

2013-01-01

Nearly 30% of the approximately 700,000 military personnel who served in Operation Desert Storm (1990-1991) have developed Gulf War Illness, a condition that presents with symptoms such as cognitive impairment, autonomic dysfunction, debilitating fatigue and chronic widespread pain that implicate the central nervous system. A hallmark complaint of subjects with Gulf War Illness is post-exertional malaise; defined as an exacerbation of symptoms following physical and/or mental effort. To study the causal relationship between exercise, the brain, and changes in symptoms, 28 Gulf War veterans and 10 controls completed an fMRI scan before and after two exercise stress tests to investigate serial changes in pain, autonomic function, and working memory. Exercise induced two clinical Gulf War Illness subgroups. One subgroup presented with orthostatic tachycardia (n = 10). This phenotype correlated with brainstem atrophy, baseline working memory compensation in the cerebellar vermis, and subsequent loss of compensation after exercise. The other subgroup developed exercise induced hyperalgesia (n = 18) that was associated with cortical atrophy and baseline working memory compensation in the basal ganglia. Alterations in cognition, brain structure, and symptoms were absent in controls. Our novel findings may provide an understanding of the relationship between the brain and post-exertional malaise in Gulf War Illness.

On the use of wearable physiological monitors to assess heat strain during occupational heat stress.

PubMed

Notley, Sean R; Flouris, Andreas D; Kenny, Glen P

2018-05-04

Workers in many industries are required to perform arduous work in high heat stress conditions, which can lead to rapid increases in body temperature that elevate the risk of heat-related illness or even death. Traditionally, effort to mitigate work-related heat injury has been directed to the assessment of environmental heat stress (e.g., wet-bulb globe temperature), rather than the associated physiological strain responses (e.g., heart rate, skin and core temperatures). However, since a workers physiological response to a given heat stress is modified independently by inter-individual factors (e.g., age, sex, chronic disease, others) and intra-individual factors both within (e.g., medication use, fitness, acclimation and hydration state, others) and beyond a workers control (e.g., shift duration, illness, others), it becomes challenging to protect workers on an individual basis from heat-related injury without assessing those physiological responses. Recent advancements in wearable technology have made it possible to monitor one or more physiological indices of heat strain. Nonetheless, information on the utility of the wearable systems available for assessing occupational heat strain is unavailable. This communication is therefore directed at identifying the physiological indices of heat strain that may be quantified in the workplace and evaluating the wearable monitoring systems available for assessing those responses. Finally, emphasis is directed to the barriers associated with implementing these devices to assist in mitigating work-related heat injury. This information is fundamental for protecting worker health and could also be utilized to prevent heat illnesses in vulnerable people during leisure or athletic activities in the heat.

Extreme Heat: A Prevention Guide to Promote Your Personal Health and Safety

MedlinePlus

... in your office, school, or home. Related Links Climate Change- Extreme Heat Heat Stress Illness Search Heat Stress Illness Data Temperature Extremes- Climate and Health Language: English (US) Español (Spanish) File ...

On the heating mechanism of magnetic flux loops in the solar atmosphere

NASA Technical Reports Server (NTRS)

Song, M. T.; Wu, S. T.

1984-01-01

An investigation is conducted of physical heating mechanisms due to the ponderomotive forces exerted by turbulent waves along the solar atmosphere's curved magnetic flux loops. Results indicate that the temperature difference between the inside and outside of the flux loop can be classified into three parts, two of which represent the cooling or heating effect exerted by the ponderomotive force, while the third is the heating effect due to turbulent energy conversion from the localized plasma. This heating mechanism is used to illustrate solar atmospheric heating by means of an example that leads to the formulation of plages.

Physiological tolerance to uncompensated heat stress in soldiers: effects of various types of body cooling systems.

PubMed

Jovanović, Dalibor; Karkalić, Radovan; Zeba, Snjezana; Pavlović, Miroslav; Radaković, Sonja S

2014-03-01

In military services, emergency situations when soldiers are exposed to a combination of nuclear, biological and chemical (NBC) contamination combined with heat stress, are frequent and complex. In these specific conditions, usage of personal body cooling systems may be effective in reducing heat stress. The present study was conducted in order to evaluate the efficiency of four various types of contemporary personal body cooling systems based on the "Phase Change Material" (PCM), and its effects on soldiers' subjective comfort and physiological performance during exertional heat stress in hot environments. Ten male soldiers were voluntarily subjected to exertional heat stress tests (EHSTs) consisted of walking on a treadmill (5.5 km/h) in hot conditions (40 degreesC) in climatic chamber, wearing NBC isolating impermeable protective suits. One of the tests was performed without any additional cooling solution (NOCOOL), and four tests were performed while using different types of cooling systems: three in a form of vests and one as underwear. Physiological strain was determined by the mean skin temperature (Tsk), tympanic temperature (Tty), and heart rate values (HR), while sweat rates (SwR) indicated changes in hydration status. In all the cases EHST induced physiological response manifested through increasing Tty, HR and SwR. Compared to NOCOOL tests, when using cooling vests, Tty and Tsk were significantly lower (on 35th min, for 0.44 +/- 0.03 and 0.49 +/- 0.05 degrees C, respectively; p < 0.05), as well as the average SwR (0.17 +/- 0.03 L/m2/h). When using underwear, the values of given parameters were not significantly different compared to NOCOOL tests. Using a body cooling system based on PCM in the form of vest under NBC protective clothes during physical activity in hot conditions, reduces sweating and alleviates heat stress manifested by increased core and skin temperatures and heart rate values. These effects directly improve heat tolerance, hydration

Within-year Exertional Heat Illness Incidence in U.S. Army Soldiers, 2008-2012

DTIC Science & Technology

2015-06-01

index (MDI;(17)) were created. Wind speed (in kph) was calculated as wind speed (in mph)*1.61. Wind chill was calculated for all climate samples...downloaded from the NOAA website, new variables for wind speed (converted from mph to kph), wind chill , minimum temperature, and modified discomfort...Windspeed_Kph** 0.16 + 0.3965 * DryBulbCelsius * Windspeed_Kph ** 0.16. Dry bulb temperatures (in °C) and wind chill temperatures (in °C) were

Evaluation of Diagnostic Codes in Morbidity and Mortality Data Sources for Heat-Related Illness Surveillance

PubMed Central

Watkins, Sharon

2017-01-01

Objectives: The primary objective of this study was to identify patients with heat-related illness (HRI) using codes for heat-related injury diagnosis and external cause of injury in 3 administrative data sets: emergency department (ED) visit records, hospital discharge records, and death certificates. Methods: We obtained data on ED visits, hospitalizations, and deaths for Florida residents for May 1 through October 31, 2005-2012. To identify patients with HRI, we used codes from the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) to search data on ED visits and hospitalizations and codes from the International Classification of Diseases, Tenth Revision (ICD-10) to search data on deaths. We stratified the results by data source and whether the HRI was work related. Results: We identified 23 981 ED visits, 4816 hospitalizations, and 140 deaths in patients with non–work-related HRI and 2979 ED visits, 415 hospitalizations, and 23 deaths in patients with work-related HRI. The most common diagnosis codes among patients were for severe HRI (heat exhaustion or heatstroke). The proportion of patients with a severe HRI diagnosis increased with data source severity. If ICD-9-CM code E900.1 and ICD-10 code W92 (excessive heat of man-made origin) were used as exclusion criteria for HRI, 5.0% of patients with non–work-related deaths, 3.0% of patients with work-related ED visits, and 1.7% of patients with work-related hospitalizations would have been removed. Conclusions: Using multiple data sources and all diagnosis fields may improve the sensitivity of HRI surveillance. Future studies should evaluate the impact of converting ICD-9-CM to ICD-10-CM codes on HRI surveillance of ED visits and hospitalizations. PMID:28379784

Heat or Cold: Which One Exerts Greater Deleterious Effects on Health in a Basin Climate City? Impact of Ambient Temperature on Mortality in Chengdu, China.

PubMed

Cui, Yan; Yin, Fei; Deng, Ying; Volinn, Ernest; Chen, Fei; Ji, Kui; Zeng, Jing; Zhao, Xing; Li, Xiaosong

2016-12-10

Background : Although studies from many countries have estimated the impact of ambient temperature on mortality, few have compared the relative impacts of heat and cold on health, especially in basin climate cities. We aimed to quantify the impact of ambient temperature on mortality, and to compare the contributions of heat and cold in a large basin climate city, i.e., Chengdu (Sichuan Province, China); Methods : We estimated the temperature-mortality association with a distributed lag non-linear model (DLNM) with a maximum lag-time of 21 days while controlling for long time trends and day of week. We calculated the mortality risk attributable to heat and cold, which were defined as temperatures above and below an "optimum temperature" that corresponded to the point of minimum mortality. In addition, we explored effects of individual characteristics; Results : The analysis provides estimates of the overall mortality burden attributable to temperature, and then computes the components attributable to heat and cold. Overall, the total fraction of deaths caused by both heat and cold was 10.93% (95%CI: 7.99%-13.65%). Taken separately, cold was responsible for most of the burden (estimate 9.96%, 95%CI: 6.90%-12.81%), while the fraction attributable to heat was relatively small (estimate 0.97%, 95%CI: 0.46%-2.35%). The attributable risk (AR) of respiratory diseases was higher (19.69%, 95%CI: 14.45%-24.24%) than that of cardiovascular diseases (11.40%, 95%CI: 6.29%-16.01%); Conclusions : In Chengdu, temperature was responsible for a substantial fraction of deaths, with cold responsible for a higher proportion of deaths than heat. Respiratory diseases exert a larger effect on death than other diseases especially on cold days. There is potential to reduce respiratory-associated mortality especially among the aged population in basin climate cities when the temperature deviates beneath the optimum. The result may help to comprehensively assess the impact of ambient

Novel Cooling Strategies for Military Training and Operations.

PubMed

Lee, Jason K W; Kenefick, Robert W; Cheuvront, Samuel N

2015-11-01

The deleterious effects of environmental heat stress, combined with high metabolic loads and protective clothing and equipment of the modern Warfighter, impose severe heat strain, impair task performance, and increase risk of heat illness, thereby reducing the chance for mission success. Despite the implementation of heat-risk mitigation procedures over the past decades, task performance still suffers and exertional heat illness remains a major military problem. We review 3 novel heat mitigation strategies that may be implemented in the training or operational environment to reduce heat strain and the risk of exertional heat illness. These strategies include ingestion of ice slurry, arm immersion cooling, and microclimate cooling. Each of these strategies is suitable for use in different scenarios and the choice of cooling strategy is contingent on the requirements, circumstances, and constraints of the training and operational scenario. Ingestion of ice slurry and arm immersion cooling are practical strategies that may be implemented during training scenarios; ice slurry can be ingested before and during exercise, whereas arm immersion cooling can be administered after exercise-heat exposure. In the operational environment, existing microclimate cooling can be implemented with retrofitted vehicles and as an unmounted system, and it has the potential for use in many military occupational scenarios. This review will discuss the efficacy, limitations, and practical considerations for field implementation of each strategy.

Heat-related symptoms in sugarcane harvesters.

PubMed

Crowe, Jennifer; Nilsson, Maria; Kjellstrom, Tord; Wesseling, Catharina

2015-05-01

Exposure to heat stress is a documented risk for Central American sugarcane harvesters. However, little is known about heat-related illness in this population. This study examined the frequency of heat-related health effects among harvesters (n = 106) exposed to occupational heat stress compared to non-harvesters (n = 63). Chi-square test and gamma statistic were used to evaluate differences in self-reported symptoms and trends over heat exposure categories. Heat and dehydration symptoms (headache, tachycardia, muscle cramps, fever, nausea, difficulty breathing, dizziness, swelling of hands/feet, and dysuria) were experienced at least once per week significantly more frequently among harvesters. Percentages of workers reporting heat and dehydration symptoms increased in accordance with increasing heat exposure categories. A large percentage of harvesters are experiencing heat illness throughout the harvest demonstrating an urgent need for improved workplace practices, particularly in light of climate change and the epidemic of chronic kidney disease prevalent in this population. © 2015 Wiley Periodicals, Inc.

Acute whole-body cooling for exercise-induced hyperthermia: a systematic review.

PubMed

McDermott, Brendon P; Casa, Douglas J; Ganio, Matthew S; Lopez, Rebecca M; Yeargin, Susan W; Armstrong, Lawrence E; Maresh, Carl M

2009-01-01

To assess existing original research addressing the efficiency of whole-body cooling modalities in the treatment of exertional hyperthermia. During April 2007, we searched MEDLINE, EMBASE, Scopus, SportDiscus, CINAHL, and Cochrane Reviews databases as well as ProQuest for theses and dissertations to identify research studies evaluating whole-body cooling treatments without limits. Key words were cooling, cryotherapy, water immersion, cold-water immersion, ice-water immersion, icing, fanning, bath, baths, cooling modality, heat illness, heat illnesses, exertional heatstroke, exertional heat stroke, heat exhaustion, hyperthermia, hyperthermic, hyperpyrexia, exercise, exertion, running, football, military, runners, marathoner, physical activity, marathoning, soccer, and tennis. Two independent reviewers graded each study on the Physiotherapy Evidence Database (PEDro) scale. Seven of 89 research articles met all inclusion criteria and a minimum score of 4 out of 10 on the PEDro scale. After an extensive and critical review of the available research on whole-body cooling for the treatment of exertional hyperthermia, we concluded that ice-water immersion provides the most efficient cooling. Further research comparing whole-body cooling modalities is needed to identify other acceptable means. When ice-water immersion is not possible, continual dousing with water combined with fanning the patient is an alternative method until more advanced cooling means can be used. Until future investigators identify other acceptable whole-body cooling modalities for exercise-induced hyperthermia, ice-water immersion and cold-water immersion are the methods proven to have the fastest cooling rates.

Pathophysiology of Heat-Related Illnesses

DTIC Science & Technology

2012-01-01

Figure 10-4). deHydrATion And elecTrolyTe imBAlAnce Water requirements during heat exposure are primarily deter- mined by a person’s sweat losses. Water...the effect of cyclooxygenase inhibition, J Clin Invest 81:1162, 1988. 241. Opal SM, Fisher CJ Jr, Dhainaut JF, et al: Confirmatory interleukin-1...inhibition, J Clin Invest 81:1162, 1988. 241. Opal SM, Fisher CJ Jr, Dhainaut JF, et al: Confirmatory interleukin-1 receptor antagonist trial in severe

An Exertional Heat Stroke Survivor's Return to Running: An Integrated Approach on the Treatment, Recovery, and Return to Activity.

PubMed

Adams, William M; Hosokawa, Yuri; Huggins, Robert A; Mazerolle, Stephanie M; Casa, Douglas J

2016-08-01

Evidence-based best practices for the recognition and treatment of exertional heat stroke (EHS) indicate that rectal thermometry and immediate, aggressive cooling via cold-water immersion ensure survival from this medical condition. However, little is known about the recovery, medical follow-up, and return to activity after an athlete has suffered EHS. To highlight the transfer of evidenced-based research into clinical practice by chronicling the treatment, recovery, and return to activity of a runner who suffered an EHS during a warm-weather road race. Case study. Warm-weather road race. 53-y-old recreationally active man. A runner's treatment, recovery, and return to activity from EHS and 2014 Falmouth Road Race performance. Runner's perceptions and experiences with EHS, body temperature, heart rate, hydration status, exercise intensity. The runner successfully completed the 2014 Falmouth Road Race without incident of EHS. Four dominant themes emerged from the data: predisposing factors, ideal treatment, lack of medical follow-up, and patient education. The first theme identified 3 predisposing factors that contributed to the runner's EHS: hydration, sleep loss, and lack of heat acclimatization. The runner received ideal treatment using evidence-based best practices. A lack of long-term medical care following the EHS with no guidance on the runner's return to full activity was observed. The runner knew very little about EHS before the 2013 race, which drove him to seek knowledge as to why he suffered EHS. Using this newly learned information, he successfully completed the 2014 Falmouth Road Race without incident. This case supports prior literature examining the factors that predispose individuals to EHS. Although evidence-based best practices regarding prompt recognition and treatment of EHS ensure survival, this case highlights the lack of medical follow-up and physician-guided return to activity after EHS.

Identification of barriers to the prevention and treatment of heat-related illness in Latino farmworkers using activity-oriented, participatory rural appraisal focus group methods

PubMed Central

2013-01-01

Background Heat-related illness (HRI) is an important cause of non-fatal illness and death in farmworkers. We sought to identify potential barriers to HRI prevention and treatment in Latino farmworkers. Methods We conducted three semi-structured focus group discussions with 35 Latino farmworkers in the Central Washington, USA area using participatory rural appraisal techniques. Interviews were audio taped and transcribed in Spanish. Three researchers reviewed and coded transcripts and field notes, and investigator triangulation was used to identify relevant themes and quotes. Results Although the majority of participants in our study reported never receiving formal HRI training, most participants were aware that extreme heat can cause illness and were able to accurately describe HRI symptoms, risk factors, and certain prevention strategies. Four main observations regarding farmworkers’ HRI-relevant beliefs and attitudes were identified: 1) farmworkers subscribe to varying degrees to the belief that cooling treatments should be avoided after heat exposure, with some believing that such treatments should be avoided after heat exposure, and others encouraging the use of such treatments; 2) the desire to lose weight may be reflected in behaviors that promote increased sweating; 3) highly caffeinated energy drinks are preferred to increase work efficiency and maintain alertness; and 4) the location of drinking water at work (e.g. next to restrooms) and whether water is clean, but not necessarily chemically-treated, are important considerations in deciding whether to drink the water provided at worksites. Conclusions We identified potential barriers to HRI prevention and treatment related to hydration, certain HRI treatments, clothing use, and the desire to lose weight among Latino farmworkers. Strategies to address potential barriers to HRI prevention and treatment in this population may include engineering, administrative, and health education and health promotion

Identification of barriers to the prevention and treatment of heat-related illness in Latino farmworkers using activity-oriented, participatory rural appraisal focus group methods.

PubMed

Lam, Michelle; Krenz, Jennifer; Palmández, Pablo; Negrete, Maria; Perla, Martha; Murphy-Robinson, Helen; Spector, June T

2013-10-24

Heat-related illness (HRI) is an important cause of non-fatal illness and death in farmworkers. We sought to identify potential barriers to HRI prevention and treatment in Latino farmworkers. We conducted three semi-structured focus group discussions with 35 Latino farmworkers in the Central Washington, USA area using participatory rural appraisal techniques. Interviews were audio taped and transcribed in Spanish. Three researchers reviewed and coded transcripts and field notes, and investigator triangulation was used to identify relevant themes and quotes. Although the majority of participants in our study reported never receiving formal HRI training, most participants were aware that extreme heat can cause illness and were able to accurately describe HRI symptoms, risk factors, and certain prevention strategies. Four main observations regarding farmworkers' HRI-relevant beliefs and attitudes were identified: 1) farmworkers subscribe to varying degrees to the belief that cooling treatments should be avoided after heat exposure, with some believing that such treatments should be avoided after heat exposure, and others encouraging the use of such treatments; 2) the desire to lose weight may be reflected in behaviors that promote increased sweating; 3) highly caffeinated energy drinks are preferred to increase work efficiency and maintain alertness; and 4) the location of drinking water at work (e.g. next to restrooms) and whether water is clean, but not necessarily chemically-treated, are important considerations in deciding whether to drink the water provided at worksites. We identified potential barriers to HRI prevention and treatment related to hydration, certain HRI treatments, clothing use, and the desire to lose weight among Latino farmworkers. Strategies to address potential barriers to HRI prevention and treatment in this population may include engineering, administrative, and health education and health promotion strategies at individual, workplace

20 CFR 220.132 - Physical exertion requirements.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 20 Employees' Benefits 1 2010-04-01 2010-04-01 false Physical exertion requirements. 220.132... ACT DETERMINING DISABILITY Vocational Considerations § 220.132 Physical exertion requirements. To determine the physical exertion requirements of work in the national economy, jobs are classified as...

20 CFR 220.132 - Physical exertion requirements.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 20 Employees' Benefits 1 2013-04-01 2012-04-01 true Physical exertion requirements. 220.132... ACT DETERMINING DISABILITY Vocational Considerations § 220.132 Physical exertion requirements. To determine the physical exertion requirements of work in the national economy, jobs are classified as...

20 CFR 220.132 - Physical exertion requirements.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 20 Employees' Benefits 1 2011-04-01 2011-04-01 false Physical exertion requirements. 220.132... ACT DETERMINING DISABILITY Vocational Considerations § 220.132 Physical exertion requirements. To determine the physical exertion requirements of work in the national economy, jobs are classified as...

20 CFR 220.132 - Physical exertion requirements.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 20 Employees' Benefits 1 2014-04-01 2012-04-01 true Physical exertion requirements. 220.132... ACT DETERMINING DISABILITY Vocational Considerations § 220.132 Physical exertion requirements. To determine the physical exertion requirements of work in the national economy, jobs are classified as...

20 CFR 220.132 - Physical exertion requirements.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 20 Employees' Benefits 1 2012-04-01 2012-04-01 false Physical exertion requirements. 220.132... ACT DETERMINING DISABILITY Vocational Considerations § 220.132 Physical exertion requirements. To determine the physical exertion requirements of work in the national economy, jobs are classified as...

A Virtual Rat for Simulating Environmental and Exertional Heat Stress

DTIC Science & Technology

2014-10-02

unsuitable for accurately determin- ing the spatiotemporal temperature distribution in the animal due to heat stress and for performing mechanistic analysis ...possible in the original experiments. Finally, we performed additional simu- lations using the virtual rat to facilitate comparative analysis of the...capability of the virtual rat to account for the circadian rhythmicity in core temperatures during an in- crease in the external temperature from 22

Working safely in summertime heat

Treesearch

Robert B. Rummer

1997-01-01

As logging operations continue in the hotter months of he year, the safety hazard of heat stress appears. Loggers are particularly at risk, because the combination of hard physical work and outdoor conditions puts high demands on the body. While loggers rarely die from heat stress, they may suffer heat illness symptoms ranging from the discomfort of heat rash to nausea...

Knowledge and awareness of heat-related morbidity among adult recreational endurance athletes

NASA Astrophysics Data System (ADS)

Shendell, Derek G.; Alexander, Melannie S.; Lorentzson, Lauren; McCarty, Frances A.

2010-07-01

Adults have been increasingly motivated to compete in recreational endurance sports events. Amateurs may lack a complete understanding of recommended strategies for handling heat and humidity, making heat-related illnesses increasingly possible. This is compounded by global climate change and increasing average surface and air temperatures, especially in urban areas of industrialized nations in Europe and North America that have hosted most events to date. We conducted an on-line, secure survey at the 2nd Annual ING Georgia Marathon and Half-Marathon in Atlanta, Georgia, in 2008. We included previously validated questions on participant socio-demographics, training locations, and knowledge and awareness of heat-related illnesses. Participants were aware of heat illnesses, and of heat stroke as a serious form of heat stress. However, the majority, across age and gender, did not understand the potential severity of heat stroke. Furthermore, 1-in-5 participants did not understand the concept of heat stress as a form of heat-related illness, and how heat stress may result from buildup of muscle-generated heat in the body. Adult recreational endurance athletes are another susceptible, vulnerable population sub-group for applied research and public health educational interventions, especially in urban areas of industrialized nations in Europe and North America.

Knowledge and awareness of heat-related morbidity among adult recreational endurance athletes.

PubMed

Shendell, Derek G; Alexander, Melannie S; Lorentzson, Lauren; McCarty, Frances A

2010-07-01

Adults have been increasingly motivated to compete in recreational endurance sports events. Amateurs may lack a complete understanding of recommended strategies for handling heat and humidity, making heat-related illnesses increasingly possible. This is compounded by global climate change and increasing average surface and air temperatures, especially in urban areas of industrialized nations in Europe and North America that have hosted most events to date. We conducted an on-line, secure survey at the 2nd Annual ING Georgia Marathon and Half-Marathon in Atlanta, Georgia, in 2008. We included previously validated questions on participant socio-demographics, training locations, and knowledge and awareness of heat-related illnesses. Participants were aware of heat illnesses, and of heat stroke as a serious form of heat stress. However, the majority, across age and gender, did not understand the potential severity of heat stroke. Furthermore, 1-in-5 participants did not understand the concept of heat stress as a form of heat-related illness, and how heat stress may result from buildup of muscle-generated heat in the body. Adult recreational endurance athletes are another susceptible, vulnerable population sub-group for applied research and public health educational interventions, especially in urban areas of industrialized nations in Europe and North America.

Heat or Cold: Which One Exerts Greater Deleterious Effects on Health in a Basin Climate City? Impact of Ambient Temperature on Mortality in Chengdu, China

PubMed Central

Cui, Yan; Yin, Fei; Deng, Ying; Volinn, Ernest; Chen, Fei; Ji, Kui; Zeng, Jing; Zhao, Xing; Li, Xiaosong

2016-01-01

Background: Although studies from many countries have estimated the impact of ambient temperature on mortality, few have compared the relative impacts of heat and cold on health, especially in basin climate cities. We aimed to quantify the impact of ambient temperature on mortality, and to compare the contributions of heat and cold in a large basin climate city, i.e., Chengdu (Sichuan Province, China); Methods: We estimated the temperature-mortality association with a distributed lag non-linear model (DLNM) with a maximum lag-time of 21 days while controlling for long time trends and day of week. We calculated the mortality risk attributable to heat and cold, which were defined as temperatures above and below an “optimum temperature” that corresponded to the point of minimum mortality. In addition, we explored effects of individual characteristics; Results: The analysis provides estimates of the overall mortality burden attributable to temperature, and then computes the components attributable to heat and cold. Overall, the total fraction of deaths caused by both heat and cold was 10.93% (95%CI: 7.99%–13.65%). Taken separately, cold was responsible for most of the burden (estimate 9.96%, 95%CI: 6.90%–12.81%), while the fraction attributable to heat was relatively small (estimate 0.97%, 95%CI: 0.46%–2.35%). The attributable risk (AR) of respiratory diseases was higher (19.69%, 95%CI: 14.45%–24.24%) than that of cardiovascular diseases (11.40%, 95%CI: 6.29%–16.01%); Conclusions: In Chengdu, temperature was responsible for a substantial fraction of deaths, with cold responsible for a higher proportion of deaths than heat. Respiratory diseases exert a larger effect on death than other diseases especially on cold days. There is potential to reduce respiratory-associated mortality especially among the aged population in basin climate cities when the temperature deviates beneath the optimum. The result may help to comprehensively assess the impact of ambient

46 CFR 153.434 - Heat transfer coils within a tank.

Code of Federal Regulations, 2012 CFR

2012-10-01

... SHIPS CARRYING BULK LIQUID, LIQUEFIED GAS, OR COMPRESSED GAS HAZARDOUS MATERIALS Design and Equipment... the heat transfer fluid at a pressure greater than the pressure exerted on the heating or cooling...

Virtual exertions: evoking the sense of exerting forces in virtual reality using gestures and muscle activity.

PubMed

Chen, Karen B; Ponto, Kevin; Tredinnick, Ross D; Radwin, Robert G

2015-06-01

This study was a proof of concept for virtual exertions, a novel method that involves the use of body tracking and electromyography for grasping and moving projections of objects in virtual reality (VR). The user views objects in his or her hands during rehearsed co-contractions of the same agonist-antagonist muscles normally used for the desired activities to suggest exerting forces. Unlike physical objects, virtual objects are images and lack mass. There is currently no practical physically demanding way to interact with virtual objects to simulate strenuous activities. Eleven participants grasped and lifted similar physical and virtual objects of various weights in an immersive 3-D Cave Automatic Virtual Environment. Muscle activity, localized muscle fatigue, ratings of perceived exertions, and NASA Task Load Index were measured. Additionally, the relationship between levels of immersion (2-D vs. 3-D) was studied. Although the overall magnitude of biceps activity and workload were greater in VR, muscle activity trends and fatigue patterns for varying weights within VR and physical conditions were the same. Perceived exertions for varying weights were not significantly different between VR and physical conditions. Perceived exertion levels and muscle activity patterns corresponded to the assigned virtual loads, which supported the hypothesis that the method evoked the perception of physical exertions and showed that the method was promising. Ultimately this approach may offer opportunities for research and training individuals to perform strenuous activities under potentially safer conditions that mimic situations while seeing their own body and hands relative to the scene. © 2014, Human Factors and Ergonomics Society.

78 FR 78962 - Criteria for a Recommended Standard; Occupational Exposure to Heat and Hot Environments; Draft...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-12-27

.... Heat stress can result in heat-related illnesses such as heat stroke, heat exhaustion, heat cramps, or... related materials, visit http://www.regulations.gov and enter CDC-2013-0025 in the search field and click... hydration that should be considered? (4) Are there any additional risk factors for heat-related illnesses...

Heat and moisture exchangers (HMEs) and heated humidifiers (HHs) in adult critically ill patients: a systematic review, meta-analysis and meta-regression of randomized controlled trials.

PubMed

Vargas, Maria; Chiumello, Davide; Sutherasan, Yuda; Ball, Lorenzo; Esquinas, Antonio M; Pelosi, Paolo; Servillo, Giuseppe

2017-05-29

The aims of this systematic review and meta-analysis of randomized controlled trials are to evaluate the effects of active heated humidifiers (HHs) and moisture exchangers (HMEs) in preventing artificial airway occlusion and pneumonia, and on mortality in adult critically ill patients. In addition, we planned to perform a meta-regression analysis to evaluate the relationship between the incidence of artificial airway occlusion, pneumonia and mortality and clinical features of adult critically ill patients. Computerized databases were searched for randomized controlled trials (RCTs) comparing HHs and HMEs and reporting artificial airway occlusion, pneumonia and mortality as predefined outcomes. Relative risk (RR), 95% confidence interval for each outcome and I 2 were estimated for each outcome. Furthermore, weighted random-effect meta-regression analysis was performed to test the relationship between the effect size on each considered outcome and covariates. Eighteen RCTs and 2442 adult critically ill patients were included in the analysis. The incidence of artificial airway occlusion (RR = 1.853; 95% CI 0.792-4.338), pneumonia (RR = 932; 95% CI 0.730-1.190) and mortality (RR = 1.023; 95% CI 0.878-1.192) were not different in patients treated with HMEs and HHs. However, in the subgroup analyses the incidence of airway occlusion was higher in HMEs compared with HHs with non-heated wire (RR = 3.776; 95% CI 1.560-9.143). According to the meta-regression, the effect size in the treatment group on artificial airway occlusion was influenced by the percentage of patients with pneumonia (β = -0.058; p = 0.027; favors HMEs in studies with high prevalence of pneumonia), and a trend was observed for an effect of the duration of mechanical ventilation (MV) (β = -0.108; p = 0.054; favors HMEs in studies with longer MV time). In this meta-analysis we found no superiority of HMEs and HHs, in terms of artificial airway occlusion, pneumonia and

46 CFR 153.434 - Heat transfer coils within a tank.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 46 Shipping 5 2010-10-01 2010-10-01 false Heat transfer coils within a tank. 153.434 Section 153... Cargo Temperature Control Systems § 153.434 Heat transfer coils within a tank. When a cargo tank... the heat transfer fluid at a pressure greater than the pressure exerted on the heating or cooling...

46 CFR 153.434 - Heat transfer coils within a tank.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 46 Shipping 5 2011-10-01 2011-10-01 false Heat transfer coils within a tank. 153.434 Section 153... Cargo Temperature Control Systems § 153.434 Heat transfer coils within a tank. When a cargo tank... the heat transfer fluid at a pressure greater than the pressure exerted on the heating or cooling...

46 CFR 153.434 - Heat transfer coils within a tank.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 46 Shipping 5 2014-10-01 2014-10-01 false Heat transfer coils within a tank. 153.434 Section 153... Cargo Temperature Control Systems § 153.434 Heat transfer coils within a tank. When a cargo tank... the heat transfer fluid at a pressure greater than the pressure exerted on the heating or cooling...

46 CFR 153.434 - Heat transfer coils within a tank.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 46 Shipping 5 2013-10-01 2013-10-01 false Heat transfer coils within a tank. 153.434 Section 153... Cargo Temperature Control Systems § 153.434 Heat transfer coils within a tank. When a cargo tank... the heat transfer fluid at a pressure greater than the pressure exerted on the heating or cooling...

Camelid heat stress: 15 cases (2003–2011)

PubMed Central

Norton, Piper L.; Gold, Jenifer R.; Russell, Karen E.; Schulz, Kara L.; Porter, Brian F.

2014-01-01

This case series describes novel findings associated with heat stress in 15 cases in South American camelids that had no pre-existing illnesses and which had clinical signs of illness after exposure to a warm environment. Novel findings include decreased packed cell volume and albumin concentration and mild spinal axonal degeneration. Heat stress should be considered in weak camelids with a history of hyperthermia. PMID:25320390

Clinical Management of Heat-Related Illnesses

DTIC Science & Technology

2012-01-01

rhabdomyolysis and multiorgan dysfunction syndrome, and it may result in death from overwhelming cell necrosis caused by a lethal heat-shock exposure...complications such as rhabdomyolysis and multiorgan dysfunction syndrome, and it may result in death from overwhelming cell necrosis caused by a...acetaminophen lower Tco by normalizing the elevated hypothalamic set point that is caused by pyrogens; in heatstroke, the set point is normal, with

Marginal effects of a large caffeine dose on heat balance during exercise-heat stress.

PubMed

Ely, Brett R; Ely, Matthew R; Cheuvront, Samuel N

2011-02-01

The use of caffeine supplements in athletic and military populations has increased in recent years. Excessive caffeine consumption in conjunction with exercise in a hot environment may predispose individuals to heat illness. To examine heat balance induced by a large dose of caffeine during exercise in a hot environment. Ten men, not heat acclimated and not habitual caffeine users, consumed either caffeine (CAF; 9 mg/kg) or placebo (PLA) before performing cycle-ergometer exercise for 30 min at 50% VO2peak in a 40 °C, 25% relative humidity environment while body temperature (core and skin) and ratings of thermal comfort (TC) were monitored. Heat-exchange variables were calculated using partitional calorimetry and thermometry. Mean body temperature (Tb) was higher (p < .05) with CAF (37.18 ± 0.15 °C) than with PLA (36.93 ± 0.15 °C) at the start of exercise. Heat production was slightly higher (~8 W, p < .05) with CAF. There were no differences in heat storage, dry heat gains, TC, or Tb during exercise. A caffeine dose of 9 mg/kg does not appreciably alter heat balance during work in a hot environment. The small increase in Tb observed with CAF was undetected by the participants and is unlikely to increase physiological strain sufficiently to affect endurance performance or risk of heat illness.

Identification of Risk Factors for Exertional Heat Illness: A Brief Commentary on Genetic Testing

DTIC Science & Technology

2007-01-01

RYR1) gene and other genes related to disorders of skeletal muscle. Data Synthesis : EHI is a complex disorder wherein physiological, environmental, and...a life-threatening, hypermetabolic syndrome, known as a fulminant MH episode; similar (rare) events can be induced by high environmental temperatures

The secondary school football coach's relationship with the athletic trainer and perspectives on exertional heat stroke.

PubMed

Adams, William M; Mazerolle, Stephanie M; Casa, Douglas J; Huggins, Robert A; Burton, Laura

2014-01-01

Prior researchers have examined the first-aid knowledge and decision making among high school coaches, but little is known about their perceived knowledge of exertional heat stroke (EHS) or their relationships with an athletic trainer (AT). To examine secondary school football coaches' perceived knowledge of EHS and their professional relationship with an AT. Qualitative study. Web-based management system. Thirty-eight secondary school head football coaches (37 men, 1 woman) participated in this study. Their average age was 47 ± 10 years old, and they had 12 ± 9 years' experience as a head football coach. Participants responded to a series of online questions that were focused on their perceived knowledge of EHS and professional relationships with ATs. Data credibility was established through multiple-analyst triangulation and peer review. We analyzed the data by borrowing from the principles of a general inductive approach. Two dominant themes emerged from the data: perceived self-confidence of the secondary school coach and the influence of the AT. The first theme highlighted the perceived confidence, due to basic emergency care training, of the coach regarding management of an emergency situation, despite a lack of knowledge. The second theme illustrated the secondary school coach's positive professional relationships with ATs regarding patient care and emergency procedures. Of the coaches who participated, 89% (34 out of 38) indicated positive interactions with their ATs. These secondary school coaches were unaware of the potential causes of EHS or the symptoms associated with EHS, and they had higher perceived levels of self-confidence in management abilities than indicated by their perceived knowledge level. The secondary school football coaches valued and understood the role of the AT regarding patient and emergency care.

Can Temperate-Water Immersion Effectively Reduce Rectal Temperature in Exertional Heat Stroke? A Critically Appraised Topic.

PubMed

Truxton, Tyler T; Miller, Kevin C

2017-09-01

Clinical Scenario: Exertional heat stroke (EHS) is a medical emergency which, if left untreated, can result in death. The standard of care for EHS patients includes confirmation of hyperthermia via rectal temperature (T rec ) and then immediate cold-water immersion (CWI). While CWI is the fastest way to reduce T rec , it may be difficult to lower and maintain water bath temperature in the recommended ranges (1.7°C-15°C [35°F-59°F]) because of limited access to ice and/or the bath being exposed to high ambient temperatures for long periods of time. Determining if T rec cooling rates are acceptable (ie, >0.08°C/min) when significantly hyperthermic humans are immersed in temperate water (ie, ≥20°C [68°F]) has applications for how EHS patients are treated in the field. Are T rec cooling rates acceptable (≥0.08°C/min) when significantly hyperthermic humans are immersed in temperate water? T rec cooling rates of hyperthermic humans immersed in temperate water (≥20°C [68°F]) ranged from 0.06°C/min to 0.19°C/min. The average T rec cooling rate for all examined studies was 0.11±0.06°C/min. Clinical Bottom Line: Temperature water immersion (TWI) provides acceptable (ie, >0.08°C/min) T rec cooling rates for hyperthermic humans post-exercise. However, CWI cooling rates are higher and should be used if feasible (eg, access to ice, shaded treatment areas). Strength of Recommendation: The majority of evidence (eg, Level 2 studies with PEDro scores ≥5) suggests TWI provides acceptable, though not ideal, T rec cooling. If possible, CWI should be used instead of TWI in EHS scenarios.

The Secondary School Football Coach's Relationship With the Athletic Trainer and Perspectives on Exertional Heat Stroke

PubMed Central

Adams, William M.; Mazerolle, Stephanie M.; Casa, Douglas J.; Huggins, Robert A.; Burton, Laura

2014-01-01

Context: Prior researchers have examined the first-aid knowledge and decision making among high school coaches, but little is known about their perceived knowledge of exertional heat stroke (EHS) or their relationships with an athletic trainer (AT). Objective: To examine secondary school football coaches' perceived knowledge of EHS and their professional relationship with an AT. Design: Qualitative study. Setting: Web-based management system. Patients or Other Participants: Thirty-eight secondary school head football coaches (37 men, 1 woman) participated in this study. Their average age was 47 ± 10 years old, and they had 12 ± 9 years' experience as a head football coach. Data Collection and Analysis: Participants responded to a series of online questions that were focused on their perceived knowledge of EHS and professional relationships with ATs. Data credibility was established through multiple-analyst triangulation and peer review. We analyzed the data by borrowing from the principles of a general inductive approach. Results: Two dominant themes emerged from the data: perceived self-confidence of the secondary school coach and the influence of the AT. The first theme highlighted the perceived confidence, due to basic emergency care training, of the coach regarding management of an emergency situation, despite a lack of knowledge. The second theme illustrated the secondary school coach's positive professional relationships with ATs regarding patient care and emergency procedures. Of the coaches who participated, 89% (34 out of 38) indicated positive interactions with their ATs. Conclusions: These secondary school coaches were unaware of the potential causes of EHS or the symptoms associated with EHS, and they had higher perceived levels of self-confidence in management abilities than indicated by their perceived knowledge level. The secondary school football coaches valued and understood the role of the AT regarding patient and emergency care. PMID:24933433

The illness/non-illness model: hypnotherapy for physically ill patients.

PubMed

Navon, Shaul

2014-07-01

This article proposes a focused, novel sub-set of the cognitive behavioral therapy approach to hypnotherapy for physically ill patients, based upon the illness/non-illness psychotherapeutic model for physically ill patients. The model is based on three logical rules used in differentiating illness from non-illness: duality, contradiction, and complementarity. The article discusses the use of hypnotic interventions to help physically ill and/or disabled patients distinguish between illness and non-illness in their psychotherapeutic themes and attitudes. Two case studies illustrate that patients in this special population group can be taught to learn the language of change and to use this language to overcome difficult situations. The model suggests a new clinical mode of treatment in which individuals who are physically ill and/or disabled are helped in coping with actual motifs and thoughts related to non-illness or non-disability.

The effect of fever, febrile illnesses, and heat exposures on the risk of neural tube defects in a Texas-Mexico border population.

PubMed

Suarez, Lucina; Felkner, Marilyn; Hendricks, Kate

2004-10-01

Hyperthermia produces neural tube defects (NTDs) in a variety of animal species. Elevated maternal body temperatures may also place the developing human embryo at risk. We examined the relation between maternal hyperthermia and the development of NTDs in a high-risk Mexican-American population. Case-women were Mexican-American women with NTD-affected pregnancies who resided and delivered in any of the 14 Texas counties bordering Mexico, during 1995-2000. Control-women were randomly selected from study area residents delivering normal live births, frequency-matched to cases by hospital and year. Information on maternal fevers, febrile illnesses, exposures to heat generated from external sources, and hyperthermia-inducing activities was gathered through in-person interviews, conducted about six weeks postpartum. The risk effect (OR) associated with maternal fever in the first trimester, compared to no fever, was 2.9 (95% CI, 1.5-5.7). Women taking fever-reducing medications showed a lower risk effect (OR, 2.4; 95% CI, 1.0-5.6) than those who did not (OR, 3.8; 95% CI, 1.4-10.9). First-trimester maternal exposures to heat devices such as hot tubs, saunas, or electric blankets were associated with an OR of 3.6 (95% CI, 1.1-15.9). Small insignificant effects were observed for activities such as cooking in a hot kitchen (OR, 1.6; 95% CI, 1.0-2.6) and working or exercising in the sun (OR, 1.4; 95% CI, 0.9-2.2). Maternal hyperthermia increases the risk for NTD-affected offspring. Women intending to become pregnant should avoid intense heat exposures, carefully monitor and manage their febrile illnesses, and routinely consume folic acid supplements. (c) 2004 Wiley-Liss, Inc.

When exercise causes exertional rhabdomyolysis.

PubMed

Furman, Janet

2015-04-01

Exertional rhabdomyolysis is a clinical condition caused by intense, repetitive exercise or a sudden increase in exercise in an untrained person, although rhabdomyolysis can occur in trained athletes. In many cases, the presentation of early, uncomplicated rhabdomyolysis is subtle, but serious complications such as renal failure, compartment syndrome, and dysrhythmias may arise if severe exertional rhabdomyolysis is undiagnosed or untreated. Management is further complicated by the lack of concrete management guidelines for treating rhabdomyolysis and returning patients to activity.

The effects of a heat acclimation protocol in persons with spinal cord injury.

PubMed

Trbovich, Michelle B; Kiratli, Jenny B; Price, Mike J

2016-12-01

Persons without spinal cord injury (SCI) physiologically acclimate between seven to fourteen consecutive days of exercise in the heat. Decreased resting and exercise core temperature, decreased heart rate, increased plasma volume and increased thermal comfort during exercise are changes consistent with heat acclimation. Autonomic dysfunction after SCI impairs heat dissipation through sweating and vasodilation. The purpose of this study is to determine if seven consecutive days of exercise in the heat would result in physiologic changes consistent with heat acclimation in persons with SCI. Ten persons with SCI divided into two groups: tetraplegia (n=5) and paraplegia (n=5) exercised in 35°C using an arm ergometer at 50% W peak for 30min followed by 15min rest. This protocol was repeated over seven consecutive days. Heart rate (HR), skin temperature, aural temperature (T aur ), rate of perceived exertion (RPE), rate of perceived thermal strain (RPTS), and plasma volume (PV) were measured throughout the protocol. There were no significant differences in resting T aur exercise T aur , mean skin temperature, HR, PV, RPE or RPTS over the 7 days for either the tetraplegic or paraplegic group. Participants with SCI did not demonstrate the ability to dissipate heat more efficiently over 7 days of exercise at 35°C. The lack of heat acclimation seen in persons with SCI has implications for the athlete and non-athlete alike. For the SCI athlete, inability to acclimate will impair performance and endurance especially in warm environments, compared to the person without SCI. For the SCI non-athlete, there is a greater risk of heat-related illness in warm environments that can negatively affect participation in outdoor activities and thus quality of life. Published by Elsevier Ltd.

Coal home heating and environmental tobacco smoke in relation to lower respiratory illness in Czech children, from birth to 3 years of age

DOE Office of Scientific and Technical Information (OSTI.GOV)

Baker, R.J.; Hert-Picciotto, I.; Dostal, M.

2006-07-15

The objective of this study was to evaluate how indoor pollution from tobacco and home heating may adversely affect respiratory health in young children. A total of 452 children born 1994-1996 in two districts in the Czech Republic participated. Lower respiratory illness (LRI) diagnoses occurred more frequently in children from homes heated by coal (vs. other energy sources or distant furnaces; rate ratio (RR) = 1.45; 95% confidence interval (CI), 1.07-1.97). Maternal prenatal smoking and other adult smokers also increased LRI rates (respectively: RR = 1.48; 95% CI, 1.10-2.01; and RR = 1.29; 95% CI, 1.01-1.65). Cooking fuels (primarily electricity,more » natural gas, or propane) were not associated with LRI incidence. For children never breast-fed, coal home heating and mother's smoking conferred substantially greater risks: RR = 2.77 (95% CI, 1.45-5.27) and RR = 2.52 (95% CI, 1.31-4.85), respectively. This maternal smoking and coal home heating increased risk for LRI in the first 3 years of life, particularly in children not breast-fed.« less

A Case-Crossover Study of Heat Exposure and Injury Risk in Outdoor Agricultural Workers.

PubMed

Spector, June T; Bonauto, David K; Sheppard, Lianne; Busch-Isaksen, Tania; Calkins, Miriam; Adams, Darrin; Lieblich, Max; Fenske, Richard A

2016-01-01

Recent research suggests that heat exposure may increase the risk of traumatic injuries. Published heat-related epidemiological studies have relied upon exposure data from individual weather stations. To evaluate the association between heat exposure and traumatic injuries in outdoor agricultural workers exposed to ambient heat and internal heat generated by physical activity using modeled ambient exposure data. A case-crossover study using time-stratified referent selection among 12,213 outdoor agricultural workers with new Washington State Fund workers' compensation traumatic injury claims between 2000 and 2012 was conducted. Maximum daily Humidex exposures, derived from modeled meteorological data, were assigned to latitudes and longitudes of injury locations on injury and referent dates. Conditional logistic regression was used to estimate odds ratios of injury for a priori daily maximum Humidex categories. The mean of within-stratum (injury day and corresponding referent days) standard deviations of daily maximum Humidex was 4.8. The traumatic injury odds ratio was 1.14 (95% confidence interval 1.06, 1.22), 1.15 (95% confidence interval 1.06, 1.25), and 1.10 (95% confidence interval 1.01, 1.20) for daily maximum Humidex of 25-29, 30-33, and ≥34, respectively, compared to < 25, adjusted for self-reported duration of employment. Stronger associations were observed during cherry harvest duties in the June and July time period, compared to all duties over the entire study period. Agricultural workers laboring in warm conditions are at risk for heat-related traumatic injuries. Combined heat-related illness and injury prevention efforts should be considered in high-risk populations exposed to warm ambient conditions in the setting of physical exertion.

Human behavioral thermoregulation during exercise in the heat.

PubMed

Flouris, A D; Schlader, Z J

2015-06-01

The human capacity to perform prolonged exercise is impaired in hot environments. To address this issue, a number of studies have investigated behavioral aspects of thermoregulation that are recognized as important factors in determining performance. In this review, we evaluated and interpreted the available knowledge regarding the voluntary control of exercise work rate in hot environments. Our analysis indicated that: (a) Voluntary reductions in exercise work rate in uncompensable heat aid thermoregulation and are, therefore, thermoregulatory behaviors. (b) Unlike thermal behavior during rest, the role of thermal comfort as the ultimate mediator of thermal behavior during exercise in the heat remains uncertain. By contrast, the rating of perceived exertion appears to be the key perceptual controller under such conditions, with thermal perception playing a more modulatory role. (c) Prior to increases in core temperature (when only skin temperature is elevated), reductions in self-selected exercise work rate in the heat are likely mediated by thermal perception (thermal comfort and sensation) and its influence on the rating of perceived exertion. (d) However, when both core and skin temperatures are elevated, factors associated with cardiovascular strain likely dictate the rate of perceived exertion response, thereby mediating such voluntary reductions in exercise work rate. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Exertion and acute coronary artery injury.

PubMed

Black, A; Black, M M; Gensini, G

1975-12-01

Twelve cases of myocardial infarction as related to strenuous exertion are presented with the pathological findings in several of these cases. Three cases with coronary arteriography are also presented. The pathology of coronary arteriosclerotic plaques and the vulnerability to acute injury is reviewed and discussed. It is concluded that strenuous exertion can cause acute injury to coronary artery plaques due to the unusual stressful whip-like action to which coronary arteries are subject. These injuries may initiate as cracks in the plaques or subintimal hemorrhages and proceed to coronary occlusion and ultimate myocardial infarction. With this concept in mind we use the term of "crack in the plaque" (Black's Crack in the Plaque) to account for the sudden appearance of clinical coronary artery disease appearing during or shortly after exertion, or other stressful situations in patients without previous existing evidence of clinical coronary artery disease. This could also account for exacerbation of symptoms or death occurring after exertion in previously quiescent asymptomatic known coronary artery disease subjects. This concept may explain some of the puzzling features of coronary disease.

Heat stress, gastrointestinal permeability and interleukin-6 signaling - Implications for exercise performance and fatigue.

PubMed

Vargas, Nicole; Marino, Frank

2016-01-01

Exercise in heat stress exacerbates performance decrements compared to normothermic environments. It has been documented that the performance decrements are associated with reduced efferent drive from the central nervous system (CNS), however, specific factors that contribute to the decrements are not completely understood. During exertional heat stress, blood flow is preferentially distributed away from the intestinal area to supply the muscles and brain with oxygen. Consequently, the gastrointestinal barrier becomes increasingly permeable, resulting in the release of lipopolysaccharides (LPS, endotoxin) into the circulation. LPS leakage stimulates an acute-phase inflammatory response, including the release of interleukin (IL)-6 in response to an increasingly endotoxic environment. If LPS translocation is too great, heat shock, neurological dysfunction, or death may ensue. IL-6 acts initially in a pro-inflammatory manner during endotoxemia, but can attenuate the response through signaling the hypothalamic pituitary adrenal (HPA)-axis. Likewise, IL-6 is believed to be a thermoregulatory sensor in the gut during the febrile response, hence highlighting its role in periphery - to - brain communication. Recently, IL-6 has been implicated in signaling the CNS and influencing perceptions of fatigue and performance during exercise. Therefore, due to the cascade of events that occur during exertional heat stress, it is possible that the release of LPS and exacerbated response of IL-6 contributes to CNS modulation during exertional heat stress. The purpose of this review is to evaluate previous literature and discuss the potential role for IL-6 during exertional heat stress to modulate performance in favor of whole body preservation.

Athlete exertion injuries.

PubMed

Orava, S; Puranen, J

1978-01-01

Over a period of three years 829 cases of greater than or equal to 16-year-old athlete exertion injuries and syndromes were collected. There were 75 women and 754 men in the series. About 90% of the athletes had been training regularly for more than two years, and 75% of them trained 6 times a week or more. Approximately 52% of the injuries occurred in track and field athletics, about 17% in ball events, 13.6% in skiing, 7.4% in orienteering, and 4.7% in power events. Other sports were associated with fewer exertion injuries. 28.7% of the conditions occurred in the knee, 17% in the ankle, foot and heel, 14.8% in the leg, 8.2% in the back and trunk, 8.1% in the thigh, 7.4% in the achilles tendon. The rest were in the shoulder, neck and upper extremities. In 92% of the patients conservative treatment and rest were used. Only 8% of the cases were treated surgically.

Individual and Public-Program Adaptation: Coping with Heat Waves in Five Cities in Canada

PubMed Central

Alberini, Anna; Gans, Will; Alhassan, Mustapha

2011-01-01

Heat Alert and Response Systems (HARS) are currently undergoing testing and implementation in Canada. These programs seek to reduce the adverse health effects of heat waves on human health by issuing weather forecasts and warnings, informing individuals about possible protections from excessive heat, and providing such protections to vulnerable subpopulations and individuals at risk. For these programs to be designed effectively, it is important to know how individuals perceive the heat, what their experience with heat-related illness is, how they protect themselves from excessive heat, and how they acquire information about such protections. In September 2010, we conducted a survey of households in 5 cities in Canada to study these issues. At the time of the survey, these cities had not implemented heat outreach and response systems. The study results indicate that individuals’ recollections of recent heat wave events were generally accurate. About 21% of the sample reported feeling unwell during the most recent heat spell, but these illnesses were generally minor. Only in 25 cases out of 243, these illnesses were confirmed or diagnosed by a health care professional. The rate at which our respondents reported heat-related illnesses was higher among those with cardiovascular and respiratory illnesses, was higher among younger respondents and bore no relationship with the availability of air conditioning at home. Most of the respondents indicated that they would not dismiss themselves as “not at risk” and that they would cope with excessive heat by staying in air conditioned environments and keeping well hydrated. Despite the absence of heat outreach and education programs in their city, our respondents at least a rough idea of how to take care of themselves. The presence of air conditioning and knowledge of cooling centers is location-specific, which provides opportunities for targeting HARS interventions. PMID:22408596

Palm kernel cake extract exerts hepatoprotective activity in heat-induced oxidative stress in chicken hepatocytes.

PubMed

Oskoueian, Ehsan; Abdullah, Norhani; Idrus, Zulkifli; Ebrahimi, Mahdi; Goh, Yong Meng; Shakeri, Majid; Oskoueian, Armin

2014-10-02

Palm kernel cake (PKC), the most abundant by-product of oil palm industry is believed to contain bioactive compounds with hepatoprotective potential. These compounds may serve as hepatoprotective agents which could help the poultry industry to alleviate adverse effects of heat stress on liver function in chickens. This study was performed to evaluate the hepatoprotective potential of PKC extract in heat-induced oxidative stress in chicken hepatocytes. The nature of the active metabolites and elucidation of the possible mechanism involved were also investigated. The PKC extract possessed free radical scavenging activity with values significantly (p < 0.05) lower than silymarin as the reference antioxidant. Heat-induced oxidative stress in chicken hepatocyte impaired the total protein, lipid peroxidation and antioxidant enzymes activity significantly (p < 0.05). Treatment of heat-induced hepatocytes with PKC extract (125 μg/ml) and silymarin as positive control increased these values significantly (p < 0.05). The real time PCR and western blot analyses revealed the significant (p < 0.05) up-regulation of oxidative stress biomarkers including TNF-like, IFN-γ and IL-1β genes; NF-κB, COX-2, iNOS and Hsp70 proteins expression upon heat stress in chicken hepatocytes. The PKC extract and silymarin were able to alleviate the expression of all of these biomarkers in heat-induced chicken hepatocytes. The gas chromatography-mass spectrometry analysis of PKC extract showed the presence of fatty acids, phenolic compounds, sugar derivatives and other organic compounds such as furfural which could be responsible for the observed hepatoprotective activity. Palm kernel cake extract could be a potential agent to protect hepatocytes function under heat induced oxidative stress.

Post-Exertional Malaise in Patients with ME and CFS with Comorbid Fibromyalgia.

PubMed

McManimen, Stephanie L; Jason, Leonard A

2017-01-01

Myalgic encephalomyelitis (ME) and chronic fatigue syndrome (CFS) share some similar symptoms with fibromyalgia (FM). Prior research has found increased illness severity when patients have FM that is comorbid with ME and CFS. For example, post-exertional malaise (PEM) has been shown to be more severe in those with comorbid FM. However, PEM can be separated into two factors, Muscle and General PEM. It is unknown if the more severe PEM findings in comorbid FM are due to the Muscle or General PEM factor. The purpose of this study was to determine if the PEM differences seen between patients with and without comorbid FM exist for the Muscle or General PEM factors. An international convenience sample was collected via an online questionnaire. The questionnaire assessed the frequency and severity of several PEM-related symptoms. Additionally, participants provided information regarding the course and characteristics of their illness. Participants that indicated a comorbid diagnosis of FM displayed significantly more frequent and severe PEM symptoms in the Muscle and General PEM factors. The FM group also indicated significantly worse physical functioning compared to the group without comorbid FM. The secondary diagnosis of FM in addition to ME and CFS appears to amplify the PEM symptomatology and worsen patients' physical functioning. The findings of this study have notable implications on the inclusion of patients with comorbid FM in ME and CFS research studies.

Heat stress, gastrointestinal permeability and interleukin-6 signaling — Implications for exercise performance and fatigue

PubMed Central

Vargas, Nicole; Marino, Frank

2016-01-01

ABSTRACT Exercise in heat stress exacerbates performance decrements compared to normothermic environments. It has been documented that the performance decrements are associated with reduced efferent drive from the central nervous system (CNS), however, specific factors that contribute to the decrements are not completely understood. During exertional heat stress, blood flow is preferentially distributed away from the intestinal area to supply the muscles and brain with oxygen. Consequently, the gastrointestinal barrier becomes increasingly permeable, resulting in the release of lipopolysaccharides (LPS, endotoxin) into the circulation. LPS leakage stimulates an acute-phase inflammatory response, including the release of interleukin (IL)-6 in response to an increasingly endotoxic environment. If LPS translocation is too great, heat shock, neurological dysfunction, or death may ensue. IL-6 acts initially in a pro-inflammatory manner during endotoxemia, but can attenuate the response through signaling the hypothalamic pituitary adrenal (HPA)-axis. Likewise, IL-6 is believed to be a thermoregulatory sensor in the gut during the febrile response, hence highlighting its role in periphery – to – brain communication. Recently, IL-6 has been implicated in signaling the CNS and influencing perceptions of fatigue and performance during exercise. Therefore, due to the cascade of events that occur during exertional heat stress, it is possible that the release of LPS and exacerbated response of IL-6 contributes to CNS modulation during exertional heat stress. The purpose of this review is to evaluate previous literature and discuss the potential role for IL-6 during exertional heat stress to modulate performance in favor of whole body preservation. PMID:27857954

Implementation of the Montreal heat response plan during the 2010 heat wave.

PubMed

Price, Karine; Perron, Stéphane; King, Norman

2013-02-11

The objective of this paper is to describe Montreal's heat response plan and its application during the July 2010 heat wave. The Montreal heat response plan is designed to ensure the surveillance of weather and health indicators during the summer season and to coordinate actions to be undertaken during this period to reduce morbidity and mortality due to heat, particularly when weather thresholds are reached or an increase in health indicators is observed. It was developed to coordinate and apply intervention measures on the Island of Montreal and has been in effect since 2004. In the beginning of July 2010, Montreal experienced a heat wave that lasted 5 days. During this period, health indicators such as total mortality, prehospital emergency transports, calls to the health information line and hospital admissions were monitored by the Montreal public health surveillance system. The decision to implement emergency interventions and actions performed by regional and local public health and municipal partners (intervention level) was made following attainment of a predetermined weather threshold and increases in health indicators. The significant increase in daily observed mortality from all causes and in particular people dying at home or in the community prompted the Director of public health to conduct a chart review of all people deceased from July 5 to July 11, 2010 to determine cause of death and underlying health conditions. During the heat wave, there were 304 reported deaths from all causes in Montreal residents, of which 106 were probably or possibly heat-related. Major underlying health conditions in heat-related deaths included cardiovascular problems and mental health illness. Furthermore, in the case of people with mental illness who died during the heat wave, the chart review revealed that many were contacted 24 hours prior to their death by health care professionals, family members, neighbours or friends. Following the 2010 heat wave, the Montreal

Heat acclimation responses of an ultra-endurance running group preparing for hot desert-based competition.

PubMed

Costa, Ricardo J S; Crockford, Michael J; Moore, Jonathan P; Walsh, Neil P

2014-01-01

�C T amb. Preventing exertional heat illnesses and optimising performance outcomes in ultra-endurance runners may occur with exposure to at least 2 h of exercise-heat stress on at least two occasions in the days leading up to multi-stage ultra-marathon competition in the heat.

Rate of Perceived Exertion of Female Aviation Workers Pertaining to Selected Aviation Workspace and Recommended Fitness Regime to Reduce Exertion

NASA Astrophysics Data System (ADS)

Harridon, Mohd

2018-05-01

In aviation maintenance, workers usually work in tight spaces to maintain or repair aircraft. These constricted spaces provide uncomfortable feeling to these workers and in return the workmanship of the workers declined in terms of quality and thus affect the safety of the aircraft. However, some workers are fit enough to go through these conditions without hassle or without much pain. This paper focused upon female aviation workers and collected data on their rate of perceived exertion pertaining to two selected aviation workspaces. The data and analyses showed that those who are fit felt less exertion while those who are not fit felt more exertion. This paper then recommended several physical exercises to increase their fitness and in turn reduce the exertion felt.

Prior Acute Mental Exertion in Exercise and Sport

PubMed Central

Silva-Júnior, Fernando Lopes e; Emanuel, Patrick; Sousa, Jordan; Silva, Matheus; Teixeira, Silmar; Pires, Flávio Oliveira; Machado, Sérgio; Arias-Carrion, Oscar

2016-01-01

Introduction: Mental exertion is a psychophysiological state caused by sustained and prolonged cognitive activity. The understanding of the possible effects of acute mental exertion on physical performance, and their physiological and psychological responses are of great importance for the performance of different occupations, such as military, construction workers, athletes (professional or recreational) or simply practicing regular exercise, since these occupations often combine physical and mental tasks while performing their activities. However, the effects of implementation of a cognitive task on responses to aerobic exercise and sports are poorly understood. Our narrative review aims to provide information on the current research related to the effects of prior acute mental fatigue on physical performance and their physiological and psychological responses associated with exercise and sports. Methods: The literature search was conducted using the databases PubMed, ISI Web of Knowledge and PsycInfo using the following terms and their combinations: “mental exertion”, “mental fatigue”, “mental fatigue and performance”, “mental exertion and sports” “mental exertion and exercise”. Results: We concluded that prior acute mental exertion affects effectively the physiological and psychophysiological responses during the cognitive task, and performance in exercise. Conclusion: Additional studies involving prior acute mental exertion, exercise/sports and physical performance still need to be carried out in order to analyze the physiological, psychophysiological and neurophysiological responses subsequently to acute mental exertion in order to identify cardiovascular factors, psychological, neuropsychological associates. PMID:27867415

Exertion Testing in Youth with Mild Traumatic Brain Injury/Concussion.

PubMed

Dematteo, Carol; Volterman, Kimberly A; Breithaupt, Peter G; Claridge, Everett A; Adamich, John; Timmons, Brian W

2015-11-01

The decision regarding return to activity (RTA) after mild traumatic brain injuries/concussion is one of the most difficult and controversial areas in concussion management, particularly for youth. This study investigated how youth with postconcussion syndrome (PCS) are affected by exertion and whether standardized exertion testing using the McMaster All-Out Progressive Continuous Cycling Test can contribute to clinical decision making for safe RTA. Fifty-four youth (8.5-18.3 yr) with a previously confirmed concussion participated in the study. Each participant performed exertion testing on a cycle ergometer and completed a Postconcussion Symptom scale at the following time points: before exertion (baseline), 5 and 30 min, and 24 h after exertion. A modified Postconcussion Symptom scale was administered at 2-min intervals during exertion. Participants had a mean ± SD symptom duration of 6.3 ± 6.9 months after the most recent concussive injury, with a median of 4.1 months (range, 0.7-35 months). Sixty-three percent of participants had symptoms during exertion testing. Symptom profile (number and severity) significantly affected perception of exertion at 50% peak mechanical power. During acute assessment of symptoms (30-min after exertion), headache (P = 0.39), nausea (P = 0.63), and dizziness (P = 0.35) did not change. However, both the number and severity of symptoms significantly improved over 24 h, with 56.8% of youth showing improvements. The time from the most recent injury had a significant effect on the symptom score at baseline, 30 min after exertion, and 24 h after exertion. Exertion testing has an important role in the evaluation of symptoms and readiness to RTA, particularly in youth who are slow to recover. Overall, controlled exertion seemed to lesson symptoms for most youth.

Exertional Rhabdomyolysis after Spinning.

PubMed

Jeong, Youjin; Kweon, Hyuk-Jung; Oh, Eun-Jung; Ahn, Ah-Leum; Choi, Jae-Kyung; Cho, Dong-Yung

2016-11-01

Any strenuous muscular exercise may trigger rhabdomyolysis. We report an episode of clinically manifested exertional rhabdomyolysis due to stationary cycling, commonly known as spinning. Reports of spinning-related rhabdomyolysis are rare in the English literature, and the current case appears to be the first such case reported in South Korea. A previously healthy 21-year-old Asian woman presented with severe thigh pain and reddish-brown urinary discoloration 24-48 hours after attending a spinning class at a local gymnasium. Paired with key laboratory findings, her symptoms were suggestive of rhabdomyolysis. She required hospital admission to sustain renal function through fluid resuscitation therapy and fluid balance monitoring. Because exertional rhabdomyolysis may occur in any unfit but otherwise healthy individual who indulges in stationary cycling, the potential health risks of this activity must be considered.

A prospective randomised trial of probiotics in critically ill patients.

PubMed

McNaught, Clare E; Woodcock, Nicholas P; Anderson, Alexander D G; MacFie, John

2005-04-01

Probiotics exert a beneficial effect on the host through modulation of gastrointestinal microflora. The aim of this study was to investigate the effect of the probiotic Lactobacillus plantarum 299v on gut barrier function and the systemic inflammatory response in critically ill patients. One hundred and three critically ill patients were randomised to receive an oral preparation containing L. plantarum 299v (ProViva) in addition to conventional therapy (treatment group, n = 52) or conventional therapy alone (control group, n = 51). Serial outcome measures included gastric colonisation, intestinal permeability (lactulose/rhamnose dual-sugar probe technique), endotoxin exposure (IgM EndoCAb), C-reactive protein and Interleukin 6 levels. L. plantarum had no identifiable effect on gastric colonisation, intestinal permeability, endotoxin exposure or serum CRP levels. There were no differences between the groups in terms of septic morbidity or mortality. On day 15 serum IL-6 levels were significantly lower in the treatment group compared to controls. The enteral administration of L. plantarum 299v to critically ill patients was associated with a late attenuation of the systemic inflammatory response. This was not accompanied by any significant changes in the intestinal microflora, intestinal permeability, endotoxin exposure, septic morbidity or mortality.

Chronic Exertional Compartment Syndrome

MedlinePlus

... Sometimes chronic exertional compartment syndrome is mistaken for shin splints, a more common cause of leg pain in ... such as running. If you think you have shin splints but they don't get better with self- ...

Perceived Exertion of the PACER in High School Students

ERIC Educational Resources Information Center

Smith, John D.; Holmes, Patricia A.

2013-01-01

The purpose of this study was to explore high school students' perceived exertion after participating in the Progressive Aerobic Cardiovascular Endurance Run (PACER). Immediately after completing the PACER, students (N = 792) indicated their perceived exertion on the OMNI rating of perceived exertion (RPE) for children (1-10 scale). All students,…

Exertional Rhabdomyolysis after Spinning

PubMed Central

Jeong, Youjin; Oh, Eun-Jung; Ahn, Ah-Leum; Choi, Jae-Kyung; Cho, Dong-Yung

2016-01-01

Any strenuous muscular exercise may trigger rhabdomyolysis. We report an episode of clinically manifested exertional rhabdomyolysis due to stationary cycling, commonly known as spinning. Reports of spinning-related rhabdomyolysis are rare in the English literature, and the current case appears to be the first such case reported in South Korea. A previously healthy 21-year-old Asian woman presented with severe thigh pain and reddish-brown urinary discoloration 24–48 hours after attending a spinning class at a local gymnasium. Paired with key laboratory findings, her symptoms were suggestive of rhabdomyolysis. She required hospital admission to sustain renal function through fluid resuscitation therapy and fluid balance monitoring. Because exertional rhabdomyolysis may occur in any unfit but otherwise healthy individual who indulges in stationary cycling, the potential health risks of this activity must be considered. PMID:27900075

Heated hatha yoga to target cortisol reactivity to stress and affective eating in women at risk for obesity-related illnesses: A randomized controlled trial.

PubMed

Hopkins, Lindsey B; Medina, Johnna L; Baird, Scarlett O; Rosenfield, David; Powers, Mark B; Smits, Jasper A J

2016-06-01

Cortisol reactivity to stress is associated with affective eating, an important behavioral risk factor for obesity and related metabolic diseases. Yoga practice is related to decreases in stress and cortisol levels, thus emerging as a potential targeted complementary intervention for affective eating. This randomized controlled trial examined the efficacy of a heated, hatha yoga intervention for reducing cortisol reactivity to stress and affective eating. Females (N = 52; ages 25-46 years; 75% White) at risk for obesity and related illnesses were randomly assigned to 8 weeks of Bikram Yoga practice or to waitlist control. Cortisol reactivity to a laboratory stress induction were measured at Weeks 0 (pretreatment) and 9 (posttreatment). Self-reported binge eating frequency and coping motives for eating were assessed at Weeks 0, 3, 6, and 9. Among participants with elevated cortisol reactivity at pretreatment ("high reactors"), those randomized to the yoga condition evidenced greater pre- to posttreatment reductions in cortisol reactivity (p = .042, d = .85), but there were not significant condition differences for the "low reactors" (p = .178, d = .53). Yoga participants reported greater decreases in binge eating frequency (p = .040, d = .62) and eating to cope with negative affect (p = .038, d = .54). This study provides preliminary support for the efficacy of heated hatha yoga for treating physiological stress reactivity and affective eating among women at risk for obesity-related illnesses. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

Musical agency reduces perceived exertion during strenuous physical performance

PubMed Central

Fritz, Thomas Hans; Hardikar, Samyogita; Demoucron, Matthias; Niessen, Margot; Demey, Michiel; Giot, Olivier; Li, Yongming; Haynes, John-Dylan; Villringer, Arno; Leman, Marc

2013-01-01

Music is known to be capable of reducing perceived exertion during strenuous physical activity. The current interpretation of this modulating effect of music is that music may be perceived as a diversion from unpleasant proprioceptive sensations that go along with exhaustion. Here we investigated the effects of music on perceived exertion during a physically strenuous task, varying musical agency, a task that relies on the experience of body proprioception, rather than simply diverting from it. For this we measured psychologically indicated exertion during physical workout with and without musical agency while simultaneously acquiring metabolic values with spirometry. Results showed that musical agency significantly decreased perceived exertion during workout, indicating that musical agency may actually facilitate physically strenuous activities. This indicates that the positive effect of music on perceived exertion cannot always be explained by an effect of diversion from proprioceptive feedback. Furthermore, this finding suggests that the down-modulating effect of musical agency on perceived exertion may be a previously unacknowledged driving force for the development of music in humans: making music makes strenuous physical activities less exhausting. PMID:24127588

Musical agency reduces perceived exertion during strenuous physical performance.

PubMed

Fritz, Thomas Hans; Hardikar, Samyogita; Demoucron, Matthias; Niessen, Margot; Demey, Michiel; Giot, Olivier; Li, Yongming; Haynes, John-Dylan; Villringer, Arno; Leman, Marc

2013-10-29

Music is known to be capable of reducing perceived exertion during strenuous physical activity. The current interpretation of this modulating effect of music is that music may be perceived as a diversion from unpleasant proprioceptive sensations that go along with exhaustion. Here we investigated the effects of music on perceived exertion during a physically strenuous task, varying musical agency, a task that relies on the experience of body proprioception, rather than simply diverting from it. For this we measured psychologically indicated exertion during physical workout with and without musical agency while simultaneously acquiring metabolic values with spirometry. Results showed that musical agency significantly decreased perceived exertion during workout, indicating that musical agency may actually facilitate physically strenuous activities. This indicates that the positive effect of music on perceived exertion cannot always be explained by an effect of diversion from proprioceptive feedback. Furthermore, this finding suggests that the down-modulating effect of musical agency on perceived exertion may be a previously unacknowledged driving force for the development of music in humans: making music makes strenuous physical activities less exhausting.

The Role of Heat Tolerance Testing in Recovery and Return to Duty

DTIC Science & Technology

2008-10-01

CV diseases Hyperthyroidism Pheochromocytoma Infectious diseases Diabetes mellitus Psychiatric illness Parkinsonism Congenital abnormalities: CF...environments. To assess the heat tolerance status of prior heat stroke patient. Heat tolerance test (HTT) “HTT was effective in evaluating the heat tolerance

[Sports and extreme conditions. Cardiovascular incidence in long term exertion and extreme temperatures (heat, cold)].

PubMed

Melin, B; Savourey, G

2001-06-30

During ultra-endurance exercise, both increase in body temperature and dehydration due to sweat losses, lead to a decrease in central blood volume. The heart rate drift allows maintaining appropriate cardiac output, in order to satisfy both muscle perfusion and heat transfer requirements by increasing skin blood flow. The resulting dehydration can impair thermal regulation and increase the risks of serious accidents as heat stroke. Endurance events, lasting more than 8 hours, result in large sweat sodium chloride losses. Thus, ingestion of large amounts of water with poor salt intake can induce symptomatic hyponatremia (plasma sodium < 130 mEq/L) which is also a serious accident. Heat environment increases the thermal constraint and when the air humidity is high, evaporation of sweat is compromise. Thus, thermal stress becomes uncompensable which increases the risk of cardiovascular collapse. Cold exposure induces physiological responses to maintain internal temperature by both limiting thermal losses and increasing metabolic heat production. Cold can induce accidental hypothermia and local frost-bites; moreover, it increases the risk of arrhythmia during exercise. Some guidelines (cardiovascular fitness, water and electrolyte intakes, protective clothing) are given for each extreme condition.

Parents' and Coaches' Guide to Dehydration and Other Heat Illnesses in Children

MedlinePlus

... illnesses can be prevented and successfully treated. Children sweat less than adults. This makes it harder for ... they do not replace body fluids lost by sweating. Being even a little dehydrated can make a ...

20 CFR 220.135 - Exertional and nonexertional limitations.

Code of Federal Regulations, 2011 CFR

2011-04-01

... limitations of function or restrictions which limit the claimant's ability to meet certain demands of jobs... as exertional if they affect the claimant's ability to meet the strength demands of jobs. The... Department of Labor, to determine the exertional requirements of work which exists in the national economy...

20 CFR 220.135 - Exertional and nonexertional limitations.

Code of Federal Regulations, 2013 CFR

2013-04-01

... limitations of function or restrictions which limit the claimant's ability to meet certain demands of jobs... as exertional if they affect the claimant's ability to meet the strength demands of jobs. The... Department of Labor, to determine the exertional requirements of work which exists in the national economy...

20 CFR 220.135 - Exertional and nonexertional limitations.

Code of Federal Regulations, 2012 CFR

2012-04-01

... limitations of function or restrictions which limit the claimant's ability to meet certain demands of jobs... as exertional if they affect the claimant's ability to meet the strength demands of jobs. The... Department of Labor, to determine the exertional requirements of work which exists in the national economy...

20 CFR 220.135 - Exertional and nonexertional limitations.

Code of Federal Regulations, 2014 CFR

2014-04-01

... limitations of function or restrictions which limit the claimant's ability to meet certain demands of jobs... as exertional if they affect the claimant's ability to meet the strength demands of jobs. The... Department of Labor, to determine the exertional requirements of work which exists in the national economy...

Thermoregulatory disorders and illness related to heat and cold stress.

PubMed

Cheshire, William P

2016-04-01

Thermoregulation is a vital function of the autonomic nervous system in response to cold and heat stress. Thermoregulatory physiology sustains health by keeping body core temperature within a degree or two of 37°C, which enables normal cellular function. Heat production and dissipation are dependent on a coordinated set of autonomic responses. The clinical detection of thermoregulatory impairment provides important diagnostic and localizing information in the evaluation of disorders that impair thermoregulatory pathways, including autonomic neuropathies and ganglionopathies. Failure of neural thermoregulatory mechanisms or exposure to extreme or sustained temperatures that overwhelm the body's thermoregulatory capacity can also result in potentially life-threatening departures from normothermia. Hypothermia, defined as a core temperature of <35.0°C, may present with shivering, respiratory depression, cardiac dysrhythmias, impaired mental function, mydriasis, hypotension, and muscle dysfunction, which can progress to cardiac arrest or coma. Management includes warming measures, hydration, and cardiovascular support. Deaths from hypothermia are twice as frequent as deaths from hyperthermia. Hyperthermia, defined as a core temperature of >40.5°C, may present with sweating, flushing, tachycardia, fatigue, lightheadedness, headache, and paresthesia, progressing to weakness, muscle cramps, oliguria, nausea, agitation, hypotension, syncope, confusion, delirium, seizures, and coma. Mental status changes and core temperature distinguish potentially fatal heat stroke from heat exhaustion. Management requires the immediate reduction of core temperature. Ice water immersion has been shown to be superior to alternative cooling measures. Avoidance of thermal risk and early recognition of cold or heat stress are the cornerstones of preventive therapy. Copyright © 2016 The Author. Published by Elsevier B.V. All rights reserved.

Exertional myopathy in whooping cranes (Grus americana) with prognostic guidelines.

PubMed

Hanley, Christopher S; Thomas, Nancy J; Paul-Murphy, Joanne; Hartup, Barry K

2005-09-01

Exertional myopathy developed in three whooping cranes (Grus americana) secondary to routine capture, handling, and trauma. Presumptive diagnosis of exertional myopathy was based on history of recent capture or trauma, clinical signs, and elevation of aspartate aminotransferase, alanine aminotransferase, creatine kinase, lactate dehydrogenase, and serum potassium. Treatments were attempted in each case, but ultimately were not successful. Gross and microscopic lesions at necropsy confirmed the diagnosis in each case, with the leg musculature most severely affected. Guidelines for determining prognosis of exertional myopathy in cranes have been included based on the analysis of these cases and others in the literature. As treatment is largely unrewarding, prevention remains the key in controlling exertional myopathy. Identification of predisposing factors and proper handling, immobilization, and transportation techniques can help prevent development of exertional myopathy in cranes.

Exertional myopathy in whooping cranes (Grus americana) with prognostic guidlelines

USGS Publications Warehouse

Hanley, C.S.; Thomas, N.J.; Paul-Murphy, P.; Hartup, B.K.

2005-01-01

Exertional myopathy developed in three whooping cranes (Grus americana) secondary to routine capture, handling, and trauma. Presumptive diagnosis of exertional myopathy was based on history of recent capture or trauma, clinical signs, and elevation of aspartate aminotransferase, alanine aminotransferase, creatine kinase, lactate dehydrogenase, and serum potassium. Treatments were attempted in each case, but ultimately were not successful. Gross and microscopic lesions at necropsy confirmed the diagnosis in each case, with the leg musculature most severely affected. Guidelines for determining prognosis of exertional myopathy in cranes have been included based on the analysis of these cases and others in the literature. As treatment is largely unrewarding, prevention remains the key in controlling exertional myopathy. Identification of predisposing factors and proper handling, immobilization, and transportation techniques can help prevent development of exertional myopathy in cranes.

Preservation of Cognitive Performance with Age during Exertional Heat Stress under Low and High Air Velocity

PubMed Central

Wright Beatty, Heather E.; Keillor, Jocelyn M.; Hardcastle, Stephen G.; Boulay, Pierre; Kenny, Glen P.

2015-01-01

Older adults may be at greater risk for occupational injuries given their reduced capacity to dissipate heat, leading to greater thermal strain and potentially cognitive decrements. Purpose. To examine the effects of age and increased air velocity, during exercise in humid heat, on information processing and attention. Methods. Nine young (24 ± 1 years) and 9 older (59 ± 1 years) males cycled 4 × 15 min (separated by 15 min rest) at a fixed rate of heat production (400 W) in humid heat (35°C, 60% relative humidity) under 0.5 (low) and 3.0 (high) m·s−1 air velocity wearing coveralls. At rest, immediately following exercise (end exercise), and after the final recovery, participants performed an abbreviated paced auditory serial addition task (PASAT, 2 sec pace). Results. PASAT numbers of correct responses at end exercise were similar for young (low = 49 ± 3; high = 51 ± 3) and older (low = 46 ± 5; high = 47 ± 4) males and across air velocity conditions, and when scored relative to age norms. Psychological sweating, or an increased sweat rate with the administration of the PASAT, was observed in both age groups in the high condition. Conclusion. No significant decrements in attention and speeded information processing were observed, with age or altered air velocity, following intermittent exercise in humid heat. PMID:25874223

Burden and Risk Factors for Cold-Related Illness and Death in New York City

PubMed Central

Lane, Kathryn; Ito, Kazuhiko; Johnson, Sarah; Gibson, Elizabeth A.; Matte, Thomas

2018-01-01

Exposure to cold weather can cause cold-related illness and death, which are preventable. To understand the current burden, risk factors, and circumstances of exposure for illness and death directly attributed to cold, we examined hospital discharge, death certificate, and medical examiner data during the cold season from 2005 to 2014 in New York City (NYC), the largest city in the United States. On average each year, there were 180 treat-and-release emergency department visits (average annual rate of 21.6 per million) and 240 hospital admissions (29.6 per million) for cold-related illness, and 15 cold-related deaths (1.8 per million). Seventy-five percent of decedents were exposed outdoors. About half of those exposed outdoors were homeless or suspected to be homeless. Of the 25% of decedents exposed indoors, none had home heat and nearly all were living in single-family or row homes. The majority of deaths and illnesses occurred outside of periods of extreme cold. Unsheltered homeless individuals, people who use substances and become incapacitated outdoors, and older adults with medical and psychiatric conditions without home heat are most at risk. This information can inform public health prevention strategies and interventions. PMID:29601479

A novel early risk assessment tool for detecting clinical outcomes in patients with heat-related illness (J-ERATO score): Development and validation in independent cohorts in Japan.

PubMed

Hayashida, Kei; Kondo, Yutaka; Hifumi, Toru; Shimazaki, Junya; Oda, Yasutaka; Shiraishi, Shinichiro; Fukuda, Tatsuma; Sasaki, Junichi; Shimizu, Keiki

2018-01-01

We sought to develop a novel risk assessment tool to predict the clinical outcomes after heat-related illness. Prospective, multicenter observational study. Patients who transferred to emergency hospitals in Japan with heat-related illness were registered. The sample was divided into two parts: 60% to construct the score and 40% to validate it. A binary logistic regression model was used to predict hospital admission as a primary outcome. The resulting model was transformed into a scoring system. A total of 3,001 eligible patients were analyzed. There was no difference in variables between development and validation cohorts. Based on the result of a logistic regression model in the development phase (n = 1,805), the J-ERATO score was defined as the sum of the six binary components in the prehospital setting (respiratory rate≥22 /min, Glasgow coma scale<15, systolic blood pressure≤100 mmHg, heart rate≥100 bpm, body temperature≥38°C, and age≥65 y), for a total score ranging from 0 to 6. In the validation phase (n = 1,196), the score had excellent discrimination (C-statistic 0.84; 95% CI 0.79-0.89, p<0.0001) and calibration (P>0.2 by Hosmer-Lemeshow test). The observed proportion of hospital admission increased with increasing J-ERATO score (score = 0, 5.0%; score = 1, 15.0%; score = 2, 24.6%; score = 3, 38.6%; score = 4, 68.0%; score = 5, 85.2%; score = 6, 96.4%). Multivariate analyses showed that the J-ERATO score was an independent positive predictor of hospital admission (adjusted OR, 2.43; 95% CI, 2.06-2.87; P<0.001), intensive care unit (ICU) admission (3.73; 2.95-4.72; P<0.001) and in-hospital mortality (1.65; 1.18-2.32; P = 0.004). The J-ERATO score is simply assessed and can facilitate the identification of patients with higher risk of heat-related hospitalization. This scoring system is also significantly associated with the higher likelihood of ICU admission and in-hospital mortality after heat-related hospitalization.

Using Ratings of Perceived Exertion in Physical Education

ERIC Educational Resources Information Center

Lagally, Kristen M.

2013-01-01

Ratings of perceived exertion have been shown to be a valid method of monitoring physical activity intensity for both adults and children. As such, this subjective method may serve as an alternative to objective measurements for assessing students' performance on national standards 2 and 4. The OMNI-Child perceived exertion scales were…

Force Exertion Capacity Measurements in Haptic Virtual Environments

ERIC Educational Resources Information Center

Munih, Marko; Bardorfer, Ales; Ceru, Bojan; Bajd, Tadej; Zupan, Anton

2010-01-01

An objective test for evaluating functional status of the upper limbs (ULs) in patients with muscular distrophy (MD) is presented. The method allows for quantitative assessment of the UL functional state with an emphasis on force exertion capacity. The experimental measurement setup and the methodology for the assessment of maximal exertable force…

Monitoring stress and recovery: new insights for the prevention of injuries and illnesses in elite youth soccer players.

PubMed

Brink, Michel S; Visscher, Chris; Arends, Suzanne; Zwerver, Johannes; Post, Wendy J; Lemmink, Koen Apm

2010-09-01

Elite youth soccer players have a relatively high risk for injuries and illnesses due to increased physical and psychosocial stress. The aim of this study is to investigate how measures to monitor stress and recovery, and its analysis, provide useful information for the prevention of injuries and illnesses in elite youth soccer players. 53 elite soccer players between 15 and 18 years of age participated in this study. To determine physical stress, soccer players registered training and match duration and session rating of perceived exertion for two competitive seasons by means of daily training logs. The Dutch version of the Recovery Stress Questionnaire for athletes (RESTQ-Sport) was administered monthly to assess the psychosocial stress-recovery state of players. The medical staff collected injury and illness data using the standardised Fédération Internationale de Football Association registration system. ORs and 95% CIs were calculated for injuries and illnesses using multinomial regression analyses. The independent measures were stress and recovery. During the study period, 320 injuries and 82 illnesses occurred. Multinomial regression demonstrated that physical stress was related to both injury and illness (range OR 1.01 to 2.59). Psychosocial stress and recovery were related the occurrence of illness (range OR 0.56 to 2.27). Injuries are related to physical stress. Physical stress and psychosocial stress and recovery are important in relation to illness. Individual monitoring of stress and recovery may provide useful information to prevent soccer players from injuries and illnesses.

Effects of physical conditioning on heat tolerance in chemical-defense gear. Master's thesis

DOE Office of Scientific and Technical Information (OSTI.GOV)

Nauss, M.M.

Today the threat of chemical warfare is real. The only effective defense is the use of chemical defense gear and gas masks. Since they render chemical-warfare gases and liquids impermeable to penetration, they also prohibit sweat evaporation in conditions of thermal stress and thus, contribute to heat illness development. Historically, it has been the hot, humid tropics where United Nation's peacekeeping forces have been called, thus the use of chemical-defense gear in these regions is a realistic possibility and heat illness could affect the outcome of any mission carried out there. The human body only operates within a narrow rangemore » of core temparatures, and heat illness is the result of a breakdown in homeostasis. Many factors influence heat tolerance, thus maintaining core temperature within a safe range. Adequate hydration, acclimitization to heat, low body weight, young age, low alcohol intake, and physical fitness all contribute to heat tolerance. This proposal attempts to look specifically at the effect of physical conditioning on heat tolerance in chemical-defense gear as a possible solution to the heat-stress problem noted in this gear. Trainee graduates attending technical training schools at Lackland AFB, Texas, will be tested for maximum oxygen uptake (VO/2max) and heat tolerance time (HTT) in chemical defense gear on bicycle ergometers at Brooks AFB, Texas. Half of these subjects will be physically conditioned for 12 weeks.« less

Do placebo expectations influence perceived exertion during physical exercise?

PubMed

Mothes, Hendrik; Leukel, Christian; Seelig, Harald; Fuchs, Reinhard

2017-01-01

This study investigates the role of placebo expectations in individuals' perception of exertion during acute physical exercise. Building upon findings from placebo and marketing research, we examined how perceived exertion is affected by expectations regarding a) the effects of exercise and b) the effects of the exercise product worn during the exercise. We also investigated whether these effects are moderated by physical self-concept. Seventy-eight participants conducted a moderate 30 min cycling exercise on an ergometer, with perceived exertion (RPE) measured every 5 minutes. Beforehand, each participant was randomly assigned to 1 of 4 conditions and watched a corresponding film clip presenting "scientific evidence" that the exercise would or would not result in health benefits and that the exercise product they were wearing (compression garment) would additionally enhance exercise benefits or would only be worn for control purposes. Participants' physical self-concept was assessed via questionnaire. Results partially demonstrated that participants with more positive expectations experienced reduced perceived exertion during the exercise. Furthermore, our results indicate a moderator effect of physical self-concept: Individuals with a high physical self-concept benefited (in terms of reduced perceived exertion levels) in particular from an induction of generally positive expectations. In contrast, individuals with a low physical self-concept benefited when positive expectations were related to the exercise product they were wearing. In sum, these results suggest that placebo expectations may be a further, previously neglected class of psychological factors that influence the perception of exertion.

Do placebo expectations influence perceived exertion during physical exercise?

PubMed Central

Leukel, Christian; Seelig, Harald; Fuchs, Reinhard

2017-01-01

This study investigates the role of placebo expectations in individuals’ perception of exertion during acute physical exercise. Building upon findings from placebo and marketing research, we examined how perceived exertion is affected by expectations regarding a) the effects of exercise and b) the effects of the exercise product worn during the exercise. We also investigated whether these effects are moderated by physical self-concept. Seventy-eight participants conducted a moderate 30 min cycling exercise on an ergometer, with perceived exertion (RPE) measured every 5 minutes. Beforehand, each participant was randomly assigned to 1 of 4 conditions and watched a corresponding film clip presenting “scientific evidence” that the exercise would or would not result in health benefits and that the exercise product they were wearing (compression garment) would additionally enhance exercise benefits or would only be worn for control purposes. Participants’ physical self-concept was assessed via questionnaire. Results partially demonstrated that participants with more positive expectations experienced reduced perceived exertion during the exercise. Furthermore, our results indicate a moderator effect of physical self-concept: Individuals with a high physical self-concept benefited (in terms of reduced perceived exertion levels) in particular from an induction of generally positive expectations. In contrast, individuals with a low physical self-concept benefited when positive expectations were related to the exercise product they were wearing. In sum, these results suggest that placebo expectations may be a further, previously neglected class of psychological factors that influence the perception of exertion. PMID:28662168

Factors affecting heat illness when working in conditions of thermal stress.

PubMed

Bates, G; Gazey, C; Cena, K

1996-06-01

In hot working conditions, high sweat rates with excessive loss of body fluids may result in dehydration and electrolyte imbalance. It is well established that dehydration and/or electrolyte disturbances will impair work performance, and, if prolonged or severe, can pose a serious risk to health. The lesser condition of hypohydration is undoubtedly widespread in the workplace, and may be indirectly responsible for less than optimal performance and workplace accidents. With the aid of a new sweat collection method, fluid and electrolyte loss from a population of male workers with varying fitness and body composition has been documented. This has provided the basis for prescribing guidelines of fluid replacement when working in the heat. In addition, the minimum duration of heat exposure required to trigger heat acclimmatization was sought using sweat sodium as an indicator. Rehydration at the rate of 500 ml/h (250 ml every 30 min) is recommended for people working in all but extreme heat (> 45 degrees C). Electrolyte supplements (sodium and potassium) are not generally required in the workplace, but may be warranted in certain circumstances to avoid hyponatremia (> 3 h). The ability to predict the susceptibility of an individual to fluid and electrolyte disturbances cannot be made from age, body composition, ethnicity or VO2max, although a high VO2max appears to enhance heat tolerance. Sodium loss in sweat varies greatly and is not significantly related to sweat rate. Acclimatization results in a significant decrease in sweat sodium and increased sweat rate during summer compared with winter. This advantageous physiological adaptation requires a minimum of 9 h of heat exposure to initiate.

Illness Identity in Adults with a Chronic Illness.

PubMed

Oris, Leen; Luyckx, Koen; Rassart, Jessica; Goubert, Liesbet; Goossens, Eva; Apers, Silke; Arat, Seher; Vandenberghe, Joris; Westhovens, René; Moons, Philip

2018-02-21

The present study examines the concept of illness identity, the degree to which a chronic illness is integrated into one's identity, in adults with a chronic illness by validating a new self-report questionnaire, the Illness Identity Questionnaire (IIQ). Self-report questionnaires on illness identity, psychological, and physical functioning were assessed in two samples: adults with congenital heart disease (22-78 year old; n = 276) and with multisystem connective tissue disorders (systemic lupus erythematosus or systemic sclerosis; 17-81 year old; n = 241). The IIQ could differentiate four illness identity states (i.e., engulfment, rejection, acceptance, and enrichment) in both samples, based on exploratory and confirmatory factor analysis. All four subscales proved to be reliable. Rejection and engulfment were related to maladaptive psychological and physical functioning, whereas acceptance and enrichment were related to adaptive psychological and physical functioning. The present findings underscore the importance of the concept of illness identity. The IIQ, a self-report questionnaire, is introduced to measure four different illness identity states in adults with a chronic illness.

Increased Air Velocity Reduces Thermal and Cardiovascular Strain in Young and Older Males during Humid Exertional Heat Stress.

PubMed

Wright Beatty, Heather E; Hardcastle, Stephen G; Boulay, Pierre; Flouris, Andreas D; Kenny, Glen P

2015-01-01

Older adults have been reported to have a lower evaporative heat loss capacity than younger adults during exercise when full sweat evaporation is permitted. However, it is unclear how conditions of restricted evaporative and convective heat loss (i.e., high humidity, clothing insulation) alter heat stress. to the purpose of this study was to examine the heat stress responses of young and older males during and following exercise in a warm/humid environment under two different levels of air velocity. Ten young (YOUNG: 24±2 yr) and 10 older (OLDER: 59±3 yr) males, matched for body surface area performed 4×15-min cycling bouts (15-min rest) at a fixed rate of heat production (400 W) in warm/humid conditions (35°C, 60% relative humidity) under 0.5 (Low) and 3.0 (High) m·s(-1) air velocity while wearing work coveralls. Rectal (Tre) and mean skin (MTsk) temperatures, heart rate (HR), local sweat rate, % max skin blood flow (SkBF) (recovery only), and blood pressure (recovery only) were measured. High air velocity reduced core and skin temperatures (p < 0.05) equally in YOUNG and OLDER males (p > 0.05) but was more effective in reducing cardiovascular strain (absolute and % max HR; p < 0.05) in YOUNG males (p < 0.05). Greater increases in local dry heat loss responses (% max SkBF and cutaneous vascular conductance) were detected across time in OLDER than YOUNG males in both conditions (p < 0.05). Local dry heat loss responses and cardiovascular strain were attenuated during the High condition in YOUNG compared to OLDER (p < 0.05). High air velocity reduced the number of males surpassing the 38.0°C Tre threshold from 90% (Low) to 50% (High). Despite age-related local heat loss differences, YOUNG and OLDER males had similar levels of heat stress during intermittent exercise in warm and humid conditions while wearing work coveralls. Increased air velocity was effective in reducing heat stress equally, and cardiovascular strain to a greater extent, in YOUNG and OLDER

VALIDATION OF ADULT OMNI PERCEIVED EXERTION SCALES FOR ELLIPTICAL ERGOMETRY12

PubMed Central

MAYS, RYAN J.; GOSS, FREDRIC L.; SCHAFER, MARK A.; KIM, KEVIN H.; NAGLE-STILLEY, ELIZABETH F.; ROBERTSON, ROBERT J.

2012-01-01

Summary This investigation examined the validity of newly developed Adult OMNI Elliptical Ergometer Ratings of Perceived Exertion Scales. Sixty men and women performed a graded exercise test on an elliptical ergometer. Oxygen consumption (VO2), heart rate (HR) and ratings of perceived exertion were recorded each stage from the Borg 15 Category Scale and two different OMNI scales. One scale employed an elliptical ergometer format of the OMNI Picture System of Perceived Exertion. The second scale modified verbal, numerical, and pictorial descriptors at the low end of the response range. Concurrent and construct validity were established by the positive relation between ratings of perceived exertion from each OMNI scale with VO2, HR and Borg Scale ratings of perceived exertion (men, r = .94–.97; women, r = .93–.98). Validity was established for both OMNI scales, indicating either metric can be used to estimate ratings of perceived exertion during partial weight bearing exercise. PMID:21319623

Human heat adaptation.

PubMed

Taylor, Nigel A S

2014-01-01

In this overview, human morphological and functional adaptations during naturally and artificially induced heat adaptation are explored. Through discussions of adaptation theory and practice, a theoretical basis is constructed for evaluating heat adaptation. It will be argued that some adaptations are specific to the treatment used, while others are generalized. Regarding ethnic differences in heat tolerance, the case is put that reported differences in heat tolerance are not due to natural selection, but can be explained on the basis of variations in adaptation opportunity. These concepts are expanded to illustrate how traditional heat adaptation and acclimatization represent forms of habituation, and thermal clamping (controlled hyperthermia) is proposed as a superior model for mechanistic research. Indeed, this technique has led to questioning the perceived wisdom of body-fluid changes, such as the expansion and subsequent decay of plasma volume, and sudomotor function, including sweat habituation and redistribution. Throughout, this contribution was aimed at taking another step toward understanding the phenomenon of heat adaptation and stimulating future research. In this regard, research questions are posed concerning the influence that variations in morphological configuration may exert upon adaptation, the determinants of postexercise plasma volume recovery, and the physiological mechanisms that modify the cholinergic sensitivity of sweat glands, and changes in basal metabolic rate and body core temperature following adaptation. © 2014 American Physiological Society.

20 CFR 404.1569a - Exertional and nonexertional limitations.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 20 Employees' Benefits 2 2014-04-01 2014-04-01 false Exertional and nonexertional limitations. 404.1569a Section 404.1569a Employees' Benefits SOCIAL SECURITY ADMINISTRATION FEDERAL OLD-AGE, SURVIVORS... of jobs by various exertional levels (sedentary, light, medium, heavy, and very heavy) in terms of...

20 CFR 404.1569a - Exertional and nonexertional limitations.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 20 Employees' Benefits 2 2013-04-01 2013-04-01 false Exertional and nonexertional limitations. 404.1569a Section 404.1569a Employees' Benefits SOCIAL SECURITY ADMINISTRATION FEDERAL OLD-AGE, SURVIVORS... of jobs by various exertional levels (sedentary, light, medium, heavy, and very heavy) in terms of...

20 CFR 416.969a - Exertional and nonexertional limitations.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 20 Employees' Benefits 2 2011-04-01 2011-04-01 false Exertional and nonexertional limitations. 416.969a Section 416.969a Employees' Benefits SOCIAL SECURITY ADMINISTRATION SUPPLEMENTAL SECURITY INCOME... of jobs by various exertional levels (sedentary, light, medium, heavy, and very heavy) in terms of...

20 CFR 404.1569a - Exertional and nonexertional limitations.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 20 Employees' Benefits 2 2012-04-01 2012-04-01 false Exertional and nonexertional limitations. 404.1569a Section 404.1569a Employees' Benefits SOCIAL SECURITY ADMINISTRATION FEDERAL OLD-AGE, SURVIVORS... of jobs by various exertional levels (sedentary, light, medium, heavy, and very heavy) in terms of...

20 CFR 416.969a - Exertional and nonexertional limitations.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 20 Employees' Benefits 2 2013-04-01 2013-04-01 false Exertional and nonexertional limitations. 416.969a Section 416.969a Employees' Benefits SOCIAL SECURITY ADMINISTRATION SUPPLEMENTAL SECURITY INCOME... of jobs by various exertional levels (sedentary, light, medium, heavy, and very heavy) in terms of...

20 CFR 404.1569a - Exertional and nonexertional limitations.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 20 Employees' Benefits 2 2011-04-01 2011-04-01 false Exertional and nonexertional limitations. 404.1569a Section 404.1569a Employees' Benefits SOCIAL SECURITY ADMINISTRATION FEDERAL OLD-AGE, SURVIVORS... of jobs by various exertional levels (sedentary, light, medium, heavy, and very heavy) in terms of...

20 CFR 416.969a - Exertional and nonexertional limitations.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 20 Employees' Benefits 2 2012-04-01 2012-04-01 false Exertional and nonexertional limitations. 416.969a Section 416.969a Employees' Benefits SOCIAL SECURITY ADMINISTRATION SUPPLEMENTAL SECURITY INCOME... of jobs by various exertional levels (sedentary, light, medium, heavy, and very heavy) in terms of...

20 CFR 416.969a - Exertional and nonexertional limitations.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 20 Employees' Benefits 2 2014-04-01 2014-04-01 false Exertional and nonexertional limitations. 416.969a Section 416.969a Employees' Benefits SOCIAL SECURITY ADMINISTRATION SUPPLEMENTAL SECURITY INCOME... of jobs by various exertional levels (sedentary, light, medium, heavy, and very heavy) in terms of...

20 CFR 404.1569a - Exertional and nonexertional limitations.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Exertional and nonexertional limitations. 404.1569a Section 404.1569a Employees' Benefits SOCIAL SECURITY ADMINISTRATION FEDERAL OLD-AGE, SURVIVORS... of jobs by various exertional levels (sedentary, light, medium, heavy, and very heavy) in terms of...

20 CFR 416.969a - Exertional and nonexertional limitations.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Exertional and nonexertional limitations. 416.969a Section 416.969a Employees' Benefits SOCIAL SECURITY ADMINISTRATION SUPPLEMENTAL SECURITY INCOME... of jobs by various exertional levels (sedentary, light, medium, heavy, and very heavy) in terms of...

Strategies and factors associated with preparing for competing in the heat: a cohort study at the 2015 IAAF World Athletics Championships

PubMed Central

Périard, Julien D; Racinais, Sébastien; Dahlström, Örjan; Spreco, Armin; Bargoria, Victor; Halje, Karin; Alonso, Juan-Manuel

2017-01-01

Purpose Assess exertional heat illness (EHI) history and preparedness in athletes competing in a World Athletics Championships under hot/humid conditions and identify the factors associated with preparedness strategies. Methods Of the 207 registered national teams invited to participate in the study, 50 (24%) accepted. The 957 athletes (49% of all 1965 registered) in these teams were invited to complete a precompetition questionnaire evaluating EHI history, heat stress prevention (heat acclimatisation, precooling and hydration) and recovery. Responses from 307 (32%) athletes were separated in field events, sprints, middle-distance and long-distance running, and decathlon/heptathlon for analysis. Results 48% of athletes had previously experienced EHI symptoms and 8.5% had been diagnosed with EHI. 15% heat acclimatised (∼20 days) before the championships. 52% had a precooling strategy, ice slurry ingestion (24%) being the most prevalent and women using it more frequently than men (p=0.005). 96% of athletes had a fluid consumption strategy, which differed between event categories (p<0.001). The most common volumes planned on being consumed were 0.5–1 L (27.2%) and ≥2 L (21.8%), water being the most frequent. 89% of athletes planned on using at least one recovery strategy. Female sex (p=0.024) and a previous EHI diagnosis increased the likelihood of using all 3 prevention strategies (p<0.001). Conclusions At a World Championships with expected hot/humid conditions, less than one-fifth of athletes heat acclimatised, half had a precooling strategy and almost all a hydration plan. Women, and especially athletes with an EHI history, were more predisposed to use a complete heat stress prevention strategy. More information regarding heat acclimatisation should be provided to protect athlete health and optimise performance at major athletics competitions in the heat. PMID:27815238

Physical Exertion and Immediate Classroom Mental Performance Among Elementary School Children.

ERIC Educational Resources Information Center

Gabbard, Carl

This study was designed (1) to investigate the relationship between physical exertion and mental performance in elementary school children and (2) to determine if male or female mental performances are more affected by physical exertion. A total of 95 second graders participated in six treatments of induced physical exertion during their regularly…

Short-Term, Low-Volume Training Improves Heat Acclimatization in an Operational Context

PubMed Central

Charlot, Keyne; Tardo-Dino, Pierre-Emmanuel; Buchet, Jean-François; Koulmann, Nathalie; Bourdon, Stéphanie; Lepetit, Benoit; Roslonski, Martin; Jousseaume, Loïc; Malgoyre, Alexandra

2017-01-01

Personnel who travel to areas with a hot climate (WBGT > 27°C) may suffer from the heat (physiological strain, thermal discomfort, increased probability of heat illness), making them partially or fully inoperative. Performing physical activities during heat acclimatization is known to improve this process (i.e., improve measures of acclimatization for the same duration of acclimation). However, it is unknown whether such training would be efficient in an operative context, characterized by a high volume of work-related physical activity. Thirty French soldiers (Training group, T) performed a short (5 days), progressive, moderate (from three to five 8-min running sets at 50% of the speed at VO2max for 32–56 min) aerobic training program upon arriving at their base in United Arab Emirates (~40°C and 12% RH). A control group (30 soldiers; No Training, NT) continued to perform their usual outdoor military activities (~6 h.d−1). A field heat stress test (HST; three 8-min running sets at 50% of the speed at VO2max) was performed, before and after the heat acclimatization period, to assess physiological and subjective changes. Rectal temperature, heart rate (HR), thermal discomfort at rest and at the end of exercise, rates of perceived exertion (RPE), and sweat loss and osmolality decreased following heat acclimatization in both groups. However, the decreases in the T group were larger than those in the NT group for HR at the end of exercise (−20 ± 13 vs. −13 ± 6 bpm, respectively, p = 0.044), thermal discomfort at rest (−2.6 ± 2.7 vs. −1.4 ± 2.1 cm, respectively, p = 0.013) and at the end of exercise (−2.6 ± 1.9 vs. −1.6 ± 1.7 cm, respectively, p = 0.037) and RPE (−2.3 ± 1.8 vs. −1.3 ± 1.7, respectively, p = 0.035). Thus, we showed that adding short (<60 min), daily, moderate-intensity training sessions during a professional mission in a hot and dry environment accelerated several heat-acclimatization-induced changes at rest and during

Transient heat-stress compromises the resistance of wheat seedlings to Hessian fly (Diptera: Cecidomyiidae) infestation

USDA-ARS?s Scientific Manuscript database

Heat-stress exerts profound impact on resistance of plants to parasites. In this research, we investigated the impact of an acute, transient heat-stress on the resistance of the wheat line 'Molly', which contains the resistance gene H13, to an avirulent Hessian fly [Mayetiola destructor (Say)] popu...

A 3-D Mathematical Model to Identify Organ-Specific Risks in Rats During Thermal Stress

DTIC Science & Technology

2013-01-01

increases in rat core temperature in antic- ipation of the lights-off (active) period at 1800. This response is anticipatory of the active period when...Epidemiology of hospitalizations and deaths from heat illness in soldiers. Med Sci Sports Exerc 37: 1338–1344, 2005. 11. Casa DJ, Armstrong LE, Ganio...MS, Yeargin SW. Exertional heat stroke in competitive athletes. Curr Sports Med Rep 4: 309–317, 2005. 12. Chang CK, Chang CP, Chiu WT, Lin MT

Understanding of flux-limited behaviors of heat transport in nonlinear regime

NASA Astrophysics Data System (ADS)

Guo, Yangyu; Jou, David; Wang, Moran

2016-01-01

The classical Fourier's law of heat transport breaks down in highly nonequilibrium situations as in nanoscale heat transport, where nonlinear effects become important. The present work is aimed at exploring the flux-limited behaviors based on a categorization of existing nonlinear heat transport models in terms of their theoretical foundations. Different saturation heat fluxes are obtained, whereas the same qualitative variation trend of heat flux versus exerted temperature gradient is got in diverse nonlinear models. The phonon hydrodynamic model is proposed to act as a standard to evaluate other heat flux limiters because of its more rigorous physical foundation. A deeper knowledge is thus achieved about the phenomenological generalized heat transport models. The present work provides deeper understanding and accurate modeling of nonlocal and nonlinear heat transport beyond the diffusive limit.

Exertional headache and coronary ischemia despite normal electrocardiographic stress testing.

PubMed

Cutrer, F Michael; Huerter, Karina

2006-01-01

Exertional headaches may under certain conditions reflect coronary ischemia. We report the case of a patient seen in a neurology referral practice whose exertional headaches, even in the face of two normal electrocardiographic stress tests and in the absence of underlying chest pain were the sole symptoms of coronary ischemia as detected by Tc-99m Sestamibi testing SPECT stress testing. Stent placement resulted in complete resolution of headaches. Exertional headache in the absence of chest pain may reflect underlying symptomatic coronary artery disease (CAD) even when conventional electrocardiographic stress testing does not indicate ischemia.

Illness uncertainty and illness intrusiveness as predictors of depressive and anxious symptomology in college students with chronic illnesses.

PubMed

Mullins, Alexandria J; Gamwell, Kaitlyn L; Sharkey, Christina M; Bakula, Dana M; Tackett, Alayna P; Suorsa, Kristina I; Chaney, John M; Mullins, Larry L

2017-07-01

To examine predictors of psychological functioning in college students with chronic illnesses. Participants (N = 1413) included 364 students with self-reported diagnoses of asthma or allergies, 148 students with other chronic illnesses (eg, epilepsy, type 1 diabetes), and 901 healthy students. Data were collected between November 2013 and May 2015. Participants completed online measures of psychosocial functioning, including illness uncertainty, illness intrusiveness, depression, and anxiety. Students with chronic illnesses other than asthma or allergies evidenced the greatest levels of anxious (p <. 05), but not depressive symptomology. Additionally, this group reported greater illness uncertainty and intrusiveness (p <. 05) compared to their peers. Uncertainty and intrusiveness independently predicted depressive and anxious symptoms for students in both illness groups. Compared to peers with asthma or allergies, college students with other chronic illnesses reported higher levels of anxious symptoms. Illness uncertainty and intrusiveness appear to be predictors of psychological distress, regardless of illness.

Perceived heat stress and health effects on construction workers.

PubMed

Dutta, Priya; Rajiva, Ajit; Andhare, Dileep; Azhar, Gulrez Shah; Tiwari, Abhiyant; Sheffield, Perry

2015-01-01

Increasing heat waves-particularly in urban areas where construction is most prevalent, highlight a need for heat exposure assessment of construction workers. This study aims to characterize the effects of heat on construction workers from a site in Gandhinagar. This study involved a mixed methods approach consisting of a cross sectional survey with anthropometric measurements (n = 219) and four focus groups with construction workers, as well as environmental measurements of heat stress exposure at a construction site. Survey data was collected in two seasons i.e., summer and winter months, and heat illness and symptoms were compared between the two time periods. Thematic coding of focus group data was used to identify vulnerability factors and coping mechanisms of the workers. Heat stress, recorded using a wet bulb globe temperature monitor, was compared to international safety standards. The survey findings suggest that heat-related symptoms increased in summer; 59% of all reports in summer were positive for symptoms (from Mild to Severe) as compared to 41% in winter. Focus groups revealed four dominant themes: (1) Non-occupational stressors compound work stressors; (2) workers were particularly attuned to the impact of heat on their health; (3) workers were aware of heat-related preventive measures; and (4) few resources were currently available to protect workers from heat stress. Working conditions often exceed international heat stress safety thresholds. Female workers and new employees might be at increased risk of illness or injury. This study suggests significant health impacts on construction workers from heat stress exposure in the workplace, showed that heat stress levels were higher than those prescribed by international standards and highlights the need for revision of work practices, increased protective measures, and possible development of indigenous work safety standards for heat exposure.

Perceived heat stress and health effects on construction workers

PubMed Central

Dutta, Priya; Rajiva, Ajit; Andhare, Dileep; Azhar, Gulrez Shah; Tiwari, Abhiyant; Sheffield, Perry

2015-01-01

Introduction: Increasing heat waves-particularly in urban areas where construction is most prevalent, highlight a need for heat exposure assessment of construction workers. This study aims to characterize the effects of heat on construction workers from a site in Gandhinagar. Materials and Methods: This study involved a mixed methods approach consisting of a cross sectional survey with anthropometric measurements (n = 219) and four focus groups with construction workers, as well as environmental measurements of heat stress exposure at a construction site. Survey data was collected in two seasons i.e., summer and winter months, and heat illness and symptoms were compared between the two time periods. Thematic coding of focus group data was used to identify vulnerability factors and coping mechanisms of the workers. Heat stress, recorded using a wet bulb globe temperature monitor, was compared to international safety standards. Results: The survey findings suggest that heat-related symptoms increased in summer; 59% of all reports in summer were positive for symptoms (from Mild to Severe) as compared to 41% in winter. Focus groups revealed four dominant themes: (1) Non-occupational stressors compound work stressors; (2) workers were particularly attuned to the impact of heat on their health; (3) workers were aware of heat-related preventive measures; and (4) few resources were currently available to protect workers from heat stress. Working conditions often exceed international heat stress safety thresholds. Female workers and new employees might be at increased risk of illness or injury. Conclusion: This study suggests significant health impacts on construction workers from heat stress exposure in the workplace, showed that heat stress levels were higher than those prescribed by international standards and highlights the need for revision of work practices, increased protective measures, and possible development of indigenous work safety standards for heat exposure

Forces exerted during microneurosurgery: a cadaver study

PubMed Central

Marcus, Hani J; Zareinia, Kourosh; Gan, Liu Shi; Yang, Fang Wei; Lama, Sanju; Yang, Guang-Zhong; Sutherland, Garnette R

2014-01-01

Background A prerequisite for the successful design and use of robots in neurosurgery is knowledge of the forces exerted by surgeons during neurosurgical procedures. The aim of the present cadaver study was to measure the surgical instrument forces exerted during microneurosurgery. Methods An experimental apparatus was set up consisting of a platform for human cadaver brains, a Leica microscope to provide illumination and magnification, and a Quanser 6 Degrees-Of-Freedom Telepresence System for tissue manipulation and force measurements. Results The measured forces varied significantly depending on the region of the brain (P = 0.016) and the maneuver performed (P < 0.0001). Moreover, blunt arachnoid dissection was associated with greater force exertion than sharp dissection (0.22 N vs. 0.03 N; P = 0.001). Conclusions The forces necessary to manipulate brain tissue were surprisingly low and varied depending on the anatomical structure being manipulated, and the maneuver performed. Knowledge of such forces could well increase the safety of microsurgery. © 2014 The Authors. The International Journal of Medical Robotics and Computer Assisted Surgery published by John Wiley & Sons, Ltd. PMID:24431265

Influence of permittivity on gradient force exerted on Mie spheres.

PubMed

Chen, Jun; Li, Kaikai; Li, Xiao

2018-04-01

In optical trapping, whether a particle could be stably trapped into the focus region greatly depends on the strength of the gradient force. Individual theoretical study on gradient force exerted on a Mie particle is rare because the mathematical separation of the gradient force and the scattering force in the Mie regime is difficult. Based on the recent forces separation work by Du et al. [Sci. Rep.7, 18042 (2017)SRCEC32045-232210.1038/s41598-017-17874-1], we investigate the influence of permittivity (an important macroscopic physical quantity) on the gradient force exerted on a Mie particle by cooperating numerical calculation using fast Fourier transform and analytical analysis using multipole expansion. It is revealed that gradient forces exerted on small spheres are mainly determined by the electric dipole moment except for certain permittivity with which the real part of polarizability of the electric dipole approaches zero, and gradient forces exerted on larger spheres are complex because of the superposition of the multipole moments. The classification of permittivity corresponding to different varying tendencies of gradient forces exerted on small spheres or larger Mie particles are illustrated. Absorption of particles favors the trapping of small spheres by gradient force, while it is bad for the trapping of larger particles. Moreover, the absolute values of the maximal gradient forces exerted on larger Mie particles decline greatly versus the varied imaginary part of permittivity. This work provides elaborate investigation on the different varying tendencies of gradient forces versus permittivity, which favors more accurate and free optical trapping.

Integration of Decentralized Thermal Storages Within District Heating (DH) Networks

NASA Astrophysics Data System (ADS)

Schuchardt, Georg K.

2016-12-01

Thermal Storages and Thermal Accumulators are an important component within District Heating (DH) systems, adding flexibility and offering additional business opportunities for these systems. Furthermore, these components have a major impact on the energy and exergy efficiency as well as the heat losses of the heat distribution system. Especially the integration of Thermal Storages within ill-conditioned parts of the overall DH system enhances the efficiency of the heat distribution. Regarding an illustrative and simplified example for a DH system, the interactions of different heat storage concepts (centralized and decentralized) and the heat losses, energy and exergy efficiencies will be examined by considering the thermal state of the heat distribution network.

Lipoic Acid Exerts Antioxidant and Anti-inflammatory Effects in Response to Heat Shock in C2C12 Myotubes.

PubMed

Lee, Cheng-Tse; Chang, Li-Ching; Wu, Pei-Fung

2016-06-01

This study explored that lipoic acid treatment for 24 h significantly upregulated and promoted heat shock-induced catalase expression and downregulated GPx1 messenger RNA (mRNA) expression, indicating that lipoic acid exhibits antioxidant activity in the decomposition of hydrogen peroxide by upregulating catalase expression. Moreover, lipoic acid treatment for 3 h increased and promoted heat shock-induced interleukin (IL)-6 mRNA and protein levels and that for 24 h downregulated IL-6 mRNA expression, suggesting a dual effect of lipoic acid on IL-6 regulation. Lipoic acid alone failed to increase or reduce tumor necrosis factor (TNF)-α mRNA and protein levels, whereas heat shock alone downregulated TNF-α mRNA and protein expression. These data suggest that lipoic acid does not have a proinflammatory role and that heat shock acts as an anti-inflammatory agent by downregulating TNF-α expression in C2C12 myotubes. Moreover, lipoic acid or heat shock alone upregulated the IL-6 receptor (IL-6R-α) and glycoprotein 130 (gp130) mRNA expression followed by IL-6 expression; these data indicate that the regulation of lipoic acid or heat shock is mediated by IL-6R signaling, thus suggesting that C2C12 myotubes possesses a mechanism for regulating IL-6R and gp130 expression following lipoic acid treatment or heat shock.

Exogenous salicylic acid enhances the resistance of wheat seedlings to hessian fly (Diptera: Cecidomyiidae) infestation under heat stress

USDA-ARS?s Scientific Manuscript database

Heat stress exerts significant impact on plant-parasite interactions. Phytohormones, such as salicylic acid (SA) play important roles in plant defense against parasite attacks. Here we studied the impact of a combination of heat stress and exogenous SA on wheat (Triticum aestivum L.) plant resistanc...

Exertional Rhabdomyolysis: What Is It and Why Should We Care?

ERIC Educational Resources Information Center

Thomas, David Q.; Carlson, Kelli A.; Marzano, Amy; Garrahy, Deborah

2012-01-01

Exertional rhabdomyolysis gained increased attention recently when 13 football players from the University of Iowa developed this condition after an especially demanding practice session and were hospitalized. Exertional rhabdomyolysis may lead to severe kidney stress, kidney failure, and even sudden death. Anyone who does physical exercise at a…

Climate and heat-related emergencies in Chicago, Illinois (2003-2006).

PubMed

Hartz, Donna A; Golden, Jay S; Sister, Chona; Chuang, Wen-Ching; Brazel, Anthony J

2012-01-01

Extreme heat events are responsible for more deaths in the United States than floods, hurricanes and tornados combined. Yet, highly publicized events, such as the 2003 heat wave in Europe which caused in excess of 35,000 deaths, and the Chicago heat wave of 1995 that produced over 500 deaths, draw attention away from the countless thousands who, each year, fall victim to nonfatal health emergencies and illnesses directly attributed to heat. The health impact of heat waves and excessive heat are well known. Cities worldwide are seeking to better understand heat-related illnesses with respect to the specifics of climate, social demographics and spatial distributions. This information can support better preparation for heat-related emergency situations with regards to planning for response capacity and placement of emergency resources and personnel. This study deals specifically with the relationship between climate and heat-related dispatches (HRD, emergency 911 calls) in Chicago, Illinois, between 2003 and 2006. It is part of a larger, more in-depth, study that includes urban morphology and social factors that impact heat-related emergency dispatch calls in Chicago. The highest occurrences of HRD are located in the central business district, but are generally scattered across the city. Though temperature can be a very good predictor of high HRD, heat index is a better indicator. We determined temperature and heat index thresholds for high HRD. We were also able to identify a lag in HRD as well as other situations that triggered higher (or lower) HRD than would typically be generated for the temperature and humidity levels, such as early afternoon rainfall and special events.

Climate and heat-related emergencies in Chicago, Illinois (2003-2006)

NASA Astrophysics Data System (ADS)

Hartz, Donna A.; Golden, Jay S.; Sister, Chona; Chuang, Wen-Ching; Brazel, Anthony J.

2012-01-01

Extreme heat events are responsible for more deaths in the United States than floods, hurricanes and tornados combined. Yet, highly publicized events, such as the 2003 heat wave in Europe which caused in excess of 35,000 deaths, and the Chicago heat wave of 1995 that produced over 500 deaths, draw attention away from the countless thousands who, each year, fall victim to nonfatal health emergencies and illnesses directly attributed to heat. The health impact of heat waves and excessive heat are well known. Cities worldwide are seeking to better understand heat-related illnesses with respect to the specifics of climate, social demographics and spatial distributions. This information can support better preparation for heat-related emergency situations with regards to planning for response capacity and placement of emergency resources and personnel. This study deals specifically with the relationship between climate and heat-related dispatches (HRD, emergency 911 calls) in Chicago, Illinois, between 2003 and 2006. It is part of a larger, more in-depth, study that includes urban morphology and social factors that impact heat-related emergency dispatch calls in Chicago. The highest occurrences of HRD are located in the central business district, but are generally scattered across the city. Though temperature can be a very good predictor of high HRD, heat index is a better indicator. We determined temperature and heat index thresholds for high HRD. We were also able to identify a lag in HRD as well as other situations that triggered higher (or lower) HRD than would typically be generated for the temperature and humidity levels, such as early afternoon rainfall and special events.

Exertional rhabdomyolysis: physiological response or manifestation of an underlying myopathy?

PubMed Central

Scalco, Renata S; Snoeck, Marc; Quinlivan, Ros; Treves, Susan; Laforét, Pascal; Jungbluth, Heinz; Voermans, Nicol C

2016-01-01

Exertional rhabdomyolysis is characterised by muscle breakdown associated with strenuous exercise or normal exercise under extreme circumstances. Key features are severe muscle pain and sudden transient elevation of serum creatine kinase (CK) levels with or without associated myoglobinuria. Mild cases may remain unnoticed or undiagnosed. Exertional rhabdomyolysis is well described among athletes and military personnel, but may occur in anybody exposed to unaccustomed exercise. In contrast, exertional rhabdomyolysis may be the first manifestation of a genetic muscle disease that lowers the exercise threshold for developing muscle breakdown. Repeated episodes of exertional rhabdomyolysis should raise the suspicion of such an underlying disorder, in particular in individuals in whom the severity of the rhabdomyolysis episodes exceeds the expected response to the exercise performed. The present review aims to provide a practical guideline for the acute management and postepisode counselling of patients with exertional rhabdomyolysis, with a particular emphasis on when to suspect an underlying genetic disorder. The pathophysiology and its clinical features are reviewed, emphasising four main stepwise approaches: (1) the clinical significance of an acute episode, (2) risks of renal impairment, (3) clinical indicators of an underlying genetic disorders and (4) when and how to recommence sport activity following an acute episode of rhabdomyolysis. Genetic backgrounds that appear to be associated with both enhanced athletic performance and increased rhabdomyolysis risk are briefly reviewed. PMID:27900193

Heat stress management program improving worker health and operational effectiveness: a case study.

PubMed

Huss, Rosalyn G; Skelton, Scott B; Alvis, Kimberly L; Shane, Leigh A

2013-03-01

Heat stress monitoring is a vital component of an effective health and safety program when employees work in exceptionally warm environments. Workers at hazardous waste sites often wear personal protective equipment (PPE), which increases the body heat stress load. No specific Occupational Safety and Health Administration (OSHA) regulations address heat stress; however, OSHA does provide several guidance documents to assist employers in addressing this serious workplace health hazard. This article describes a heat stress and surveillance plan implemented at a hazardous waste site as part of the overall health and safety program. The PPE requirement for work at this site, coupled with extreme environmental temperatures, made heat stress a significant concern. Occupational health nurses and industrial hygienists developed a monitoring program for heat stress designed to prevent the occurrence of significant heat-related illness in site workers. The program included worker education on the signs of heat-related illness and continuous physiologic monitoring to detect early signs of heat-related health problems. Biological monitoring data were collected before workers entered the exclusion zone and on exiting the zone following decontamination. Sixty-six site workers were monitored throughout site remediation. More than 1,700 biological monitoring data points were recorded. Outcomes included improved worker health and safety, and increased operational effectiveness. Copyright 2013, SLACK Incorporated.

Climate Change and the Emergent Epidemic of CKD from Heat Stress in Rural Communities: The Case for Heat Stress Nephropathy

PubMed Central

Glaser, Jason; Lemery, Jay; Rajagopalan, Balaji; Diaz, Henry F.; García-Trabanino, Ramón; Taduri, Gangadhar; Madero, Magdalena; Amarasinghe, Mala; Abraham, Georgi; Anutrakulchai, Sirirat; Jha, Vivekanand; Stenvinkel, Peter; Roncal-Jimenez, Carlos; Lanaspa, Miguel A.; Correa-Rotter, Ricardo; Sheikh-Hamad, David; Burdmann, Emmanuel A.; Andres-Hernando, Ana; Milagres, Tamara; Weiss, Ilana; Kanbay, Mehmet; Wesseling, Catharina; Sánchez-Lozada, Laura Gabriela

2016-01-01

Climate change has led to significant rise of 0.8°C–0.9°C in global mean temperature over the last century and has been linked with significant increases in the frequency and severity of heat waves (extreme heat events). Climate change has also been increasingly connected to detrimental human health. One of the consequences of climate-related extreme heat exposure is dehydration and volume loss, leading to acute mortality from exacerbations of pre-existing chronic disease, as well as from outright heat exhaustion and heat stroke. Recent studies have also shown that recurrent heat exposure with physical exertion and inadequate hydration can lead to CKD that is distinct from that caused by diabetes, hypertension, or GN. Epidemics of CKD consistent with heat stress nephropathy are now occurring across the world. Here, we describe this disease, discuss the locations where it appears to be manifesting, link it with increasing temperatures, and discuss ongoing attempts to prevent the disease. Heat stress nephropathy may represent one of the first epidemics due to global warming. Government, industry, and health policy makers in the impacted regions should place greater emphasis on occupational and community interventions. PMID:27151892

Fatal heat stroke in children found in parked cars: autopsy findings.

PubMed

Adato, Berliz; Dubnov-Raz, Gal; Gips, Hadas; Heled, Yuval; Epstein, Yoram

2016-09-01

A common and unfortunate cause for heat stroke-related deaths in children is entrapment in closed vehicles. The aim of this study was to analyze the pathological consequences of such grave events. Autopsy reports of all children that were brought to a national forensic medicine center after being found dead in closed vehicles over a 21-year period (1995-2015) were reviewed. Data extracted were the circumstances of the events, child age, sex, height and weight, time, date and duration of entrapment, and environmental temperatures at the time of entrapment and the autopsy findings. Eight deceased children were brought to the forensic medicine center for autopsy, and seven families consented to the procedure. Autopsy findings included diffuse petechiae and hemorrhages of serosal membranes (n = 7/7) and lung congestion (n = 3/7). Typical autopsy findings following classical heat stroke in children include diffuse petechiae and hemorrhages and lung involvement. These findings are similar to those reported in adults that had died following exertional heat stroke-a very different mechanism of heat accumulation. Prevention of future events can possibly be obtained by public education on the rapid heating of closed vehicles, the vulnerability of children to heat, and the caregiver role in child entrapment. • A common and unfortunate cause for heat stroke-related deaths in children is entrapment in closed vehicles. The pathological consequences of such grave events have not been previously reported. What is New: • This study is the first to describe autopsy findings from children who were found dead in parked cars. • Autopsy findings included diffuse petechiae hemorrhages of serosal membranes and lung congestion. • These findings are identical to those seen in adults following exertional heat stroke.

Respiratory illness caused by overheating of polyvinyl chloride.

PubMed Central

Froneberg, B; Johnson, P L; Landrigan, P J

1982-01-01

On 9 August 1979, 62 (30.8%) of 201 workers and one of 60 management personnel in a polyvinyl chloride (PVC) fabricating plant developed acute upper and lower respiratory irritation, headache, nausea, and fainting. All were taken to hospital; none died. Sixty of the patients were women. Interviews two weeks later with 57 affected and 14 unaffected workers disclosed that illness had followed exposure to fumes from an overheated (362 degrees C) PVC extruding machine. Fumes were emitted from 1100 until 1150; cases occurred from 1100 until late afternoon. All workers who became ill worked west of the overheated extruder, and the affected manager had visited that area. The earliest cases occurred closest to the machine, and incidence decreased (from 53.3% to 15.4%) with distance westward. This pattern was consistent with plant ventilation. Incidence rates in men and women did not differ (p greater than 0.1). At two and 14 weeks, pulmonary function testing of workers with persistent pulmonary symptoms showed abnormalities in 13 of 16 and in 9 of 11 respectively; the group with persistent symptoms contained an excess of non-smokers and of those with previous respiratory illnesses. One kilogram of PVC heated to 300 degrees C releases an estimated 12.9 g of hydrochloric acid (HCl) and 4.9 g of carbon monoxide (CO). We attributed the outbreak to exposure to toxic HCl and CO and rejected the hypothesis of mass psychogenic illness. PMID:7093150

Time-of-day effects of exposure to solar radiation on thermoregulation during outdoor exercise in the heat.

PubMed

Otani, Hidenori; Goto, Takayuki; Goto, Heita; Shirato, Minayuki

2017-01-01

High solar radiation has been recognised as a contributing factor to exertional heat-related illness in individuals exercising outdoors in the heat. Although solar radiation intensity has been known to have similar time-of-day variation as body temperature, the relationship between fluctuations in solar radiation associated with diurnal change in the angle of sunlight and thermoregulatory responses in individuals exercising outdoors in a hot environment remains largely unknown. The present study therefore investigated the time-of-day effects of variations in solar radiation associated with changing solar elevation angle on thermoregulatory responses during moderate-intensity outdoor exercise in the heat of summer. Eight healthy, high school baseball players, heat-acclimatised male volunteers completed a 3-h outdoor baseball trainings under the clear sky in the heat. The trainings were commenced at 0900 h in AM trial and at 1600 h in PM trial each on a separate day. Solar radiation and solar elevation angle during exercise continued to increase in AM (672-1107 W/m 2 and 44-69°) and decrease in PM (717-0 W/m 2 and 34-0°) and were higher on AM than on PM (both P < 0.001). Although ambient temperature (AM 32-36°C, PM 36-30°C) and wet-bulb globe temperature (AM 31-33°C, PM 34-27°C) also continued to increase in AM and decrease in PM, there were no differences between trials in these (both P > 0.05). Tympanic temperature measured by an infrared tympanic thermometer and mean skin temperature were higher in AM than PM at 120 and 180 min (P < 0.05). Skin temperature was higher in AM than PM at the upper arm and thigh at 120 min (P < 0.05) and at the calf at 120 and 180 min (both P < 0.05). Body heat gain from the sun was greater during exercise in AM than PM (P < 0.0001), at 0-60 min in PM than AM (P < 0.0001) and at 120-180 min in AM than PM (P < 0.0001). Dry heat loss during exercise was greater at 0-60 min (P < 0.0001), and lower at 60

Illness as Teacher: Learning from Illness

ERIC Educational Resources Information Center

Yoo, Joanne

2017-01-01

This article is a conceptual exploration into the value of illness, bodies and embodied practice in teacher education. It draws on my reflections and practitioner accounts of poor health to investigate the potential to learn from illness. I position myself in this discussion as a non-tenured academic who experiences the challenges of her uncertain…

Physical Illness, Psychiatric Illness, and the Acceptability of Suicide.

ERIC Educational Resources Information Center

Deluty, Robert H.

1989-01-01

Assessed whether attitudes toward suicide vary as function of type of illness that precipitates suicide. College students (N=455) responded to scenarios of suicide victim. Evaluations of suicide were most favorable when it occurred in response to terminal physical illness; less favorable in response to chronic, non-terminal physical illness; and…

Effects of radiant heat exposure on pacing pattern during a 15-km cycling time trial.

PubMed

Levels, Koen; de Koning, Jos; Broekhuijzen, Iris; Zwaan, Tamara; Foster, Carl; Daanen, Hein

2014-01-01

The goal of this study was to investigate the effects of different durations of skin temperature manipulation on pacing patterns and performance during a 15-km cycling time trial. Nineteen well-trained men completed three 15-km cycling time trials in 18 °C and 50% relative humidity with 4.5-km (short-heat), 9.0-km (long-heat) or without (control) radiant heat exposure applied by infrared heaters after 1.5 km in the time trial. During the time trials, power output, mean skin temperature, rectal temperature, heart rate and rating of perceived exertion were assessed. The radiant heat exposure resulted in higher mean skin temperature during the time trial for short-heat (35.0 ± 0.6 °C) and long-heat (35.3 ± 0.5 °C) than for control (32.5 ± 1.0 °C; P < 0.001), whereas rectal temperature was similar (P = 0.55). The mean power output was less for short-heat (273 ± 8 W; P = 0.001) and long-heat (271 ± 9 W; P = 0.02) than for control (287 ± 7 W), but pacing patterns did not differ (P = 0.55). Heart rate was greatest in control (177 ± 9 beats · min(-1); P < 0.001), whereas the rating of perceived exertion remained similar. We concluded that a radiant heat exposure and associated higher skin temperature reduced overall performance, but did not modify pacing pattern during a 15-km cycling time trial, regardless of the duration of the exposure.

A Comprehensive Evaluation of the Burden of Heat-Related Illness and Death within the Florida Population.

PubMed

Harduar Morano, Laurel; Watkins, Sharon; Kintziger, Kristina

2016-05-31

The failure of the human body to thermoregulate can lead to severe outcomes (e.g., death) and lasting physiological damage. However, heat-related illness (HRI) is highly preventable via individual- and community-level modification. A thorough understanding of the burden is necessary for effective intervention. This paper describes the burden of severe HRI morbidity and mortality among residents of a humid subtropical climate. Work-related and non-work-related HRI emergency department (ED) visits, hospitalizations, and deaths among Florida residents during May to October (2005-2012) were examined. Sub-groups susceptible to HRI were identified. The age-adjusted rates/100,000 person-years for non-work-related HRI were 33.1 ED visits, 5.9 hospitalizations, and 0.2 deaths, while for work-related HRI/100,000 worker-years there were 8.5 ED visits, 1.1 hospitalizations, and 0.1 deaths. The rates of HRI varied by county, data source, and work-related status, with the highest rates observed in the panhandle and south central Florida. The sub-groups with the highest relative rates regardless of data source or work-relatedness were males, minorities, and rural residents. Those aged 15-35 years had the highest ED visit rates, while for non-work-related hospitalizations and deaths the rates increased with age. The results of this study can be used for targeted interventions and evaluating changes in the HRI burden over time.

A Comprehensive Evaluation of the Burden of Heat-Related Illness and Death within the Florida Population

PubMed Central

Harduar Morano, Laurel; Watkins, Sharon; Kintziger, Kristina

2016-01-01

The failure of the human body to thermoregulate can lead to severe outcomes (e.g., death) and lasting physiological damage. However, heat-related illness (HRI) is highly preventable via individual- and community-level modification. A thorough understanding of the burden is necessary for effective intervention. This paper describes the burden of severe HRI morbidity and mortality among residents of a humid subtropical climate. Work-related and non-work-related HRI emergency department (ED) visits, hospitalizations, and deaths among Florida residents during May to October (2005–2012) were examined. Sub-groups susceptible to HRI were identified. The age-adjusted rates/100,000 person-years for non-work-related HRI were 33.1 ED visits, 5.9 hospitalizations, and 0.2 deaths, while for work-related HRI/100,000 worker-years there were 8.5 ED visits, 1.1 hospitalizations, and 0.1 deaths. The rates of HRI varied by county, data source, and work-related status, with the highest rates observed in the panhandle and south central Florida. The sub-groups with the highest relative rates regardless of data source or work-relatedness were males, minorities, and rural residents. Those aged 15–35 years had the highest ED visit rates, while for non-work-related hospitalizations and deaths the rates increased with age. The results of this study can be used for targeted interventions and evaluating changes in the HRI burden over time. PMID:27258296

New guidelines are needed to manage heat stress in elite sports--The Fédération Internationale de Volleyball (FIVB) Heat Stress Monitoring Programme.

PubMed

Bahr, Roald; Reeser, Jonathan C

2012-09-01

There seems to be a discrepancy between the available heat stress guidelines and the actual risk of heat-related illness among professional beach volleyball players competing under hot and humid conditions. To monitor heat stress and record cases of heat-related medical forfeits on the Swatch FIVB Beach Volleyball World Tour. The FIVB Heat Stress Monitoring Protocol covered events on the FIVB Beach Volleyball World Tour and FIVB Beach Volleyball World Championships during the 2009, 2010 and 2011 seasons (51 events, most of these double gender). The protocol consisted of (1) measuring the Wet Bulb Globe Temperature (WBGT) on centre court prior to the start of every match, and (2) recording any heat-related medical forfeits during the tournament. Data were collected during 48 of 51 events. There were nine events where the peak WBGT exceeded the US Navy Black flag conditions of >32.3°C and an additional two events where the peak WBGT exceeded 31°C, (meeting Red flag conditions.) In two events, the average WBGT equalled at least 31°C. One case of a medical forfeit related to heat stress was recorded over the 3-year surveillance period: an athlete whose fluid balance was compromised from a 3-day bout of acute gastroenteritis. The incidence of significant heat illness among athletes competing on the FIVB Beach Volleyball World Tour appears to be quite low, even though weather conditions frequently result in a WBGT index >32°C. Currently available guidelines appear to be inadequate to fully assess the risk of heat stress and too conservative to inform safety decisions in professional beach volleyball.

Strategies and factors associated with preparing for competing in the heat: a cohort study at the 2015 IAAF World Athletics Championships.

PubMed

Périard, Julien D; Racinais, Sébastien; Timpka, Toomas; Dahlström, Örjan; Spreco, Armin; Jacobsson, Jenny; Bargoria, Victor; Halje, Karin; Alonso, Juan-Manuel

2017-02-01

Assess exertional heat illness (EHI) history and preparedness in athletes competing in a World Athletics Championships under hot/humid conditions and identify the factors associated with preparedness strategies. Of the 207 registered national teams invited to participate in the study, 50 (24%) accepted. The 957 athletes (49% of all 1965 registered) in these teams were invited to complete a precompetition questionnaire evaluating EHI history, heat stress prevention (heat acclimatisation, precooling and hydration) and recovery. Responses from 307 (32%) athletes were separated in field events, sprints, middle-distance and long-distance running, and decathlon/heptathlon for analysis. 48% of athletes had previously experienced EHI symptoms and 8.5% had been diagnosed with EHI. 15% heat acclimatised (∼20 days) before the championships. 52% had a precooling strategy, ice slurry ingestion (24%) being the most prevalent and women using it more frequently than men (p=0.005). 96% of athletes had a fluid consumption strategy, which differed between event categories (p<0.001). The most common volumes planned on being consumed were 0.5-1 L (27.2%) and ≥2 L (21.8%), water being the most frequent. 89% of athletes planned on using at least one recovery strategy. Female sex (p=0.024) and a previous EHI diagnosis increased the likelihood of using all 3 prevention strategies (p<0.001). At a World Championships with expected hot/humid conditions, less than one-fifth of athletes heat acclimatised, half had a precooling strategy and almost all a hydration plan. Women, and especially athletes with an EHI history, were more predisposed to use a complete heat stress prevention strategy. More information regarding heat acclimatisation should be provided to protect athlete health and optimise performance at major athletics competitions in the heat. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Exertional Tolerance Assessments After Mild Traumatic Brain Injury: A Systematic Review.

PubMed

Quatman-Yates, Catherine; Bailes, Anna; Constand, Sara; Sroka, Mary Claire; Nissen, Katharine; Kurowski, Brad; Hugentobler, Jason

2018-05-01

To review the literature to identify and summarize strategies for evaluating responses to physical exertion after mild traumatic brain injury (mTBI) for clinical and research purposes. PubMed and EBSCOhost through December 31, 2016. Two independent reviewers selected studies based on the following criteria: (1) inclusion of participants with mTBI/concussion, (2) use of a measurement of physiological or psychosomatic response to exertion, (3) a repeatable description of the exertion protocol was provided, (4) a sample of at least 10 participants with a mean age between 8 and 65 years, and (5) the article was in English. The search process yielded 2685 articles, of which 14 studies met the eligibility requirements. A quality assessment using a checklist was conducted for each study by 2 independent study team members and verified by a third team member. Data were extracted by one team member and verified by a second team member. A qualitative synthesis of the studies revealed that most protocols used a treadmill or cycle ergometer as the exercise modality. Protocol methods varied across studies including differences in initial intensity determination, progression parameters, and exertion duration. Common outcome measures were self-reported symptoms, heart rate, and blood pressure. The strongest evidence indicates that exertional assessments can provide important insight about mTBI recovery and should be administered using symptoms as a guide. Additional studies are needed to verify optimal modes and protocols for post-mTBI exertional assessments. Copyright © 2017 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Metabolic Rate and Perceived Exertion of Walking in Older Adults With Idiopathic Chronic Fatigue

PubMed Central

Corbett, Duane B.; Knaggs, Jeffrey D.; Manini, Todd M.

2016-01-01

Abstract Background: Fatigue is a common complaint in older adults, often not associated with underlying medical conditions. The purpose of this study was to investigate metabolic rate (MR) of walking, walking performance, and perception-based exertion during walking in older adults with and without idiopathic chronic fatigue (ICF). Methods: 20 older adults (aged 70.8±4.9 years), reporting 2 SD above normative values of the Functional Assessment of Chronic Illness Therapy-Fatigue scale and without overt health conditions that explained their symptoms, were compared with 25 age-matched older adults (73.2±5.1 years) without fatigue symptoms. Participants walked 400 m at a rapid pace on a 20-m course. On a separate visit, oxygen consumption was measured during treadmill test at standard (40.2 m/min), preferred paces (40–83 m/min) and peak capacity. Ratings of perceived exertion (RPE) were measured at each treadmill stage and after each lap of the 400-m walk test. Results: During the 400-m walk test, individuals with ICF showed lower overall walking speed and reported a steady increase in RPE with no change observed in non-fatigued group (1.63±1.72 vs 0.27±0.68, p < .01). Similar findings on RPE were noted on treadmill test. Gross MR, mass-specific MR, mass-specific net MR, and MR as a percent of peak oxygen consumption of walking were similar between groups during standard, preferred paces and peak capacity on treadmill. Conclusions: This study suggests that ICF in older adults is not related to elevated metabolic cost of walking. Higher RPE without concomitant decreases in performance indicate a potential disconnect between metabolic output and sensations during movement. PMID:27271253

Families living with chronic illness: beliefs about illness, family, and health care.

PubMed

Årestedt, Liselott; Benzein, Eva; Persson, Carina

2015-05-01

Beliefs can be described as the lenses through which we view the world. With emerging illness, beliefs about the illness experience become important for nurses to understand to enhance well-being and healing. The aim of this study was to illuminate illness beliefs of families living with chronic illness. A qualitative design was chosen, including repeated narrative research interviews with seven Swedish families living with chronic illness. Hermeneutic analysis was used to interpret the transcribed family interviews. The result described beliefs in families, both within and across families. Both core beliefs and secondary beliefs about illness, family, and health care were revealed. Illness beliefs have importance for how families respond to and manage situations that arise from their encounters with illness. Nurses have to make space for and listen to families' stories of illness to become aware of what beliefs may support and encourage family well-being and healing. The Illness Beliefs Model provides a touchstone whereby nurses can distinguish both individual and shared beliefs within families living with chronic illness and provide ideas for family intervention if needed. © The Author(s) 2015.

Assessing Heat Stress and Health among Construction Workers in a Changing Climate: A Review

PubMed Central

Acharya, Payel; Boggess, Bethany

2018-01-01

Construction workers are at an elevated risk of heat stress, due to the strenuous nature of the work, high temperature work condition, and a changing climate. An increasing number of workers are at risk, as the industry’s growth has been fueled by high demand and vast numbers of immigrant workers entering into the U.S., the Middle East and Asia to meet the demand. The risk of heat-related illnesses is increased by the fact that little to no regulations are present and/or enforced to protect these workers. This review recognizes the issues by summarizing epidemiological studies both in the U.S. and internationally. These studies have assessed the severity with which construction workers are affected by heat stress, risk factors and co-morbidities associated with heat-related illnesses in the construction industry, vulnerable populations, and efforts in implementing preventive measures. PMID:29389908

The Impact of Illness Identity on Recovery from Severe Mental Illness.

PubMed

Yanos, Philip T; Roe, David; Lysaker, Paul H

2010-04-01

The impact of the experience and diagnosis of mental illness on one's identity has long been recognized; however, little is known about the impact of illness identity, which we define as the set of roles and attitudes that a person has developed in relation to his or her understanding of having a mental illness. The present article proposes a theoretically driven model of the impact of illness identity on the course and recovery from severe mental illness and reviews relevant research. We propose that accepting a definition of oneself as mentally ill and assuming that mental illness means incompetence and inadequacy impact hope and self-esteem, which further impact suicide risk, coping, social interaction, vocational functioning, and symptom severity. Evidence supports most of the predictions made by the model. Implications for psychiatric rehabilitation services are discussed.

Formwork pressure exerted by self-consolidating concrete

NASA Astrophysics Data System (ADS)

Omran, Ahmed Fathy

, effective ways to reduce lateral pressure by developing formulation expertise and practical guidelines to lower lateral pressure of SCC were proposed. Various design equations as well as chart diagrams to predict formwork pressure that can be exerted by SCC on column and wall elements were derived and reported. In general, the results obtained show that measured lateral pressure is lower than corresponding hydrostatic pressure. The study has shown that lateral pressure exerted by SCC is closely related to the structural build-up at rest (or thixotropy) of SCC. The latter can be controlled using different mixture proportionings, material constituents, and chemical admixtures. SCC mixture with a high rate of structural build-up at rest can develop low lateral pressure on formwork. Increased rate of structural build-up at rest can be ensured by incorporating a greater volume of coarse aggregate, lower paste volume, and/or lower sand-to-total aggregate ratio. Incorporating coarse aggregate of larger maximum size could also increase the thixotropy and hence reduce the lateral pressure. This can also be achieved by reducing the workability of SCC using less HRWRA concentration. Indeed, all mixture factors have been replaced by measuring the rate of structural build-up at rest (or thixotropy) using the developed portable vane and inclined plane field-oriented test as well as the modified Tattersall MK-III concrete rheometer. On the other hand, increasing or maintaining the concrete temperature at a certain level plays an important role to reduce the lateral pressure. The higher concrete temperature can accelerate the heat of hydration of cement with water and increase the internal friction leading to higher thixotropy. Controlling the placement rate has a great impact on the resultant lateral pressure of SCC. The lateral pressure can be reduced by slowing down the casting rate, as concrete has more time to build-up. However, this can slow down the rate of construction. The casting

High-volume plasma exchange in a patient with acute liver failure due to non-exertional heat stroke in a sauna.

PubMed

Chen, Kuan-Jung; Chen, Tso-Hsiao; Sue, Yuh-Mou; Chen, Tzay-Jinn; Cheng, Chung-Yi

2014-10-01

Heat stroke is a life-threatening condition characterized by an increased core body temperature (over 40°C) and a systemic inflammatory response, which may lead to a syndrome of multiple organ dysfunction. Heat stroke may be due to either strenuous exercise or non-exercise-induced exposure to a high environmental temperature. Current management of heat stroke is mostly supportive, with an emphasis on cooling the core body temperature and preventing the development of multiple organ dysfunction. Prognosis of heat stroke depends on the severity of organ involvement. Here, we report a rare case of non-exercise-induced heat stroke in a 73-year-old male patient who was suffering from acute liver failure after prolonged exposure in a hot sauna room. We successfully managed this patient by administering high-volume plasma exchange, and the patient recovered completely after treatment. © 2014 Wiley Periodicals, Inc.

Occurrence of injuries and illnesses during the 2009 IAAF World Athletics Championships.

PubMed

Alonso, Juan-Manuel; Tscholl, Philippe M; Engebretsen, Lars; Mountjoy, Margo; Dvorak, Jiri; Junge, Astrid

2010-12-01

To analyse the frequency and characteristics of sports injuries and illnesses incurred during the World Athletics Championships. Prospective recording of newly occurred injuries and illnesses. Twelfth International Association of Athletics Federations World Championships in Athletics 2009 in Berlin, Germany. National team physicians and physiotherapists and 1979 accredited athletes; Local Organising Committee physicians working in the Medical Centres. Incidence and characteristics of newly incurred injuries and illnesses. 236 injury incidents with 262 injured body parts and 269 different injury types were reported, representing an incidence of 135.4 injuries per 1000 registered athletes. Eighty percent affected the lower extremity. Thigh strain (13.8%) was the main diagnosis. Overuse (44.1%) was the predominant cause. Most injuries were incurred during competition (85.9%). About 43.8% of all injury events were expected to result in time-loss. 135 illnesses were reported, signifying an incidence of 68.2 per 1000 registered athletes. Upper respiratory tract infection was the most common condition (30.4%) and infection was the most frequent cause (32.6%). The incidence of injury and illnesses varied substantially among the events. The risk of injury varied with each discipline. Preventive measures should be specific and focused on minimising the potential for overuse. Attention should be paid to ensure adequate rehabilitation of previous injuries. The addition of the illness part to the injury surveillance system proved to be feasible. As most illnesses were caused by infection of the respiratory tract or were environmentally related, preventive interventions should focus on decreasing the risk of transmission, appropriate event scheduling and heat acclimatisation.

Climate Change and the Emergent Epidemic of CKD from Heat Stress in Rural Communities: The Case for Heat Stress Nephropathy.

PubMed

Glaser, Jason; Lemery, Jay; Rajagopalan, Balaji; Diaz, Henry F; García-Trabanino, Ramón; Taduri, Gangadhar; Madero, Magdalena; Amarasinghe, Mala; Abraham, Georgi; Anutrakulchai, Sirirat; Jha, Vivekanand; Stenvinkel, Peter; Roncal-Jimenez, Carlos; Lanaspa, Miguel A; Correa-Rotter, Ricardo; Sheikh-Hamad, David; Burdmann, Emmanuel A; Andres-Hernando, Ana; Milagres, Tamara; Weiss, Ilana; Kanbay, Mehmet; Wesseling, Catharina; Sánchez-Lozada, Laura Gabriela; Johnson, Richard J

2016-08-08

Climate change has led to significant rise of 0.8°C-0.9°C in global mean temperature over the last century and has been linked with significant increases in the frequency and severity of heat waves (extreme heat events). Climate change has also been increasingly connected to detrimental human health. One of the consequences of climate-related extreme heat exposure is dehydration and volume loss, leading to acute mortality from exacerbations of pre-existing chronic disease, as well as from outright heat exhaustion and heat stroke. Recent studies have also shown that recurrent heat exposure with physical exertion and inadequate hydration can lead to CKD that is distinct from that caused by diabetes, hypertension, or GN. Epidemics of CKD consistent with heat stress nephropathy are now occurring across the world. Here, we describe this disease, discuss the locations where it appears to be manifesting, link it with increasing temperatures, and discuss ongoing attempts to prevent the disease. Heat stress nephropathy may represent one of the first epidemics due to global warming. Government, industry, and health policy makers in the impacted regions should place greater emphasis on occupational and community interventions. Copyright © 2016 by the American Society of Nephrology.

Heat Control via Torque Control in Friction Stir Welding

NASA Technical Reports Server (NTRS)

Venable, Richard; Colligan, Kevin; Knapp, Alan

2004-01-01

In a proposed advance in friction stir welding, the torque exerted on the workpiece by the friction stir pin would be measured and controlled in an effort to measure and control the total heat input to the workpiece. The total heat input to the workpiece is an important parameter of any welding process (fusion or friction stir welding). In fusion welding, measurement and control of heat input is a difficult problem. However, in friction stir welding, the basic principle of operation affords the potential of a straightforward solution: Neglecting thermal losses through the pin and the spindle that supports it, the rate of heat input to the workpiece is the product of the torque and the speed of rotation of the friction stir weld pin and, hence, of the spindle. Therefore, if one acquires and suitably processes data on torque and rotation and controls the torque, the rotation, or both, one should be able to control the heat input into the workpiece. In conventional practice in friction stir welding, one uses feedback control of the spindle motor to maintain a constant speed of rotation. According to the proposal, one would not maintain a constant speed of rotation: Instead, one would use feedback control to maintain a constant torque and would measure the speed of rotation while allowing it to vary. The torque exerted on the workpiece would be estimated as the product of (1) the torque-multiplication ratio of the spindle belt and/or gear drive, (2) the force measured by a load cell mechanically coupled to the spindle motor, and (3) the moment arm of the load cell. Hence, the output of the load cell would be used as a feedback signal for controlling the torque (see figure).

Chronic exertional compartment syndrome with medial tibial stress syndrome in twins.

PubMed

Banerjee, Purnajyoti; McLean, Christopher

2011-06-14

Chronic exertional compartment syndrome and medial tibial stress syndrome are uncommon conditions that affect long-distance runners or players involved in team sports that require extensive running. We report 2 cases of bilateral chronic exertional compartment syndrome, with medial tibial stress syndrome in identical twins diagnosed with the use of a Kodiag monitor (B. Braun Medical, Sheffield, United Kingdom) fulfilling the modified diagnostic criteria for chronic exertional compartment syndrome as described by Pedowitz et al, which includes: (1) pre-exercise compartment pressure level >15 mm Hg; (2) 1 minute post-exercise pressure >30 mm Hg; and (3) 5 minutes post-exercise pressure >20 mm Hg in the presence of clinical features. Both patients were treated with bilateral anterior fasciotomies through minimal incision and deep posterior fasciotomies with tibial periosteal stripping performed through longer anteromedial incisions under direct vision followed by intensive physiotherapy resulting in complete symptomatic recovery. The etiology of chronic exertional compartment syndrome is not fully understood, but it is postulated abnormal increases in intramuscular pressure during exercise impair local perfusion, causing ischemic muscle pain. No familial predisposition has been reported to date. However, some authors have found that no significant difference exists in the relative perfusion, in patients, diagnosed with chronic exertional compartment syndrome. Magnetic resonance images of affected compartments have indicated that the pain is not due to ischemia, but rather from a disproportionate oxygen supply versus demand. We believe this is the first report of chronic exertional compartment syndrome with medial tibial stress syndrome in twins, raising the question of whether there is a genetic predisposition to the causation of these conditions. Copyright 2011, SLACK Incorporated.

Illness behavior.

PubMed

Sirri, Laura; Grandi, Silvana

2012-01-01

The term illness behavior was introduced by Mechanic and Volkart to describe the individuals' different ways to respond to their own health status. Pilowsky's concept of abnormal illness behavior encompasses several clinical conditions characterized by a maladaptive mode of experiencing, perceiving, evaluating and responding to one's own health status. The concept of somatization was criticized because it implies the presence of psychological distress or an underlying psychiatric disturbance when an organic cause for somatic symptoms is not found. Thus, more atheoretical terms , such as functional somatic symptoms and medically unexplained symptoms, were introduced. Both Kellner's Symptom Questionnaire and Derogatis' Symptom Checklist-90 include a scale for somatic symptoms, and other questionnaires were specifically designed to measure their frequency and severity. Kellner's Illness Attitude Scales appear to be the gold standard for the measurement of the hypochondriacal spectrum, which includes several clinical conditions, such as nosophobia, thanatophobia and health anxiety. The assessment of illness denial should consider that a certain degree of denial may sometimes prevent patients from overwhelming psychological distress resulting from life-threatening or stigmatized diseases. Denial may concern both physical and psychiatric symptoms. Specific instruments are available for both types of denial. The cognitive and emotional representations developed by subjects when they have to cope with an illness or a perceived health threat are subsumed under the concept of illness perception and may be assessed by the Brief Illness Perception Questionnaire. Copyright © 2012 S. Karger AG, Basel.

The Epidemiology of Occupational Heat-Related Morbidity and Mortality in the United States: A Review of the Literature and Assessment of Research Needs in a Changing Climate

PubMed Central

Gubernot, Diane M.; Anderson, G. Brooke; Hunting, Katherine L.

2014-01-01

In recent years, the United States has experienced record-breaking summer heat. Climate change models forecast increasing U.S. temperatures and more frequent heat waves in coming years. This scoping review summarizes research findings that characterize U.S. occupational heat-related morbidity and mortality and identifies gaps in the existing research literature. Exposure to environmental heat is a significant, but overlooked, workplace hazard that has not been well-characterized or studied. The working population is diverse; job function, age, fitness level, and risk factors to heat-related illnesses vary. This review found that few studies examine or characterize the incidence of occupational heat-related illnesses and outcomes. More research on the effects of occupational heat exposure is needed to identify and implement evidence-based policies and interventions. Since heat-related health hazards at work can be anticipated before they manifest, preventive measures can be implemented before illness occurs. With no federal regulatory standards to protect workers from environmental heat exposure, and with climate change as a driver for adaptation and prevention of heat disorders, crafting policy to characterize and prevent occupational heat stress for all workers is increasingly sensible, practical, and imperative. PMID:24326903

Life-threatening heat stroke presenting with ST elevations: a report of consecutive cases during the heat wave in Austria in July 2013.

PubMed

Lassnig, Elisabeth; Dinkhauser, Patrick; Maurer, Edwin; Eber, Bernd

2014-08-01

Heat stroke is a life-threatening condition due to an acute thermoregulatory failure during exposure to high environmental temperatures. We report a series of four cases (three exertional, one classic heat stroke) during the heat wave of July 2013 in Austria. All of them presented with a core temperature > 41 °C, central nervous dysfunction, acute respiratory and renal failure, disseminated intravascular coagulation, rhabdomyolysis, and severe electrocardiographic changes, two cases even mimicking ST-elevation myocardial infarction. The patients were cooled to normal temperature with the "Arctic sun" external cooling system within hours. Electrocardiographic changes resolved quickly. All patients primarily recovered from multiple organ dysfunction and could be discharged from intensive care unit. Unfortunately, the two elder patients died 1 week and 5 weeks later because of late complications.

The prevalence and preventive measures of the respiratory illness among Malaysian pilgrims in 2013 Hajj season.

PubMed

Hashim, Suhana; Ayub, Zeti N; Mohamed, Zeehaida; Hasan, Habsah; Harun, Azian; Ismail, Nabilah; Rahman, Zaidah A; Suraiya, Siti; Naing, Nyi Nyi; Aziz, Aniza A

2016-02-01

Respiratory illness continues to exert a burden on hajj pilgrims in Makkah. The purpose of this study is to determine the prevalence of respiratory illness and its associated factors among Malaysian hajj pilgrims in 2013 and to describe its preventive measures. A cross-sectional study was conducted in Makkah and Malaysia during the 2013 hajj season. A self-administered proforma on social demographics, previous experience of hajj or umrah, smoking habits, co-morbid illness and practices of preventive measures against respiratory illness were obtained. A total of 468 proforma were analysed. The prevalence of the respiratory illness was 93.4% with a subset of 78.2% fulfilled the criteria for influenza-like illness (ILI). Most of them (77.8%) had a respiratory illness of <2 weeks duration. Approximately 61.8% were administered antibiotics but only 2.1% of them had been hospitalized. Most of them acquired the infection after a brief stay at Arafat (81.2%). Vaccination coverages for influenza virus and pneumococcal disease were quite high, 65.2% and 59.4%, respectively. For other preventive measures practices, only 31.8% of them practiced good hand hygiene, ∼82.9% of pilgrims used surgical face masks, N95 face masks, dry towels, wet towels or veils as their face masks. Nearly one-half of the respondents (44.4%) took vitamins as their food supplement. Malaysian hajj pilgrims with previous experience of hajj (OR 0.24; 95% CI 0.10-0.56) or umrah (OR 0.19; 95% CI 0.07-0.52) and those who have practiced good hand hygiene (OR 0.35; 95% CI 0.16-0.79) were found to be significantly associated with lower risk of having respiratory illness. Otherwise, pilgrims who had contact with those with respiratory illness (OR 2.61; 95% CI 1.12-6.09) was associated with higher risk. The prevalence of respiratory illness remains high among Malaysian hajj pilgrims despite having some practices of preventive measures. All preventive measures which include hand hygiene, wearing face masks and

Chronic exertional compartment syndrome of the superficial posterior compartment: Soleus syndrome.

PubMed

Gross, Christopher E; Parekh, Bela J; Adams, Samuel B; Parekh, Selene G

2015-01-01

Chronic exertional compartment syndrome (CECS) represents the second most-common cause of exertional leg pain with incidence of 27-33%. CECS of the superficial posterior compartment, or soleus syndrome, is rare and has only been discussed briefly in the literature. We discuss the management of two patients with bilateral soleus syndrome or CECS of the superficial posterior compartment.

Use of Biomarkers to Optimize Heat Acclimation in Women

DTIC Science & Technology

1996-10-01

that synthesis of HSP72 was induced in lymphocytes, spleen cells and soleus muscle after 20 min of exercise while rectal temperature elevated above 40...lethal temperatures for death due to nonexertionally and exertionally induced heat exhaustion, respectively (15). Upon completion of the exercise ...During exercise , interstitial fluid levels are reduced due to sweat formation and fluid shifts which tend to induce hypovolemia, compromising

Medical students' attitudes to mental illnesses and to psychiatry before and after the psychiatric clerkship: Training in a specialty and a general hospital.

PubMed

Economou, Marina; Kontoangelos, Kontantinos; Peppou, Lily Evangelia; Arvaniti, Aikaterini; Samakouri, Maria; Douzenis, Athanasios; Papadimitriou, George N

2017-12-01

Medical students' attitudes to mental illnesses and psychiatry may be reshaped during the psychiatric training, with important implications in their future practice of the profession. Therefore, the present study set out to explore the impact of the psychiatric clerkship in students' attitudes, while taking into consideration the site of their practical training. To this end, a total of 678 final-year medical students were recruited. Students completed a self-reported questionnaire entailing the Attitudes to Psychiatry scale, the Attitudes to Mental Illness scale and the Greek Social Distance scale before and after their placement. Findings indicate that the psychiatric clerkship had a positive effect in reducing stigma towards both psychiatry and mental illnesses, with the effect being more pronounced in the general hospital with respect to the former, while in the specialty hospital was more marked regarding the latter. A further exploration of the determinants of change revealed that the improvement discerned in the general hospital was only among those without professional experience of mental illnesses. Therefore, the psychiatric clerkship may exert a substantial influence on shaping favourable attitudes towards mental illnesses and psychiatry; however, other elements should also be taken into consideration, if the clerkship is to tackle stigma in healthcare. Copyright © 2017 Elsevier B.V. All rights reserved.

Stigma in mental illness: attitudes of medical students towards mental illness.

PubMed

Mas, A; Hatim, A

2002-12-01

Negative attitudes towards people with mental illness can be attributed to stigma. The objective of this study was to determine the attitudes of medical students towards mental illness by comparing those who have had contact with mental patients and those who have not. This study also assesses to what extent knowledge about mental illness can affect the students' attitude. A vignette and two dependent measures (social distance scale and dangerousness scale) were used to assess the attitudes of medical students towards mental illness. They comprised of 108 first year and 85 final year medical students in University of Malaya, Kuala Lumpur. The first year students didn't have any prior psychiatric training. The final year students who had knowledge and contact (undergone 8 weeks of clinical psychiatric training) were less stigmatizing toward mentally ill patients. There were no significant differences in the attitudes towards mentally ill patient among the first year students (no knowledge) regardless they had previous contact or not. Knowledge seems to have the effect in inculcating greater tolerance of mental illness. Contact by itself is not sufficient for attitude changes.

Cost of illness and illness perceptions in patients with fibromyalgia.

PubMed

Vervoort, Vera M; Vriezekolk, Johanna E; Olde Hartman, Tim C; Cats, Hans A; van Helmond, Toon; van der Laan, Willemijn H; Geenen, Rinie; van den Ende, Cornelia H

2016-01-01

The disease impact and economic burden of fibromyalgia (FM) are high for patients and society at large. Knowing potential determinants of economic costs may help in reducing this burden. Cognitive appraisals (perceptions) of the illness could affect costs. The present study estimated costs of illness in FM and examined the association between these costs and illness perceptions. Questionnaire data of FM severity (FIQ), illness perceptions (IPQ-R-FM), productivity losses (SF-HLQ) and health care use were collected in a cohort of patients with FM. Costs were calculated and dichotomised (median split). Univariate and hierarchic logistic regression models examined the unique association of each illness perception with 1) health care costs and 2) costs of productivity losses. Covariates were FM severity, comorbidity and other illness perceptions. 280 patients participated: 95% female, mean age 42 (SD=12) years. Annualised costs of FM per patient were €2944 for health care, and €5731 for productivity losses. In multivariate analyses, a higher disease impact (FIQ) and two of seven illness perceptions (IPQ-R-FM) were associated with high health care costs: 1) high scores on 'cyclical timeline' reflecting a fluctuating, unpredictable course and 2) low scores on 'emotional representations', thus not perceiving a connection between fibromyalgia and emotions. None of the variables was associated with productivity losses. Our study indicates that perceiving a fluctuating course and low emotional representation, which perhaps reflects somatic fixation, are associated with health care costs in FM. Future studies should examine whether targeting these illness perceptions results in reduction of costs.

A Comparison of a Maximum Exertion Method and a Model-Based, Sub-Maximum Exertion Method for Normalizing Trunk EMG

PubMed Central

Cholewicki, Jacek; van Dieën, Jaap; Lee, Angela S.; Reeves, N. Peter

2011-01-01

The problem with normalizing EMG data from patients with painful symptoms (e.g. low back pain) is that such patients may be unwilling or unable to perform maximum exertions. Furthermore, the normalization to a reference signal, obtained from a maximal or sub-maximal task, tends to mask differences that might exist as a result of pathology. Therefore, we presented a novel method (GAIN method) for normalizing trunk EMG data that overcomes both problems. The GAIN method does not require maximal exertions (MVC) and tends to preserve distinct features in the muscle recruitment patterns for various tasks. Ten healthy subjects performed various isometric trunk exertions, while EMG data from 10 muscles were recorded and later normalized using the GAIN and MVC methods. The MVC method resulted in smaller variation between subjects when tasks were executed at the three relative force levels (10%, 20%, and 30% MVC), while the GAIN method resulted in smaller variation between subjects when the tasks were executed at the three absolute force levels (50 N, 100 N, and 145 N). This outcome implies that the MVC method provides a relative measure of muscle effort, while the GAIN-normalized EMG data gives an estimate of the absolute muscle force. Therefore, the GAIN-normalized EMG data tends to preserve the EMG differences between subjects in the way they recruit their muscles to execute various tasks, while the MVC-normalized data will tend to suppress such differences. The appropriate choice of the EMG normalization method will depend on the specific question that an experimenter is attempting to answer. PMID:21665489

Heat stress intervention research in construction: gaps and recommendations.

PubMed

Yang, Yang; Chan, Albert Ping-Chuen

2017-06-08

Developing heat stress interventions for construction workers has received mounting concerns in recent years. However, limited efforts have been exerted to elaborate the rationale, methodology, and practicality of heat stress intervention in the construction industry. This study aims to review previous heat stress intervention research in construction, to identify the major research gaps in methodological issues, and to offer detailed recommendations for future studies. A total of 35 peer-reviewed journal papers have been identified to develop administrative, environmental or personal engineering interventions to safeguard construction workers. It was found that methodological limitations, such as arbitrary sampling methods and unreliable instruments, could be the major obstacle in undertaking heat stress intervention research. To bridge the identified research gaps, this study then refined a research framework for conducting heat stress intervention studies in the construction industry. The proposed research strategy provides researchers and practitioners with fresh insights into expanding multidisciplinary research areas and solving practical problems in the management of heat stress. The proposed research framework may foster the development of heat stress intervention research in construction, which further aids researchers, practitioners, and policymakers in formulating proper intervention strategies.

The Influence of a Bout of Exertion on Novice Barefoot Running Dynamics

PubMed Central

Hashish, Rami; Samarawickrame, Sachithra D.; Baker, Lucinda; Salem, George J.

2016-01-01

Barefoot, forefoot strike (FFS) running has recently risen in popularity. Relative to shod, rear-foot strike (RFS) running, employing a FFS is associated with heightened triceps surae muscle activation and ankle mechanical demand. Novice to this pattern, it is plausible that habitually shod RFS runners exhibit fatigue to the triceps surae when acutely transitioning to barefoot running, thereby limiting their ability to attenuate impact. Therefore, the purpose was to determine how habitually shod RFS runners respond to an exertion bout of barefoot running, operationally defined as a barefoot run 20% of mean daily running distance. Twenty-one RFS runners performed novice barefoot running, before and after exertion. Ankle peak torque, triceps surae EMG median frequency, foot-strike patterns, joint energy absorption, and loading rates were evaluated. Of the 21 runners, 6 maintained a RFS, 10 adopted a mid-foot strike (MFS), and 5 adopted a FFS during novice barefoot running. In-response to exertion, MFS and FFS runners demonstrated reductions in peak torque, median frequency, and ankle energy absorption, and an increase in loading rate. RFS runners demonstrated reductions in peak torque and loading rate. These results indicate that a short bout of running may elicit fatigue to novice barefoot runners, limiting their ability to attenuate impact. Key points In response to exertion, novice barefoot runners demonstrate fatigue to their soleus. In response to exertion, novice barefoot runners demonstrate a reduction in ankle energy absorption In response to exertion, novice barefoot runners demonstrate an increase in loading rate PMID:27274672

The Influence of a Bout of Exertion on Novice Barefoot Running Dynamics.

PubMed

Hashish, Rami; Samarawickrame, Sachithra D; Baker, Lucinda; Salem, George J

2016-06-01

Barefoot, forefoot strike (FFS) running has recently risen in popularity. Relative to shod, rear-foot strike (RFS) running, employing a FFS is associated with heightened triceps surae muscle activation and ankle mechanical demand. Novice to this pattern, it is plausible that habitually shod RFS runners exhibit fatigue to the triceps surae when acutely transitioning to barefoot running, thereby limiting their ability to attenuate impact. Therefore, the purpose was to determine how habitually shod RFS runners respond to an exertion bout of barefoot running, operationally defined as a barefoot run 20% of mean daily running distance. Twenty-one RFS runners performed novice barefoot running, before and after exertion. Ankle peak torque, triceps surae EMG median frequency, foot-strike patterns, joint energy absorption, and loading rates were evaluated. Of the 21 runners, 6 maintained a RFS, 10 adopted a mid-foot strike (MFS), and 5 adopted a FFS during novice barefoot running. In-response to exertion, MFS and FFS runners demonstrated reductions in peak torque, median frequency, and ankle energy absorption, and an increase in loading rate. RFS runners demonstrated reductions in peak torque and loading rate. These results indicate that a short bout of running may elicit fatigue to novice barefoot runners, limiting their ability to attenuate impact. Key pointsIn response to exertion, novice barefoot runners demonstrate fatigue to their soleus.In response to exertion, novice barefoot runners demonstrate a reduction in ankle energy absorptionIn response to exertion, novice barefoot runners demonstrate an increase in loading rate.

Housing conditions, respiratory illness, and lung function in children in South Wales.

PubMed Central

Yarnell, J W; St Leger, A S

1977-01-01

The hypothesis was tested that respiratory illness in children occurs more commonly in old housing than in housing built to modern standards. Three areas of housing were chosen in a South Wales valley: a recently constructed council estate with district central heating; a modern council estate heated with open coal fires; and an area of much older, traditional valley housing. Mothers reported the greatest proportion of children free of colds and sore throats during the previous 12 months in the area of traditional valley housing; mothers of children in the centrally heated estate reported the least proportion of children free of colds. Children's lung function was best in the area of traditional valley housing and worst in the centrally heated council estate. Data on demographic indices and respiratory morbidity suggest that the inhabitants of the two council estates have comparable characteristics. Another hypothesis which may explain the findings is proposed. PMID:588858

Motivational incentives lead to a strong increase in lateral prefrontal activity after self-control exertion

PubMed Central

Luethi, Matthias S.; Binder, Julia; Boesiger, Peter; Luechinger, Roger; Rasch, Björn

2016-01-01

Self-control is key to success in life. Initial acts of self-control temporarily impair subsequent self-control performance. Why such self-control failures occur is unclear, with prominent models postulating a loss of a limited resource vs a loss of motivation, respectively. Here, we used functional magnetic resonance imaging to identify the neural correlates of motivation-induced benefits on self-control. Participants initially exerted or did not exert self-control. In a subsequent Stroop task, participants performed worse after exerting self-control, but not if they were motivated to perform well by monetary incentives. On the neural level, having exerted self-control resulted in decreased activation in the left inferior frontal gyrus. Increasing motivation resulted in a particularly strong activation of this area specifically after exerting self-control. Thus, after self-control exertion participants showed more prefrontal neural activity without improving performance beyond baseline level. These findings suggest that impaired performance after self-control exertion may not exclusively be due to a loss of motivation. PMID:27217108

Post-exertion neurocognitive test failure among student-athletes following concussion.

PubMed

McGrath, Neal; Dinn, Wayne M; Collins, Michael W; Lovell, Mark R; Elbin, R J; Kontos, Anthony P

2013-01-01

The purpose of the present study was to examine post-exertion (PE) neurocognitive performance among student-athletes following concussion who were asymptomatic and returned to baseline normal neurocognitive test levels at rest. This study examined the neurocognitive performance of a sub-set of student-athletes who 'failed' to perform at baseline levels of neurocognitive function, i.e. exhibited downward reliable change index (RCI) alterations following a moderate exertional protocol during recovery from concussion. A retrospective records review was carried out of Immediate Post-concussion Assessment and Cognitive Testing (ImPACT) and neuropsychological consultation data among athletes with sports-related concussion from a network of 22 schools and one junior hockey programme. Fifty-four student-athletes met inclusion criteria and participated in the study. A total of 27.7% of concussed student-athletes who were symptom-free and returned to baseline on ImPACT at rest (i.e. no longer demonstrated performance deficits on neurocognitive tests) exhibited cognitive decline following moderate physical exertion. The PE cognitive changes were not simply general performance effects, but significant changes in memory ability in the presence of intact processing speed functions. The PE-Pass and PE-Fail groups did not, however, differ on post-concussive symptoms or concussion history. Clinicians' return-to-play evaluation protocols should include post-exertional computerized neurocognitive testing.

Ways of increasing muscular activity by means of isometric muscular exertion

NASA Technical Reports Server (NTRS)

Kovalik, A. V.

1980-01-01

The effect of isometric muscular exertion on the human body was investigated by having subjects perform basic movements in a sitting position in the conventional manner with additional muscle tension at 50% maximum force and at maximum force. The pulse, arterial pressure, skin temperature, respiratory rate, minute respiratory volume and electrical activity of the muscles involved were all measured. Performance of the exercises with maximum muscular exertion for 20 sec and without movement resulted in the greatest shifts in these indices; in the conventional manner substantial changes did not occur; and with isometric muscular exertion with 50% maximum force with and without movement, optimal functional shifts resulted. The latter is recommended for use in industrial exercises for the prevention of hypodynamia. Ten exercises are suggested.

Insights into the role of heat shock protein 72 to whole-body heat acclimation in humans

PubMed Central

Amorim, Fabiano Trigueiro; Fonseca, Ivana T; Machado-Moreira, Christiano A; Magalhães, Flávio de Castro

2015-01-01

Abstract Heat acclimation results in systemic and cellular adaptions that reduce the negative effect of heat and, consequently, the risk of heat illness. Although the classical changes observed with heat acclimation lead to increased tolerance to exercise in the heat by reducing heat storage (reflected in reduced core and skin temperatures) and increasing whole-body capacity for heat dissipation (greater plasma volume, sweat output, and skin blood flow), it appears that heat acclimation also induces changes at the cellular level that might increase tolerance of the whole organism to a higher core temperature for the development of fatigue. Thermotolerance is a process that involves increased resilience to an otherwise lethal heat stress that follows a sublethal exposure to heat. Thermotolerance is believed to be the result of increased content of heat shock proteins (Hsp), specially a member of the 70 kDa family, Hsp72 kDa. In humans, we and others have reported that heat acclimation increases intracellular Hsp72 levels. This increase in intracellular Hsp72 could improve whole-body organism thermotolerance by maintaining intestinal epithelial tight junction barriers, by increasing resistance to gut-associated endotoxin translocation, or by reducing the inflammatory response. In this review, we will initially provide an overview of the physiological adaptations induced by heat acclimation and emphasize the main cellular changes that occur with heat acclimation associated with intracellular accumulation of Hsp72. Finally, we will present an argument for a role of whole-body heat acclimation in augmenting cellular thermotolerance, which may protect vital organs from deleterious effects of heat stress in humans. PMID:27227070

Physical exertion and immediate mental performance of sixth-grade children.

PubMed

McNaughten, D; Gabbard, C

1993-12-01

The intent of this investigation was to examine the potential influence of varying durations of physical exertion at different times of the day on immediate mathematical performance by 120 sixth-grade boys and girls. Subjects were assigned to two control and two treatment groups (Solomon Four-group Design), with treated subjects administered physical exertion (paced walking at controlled moderate intensity) for durations of 20, 30, and 40 min. at three different times of the school day [8:30 a.m., 11:50 a.m. (before lunch), 2:20 p.m.] over 3 weeks. After each exertion session, subjects were immediately administered a 90-sec. mathematical computation test. Analysis indicated no significant differences in mathematical performance at any duration in the morning, but scores were significantly higher at 11:50 a.m. and 2:20 p.m. at 30- and 40-min. durations in comparison to the 20-min. duration. There were no differences by gender of subject.

A cross-sectional, randomized cluster sample survey of household vulnerability to extreme heat among slum dwellers in ahmedabad, india.

PubMed

Tran, Kathy V; Azhar, Gulrez S; Nair, Rajesh; Knowlton, Kim; Jaiswal, Anjali; Sheffield, Perry; Mavalankar, Dileep; Hess, Jeremy

2013-06-18

Extreme heat is a significant public health concern in India; extreme heat hazards are projected to increase in frequency and severity with climate change. Few of the factors driving population heat vulnerability are documented, though poverty is a presumed risk factor. To facilitate public health preparedness, an assessment of factors affecting vulnerability among slum dwellers was conducted in summer 2011 in Ahmedabad, Gujarat, India. Indicators of heat exposure, susceptibility to heat illness, and adaptive capacity, all of which feed into heat vulnerability, was assessed through a cross-sectional household survey using randomized multistage cluster sampling. Associations between heat-related morbidity and vulnerability factors were identified using multivariate logistic regression with generalized estimating equations to account for clustering effects. Age, preexisting medical conditions, work location, and access to health information and resources were associated with self-reported heat illness. Several of these variables were unique to this study. As sociodemographics, occupational heat exposure, and access to resources were shown to increase vulnerability, future interventions (e.g., health education) might target specific populations among Ahmedabad urban slum dwellers to reduce vulnerability to extreme heat. Surveillance and evaluations of future interventions may also be worthwhile.

Comparison of the force exerted by hippocampal and DRG growth cones.

PubMed

Amin, Ladan; Ercolini, Erika; Ban, Jelena; Torre, Vincent

2013-01-01

Mechanical properties such as force generation are fundamental for neuronal motility, development and regeneration. We used optical tweezers to compare the force exerted by growth cones (GCs) of neurons from the Peripheral Nervous System (PNS), such as Dorsal Root Ganglia (DRG) neurons, and from the Central Nervous System (CNS) such as hippocampal neurons. Developing GCs from dissociated DRG and hippocampal neurons were obtained from P1-P2 and P10-P12 rats. Comparing their morphology, we observed that the area of GCs of hippocampal neurons was 8-10 µm(2) and did not vary between P1-P2 and P10-P12 rats, but GCs of DRG neurons were larger and their area increased from P1-P2 to P10-P12 by 2-4 times. The force exerted by DRG filopodia was in the order of 1-2 pN and never exceeded 5 pN, while hippocampal filopodia exerted a larger force, often in the order of 5 pN. Hippocampal and DRG lamellipodia exerted lateral forces up to 20 pN, but lamellipodia of DRG neurons could exert a vertical force larger than that of hippocampal neurons. Force-velocity relationships (Fv) in both types of neurons had the same qualitative behaviour, consistent with a common autocatalytic model of force generation. These results indicate that molecular mechanisms of force generation of GC from CNS and PNS neurons are similar but the amplitude of generated force is influenced by their cytoskeletal properties.

Comparison of the Force Exerted by Hippocampal and DRG Growth Cones

PubMed Central

Amin, Ladan; Ercolini, Erika; Ban, Jelena; Torre, Vincent

2013-01-01

Mechanical properties such as force generation are fundamental for neuronal motility, development and regeneration. We used optical tweezers to compare the force exerted by growth cones (GCs) of neurons from the Peripheral Nervous System (PNS), such as Dorsal Root Ganglia (DRG) neurons, and from the Central Nervous System (CNS) such as hippocampal neurons. Developing GCs from dissociated DRG and hippocampal neurons were obtained from P1-P2 and P10-P12 rats. Comparing their morphology, we observed that the area of GCs of hippocampal neurons was 8-10 µm2 and did not vary between P1-P2 and P10-P12 rats, but GCs of DRG neurons were larger and their area increased from P1-P2 to P10-P12 by 2-4 times. The force exerted by DRG filopodia was in the order of 1-2 pN and never exceeded 5 pN, while hippocampal filopodia exerted a larger force, often in the order of 5 pN. Hippocampal and DRG lamellipodia exerted lateral forces up to 20 pN, but lamellipodia of DRG neurons could exert a vertical force larger than that of hippocampal neurons. Force-velocity relationships (Fv) in both types of neurons had the same qualitative behaviour, consistent with a common autocatalytic model of force generation. These results indicate that molecular mechanisms of force generation of GC from CNS and PNS neurons are similar but the amplitude of generated force is influenced by their cytoskeletal properties. PMID:23991169

Real-Time Classification of Exercise Exertion Levels Using Discriminant Analysis of HRV Data.

PubMed

Jeong, In Cheol; Finkelstein, Joseph

2015-01-01

Heart rate variability (HRV) was shown to reflect activation of sympathetic nervous system however it is not clear which set of HRV parameters is optimal for real-time classification of exercise exertion levels. There is no studies that compared potential of two types of HRV parameters (time-domain and frequency-domain) in predicting exercise exertion level using discriminant analysis. The main goal of this study was to compare potential of HRV time-domain parameters versus HRV frequency-domain parameters in classifying exercise exertion level. Rest, exercise, and recovery categories were used in classification models. Overall 79.5% classification agreement by the time-domain parameters as compared to overall 52.8% classification agreement by frequency-domain parameters demonstrated that the time-domain parameters had higher potential in classifying exercise exertion levels.

Hospitalizations for heat-stress illness varies between rural and urban areas: an analysis of Illinois data, 1987-2014.

PubMed

Jagai, Jyotsna S; Grossman, Elena; Navon, Livia; Sambanis, Apostolis; Dorevitch, Samuel

2017-04-07

The disease burden due to heat-stress illness (HSI), which can result in significant morbidity and mortality, is expected to increase as the climate continues to warm. In the United States (U.S.) much of what is known about HSI epidemiology is from analyses of urban heat waves. There is limited research addressing whether HSI hospitalization risk varies between urban and rural areas, nor is much known about additional diagnoses of patients hospitalized for HSI. Hospitalizations in Illinois for HSI (ICD-9-CM codes 992.x or E900) in the months of May through September from 1987 to 2014 (n = 8667) were examined. Age-adjusted mean monthly hospitalization rates were calculated for each county using U.S. Census population data. Counties were categorized into five urban-rural strata using Rural Urban Continuum Codes (RUCC) (RUCC1, most urbanized to RUCC5, thinly populated). Average maximum monthly temperature (°C) was calculated for each county using daily data. Multi-level linear regression models were used, with county as the fixed effect and temperature as random effect, to model monthly hospitalization rates, adjusting for the percent of county population below the poverty line, percent of population that is Non-Hispanic Black, and percent of the population that is Hispanic. All analyses were stratified by county RUCC. Additional diagnoses of patients hospitalized for HSI and charges for hospitalization were summarized. Highest rates of HSI hospitalizations were seen in the most rural, thinly populated stratum (mean annual summer hospitalization rate of 1.16 hospitalizations per 100,000 population in the thinly populated strata vs. 0.45 per 100,000 in the metropolitan urban strata). A one-degree Celsius increase in maximum monthly average temperature was associated with a 0.34 increase in HSI hospitalization rate per 100,000 population in the thinly populated counties compared with 0.02 per 100,000 in highly urbanized counties. The most common additional

Extracellular and cellular Hsp72 differ as biomarkers in acute exercise/environmental stress and recovery.

PubMed

Lee, E C-H; Muñoz, C X; McDermott, B P; Beasley, K N; Yamamoto, L M; Hom, L L; Casa, D J; Armstrong, L E; Kraemer, W J; Anderson, J M; Maresh, C M

2017-01-01

Stress-inducible Hsp72 is a potential biomarker to track risk of exertional heat illness during exercise/environmental stress. Characterization of extracellular (eHsp72) vs cellular Hsp72 (iHsp72) responses is required to define the appropriate use of Hsp72 as a reliable biomarker. In each of four repeat visits, participants (n = 6 men, 4 trials; total n = 24): (a) passively dehydrated overnight, (b) exercised (2 h) with no fluid in a hot, humid environmental chamber, (c) rested and rehydrated (1 h), (d) maximally exercised for 0.5 h, and (e) returned after 24 h of at-home recovery and rehydration. We measured rectal temperature, hydration status (% body mass loss, urine markers, serum osmolality), and Hsp72 (ELISA, flow cytometry. eHsp72 (circulating) and iHsp72 (CD3 + PBMCs) correlated (P < 0.05) with markers of heat, exercise, and dehydration stresses. eHsp72 immediately post-exercise (>15% above baseline, P < 0.05) decreased back to baseline levels by 1 h post-exercise, but iHsp72 expression continued to rise and remained elevated 24 h post-exercise (~2.5-fold baseline, P < 0.05). These data suggest that in addition to the classic physiological biomarkers of exercise heat stress, using cellular Hsp72 as an indicator of lasting effects of stress into recovery may be most appropriate for determining long-term effects of stress on risk for exertional heat illness. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Cross-validation of Peak Oxygen Consumption Prediction Models From OMNI Perceived Exertion.

PubMed

Mays, R J; Goss, F L; Nagle, E F; Gallagher, M; Haile, L; Schafer, M A; Kim, K H; Robertson, R J

2016-09-01

This study cross-validated statistical models for prediction of peak oxygen consumption using ratings of perceived exertion from the Adult OMNI Cycle Scale of Perceived Exertion. 74 participants (men: n=36; women: n=38) completed a graded cycle exercise test. Ratings of perceived exertion for the overall body, legs, and chest/breathing were recorded each test stage and entered into previously developed 3-stage peak oxygen consumption prediction models. There were no significant differences (p>0.05) between measured and predicted peak oxygen consumption from ratings of perceived exertion for the overall body, legs, and chest/breathing within men (mean±standard deviation: 3.16±0.52 vs. 2.92±0.33 vs. 2.90±0.29 vs. 2.90±0.26 L·min(-1)) and women (2.17±0.29 vs. 2.02±0.22 vs. 2.03±0.19 vs. 2.01±0.19 L·min(-1)) participants. Previously developed statistical models for prediction of peak oxygen consumption based on subpeak OMNI ratings of perceived exertion responses were similar to measured peak oxygen consumption in a separate group of participants. These findings provide practical implications for the use of the original statistical models in standard health-fitness settings. © Georg Thieme Verlag KG Stuttgart · New York.

Retrieved Latent Heating from TRMM

NASA Technical Reports Server (NTRS)

Tao, Wei-Kuo; Smith, Eric A.; Houze Jr, Robert

2008-01-01

The global hydrological cycle is central to the Earth's climate system, with rainfall and the physics of precipitation formation acting as the key links in the cycle. Two-thirds of global rainfall occurs in the tropics with the associated latent heating (LH) accounting for three-fourths of the total heat energy available to the Earth's atmosphere. In addition, fresh water provided by tropical rainfall and its variability exerts a large impact upon the structure and motions of the upper ocean layer. In the last decade, it has been established that standard products of LH from satellite measurements, particularly TRMM measurements, would be a valuable resource for scientific research and applications. Such products would enable new insights and investigations concerning the complexities of convection system life cycles, the diabatic heating controls and feedbacks related to meso-synoptic circulations and their forecasting, the relationship of tropical patterns of LH to the global circulation and climate, and strategies for improving cloud parameterizations in environmental prediction models. The status of retrieved TRMM LH products, TRMM LH inter-comparison and validation project, current TRMM LH applications and critic issues/action items (based on previous five TRMM LH workshops) is presented in this article.

Dehydration, Heat Stroke, or Hyponatremia? The Recognition, Treatment, and Prevention of Hyponatremia Caused by High Exercise Outdoor Activities.

ERIC Educational Resources Information Center

Cochran, Brent

Hyponatremia (severe sodium depletion) has symptoms similar to heat exhaustion and heat stroke and can easily be misdiagnosed. The number of wilderness users and extreme adventure activities has increased in recent years, and more cases are being diagnosed. Given that a 1993 study found that 1 in 10 cases of heat-related illnesses were…

Toward a theory of online communication in illness: concept analysis of illness blogs.

PubMed

Heilferty, Catherine McGeehin

2009-07-01

This paper is a report of a concept analysis of illness blogs and their relevance to nursing research on communication during illness. Blogs are being used by patients and family members to describe the experience of illness, but very little is known about this phenomenon. Seventeen English language databases and one Internet search engine were searched from 1990 to 2007 using the truncated term 'blog*'. Specific illness terms together with 'blog*', for example, blog* and diabetes; and blog* and cancer, were used to expand the search. Reports were included if they were of qualitative or quantitative research that included a definition of blogs or blogging and some identification or description of blog uses pertinent to the discipline. Specific emphasis was placed on blog use by individuals coping with illness experiences. 'Meta' writings by authors about their own blogging intentions and experiences were excluded. An illness blog is the online expression of the narrative of illness. Theoretical and operational definitions, defining attributes, uses, antecedents and consequences were developed. The literature search returned 45 works from 17 disciplines referring to the definition and uses of blogging. Support is offered from the review of literature and analysis of the concept for the development of a theory of online communication during illness. Reading and incorporating illness blogs into care will enhance patient-provider relationships. Analysis of the narratives being created online about the illness experience will contribute significantly to nursing's body of knowledge.

High self-perceived exercise exertion before bedtime is associated with greater objectively assessed sleep efficiency.

PubMed

Brand, Serge; Kalak, Nadeem; Gerber, Markus; Kirov, Roumen; Pühse, Uwe; Holsboer-Trachsler, Edith

2014-09-01

To assess the association between self-perceived exercise exertion before bedtime and objectively measured sleep. Fifty-two regularly exercising young adults (mean age, 19.70 years; 54% females) underwent sleep electroencephalographic recordings 1.5 h after completing moderate to vigorous exercise in the evening. Before sleeping, participants answered questions regarding degree of exertion of the exercise undertaken. Greater self-perceived exertion before bedtime was associated with higher objectively assessed sleep efficiency (r = 0.69, P <0.001); self-perceived exertion explained 48% of the variance in sleep efficiency (R2 = 0.48). Moreover, high self-perceived exercise exertion was associated with more deep sleep, shortened sleep onset time, fewer awakenings after sleep onset, and shorter wake duration after sleep onset. Multiple linear regression analysis showed that objective sleep efficiency was predicted by increased exercise exertion, shortened sleep onset time, increased deep sleep, and decreased light sleep. Against expectations and general recommendations for sleep hygiene, high self-perceived exercise exertion before bedtime was associated with better sleep patterns in a sample of healthy young adults. Further studies should also focus on elderly adults and adults suffering from insomnia. Copyright © 2014 Elsevier B.V. All rights reserved.

Exercise, physical activity, and exertion over the business cycle.

PubMed

Colman, Gregory; Dave, Dhaval

2013-09-01

Shifts in time and income constraints over economic expansions and contractions would be expected to affect individuals' behaviors. We explore the impact of the business cycle on individuals' exercise, time use, and total physical exertion, utilizing information on 112,000 individual records from the 2003-2010 American Time Use Surveys. In doing so, we test a key causal link that has been hypothesized in the relation between unemployment and health, but not heretofore assessed. Using more precise measures of exercise (and other activities) than previous studies, we find that as work-time decreases during a recession, recreational exercise, TV-watching, sleeping, childcare, and housework increase. This, however, does not compensate for the decrease in work-related exertion due to job-loss, and total physical exertion declines. These effects are strongest among low-educated men, which is validating given that employment in the Great Recession has declined most within manufacturing, mining, and construction. We also find evidence of intra-household spillover effects, wherein individuals respond to shifts in spousal employment conditional on their own labor supply. The decrease in total physical activity during recessions is especially problematic for vulnerable populations concentrated in boom-and-bust industries, and may have longer-term effects on obesity and related health outcomes. Copyright © 2013 Elsevier Ltd. All rights reserved.

Five dramas of illness.

PubMed

Frank, Arthur W

2007-01-01

First-person narratives of illness experience are dramatic: the narrator, who is also the sufferer, is caught in conflicts of forces that permit understanding more than control. Among the dramas of illness, five occur frequently in autobiographical accounts of illness. These dramas overlap and have varying emphases in different people's stories. They are the drama of genesis (what instigated the illness); the drama of emotion work (what emotional displays are required or prohibited); the drama of fear and loss; the drama of meaning; and finally, the drama of self. This five-drama framework can focus critical and clinical attention on which conflicting forces the ill person is working to reconcile, what makes that work difficult, and how conceiving of one's illness as a drama can be a source of meaning and value.

Efficacy of Liquid, Air, and Phase Change Material Torso Cooling During Light Exercise While Wearing NBC Clothing

DTIC Science & Technology

1998-03-01

and Thermal Comfort 6 Blood Sampling 6 Statistical Analyses 6 RESULTS 7 Indices of Hydration Status 7 Liquid-Cooling and PCM Cooling Vests...of Uncooled Sites 12 Vapour Pressure 12 Ratings of Thermal Comfort and Perceived Exertion 18 Indices of Heat Tolerance 18 DISCUSSION 20...ill Figures 8A and B Changes in ratings of thermal comfort of the torso and whole body during light exercise at 40°C and 30% relative humidity while

Health impacts of workplace heat exposure: an epidemiological review.

PubMed

Xiang, Jianjun; Bi, Peng; Pisaniello, Dino; Hansen, Alana

2014-01-01

With predicted increasing frequency and intensity of extremely hot weather due to changing climate, workplace heat exposure is presenting an increasing challenge to occupational health and safety. This article aims to review the characteristics of workplace heat exposure in selected relatively high risk occupations, to summarize findings from published studies, and ultimately to provide suggestions for workplace heat exposure reduction, adaptations, and further research directions. All published epidemiological studies in the field of health impacts of workplace heat exposure for the period of January 1997 to April 2012 were reviewed. Finally, 55 original articles were identified. Manual workers who are exposed to extreme heat or work in hot environments may be at risk of heat stress, especially those in low-middle income countries in tropical regions. At risk workers include farmers, construction workers, fire-fighters, miners, soldiers, and manufacturing workers working around process-generated heat. The potential impacts of workplace heat exposure are to some extent underestimated due to the underreporting of heat illnesses. More studies are needed to quantify the extent to which high-risk manual workers are physiologically and psychologically affected by or behaviourally adapt to workplace heat exposure exacerbated by climate change.

Health Impacts of Workplace Heat Exposure: An Epidemiological Review

PubMed Central

XIANG, Jianjun; BI, Peng; PISANIELLO, Dino; HANSEN, Alana

2013-01-01

With predicted increasing frequency and intensity of extremely hot weather due to changing climate, workplace heat exposure is presenting an increasing challenge to occupational health and safety. This article aims to review the characteristics of workplace heat exposure in selected relatively high risk occupations, to summarize findings from published studies, and ultimately to provide suggestions for workplace heat exposure reduction, adaptations, and further research directions. All published epidemiological studies in the field of health impacts of workplace heat exposure for the period of January 1997 to April 2012 were reviewed. Finally, 55 original articles were identified. Manual workers who are exposed to extreme heat or work in hot environments may be at risk of heat stress, especially those in low-middle income countries in tropical regions. At risk workers include farmers, construction workers, fire-fighters, miners, soldiers, and manufacturing workers working around process-generated heat. The potential impacts of workplace heat exposure are to some extent underestimated due to the underreporting of heat illnesses. More studies are needed to quantify the extent to which high-risk manual workers are physiologically and psychologically affected by or behaviourally adapt to workplace heat exposure exacerbated by climate change. PMID:24366537

Synchrony and exertion during dance independently raise pain threshold and encourage social bonding

PubMed Central

Tarr, Bronwyn; Launay, Jacques; Cohen, Emma; Dunbar, Robin

2015-01-01

Group dancing is a ubiquitous human activity that involves exertive synchronized movement to music. It is hypothesized to play a role in social bonding, potentially via the release of endorphins, which are analgesic and reward-inducing, and have been implicated in primate social bonding. We used a 2 × 2 experimental design to examine effects of exertion and synchrony on bonding. Both demonstrated significant independent positive effects on pain threshold (a proxy for endorphin activation) and in-group bonding. This suggests that dance which involves both exertive and synchronized movement may be an effective group bonding activity. PMID:26510676

Exertion fatigue and chronic fatigue are two distinct constructs in people post-stroke.

PubMed

Tseng, Benjamin Y; Billinger, Sandra A; Gajewski, Byron J; Kluding, Patricia M

2010-12-01

Post-stroke fatigue is a common and neglected issue despite the fact that it impacts daily functions, quality of life, and has been linked with a higher mortality rate because of its association with a sedentary lifestyle. The purpose of this study was to identify the contributing factors of exertion fatigue and chronic fatigue in people post-stroke. Twenty-one post-stroke people (12 males, 9 females; 59.5 ± 10.3 years of age; time after stroke 4.1 ± 3.5 years) participated in the study. The response variables included exertion fatigue and chronic fatigue. Participants underwent a standardized fatigue-inducing exercise on a recumbent stepper. Exertion fatigue level was assessed at rest and immediately after exercise using the Visual Analog Fatigue Scale. Chronic fatigue was measured by the Fatigue Severity Scale. The explanatory variables included aerobic fitness, motor control, and depressive symptoms measured by peak oxygen uptake, Fugl-Meyer motor score, and the Geriatric Depression Scale, respectively. Using forward stepwise regression, we found that peak oxygen uptake was an independent predictor of exertion fatigue (P = 0.006), whereas depression was an independent predictor of chronic fatigue (P = 0.002). Exertion fatigue and chronic fatigue are 2 distinct fatigue constructs, as identified by 2 different contributing factors.

Calcium promotes activity and confers heat stability on plant peroxidases

PubMed Central

Plieth, Christoph; Vollbehr, Sonja

2012-01-01

In this paper we demonstrate how peroxidase (PO) activities and their heat stability correlate with the availability of free Ca2+ ions. Calcium ions work as a molecular switch for PO activity and exert a protective function, rendering POs heat stable. The concentration ranges of these two activities differ markedly. POs are activated by µM Ca2+ concentration ranges, whereas heat stabilization is observed in the nM range. This suggests the existence of different Ca2+ binding sites. The heat stability of POs depends on the source plant species. Terrestrial plants have POs that exhibit higher temperature stability than those POs from limnic and marine plants. Different POs from a single species can differ in terms of heat stability. The abundance of different POs within a plant is dependent on age and developmental stage. The heat stability of a PO does not necessarily correlate with the maximum temperature the source species is usually exposed to in its natural habitat. This raises questions on the role of POs in the heat tolerance of plants. Consequently, detailed investigations are needed to identify and characterize individual POs, with regard to their genetic origin, subcellular expression, tissue abundance, developmental emergence and their functions in innate and acquired heat tolerance. PMID:22580695

Growing up with an ill parent: An examination of family characteristics and parental illness features.

PubMed

Stoeckel, Maggie; Weissbrod, Carol

2015-12-01

Existing literature suggests that the children of ill parents are vulnerable to a variety of psychosocial difficulties such as depression and anxiety. The purpose of the current study is to investigate the impact of family characteristics (parental involvement, familial support, stress experienced as a result of parental illness) and parental illness features (severity, duration, recovery status, frequency of symptoms, course) on the psychosocial functioning (depression, anxiety, life satisfaction) of late adolescents who have grown up with an ill parent but no longer live with their parents. Participants were 71 college students with a parent who experienced a chronic medical condition while they were growing up. Participants provided information regarding family characteristics, parental illness features, and the impact of parental illness. Impact of parental illness was assessed using the Impact of Illness Scale. Participants also completed measures of depression, anxiety, and life satisfaction. Participants' reported impact of parent illness was positively correlated with participant depression and anxiety. Several family characteristics and parental illness features were significantly associated with participant psychosocial functioning. In particular, lower parental involvement was correlated with greater participant depression and anxiety, as well as lower life satisfaction. These findings extend our understanding of the impact of parental illness on late adolescents' psychosocial functioning. Results could have clinical applications for psychosocial interventions in children and families coping with chronic illness. (PsycINFO Database Record (c) 2015 APA, all rights reserved).

Chronic Exertional Compartment Syndrome.

PubMed

Braver, Richard T

2016-04-01

Increased tissue pressure within a fascial compartment may be the result from any increase in volume within its contents, or any decrease in size of the fascial covering or its distensibility. This may lead to symptoms of leg tightness, pain or numbness brought about by exercise. There are multiple differential diagnoses of exercise induced leg pain and the proper diagnoses of chronic exertional compartment syndrome (CECS) is made by a careful history and by exclusion of other maladies and confirmed by compartment syndrome testing as detailed in this text. Surgical fasciotomies for the anterior, lateral, superficial and deep posterior compartments are described in detail along with ancillary procedures for chronic shin splints that should allow the athlete to return to competitive activity. Copyright © 2016 Elsevier Inc. All rights reserved.

The prozone effect exerted by the complement-binding anti-Lea on anti-D.

PubMed

Joshi, Sanmukh R; Parekh, Kamlesh H

2017-01-01

Prozone phenomenon is seen with very high-titer antibodies in an immune serum. The prozone effect on anti-D by a low-titer anti-Le a was investigated associated with neonatal jaundice. Standard methods were used in investigations. The child was born at full-term developed mild jaundice. With weak direct antiglobulin test+, her indirect serum bilirubin was progressed to 27.5 mg/dL in 48 h. Anti-D and anti-Le a were detected in the mother. Both these antibodies were detected in the child's serum though the eluate from red blood cells (RBCs) contained only anti-D. Mother's anti-D was masked by anti-Le a if the RBCs possessed both the antigens together. Anti-D was revealed only with D-positive RBCs lacking Le a or if the serum was modified by mixing with Le a+ saliva or was heated at 56°C or fortified with citrate solution. An anti-D showed prozone effect exerted by the complement-fixing anti-Le a in the test.

The 2006 California Heat Wave: Impacts on Hospitalizations and Emergency Department Visits

PubMed Central

Knowlton, Kim; Rotkin-Ellman, Miriam; King, Galatea; Margolis, Helene G.; Smith, Daniel; Solomon, Gina; Trent, Roger; English, Paul

2009-01-01

Background Climate models project that heat waves will increase in frequency and severity. Despite many studies of mortality from heat waves, few studies have examined morbidity. Objectives In this study we investigated whether any age or race/ethnicity groups experienced increased hospitalizations and emergency department (ED) visits overall or for selected illnesses during the 2006 California heat wave. Methods We aggregated county-level hospitalizations and ED visits for all causes and for 10 cause groups into six geographic regions of California. We calculated excess morbidity and rate ratios (RRs) during the heat wave (15 July to 1 August 2006) and compared these data with those of a reference period (8–14 July and 12–22 August 2006). Results During the heat wave, 16,166 excess ED visits and 1,182 excess hospitalizations occurred statewide. ED visits for heat-related causes increased across the state [RR = 6.30; 95% confidence interval (CI), 5.67–7.01], especially in the Central Coast region, which includes San Francisco. Children (0–4 years of age) and the elderly (≥ 65 years of age) were at greatest risk. ED visits also showed significant increases for acute renal failure, cardiovascular diseases, diabetes, electrolyte imbalance, and nephritis. We observed significantly elevated RRs for hospitalizations for heat-related illnesses (RR = 10.15; 95% CI, 7.79–13.43), acute renal failure, electrolyte imbalance, and nephritis. Conclusions The 2006 California heat wave had a substantial effect on morbidity, including regions with relatively modest temperatures. This suggests that population acclimatization and adaptive capacity influenced risk. By better understanding these impacts and population vulnerabilities, local communities can improve heat wave preparedness to cope with a globally warming future. PMID:19165388

The effects of passive heating and head-cooling on perception of exercise in the heat.

PubMed

Simmons, Shona E; Mündel, Toby; Jones, David A

2008-09-01

The capacity to perform exercise is reduced in a hot environment when compared to cooler conditions. A limiting factor appears to be a higher core body temperature (T (core)) and it has been suggested that an elevated T (core) reduces the drive to exercise, this being reflected in higher ratings of perceived exertion (RPE). The purpose of the present study was to determine whether passive heating to increase T (core) would have a detrimental effect on RPE and thermal comfort during subsequent exercise in the heat and whether head-cooling during passive heating would attenuate these unpleasant sensations of an elevated T (core) during subsequent exercise in the heat. Nine physically-active, non-heat-acclimated volunteers [6 males, 3 females; age: 21 +/- 1 year, VO(2max) 50 +/- 9 ml kg(-1).min(-1), peak power output: 286 +/- 43 W (mean +/- SD)] performed two 12-minute constant-load cycling tests at 70% VO(2max) in a warm-dry environment (34 +/- 1 degrees C, relative humidity <30%) separated by a period of passive heating in a sauna (68 +/- 3 degrees C) to increase T (core). In one trial, subjects had their head and face cooled continually in the sauna (HC), the other trial was a control (CON). Passive heating increased T (core) by 1.22 +/- 0.03 degrees C in the CON and by 0.75 +/- 0.07 degrees C in the HC trial (P < 0.01). Passive heating increased weighted mean skin temperature (T (msk)) in both the CON and HC trials (P < 0.01), however, head-cooling lowered T (msk) during passive heating (P < 0.05). Exercise time following passive heating was reduced in both the CON and HC trials (P < 0.05). Passive heating increased RPE (P < 0.01), however, RPE was lower following passive heating with head-cooling (P < 0.05). There was a significant correlation between T (core) and RPE (r = 0.82, P < 0.001). In conclusion, our results suggest increased RPE during exercise in the heat is primarily due to the increase in T (core). Furthermore, head-cooling attenuates the rise in T

A Cross-Sectional Study of Heat Wave-Related Knowledge, Attitude, and Practice among the Public in the Licheng District of Jinan City, China

PubMed Central

Li, Jing; Xu, Xin; Ding, Guoyong; Zhao, Yun; Zhao, Ruixia; Xue, Fuzhong; Li, Jing; Gao, Jinghong; Yang, Jun; Jiang, Baofa; Liu, Qiyong

2016-01-01

Knowledge, attitude, and practice (KAP) are three key components for reducing the adverse health impacts of heat waves. However, research in eastern China regarding this is scarce. The present study aimed to evaluate the heat wave-related KAP of a population in Licheng in northeast China. This cross-sectional study included 2241 participants. Data regarding demographic characteristics, KAP, and heat illnesses were collected using a structured questionnaire. Univariate analysis and unconditional logistic regression models were used to analyze the data. Most residents had high KAP scores, with a mean score of 12.23 (standard deviation = 2.23) on a 17-point scale. Urban women and participants aged 35–44 years had relatively high total scores, and those with high education levels had the highest total score. There was an increased risk of heat-related illness among those with knowledge scores of 3–5 on an 8-point scale with mean score of 5.40 (standard deviation = 1.45). Having a positive attitude toward sunstroke prevention and engaging in more preventive practices to avoid heat exposure had a protective interaction effect on reducing the prevalence of heat-related illnesses. Although the KAP scores were relatively high, knowledge and practice were lacking to some extent. Therefore, governments should further develop risk-awareness strategies that increase awareness and knowledge regarding the adverse health impact of heat and help in planning response strategies to improve the ability of individuals to cope with heat waves. PMID:27367715

An illness-specific version of the Revised Illness Perception Questionnaire in patients with atrial fibrillation (AF IPQ-R): Unpacking beliefs about treatment control, personal control and symptom triggers.

PubMed

Taylor, Elaina C; O'Neill, Mark; Hughes, Lyndsay D; Moss-Morris, Rona

2018-04-01

This study modified the Revised Illness Perception Questionnaire (IPQ-R) in patients with persistent atrial fibrillation (AF). Qualitative interviews and think-aloud techniques informed modification of the IPQ-R to be specific to AF patients. Confirmatory Factor Analysis (CFA) (n = 198) examined the validity of the modified IPQ-R (AF-IPQ-R). Exploratory factor analysis (EFA) examined the new AF-triggers scale. Construct validity examined associations between the AF-IPQ-R, quality of life (QoL) and beliefs about medicines. Test-retest and internal reliability were examined. Interviews indicated that patients viewed triggers of AF rather than initial causes of illness as more applicable. Patients believed specific behaviours such as rest could control AF. Treatment control beliefs related to pharmacological and procedural treatments. These data were used to modify the IPQ-R subscales and to develop a triggers of AF scale. CFA indicated good model fit. EFA of the triggers scale indicated three factors: emotional; health behaviours; and over-exertion triggers. Expected correlations were found between the AF-IPQ-R, QoL and treatment beliefs, evidencing good construct validity. The AF-IPQ-R showed sound psychometric properties. It provides more detailed specification than the IPQ-R of beliefs that may help to understand poor QoL in AF patients, and guidance for future interventions in this area.

Concepts of illness in Icelandic children.

PubMed

Hansdottir, I; Malcarne, V L

1998-06-01

To investigate the development of illness concepts among healthy Icelandic children. Participants were 68 schoolchildren, 6-7, 10-11, and 14-15 years of age, and their parents. Cognitive developmental level and understanding of physical illness were assessed within a Piagetian framework. In addition, illness experience and illness behaviors (Child Illness Behavior Questionnaire) were assessed. Results were consistent with previous studies in that the development of illness concepts among Icelandic children was consistent with Piaget's theory of cognitive development. No relation was found between illness experience and understanding of illness. A more mature understanding of illness was related to willingness to report the onset of illness. The results suggest that findings from previous studies may be generalized to a broader population.

Lactate and pH evaluation in exhausted humans with prolonged TASER X26 exposure or continued exertion.

PubMed

Ho, Jeffrey D; Dawes, Donald M; Cole, Jon B; Hottinger, Julie C; Overton, Kenneth G; Miner, James R

2009-09-10

Safety concerns about TASER Conducted Electrical Weapon (CEW) use and media reports of deaths after exposure have been expressed. CEWs are sometimes used on exhausted subjects to end resistance. The alternative is often a continued struggle. It is unclear if CEW use is metabolically different than allowing a continued struggle. We sought to determine if CEW exposure on exhausted humans caused worsening acidosis when compared with continued exertion. This was a prospective study of human volunteers recruited during a CEW training course. Volunteers were from several different occupations and represented a wide range of ages and body mass index characteristics. Medical histories, baseline pH and lactate values were obtained. Patients were assigned to one of four groups: 2 control groups consisting of Exertion only and CEW Exposure only, and the 2 experimental groups that were Exertion plus CEW Exposure and Exertion plus additional Exertion. Blood sampling occurred after Exertion and after any CEW exposure. This was repeated every 2-min until 20 min after protocol completion. Descriptive statistics were used to compare the four groups. The experimental groups and the control groups were compared individually at each time point using Wilcoxon rank sum tests. Lactate and pH association was assessed using multiple linear regression. Forty subjects were enrolled. There were no median pH or lactate differences between CEW Exposure groups at baseline, or between Exertion protocol groups immediately after completion. The CEW Exposure only group had higher pH and lower lactate values at all time points after exposure than the Exertion only group. After completing the Exertion protocol, there was no difference in the pH or lactate values between the continued Exertion group and the CEW Exposure group at any time points. Subjects who had CEW Exposure only had higher pH and lower lactate values than subjects who completed the Exertion protocol only. CEW exposure does not appear

Popliteal Artery Entrapment or Chronic Exertional Compartment Syndrome?

PubMed Central

Gaunder, Christopher; Rivera, Jessica

2017-01-01

Diagnosis of lower limb pain in an athlete can be a challenging task due to the variety of potential etiologies and ambiguity of presenting symptoms. Five of the most commonly encountered causes of limb pain in athletes are chronic exertional compartment syndrome (CECS), medial tibial stress syndrome (MTSS), tibial stress fractures, soleal sling syndrome, and popliteal artery entrapment syndrome (PAES). Of these, the least frequent but potentially most serious of the pathologies is PAES. With an incidence of less than 1% seen in living subject studies, the condition is rare. However, a missed diagnosis will likely lead to progression of the disease and potential for unnecessary invasive procedures (McAree et al. 2008). In this paper, we present a young athlete misdiagnosed and treated for chronic exertional compartment syndrome. In both descriptive and a quick-reference table format, we review current literature and discuss how best to distinguish functional PAES from other causes of activity-related leg pain. PMID:28890727

Unconventional Secretion of Heat Shock Proteins in Cancer

PubMed Central

Santos, Tiago Góss; Martins, Vilma Regina; Hajj, Glaucia Noeli Maroso

2017-01-01

Heat shock proteins (HSPs) are abundant cellular proteins involved with protein homeostasis. They have both constitutive and inducible isoforms, whose expression levels are further increased by stress conditions, such as temperature elevation, reduced oxygen levels, infection, inflammation and exposure to toxic substances. In these situations, HSPs exert a pivotal role in offering protection, preventing cell death and promoting cell recovery. Although the majority of HSPs functions are exerted in the cytoplasm and organelles, several lines of evidence reveal that HSPs are able to induce cell responses in the extracellular milieu. HSPs do not possess secretion signal peptides, and their secretion was subject to widespread skepticism until the demonstration of the role of unconventional secretion forms such as exosomes. Secretion of HSPs may confer immune system modulation and be a cell-to-cell mediated form of increasing stress resistance. Thus, there is a wide potential for secreted HSPs in resistance of cancer therapy and in the development new therapeutic strategies. PMID:28468249

Social behaviour and illness information interact to influence the peer acceptance of children with chronic illness.

PubMed

Alderfer, M A; Wiebe, D J; Hartmann, D P

2001-09-01

Social behaviour was investigated as a contributor to the peer acceptance of children with chronic illness. We predicted that children with illness would receive less acceptance than children without illness, and that prosocial behaviour would improve acceptance, while aggressive behaviour would hamper it. Based upon attribution and cognitive bias theories, we also predicted that prosocial behaviour would be more beneficial and aggressive behaviour less damaging to the acceptance of children with illness compared to healthy children. A 3 (social behaviour: prosocial, aggressive, no information) x 2 (physical status: chronically ill, healthy) within-subjects analogue design was used. Preadolescents (N = 149) indicated social acceptance of hypothetical children portrayed in vignettes as either chronically ill or healthy with prosocial, aggressive, or no social behaviour. A 13-item social intentions scale gauged acceptance. The hypotheses were supported. Although children described as ill received lower acceptance ratings than healthy children, prosocial/ill children were more accepted than aggressive/ill children. Social behaviour interacted with physical status to affect acceptance. Social behaviour influences the peer acceptance of hypothetical children with chronic illness. Prosocial behaviour enhances acceptance of children described with illness, while aggressive behaviour hampers it. Additionally, prosocial behaviour is more beneficial, and aggressive behaviour is less damaging for children described as ill versus healthy. The potential processes by which peers judge acceptance of children with illness are discussed.

Use of thermal imagery for estimation of core body temperature during precooling, exertion, and recovery in wildland firefighter protective clothing.

PubMed

Bourlai, Thirimachos; Pryor, Riana R; Suyama, Joe; Reis, Steven E; Hostler, David

2012-01-01

Monitoring core body temperature to identify heat stress in first responders and in individuals participating in mass gatherings (e.g., marathons) is difficult. This study utilized high-sensitivity thermal imaging technology to predict the core temperature of human subjects at a distance while performing simulated field operations wearing thermal protective garments. Six male subjects participating in a study of precooling prior to exertion in wildland firefighter thermal protective clothing had thermal images of the face captured with a high-resolution thermal imaging camera concomitant with measures of core and skin temperature before, during, and after treadmill exercise in a heated room. Correlations and measures of agreement between core temperature and thermal imaging-based temperature were performed. The subjects walked an average (± standard deviation) of 42.6 (±5.9) minutes and a distance of 4.2 (±0.6) km on the treadmill. Mean heart rate at the end of exercise was 152 (±33) bpm and core body temperature at the end of exercise was 38.3°C (±0.7°C). A visual relationship and a strong correlation between core temperature and thermal imaging of the face were identified in all subjects, with the closest relationship and best agreement occurring during exercise. The Bland-Altman test of agreement during exercise revealed the majority of measurement pairs to be within two standard deviations of the measured temperature. High-resolution thermal imaging in the middle-wave infrared spectrum (3-5 μm) can be used to accurately estimate core body temperature during exertion in a hot room while participants are wearing wildland firefighting garments. Although this technology is promising, it must be refined. Using alternative measurement sites such as the skin over the carotid artery, using multiple measurement sites, or adding pulse detection may improve the estimation of body temperature by thermal imagery.

Effect of Psychiatric Illness on Acute Care Utilization at End of Life From Serious Medical Illness.

PubMed

Lavin, Kyle; Davydow, Dimitry S; Downey, Lois; Engelberg, Ruth A; Dunlap, Ben; Sibley, James; Lober, William B; Okimoto, Kelson; Khandelwal, Nita; Loggers, Elizabeth T; Teno, Joan M; Curtis, J Randall

2017-08-01

Little is known about psychiatric illness and utilization of end-of-life care. We hypothesized that preexisting psychiatric illness would increase hospital utilization at end of life among patients with chronic medical illness due to increased severity of illness and care fragmentation. We reviewed electronic health records to identify decedents with one or more of eight chronic medical conditions based on International Classification of Diseases-9 codes. We used International Classification of Diseases-9 codes and prescription information to identify preexisting psychiatric illness. Regression models compared hospital utilization among patients with and without psychiatric illness. Path analyses examined the effect of severity of illness and care fragmentation. Eleven percent of 16,214 patients with medical illness had preexisting psychiatric illness, which was associated with increased risk of death in nursing homes (P = 0.002) and decreased risk of death in hospitals (P < 0.001). In the last 30 days of life, psychiatric illness was associated with reduced inpatient and intensive care unit utilization but increased emergency department utilization. Path analyses confirmed an association between psychiatric illness and increased hospital utilization mediated by severity of illness and care fragmentation, but a stronger direct effect of psychiatric illness decreasing hospitalizations. Our findings differ from the increased hospital utilization for patients with psychiatric illness in circumstances other than end-of-life care. Path analyses confirmed hypothesized associations between psychiatric illness and increased utilization mediated by severity of illness and care fragmentation but identified more powerful direct effects decreasing hospital use. Further investigation should examine whether this effect represents a disparity in access to preferred care. Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All

High-Altitude Illness

MedlinePlus

... after you travel. Make sure you pack enough water while you are active. Avoid or limit the amount of alcohol you consume. High-altitude illness treatment It is important to treat high-altitude illness ...

Heat: not black, not white. It's gray!!!

PubMed

Singh, Laxmi Prabha; Kapoor, Medha; Singh, Shashi Bala

2013-01-01

Heat-related illness (HRI) is a broad term that includes clinical conditions ranging from heat cramps and syncope to heat exhaustion and heatstroke, which may result in death. HRIs are one of the major causes of death worldwide and continue to increase in severity with the rise in global temperature. The identification and estimation of heat-related morbidity and mortality is a major challenge. Heat stress manifests itself into respiratory, cardiovascular, and cerebrovascular disorders, leading to the attribution of the deaths caused by heat stress to these disorders. Although HRIs affect mankind in general, certain occupational workers such as soldiers and athletes are more prone. Various pharmacological and nonpharmacological strategies have been employed to combat HRIs. Despite this, heat exposure results in significant morbidity and mortality. Hence, complete understanding of HRIs at physiological as well as molecular level is required to facilitate design of more efficient preventive and treatment strategies. The impact of heat on mankind is not just restricted to HRIs. Heat treatment, i.e., thermotherapy, has been used extensively since ancient times for relieving pain, making heat a two-edged sword. This review attempts to summarize various HRIs, their physiological and molecular basis, and the state-of-the-art techniques/research initiatives to combat the same. It also illustrates the application of thermotherapy as a means for improving quality of life and morbidity associated with several disease conditions such as fibromyalgia syndrome, heart diseases, cancer, chronic pain, and depression.

Relationships between recall of perceived exertion and blood lactate concentration in a judo competition.

PubMed

Serrano, M A; Salvador, A; González-Bono, E G; Sanchís, C; Suay, F

2001-06-01

Relationships between perceived exertion and blood lactate have usually been studied in laboratory or training contexts but not in competition, the most important setting in which sports performance is evaluated. The purpose of this study was to examine the relationships between psychological and physiological indices of the physical effort in a competition setting, taking into account the duration of effort. For this, we employed two Ratings of Perceived Exertion (RPE and CR-10) and lactic acid plasma concentration as a biological marker of the effort performed. 13 male judo fighters who participated in a sports club competition provided capillary blood samples to assay lactate concentrations and indicated on scale their Recall of Perceived Exertion in the total competition and again in just the Last Fight to compare the usefulness of RPE and CR-10 in assessing discrete bouts of effort and a whole session. Analysis showed that perceived exertion or the effort made during the whole competition was positively and significantly related to maximal lactate concentration and lactate increase in competition, thus extending the validity of this scale to sports contests. The Recall of Perceived Exertion scores were not significantly correlated with the duration of effort.

Recreational water–related illness

PubMed Central

Sanborn, Margaret; Takaro, Tim

2013-01-01

Abstract Objective To review the risk factors, management, and prevention of recreational water–related illness in family practice. Sources of information Original and review articles from January 1998 to February 2012 were identified using PubMed and the search terms water-related illness, recreational water illness, and swimmer illness. Main message There is a 3% to 8% risk of acute gastrointestinal illness (AGI) after swimming. The high-risk groups for AGI are children younger than 5 years, especially if they have not been vaccinated for rotavirus, and elderly and immunocompromised patients. Children are at higher risk because they swallow more water when swimming, stay in the water longer, and play in the shallow water and sand, which are more contaminated. Participants in sports with a lot of water contact like triathlon and kite surfing are also at high risk, and even activities involving partial water contact like boating and fishing carry a 40% to 50% increase in risk of AGI compared with nonwater recreational activities. Stool cultures should be done when a recreational water illness is suspected, and the clinical dehydration scale is a useful clinical tool for assessing the treatment needs of affected children. Conclusion Recreational water illness is the main attributable cause of AGI during swimming season. Recognition that swimming is a substantial source of illness can help prevent recurrent and secondary cases. Rotavirus vaccine is highly recommended for children who will swim frequently. PMID:23673583

Biophysical aspects of human thermoregulation during heat stress.

PubMed

Cramer, Matthew N; Jay, Ollie

2016-04-01

Humans maintain a relatively constant core temperature through the dynamic balance between endogenous heat production and heat dissipation to the surrounding environment. In response to metabolic or environmental disturbances to heat balance, the autonomic nervous system initiates cutaneous vasodilation and eccrine sweating to facilitate higher rates of dry (primarily convection and radiation) and evaporative transfer from the body surface; however, absolute heat losses are ultimately governed by the properties of the skin and the environment. Over the duration of a heat exposure, the cumulative imbalance between heat production and heat dissipation leads to body heat storage, but the consequent change in core temperature, which has implications for health and safety in occupational and athletic settings particularly among certain clinical populations, involves a complex interaction between changes in body heat content and the body's morphological characteristics (mass, surface area, and tissue composition) that collectively determine the body's thermal inertia. The aim of this review is to highlight the biophysical aspects of human core temperature regulation by outlining the principles of human energy exchange and examining the influence of body morphology during exercise and environmental heat stress. An understanding of the biophysical factors influencing core temperature will enable researchers and practitioners to better identify and treat individuals/populations most vulnerable to heat illness and injury during exercise and extreme heat events. Further, appropriate guidelines may be developed to optimize health, safety, and work performance during heat stress. Copyright © 2016 Elsevier B.V. All rights reserved.

Insuring Consumption Against Illness.

PubMed

Gertler, Paul; Gruber, Jonathan

One of the most sizable and least predictable shocks to economic opportunities in developing countries is major illness. We investigate the extent to which families are able to insure consumption against major illness using a unique panel data set from Indonesia that combines excellent measures of health status with consumption information. We find that there are significant economic costs associated with major illness, and that there is very imperfect insurance of consumption over illness episodes. These estimates suggest that public disability insurance or subsidies for medical care may improve welfare by providing consumption insurance.

Heat resistance of histamine-producing bacteria in irradiated tuna loins.

PubMed

Enache, Elena; Kataoka, Ai; Black, D Glenn; Weddig, Lisa; Hayman, Melinda; Bjornsdottir-Butler, Kristin

2013-09-01

Consumption of foods high in biogenic amines leads to an illness known as histamine, or scombrotoxin, poisoning. The illness is commonly associated with consumption of fish with high levels of histamine ( $ 500 ppm). The objective of this study was to determine and compare the heat resistance of five histamine-producing bacteria in irradiated albacore tuna loins. Heat-resistance parameters (D- and z-values) were determined for Morganella morganii, Raoultella planticola, Hafnia alvei, and Enterobacter aerogenes. D- or z-values were not determined for Photobacterium damselae, which was the most heat-sensitive organism in this study. P. damselae declined > 5.9 log CFU/g after a heat treatment of 50°C for 10 min, 54°C for 3 min, and 56°C for 0.5 min. M. morganii was the most heat-resistant histamine-producing bacteria in albacore tuna loins, followed by E. aerogenes, H. alvei, and R. planticola. M. morganii and E. aerogenes had the highest D(50°C), 49.7 ± 17.57 and 51.8 ± 17.38 min, respectively. In addition, M. morganii had the highest D-values for all other temperatures (54, 56, and 58°C) tested. D- and zvalues were also determined for M. morganii in skipjack tuna. While no significant (P > 0.05) difference was observed between D(54°C) and D(56°C) of M. morganii in either albacore or skipjack tuna, the D(58°C) (0.4 ± 0.17 min) was significantly lower (P < 0.05) in skipjack than in albacore (0.9 ± 0.24 min). The z-values for all organisms tested were in the range of 3.2 to 3.8°C. This study suggests that heat treatment designed to control M. morganii in tuna loins is sufficient for controlling histamine-producing bacteria in canned-tuna processing environments.

Severity of Illness Scores May Misclassify Critically Ill Obese Patients.

PubMed

Deliberato, Rodrigo Octávio; Ko, Stephanie; Komorowski, Matthieu; Armengol de La Hoz, M A; Frushicheva, Maria P; Raffa, Jesse D; Johnson, Alistair E W; Celi, Leo Anthony; Stone, David J

2018-03-01

Severity of illness scores rest on the assumption that patients have normal physiologic values at baseline and that patients with similar severity of illness scores have the same degree of deviation from their usual state. Prior studies have reported differences in baseline physiology, including laboratory markers, between obese and normal weight individuals, but these differences have not been analyzed in the ICU. We compared deviation from baseline of pertinent ICU laboratory test results between obese and normal weight patients, adjusted for the severity of illness. Retrospective cohort study in a large ICU database. Tertiary teaching hospital. Obese and normal weight patients who had laboratory results documented between 3 days and 1 year prior to hospital admission. None. Seven hundred sixty-nine normal weight patients were compared with 1,258 obese patients. After adjusting for the severity of illness score, age, comorbidity index, baseline laboratory result, and ICU type, the following deviations were found to be statistically significant: WBC 0.80 (95% CI, 0.27-1.33) × 10/L; p = 0.003; log (blood urea nitrogen) 0.01 (95% CI, 0.00-0.02); p = 0.014; log (creatinine) 0.03 (95% CI, 0.02-0.05), p < 0.001; with all deviations higher in obese patients. A logistic regression analysis suggested that after adjusting for age and severity of illness at least one of these deviations had a statistically significant effect on hospital mortality (p = 0.009). Among patients with the same severity of illness score, we detected clinically small but significant deviations in WBC, creatinine, and blood urea nitrogen from baseline in obese compared with normal weight patients. These small deviations are likely to be increasingly important as bigger data are analyzed in increasingly precise ways. Recognition of the extent to which all critically ill patients may deviate from their own baseline may improve the objectivity, precision, and generalizability of ICU mortality

Linking potential heat source and sink to urban heat island: Heterogeneous effects of landscape pattern on land surface temperature.

PubMed

Li, Weifeng; Cao, Qiwen; Lang, Kun; Wu, Jiansheng

2017-05-15

Rapid urbanization has significantly contributed to the development of urban heat island (UHI). Regulating landscape composition and configuration would help mitigate the UHI in megacities. Taking Shenzhen, China, as a case study area, we defined heat source and heat sink and identified strong and weak sources as well as strong and weak sinks according to the natural and socioeconomic factors influencing land surface temperature (LST). Thus, the potential thermal contributions of heat source and heat sink patches were differentiated. Then, the heterogeneous effects of landscape pattern on LST were examined by using semiparametric geographically weighted regression (SGWR) models. The results showed that landscape composition has more significant effects on thermal environment than configuration. For a strong source, the percentage of patches has a positive impact on LST. Additionally, when mosaicked with some heat sink, even a small improvement in the degree of dispersion of a strong source helps to alleviate UHI. For a weak source, the percentage and density of patches have positive impacts on LST. For a strong sink, the percentage, density, and degree of aggregation of patches have negative impacts on LST. The effects of edge density and patch shape complexity vary spatially with the fragmentation of a strong sink. Similarly, the impacts of a weak sink are mainly exerted via the characteristics of percent, density, and shape complexity of patches. Copyright © 2017 Elsevier B.V. All rights reserved.

The effect of bracing availability on one-hand isometric force exertion capability.

PubMed

Jones, Monica L H; Reed, Matthew P; Chaffin, Don B

2013-01-01

Environmental obstructions that workers encounter can kinematically limit the postures that they can achieve. However, such obstructions can also provide an opportunity for additional support by bracing with the hand, thigh or other body part. The reaction forces on bracing surfaces, which are in addition to those acting at the feet and task hand, are hypothesised to improve force exertion capability, and become required inputs to biomechanical analysis of tasks with bracing. The effects of kinematic constraints and associated bracing opportunities on isometric hand force were quantified in a laboratory study of 22 men and women. Analyses of one-hand maximal push, pull and lift tasks demonstrated that bracing surfaces available at the thighs and non-task hand enabled participants to exert an average of 43% more force at the task hand. Task hand force direction deviated significantly from the nominal direction for exertions performed with bracing at both medium and low task hand locations. This study quantifies the effect of bracing on kinematically constrained force exertions. Knowledge that appropriate bracing surfaces can substantially increase hand force is critical to the evaluation of task-oriented strength capability. Force estimates may also involve large off-axis components, which have clear implications for ergonomic analyses of manual tasks.

Heat Exhaustion in a Rat Model: Lithium as a Biochemical Probe

DTIC Science & Technology

1989-09-30

depletion, potassium wasting, polyuria , and abnormal thermoregulation (2,3,8-17). Each of these effects may predispose to developing heat-induced illness...control and lithium groups. Lithium treatment in humans has often been associated with polyuria (10,16) thought to be secondary to renal toxicity of

Dynamics of Perceived Exertion in Constant-Power Cycling: Time- and Workload-Dependent Thresholds

ERIC Educational Resources Information Center

Balagué, Natàlia; Hristovski, Robert; García, Sergi; Aguirre, Cecilia; Vázquez, Pablo; Razon, Selen; Tenenbaum, Gershon

2015-01-01

Purpose: The purpose of this study was to test the dynamics of perceived exertion shifts (PES) as a function of time and workload during constant-power cycling. Method: Fifty-two participants assigned to 4 groups performed a cycling task at 4 different constant workloads corresponding to their individual rates of perceived exertion (RPEs = 13, 15,…

Programmed Physical Exertion in Recovery From Sports-Related Concussion: A Randomized Pilot Study.

PubMed

Maerlender, Arthur; Rieman, Wanda; Lichtenstein, Jonathan; Condiracci, C

2015-01-01

Although no data exist, general practice recommends only rest following concussion. This randomized clinical trial found that programmed physical exertion during recovery produced no significant differences in recovery time between groups of participants. However, high levels of exertion were deleterious. This study provides initial evidence that moderate physical activity is a safe replacement behavior during recovery.

Effects of prior physical exertion on tolerance to hypoxia, orthostatic stress, and physical fatigue.

DOT National Transportation Integrated Search

1982-03-01

Ten healthy men, 20-35 years old, were tested for tolerance to hypoxia, orthostatic stress, and physical fatigue after a period of rest, and, on another occasion, after a period of physical exertion. Exertion consisted of four 10-min periods of pedal...

Ready steady push--a study of the role of arm posture in manual exertions.

PubMed

Okunribido, Olanrewaju O; Haslegrave, Christine M

2008-02-01

This study investigated arm posture and hand forces during bi-manual pushing. Nine male and eight female participants performed isometric exertions at two reach distances (0 and elbow-grip) and six different positions of the hand interface (handle), defined by the plane (longitudinal, lateral, horizontal) and orientation (0 degrees and 45 degrees). Electrogoniometer instruments were used to measure the displacements/postures of the wrist and elbow joints and the forearm, and force measuring strain gauges were used to measure the exerted hand forces (x-, y- and z-components). The results showed that ability to vary arm posture, particularly the forearm, is important during build up of force and that people tend to seek for a balance in the forces applied at the hands by exerting more in the vertical direction. Also, lateral plane handle positions permitted exertion of greater forces than longitudinal and horizontal plane positions.

Heat transfer in a microvascular network: the effect of heart rate on heating and cooling in reptiles (Pogona barbata and Varanus varius).

PubMed

Seebacher, F

2000-03-21

Thermally-induced changes in heart rate and blood flow in reptiles are believed to be of selective advantage by allowing animal to exert some control over rates of heating and cooling. This notion has become one of the principal paradigms in reptilian thermal physiology. However, the functional significance of changes in heart rate is unclear, because the effect of heart rate and blood flow on total animal heat transfer is not known. I used heat transfer theory to determine the importance of heat transfer by blood flow relative to conduction. I validated theoretical predictions by comparing them with field data from two species of lizard, bearded dragons (Pogona barbata) and lace monitors (Varanus varius). Heart rates measured in free-ranging lizards in the field were significantly higher during heating than during cooling, and heart rates decreased with body mass. Convective heat transfer by blood flow increased with heart rate. Rates of heat transfer by both blood flow and conduction decreased with mass, but the mass scaling exponents were different. Hence, rate of conductive heat transfer decreased more rapidly with increasing mass than did heat transfer by blood flow, so that the relative importance of blood flow in total animal heat transfer increased with mass. The functional significance of changes in heart rate and, hence, rates of heat transfer, in response to heating and cooling in lizards was quantified. For example, by increasing heart rate when entering a heating environment in the morning, and decreasing heart rate when the environment cools in the evening a Pogona can spend up to 44 min longer per day with body temperature within its preferred range. It was concluded that changes in heart rate in response to heating and cooling confer a selective advantage at least on reptiles of mass similar to that of the study animals (0. 21-5.6 kg). Copyright 2000 Academic Press.

Somali Refugees' Perceptions of Mental Illness.

PubMed

Bettmann, Joanna E; Penney, Deb; Clarkson Freeman, Pamela; Lecy, Natalie

2015-01-01

Nearly 13% of the U.S. population is comprised of foreign-born individuals, with Somalis constituting one of the largest resettled groups. Research suggests that, among Somali refugees, rates of mental illness are high. Yet research shows Somalis underutilize mental health services. Understanding their perceptions of mental illness and its cures may help practitioners to design more effective treatments for this population. Thus, this pilot study investigated Somali refugees' perceptions of mental illness and its treatments. Using purposive sampling, this qualitative study interviewed 20 Somali refugees using a semi-structured interview guide. Qualitative analysis yielded participants' perceptions of mental illness through their descriptions of physical symptoms accompanying mental illness, the stigma of mental illness, causes of mental illness, medical and non-medical treatments for mental illness, spirit possession causing mental illness, and the Qur'an as treatment for mental illness. Such information may help practitioners in the United States approach Somali clients in the most culturally coherent manner.

Preventing Exertional Death in Military Trainees: Recommendations and Treatment Algorithms From a Multidisciplinary Working Group.

PubMed

Webber, Bryant J; Casa, Douglas J; Beutler, Anthony I; Nye, Nathaniel S; Trueblood, Wesley E; O'Connor, Francis G

2016-04-01

Despite aggressive prevention programs and strategies, nontraumatic exertional sudden death events in military training continue to prove a difficult challenge for the Department of Defense. In November 2014, the 559th Medical Group at Joint Base San Antonio-Lackland, Texas, hosted a working group on sudden exertional death in military training. Their objectives were three-fold: (1) determine best practices to prevent sudden exertional death of military trainees, (2) determine best practices to establish safe and ethical training environments for military trainees with sickle cell trait, and (3) develop field-ready algorithms for managing military trainees who collapse during exertion. This article summarizes the major findings and recommendations of the working group. Reprint & Copyright © 2016 Association of Military Surgeons of the U.S.

Resilience in the face of serious illness among chronically ill African Americans in later life.

PubMed

Becker, Gay; Newsom, Edwina

2005-07-01

The purpose of this work was to examine older African Americans' philosophies about their chronic illnesses and how those philosophies affected chronic illness management. Three to five in-depth interviews were conducted over the course of several years with 38 respondents between the ages of 65 and 91. Both open-ended and semistructured questions were asked. Respondents demonstrated determination, perseverance, and tenacity no matter how serious their illnesses were. Racism was instrumental in shaping the responses of these African Americans to their illnesses through cultural values that emphasized independence, spirituality, and survival. Respondents demonstrated a resilient philosophy as they faced disabling illness. This research attests to the importance of examining racism in the analysis of how older ethnic minorities live with chronic illness, as it provides the context for understanding the development of culturally specific philosophies about illness. Resilience, as a culturally specific philosophy, is an important adjunct to chronic illness management in later life, and more needs to be understood about the dimensions that shape it by cultural group.

[Sports and heat stroke].

PubMed

Yuzawa, Itsuki; Miyake, Yasufumi; Aruga, Tohru

2012-06-01

We described Characteristic of the heat stroke in the sports activity in Japan. It was common in teenage men, and 15 years old had a peak with a man, the woman. Most patients did not need specific treatment. Many happened from the end of July on the outdoors around 3:00 p.m. in mid-August. There are many in order of baseball, football, tennis, and a basketball. Running and cycling had high severity of illness. Probably, grasp of an environmental condition, suitable sportswear, suitable hydration, and condition management are the best things as preventive measures.

Illness Uncertainty and Illness Intrusiveness as Predictors of Depressive and Anxious Symptomology in College Students with Chronic Illnesses

ERIC Educational Resources Information Center

Mullins, Alexandria J.; Gamwell, Kaitlyn L.; Sharkey, Christina M.; Bakula, Dana M.; Tackett, Alayna P.; Suorsa, Kristina I.; Chaney, John M.; Mullins, Larry L.

2017-01-01

Objective: To examine predictors of psychological functioning in college students with chronic illnesses. Participants: Participants (N = 1413) included 364 students with self-reported diagnoses of asthma or allergies, 148 students with other chronic illnesses (eg, epilepsy, type 1 diabetes), and 901 healthy students. Data were collected between…

A gastrointestinal anti-infectious biotherapeutic agent: the heat-treated Lactobacillus LB

PubMed Central

Liévin-Le Moal, Vanessa

2016-01-01

Experimental in vitro and in vivo studies support the hypothesis that heat-treated, lyophilized Lactobacillus acidophilus LB cells and concentrated, neutralized spent culture medium conserve the variety of pharmacological, antimicrobial activities of the live probiotic strain against several infectious agents involved in well-established acute and persistent watery diarrhoea and gastritis. Heat-treated cells and heat-stable secreted molecules trigger multiple strain-specific activities explaining the therapeutic efficacy of L. acidophilus LB. This review discusses the current body of knowledge on the antimicrobial mechanisms of action exerted by L. acidophilus LB demonstrated in in vitro and in vivo experimental studies, and the evidence for the therapeutic efficacy of this anti-infectious biotherapeutic agent proved in randomized clinical trials for the treatment of acute and persistent watery diarrhoea associated with several intestinal infectious diseases in humans. PMID:26770268

Comparison of heat strain recovery in different anti-heat stress clothing ensembles after work to exhaustion.

PubMed

Zhao, Yijie; Yi, Wen; Chan, Albert P C; Chan, Daniel W M

2017-10-01

A hot environment combined with physically demanding tasks can subject workers to a higher risk of heat stress. A series of regulations and guidelines have been proposed to design appropriate anti-heat stress work uniform to reduce body heat strain. The present study aimed to examine heat strain recovery in different anti-heat stress clothing ensembles after work to exhaustion in the heat. 10 healthy males performed intermittent treadmill running/walking to exhaustion, followed by 30min passive recovery sitting in a climatic chamber, which simulated the hot and humid outdoor environment (34°C temperature, 60% relative humidity, 0.3m/s air velocity, and 450W/m 2 solar radiation). The participants took part in five wear trials in counter-balanced order, including Sportswear, CIC Uniform, NEW Uniform, ICEBANK Cooling Vest, and NEW Cooling Vest, which have different levels of cooling capacity. Core temperature, skin temperature, heart rate, sweat loss, ratings of perceived exertion, and thermal sensations were measured throughout the entire heat exposure period. Physiological heat strain indices, including the physiological strain index (PhSI) and the perceptual strain index (PeSI), were used as a yardstick to quantify and compare the rate of recovery. Significantly lower physiological strain was observed in the newly developed NEW Uniform and NEW Cooling Vest groups compared with the commonly worn CIC Uniform group during recovery. At the end of the recovery period, participants in NEW Cooling Vest achieved the highest recovery (42.18% in PhSI and 81.08% in PeSI), followed by ICEBANK Cooling Vest, Sportswear, NEW Uniform, and CIC Uniform. The cooling capacity of anti-heat stress clothing ensembles and the recovery time significantly affect the rate of recovery in PhSI and PeSI, which may benefit the industry by formulating the appropriate work-rest schedule by considering the clothing effect. Copyright © 2017 Elsevier Ltd. All rights reserved.

Shivering in acutely ill vulnerable populations.

PubMed

Holtzclaw, Barbara J

2004-01-01

The hazards of thermoregulatory shivering in the critically ill are often overlooked by caregivers. Shivering may accompany heat loss from bathing, dressing, transport, and many therapeutic activities. Febrile shivering is common during chills of fever, blood product transfusions, administration of antigenic drugs, and chemotherapy. Many patients are at risk for shivering and its negative consequences that increase oxygen expenditure and cardiorespiratory effort. Learning how underlying thermoregulatory mechanisms are involved in shivering clarifies how temperature gradients and environmental stimuli induce the shivering response. Knowledge of the anatomical progression of shivering equips the nurse to recognize or prevent this energy-consuming response. This article discusses measures to prevent shivering as well as evidence-based interventions to manage shivering during fever, aggressive cooling, and postoperative recovery. Detailed information is presented on assessment and documentation of the extent and severity of shivering.

Perceived exertion at work in women with fibromyalgia: explanatory factors and comparison with healthy women.

PubMed

Palstam, Annie; Larsson, Anette; Bjersing, Jan; Löfgren, Monika; Ernberg, Malin; Bileviciute-Ljungar, Indre; Ghafouri, Bijar; Sjörs, Anna; Larsson, Britt; Gerdle, Björn; Kosek, Eva; Mannerkorpi, Kaisa

2014-09-01

To investigate perceived exertion at work in women with fibromyalgia. A controlled cross-sectional multi-centre study. Seventy-three women with fibromyalgia and 73 healthy women matched by occupation and physical workload were compared in terms of perceived exertion at work (0-14), muscle strength, 6-min walk test, symptoms rated by Fibromyalgia Impact Questionnaire (FIQ), work status (25-100%), fear avoidance work beliefs (0-42), physical activity at work (7-21) and physical workload (1-5). Spearman's correlation coefficient and linear regression analysis were conducted. Perceived exertion at work was significantly higher in the fibromyalgia group than in the reference group (p = 0.002), while physical activity at work did not differ between the groups. Physical capacity was lower and symptom severity higher in fibromyalgia compared with references (p < 0.05). In fibromyalgia, perceived exertion at work showed moderate correlation with physical activity at work, physical workload and fear avoidance work beliefs (rs = 0.53-0.65, p < 0.001) and a fair correlation with anxiety (rs = 0.26, p = 0.027). Regression analysis indicated that the physical activity at work and fear avoidance work beliefs explained 50% of the perceived exertion at work. Women with fibromyalgia perceive an elevated exertion at work, which is associated with physical work-related factors and factors related to fear and anxiety.

Exercise performance in patients with peripheral arterial disease who have different types of exertional leg pain.

PubMed

Gardner, Andrew W; Montgomery, Polly S; Afaq, Azhar

2007-07-01

This study compared the exercise performance of patients with peripheral arterial disease (PAD) who have different types of exertional leg pain. Patients with PAD were classified into one of four groups according to the San Diego Claudication Questionnaire: intermittent claudication (n = 406), atypical exertional leg pain causing patients to stop (n = 125), atypical exertional leg pain in which patients were able to continue walking (n = 81), and leg pain on exertion and rest (n = 103). Patients were assessed on the primary outcome measures of ankle-brachial index (ABI), treadmill exercise measures, and ischemic window. All patients experienced leg pain consistent with intermittent claudication during a standardized treadmill test. The mean (+/- SD) initial claudication distance (ICD) was similar (P = .642) among patients with intermittent claudication (168 +/- 160 meters), atypical exertional leg pain causing patients to stop (157 +/- 130 meters), atypical exertional leg pain in which patients were able to continue walking (180 +/- 149 meters), and leg pain on exertion and rest (151 +/- 136 meters). The absolute claudication distance (ACD) was similar (P = .648) in the four respective groups (382 +/- 232, 378 +/- 237, 400 +/- 245, and 369 +/- 236 meters). Similarly, the ischemic window, expressed as the area under the curve (AUC) after treadmill exercise, was similar (P = .863) in these groups (189 +/- 137, 208 +/- 183, 193 +/- 143, and 199 +/- 119 AUC). PAD patients with different types of exertional leg pain, all limited by intermittent claudication during a standardized treadmill test, were remarkably similar in ICD, ACD, and ischemic window. Thus, the presence of ambulatory symptoms should be of primary clinical concern in evaluating PAD patients regardless of whether they are consistent with classic intermittent claudication.

Exogenous Salicylic Acid Enhances the Resistance of Wheat Seedlings to Hessian Fly (Diptera: Cecidomyiidae) Infestation Under Heat Stress.

PubMed

Underwood, Joshua; Moch, John; Chen, Ming-Shun; Zhu, Lieceng

2014-10-01

Heat stress exerts significant impact on plant-parasite interactions. Phytohormones, such as salicylic acid (SA), play important roles in plant defense against parasite attacks. Here, we studied the impact of a combination of heat stress and exogenous SA on the resistance of wheat (Triticum aestivum L.) plants to the Hessian fly [Mayetiola destructor (Say)]. We found that the wheat cultivar 'Molly', which contains the resistance gene H13, lost resistance to Hessian fly under heat stress (40°C for 3 and 6 h), and that exogenous application of SA on Molly seedlings right before heat stress can partially prevent the loss of resistance of Molly plants under heat conditions. Our findings have significant implications for understanding the dynamics of plant-insect interactions in the context of heat stress. © 2014 Entomological Society of America.

Core body temperature during competition in the heat: National Boys' 14s Junior Championships.

PubMed

Bergeron, Michael F; McLeod, Kathryn S; Coyle, John F

2007-11-01

To examine on-court core body temperature (T(C)) and sweat loss, as well as pre- and post-play hydration status, in elite adolescent tennis players during a national championships event in a hot climate. Eight healthy, fit, young male tennis players (mean (SD) age 13.9 (0.9) years; mass 56.0 (10.7) kg; height 169.2 (14.7) cm) were evaluated during first-round singles competition at the National Boys' 14s Junior Championships in the heat (wet-bulb globe temperature (WBGT) 29.6 (0.4) degrees C). Five of those same players were also evaluated during a same-day doubles match (WBGT 31.3 (0.5) degrees C). During doubles (4.37 (0.35) h after singles), pre-play urine specific gravity (USG) (1.025 (0.002); p = 0.06) and total sweat loss (1.9 (0.2) litres; p = 0.10) tended to be higher before and during doubles, respectively, compared to singles. However, percentage change in body mass (-0.5 (0.3) %) tended to be comparatively less (p = 0.08), even though the doubles matches were generally longer (106.6 (11.2) vs 78.8 (10.9) min; p = 0.09) and the degree minutes total was greater (p = 0.04). T(C) increased (p<0.001) during singles and remained elevated, even after 10 min following the end of play. Notably, pre-play (singles) USG was strongly associated (p = 0.005) with the players' final T(C) (38.7 (0.3) degrees C) recorded at the end of singles play. Junior tennis players who begin a match not well hydrated could have progressively increasing thermal strain and a greater risk for exertional heat illness as the match advances.

Co-occurring mental illness and health care utilization and expenditures in adults with obesity and chronic physical illness.

PubMed

Shen, Chan; Sambamoorthi, Usha; Rust, George

2008-06-01

The objectives of the study were to compare health care expenditures between adults with and without mental illness among individuals with obesity and chronic physical illness. We performed a cross-sectional analysis of 2440 adults (older than age 21) with obesity using a nationally representative survey of households, the Medical Expenditure Panel Survey. Chronic physical illness consisted of self-reported asthma, diabetes, heart disease, hypertension, or osteoarthritis. Mental illness included affective disorders; anxiety, somatoform, dissociative, personality disorders; and schizophrenia. Utilization and expenditures by type of service (total, inpatient, outpatient, emergency room, pharmacy, and other) were the dependent variables. Chi-square tests, logistic regression on likelihood of use, and ordinary least squares regression on logged expenditures among users were performed. All regressions controlled for gender, race/ethnicity, age, martial status, region, education, employment, poverty status, health insurance, smoking, and exercise. All analyses accounted for the complex design of the survey. We found that 25% of adults with obesity and physical illness had a mental illness. The average total expenditures for obese adults with physical illness and mental illness were $9897; average expenditures were $6584 for those with physical illness only. Mean pharmacy expenditures for obese adults with physical illness and mental illness and for those with physical illness only were $3343 and $1756, respectively. After controlling for all independent variables, among adults with obesity and physical illness, those with mental illness were more likely to use emergency services and had higher total, outpatient, and pharmaceutical expenditures than those without mental illness. Among individuals with obesity and chronic physical illness, expenditures increased when mental illness is added. Our study findings suggest cost-savings efforts should examine the reasons for

[Illness, culture and religion--issues of intercultural medical ethics and nursing ethics].

PubMed

Körtner, Ulrich H J

2007-01-01

Should modern medicine be allowed to do what it is capable of? And what role are religious norms and attitudes to play in both the medical course of life and the bioethical discourse of modern societies? Questions like these are subject of current intercultural medical and nursing ethics. Religious attitudes not only influence the cultural and political surroundings of medical research but also exert a practical influence on the health and illness attitudes of the individual. Coming before moral judgement should be the endeavour to understand one's counterpart, namely the patient, and his/her socio-cultural background. The question to be answered is how therapy and nursing can best be applied within the given socio-cultural framework without those responsible denying their own medical premises or their own concepts of nursing. Intercultural medical and nursing ethics provide an important contribution to the current debate on integration.

Exertional Rhabdomyolysis in a 21-Year-Old Healthy Woman: A Case Report.

PubMed

McKay, Brianna D; Yeo, Noelle M; Jenkins, Nathaniel D M; Miramonti, Amelia A; Cramer, Joel T

2017-05-01

McKay, BD, Yeo, NM, Jenkins, NDM, Miramonti, AA, and Cramer, JT. Exertional rhabdomyolysis in a 21-year-old healthy woman: a case report. J Strength Cond Res 31(5): 1403-1410, 2017-The optimal resistance training program to elicit muscle hypertrophy has been recently debated and researched. Although 3 sets of 10 repetitions at 70-80% of the 1 repetition maximum (1RM) are widely recommended, recent studies have shown that low-load (∼30% 1RM) high-repetition (3 sets of 30-40 repetitions) resistance training can elicit similar muscular hypertrophy. Incidentally, this type of resistance training has gained popularity. In the process of testing this hypothesis in a research study in our laboratory, a subject was diagnosed with exertional rhabdomyolysis after completing a resistance training session that involved 3 sets to failure at 30% 1RM. Reviewed were the events leading up to and throughout the diagnosis of exertional rhabdomyolysis in a healthy recreationally-trained 21-year-old woman who was enrolled in a study that compared the acute effects of high-load low-repetition vs. low-load high-repetition resistance training. The subject completed a total of 143 repetitions of the bilateral dumbbell biceps curl exercise. Three days after exercise, she reported excessive muscle soreness and swelling and sought medical attention. She was briefly hospitalized and then discharged with instructions to take acetaminophen for soreness, drink plenty of water, rest, and monitor her creatine kinase (CK) concentrations. Changes in the subject's CK concentrations, ultrasound-determined muscle thickness, and echo intensity monitored over a 14-day period are reported. This case illustrates the potential risk of developing exertional rhabdomyolysis after a low-load high-repetition resistance training session in healthy, young, recreationally-trained women. The fact that exertional rhabdomyolysis is a possible outcome may warrant caution when prescribing this type of resistance

Illness representations, coping, and illness outcomes in people with cancer: a systematic review and meta-analysis.

PubMed

Richardson, Emma M; Schüz, Natalie; Sanderson, Kristy; Scott, Jennifer L; Schüz, Benjamin

2017-06-01

Cancer is associated with negative health and emotional outcomes in those affected by it, suggesting the need to better understand the psychosocial determinants of illness outcomes and coping. The common sense model is the leading psychological model of self-regulation in the face of illness and assumes that subjective illness representations explain how people attempt to cope with illness. This systematic review and meta-analysis examines the associations of the common sense model's illness representation dimensions with health and coping outcomes in people with cancer. A systematic literature search located 54 studies fulfilling the inclusion criteria, with 38 providing sufficient data for meta-analysis. A narrative review of the remaining studies was also conducted. Random-effects models revealed small to moderate effect sizes (Fisher Z) for the relations between illness representations and coping behaviors (in particular between control perceptions, problem-focused coping, and cognitive reappraisal) and moderate to large effect sizes between illness representations and illness outcomes (in particular between identity, consequences, emotional representations, and psychological distress). The narrative review of studies with insufficient data provided similar results. The results indicate how illness representations relate to illness outcomes in people with cancer. However, more high-quality studies are needed to examine causal effects of illness representations on coping and outcomes. High heterogeneity indicates potential moderators of the relationships between illness representations and health and coping outcomes, including diagnostic, prognostic, and treatment-related variables. This review can inform the design of interventions to improve coping strategies and mental health outcomes in people with cancer. Copyright © 2016 John Wiley & Sons, Ltd.

An investigation of models of illness in carers of schizophrenia patients using the Illness Perception Questionnaire.

PubMed

Barrowclough, C; Lobban, F; Hatton, C; Quinn, J

2001-11-01

Although carers' reactions to schizophrenic illness in a close family member may have important implications for the patient and for themselves, little is known of factors that influence the way carers respond. In the area of physical health problems, people's models of their illness or illness representations have been found to be related to the ways they react and cope with their illness. This study examines the use of a modified form of the Illness Perception Questionnaire (IPQ) to investigate illness models in a sample of carers of schizophrenia patients. Forty-seven carers participated. The psychometric properties of the modified IPQ were examined, and a number of carer and patient outcomes were investigated in relation to carer scores on the illness identity, consequences, control-cure and timeline subscales of the modified IPQ. These outcomes included measures of carer distress and burden, expressed emotion dimensions, and patient functioning. The modified IPQ was found to be a reliable measure of carers' perceptions of schizophrenia. Carer functioning, the patient-carer relationship and patient illness characteristics were associated with different dimensions of illness perceptions. The findings support the proposal that carer cognitive representations of the illness may have important implications for both carer and patient outcomes in schizophrenia.

Glutamine effects on heat shock protein 70 and interleukines 6 and 10: Randomized trial of glutamine supplementation versus standard parenteral nutrition in critically ill children.

PubMed

Jordan, Iolanda; Balaguer, Mònica; Esteban, M Esther; Cambra, Francisco José; Felipe, Aida; Hernández, Lluïsa; Alsina, Laia; Molero, Marta; Villaronga, Miquel; Esteban, Elisabeth

2016-02-01

To determine whether glutamine (Gln) supplementation would have a role modifying both the oxidative stress and the inflammatory response of critically ill children. Prospective, randomized, double-blind, interventional clinical trial. Selection criteria were children requiring parenteral nutrition for at least 5 days diagnosed with severe sepsis or post major surgery. Patients were randomly assigned to standard parenteral nutrition (SPN, 49 subjects) or standard parenteral nutrition with glutamine supplementation (SPN + Gln, 49 subjects). Glutamine levels failed to show statistical differences between groups. At day 5, patients in the SPN + Gln group had significantly higher levels of HSP-70 (heat shock protein 70) as compared with the SPN group (68.6 vs 5.4, p = 0.014). In both groups, IL-6 (interleukine 6) levels showed a remarkable descent from baseline and day 2 (SPN: 42.24 vs 9.39, p < 0.001; SPN + Gln: 35.20 vs 13.80, p < 0.001) but only the treatment group showed a statistically significant decrease between day 2 and day 5 (13.80 vs 10.55, p = 0.013). Levels of IL-10 (interleukine 10) did not vary among visits except in the SPN between baseline and day 2 (9.55 vs 5.356, p < 0.001). At the end of the study, no significant differences between groups for PICU and hospital stay were observed. No adverse events were detected in any group. Glutamine supplementation in critically-ill children contributed to maintain high HSP-70 levels for longer. Glutamine supplementation had no influence on IL-10 and failed to show a significant reduction of IL-6 levels. Copyright © 2015 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

Ratings of perceived exertion by women with internal or external locus of control.

PubMed

Hassmén, P; Koivula, N

1996-10-01

Ratings of perceived exertion are frequently used to estimate the strain and effort experienced subjectively by individuals during various forms of physical activity. A number of factors, both physiological and psychological in origin, have been suggested to work as modifiers of the exertion perceived by the individual. It has been reported in nonsport-related research that individuals with an internal locus of control seem to pay more attention to relevant information and use the available information more adequately than individuals with an external locus of control. The reputed inferior information-processing abilities of externals compared with internals could possibly also influence the ratings of perceived exertion, with externals being less accurate in their ratings. Whether locus of control might be such a factor was investigated. Fifty women worked on an ergometer cycle at four different work loads. The results showed statistically significant differences in subjective ratings of perceived exertion between externals and internals, especially at heavier work loads. Such differences might be because of unequal information-processing abilities, as the observed discrepancies occurred at higher work intensities, when more cues are available for processing.

Perceived exertion is as effective as the perceptual strain index in predicting physiological strain when wearing personal protective clothing.

PubMed

Borg, David N; Costello, Joseph T; Bach, Aaron J; Stewart, Ian B

2017-02-01

The perceptual strain index (PeSI) has been shown to overcome the limitations associated with the assessment of the physiological strain index (PSI), primarily the need to obtain a core body temperature measurement. The PeSI uses the subjective scales of thermal sensation and perceived exertion (RPE) to provide surrogate measures of core temperature and heart rate, respectively. Unfortunately, thermal sensation has shown large variability in providing an estimation of core body temperature. Therefore, the primary aim of this study was to determine if thermal comfort improved the ability of the PeSI to predict the PSI during exertional-heat stress. Eighteen healthy males (age: 23.5years; body mass: 79.4kg; maximal aerobic capacity: 57.2ml·kg -1 ·min -1 ) wore four different chemical/biological protective garments while walking on treadmill at a low (<325W) or moderate (326-499W) metabolic workload in environmental conditions equivalent to wet bulb globe temperatures 21, 30 or 37°C. Trials were terminated when heart rate exceeded 90% of maximum, when core body temperature reached 39°C, at 120min or due to volitional fatigue. Core body temperature, heart rate, thermal sensation, thermal comfort and RPE were recorded at 15min intervals and at termination. Multiple statistical methods were used to determine the most accurate perceptual predictor. Significant moderate relationships were observed between the PeSI (r=0.74; p<0.001), the modified PeSI (r=0.73; p<0.001) and unexpectedly RPE (r=0.71; p<0.001) with the PSI, respectively. The PeSI (mean bias: -0.8±1.5 based on a 0-10 scale; area under the curve: 0.887), modified PeSI (mean bias: -0.5±1.4 based on 0-10 scale; area under the curve: 0.886) and RPE (mean bias: -0.7±1.4 based on a 0-10 scale; area under the curve: 0.883) displayed similar predictive performance when participants experienced high-to-very high levels of physiological strain. Modifying the PeSI did not improve the subjective prediction of

Random Assignment to Illness: Teaching Illness and Disease in the Introductory Health Communication Course

ERIC Educational Resources Information Center

Gray, Jennifer B.; Riley, Sarah

2011-01-01

A key concept in health communication is the difference between disease and illness: disease refers to the physical manifestations of a condition, while illness encompasses the physical, emotional, social, communicative, and psychological experience of living with a condition. The individual illness experience takes into account the full story of…

Inverse problems and optimal experiment design in unsteady heat transfer processes identification

NASA Technical Reports Server (NTRS)

Artyukhin, Eugene A.

1991-01-01

Experimental-computational methods for estimating characteristics of unsteady heat transfer processes are analyzed. The methods are based on the principles of distributed parameter system identification. The theoretical basis of such methods is the numerical solution of nonlinear ill-posed inverse heat transfer problems and optimal experiment design problems. Numerical techniques for solving problems are briefly reviewed. The results of the practical application of identification methods are demonstrated when estimating effective thermophysical characteristics of composite materials and thermal contact resistance in two-layer systems.

Evaluation of a Heat Vulnerability Index on Abnormally Hot Days: An Environmental Public Health Tracking Study

PubMed Central

Mann, Jennifer K.; Alfasso, Ruth; English, Paul B.; King, Galatea C.; Lincoln, Rebecca A.; Margolis, Helene G.; Rubado, Dan J.; Sabato, Joseph E.; West, Nancy L.; Woods, Brian; Navarro, Kathleen M.; Balmes, John R.

2012-01-01

Background: Extreme hot weather conditions have been associated with increased morbidity and mortality, but risks are not evenly distributed throughout the population. Previously, a heat vulnerability index (HVI) was created to geographically locate populations with increased vulnerability to heat in metropolitan areas throughout the United States. Objectives: We sought to determine whether areas with higher heat vulnerability, as characterized by the HVI, experienced higher rates of morbidity and mortality on abnormally hot days. Methods: We used Poisson regression to model the interaction of HVI and deviant days (days whose deviation of maximum temperature from the 30-year normal maximum temperature is at or above the 95th percentile) on hospitalization and mortality counts in five states participating in the Environmental Public Health Tracking Network for the years 2000 through 2007. Results: The HVI was associated with higher hospitalization and mortality rates in all states on both normal days and deviant days. However, associations were significantly stronger (interaction p-value < 0.05) on deviant days for heat-related illness, acute renal failure, electrolyte imbalance, and nephritis in California, heat-related illness in Washington, all-cause mortality in New Mexico, and respiratory hospitalizations in Massachusetts. Conclusion: Our results suggest that the HVI may be a marker of health vulnerability in general, although it may indicate greater vulnerability to heat in some cases. PMID:22538066

Cardiovascular adaptations supporting human exercise-heat acclimation.

PubMed

Périard, Julien D; Travers, Gavin J S; Racinais, Sébastien; Sawka, Michael N

2016-04-01

This review examines the cardiovascular adaptations along with total body water and plasma volume adjustments that occur in parallel with improved heat loss responses during exercise-heat acclimation. The cardiovascular system is well recognized as an important contributor to exercise-heat acclimation that acts to minimize physiological strain, reduce the risk of serious heat illness and better sustain exercise capacity. The upright posture adopted by humans during most physical activities and the large skin surface area contribute to the circulatory and blood pressure regulation challenge of simultaneously supporting skeletal muscle blood flow and dissipating heat via increased skin blood flow and sweat secretion during exercise-heat stress. Although it was traditionally held that cardiac output increased during exercise-heat stress to primarily support elevated skin blood flow requirements, recent evidence suggests that temperature-sensitive mechanisms may also mediate an elevation in skeletal muscle blood flow. The cardiovascular adaptations supporting this challenge include an increase in total body water, plasma volume expansion, better sustainment and/or elevation of stroke volume, reduction in heart rate, improvement in ventricular filling and myocardial efficiency, and enhanced skin blood flow and sweating responses. The magnitude of these adaptations is variable and dependent on several factors such as exercise intensity, duration of exposure, frequency and total number of exposures, as well as the environmental conditions (i.e. dry or humid heat) in which acclimation occurs. Copyright © 2016 The Authors. Published by Elsevier B.V. All rights reserved.

Does Major Illness Cause Financial Catastrophe?

PubMed Central

Cook, Keziah; Dranove, David; Sfekas, Andrew

2010-01-01

Objective We examine the financial impact of major illnesses on the near-elderly and how this impact is affected by health insurance. Data Sources We use RAND Corporation extracts from the Health and Retirement Study from 1992 to 2006.1 Study Design Our dependent variable is the change in household assets, excluding the value of the primary home. We use triple difference median regressions on a sample of newly ill/uninsured near elderly (under age 65) matched to newly ill/insured near elderly. We also include a matched control group of households whose members are not ill. Results Controlling for the effects of insurance status and illness, we find that the median household with a newly ill, uninsured individual suffers a statistically significant decline in household assets of between 30 and 50 percent relative to households with matched insured individuals. Newly ill, insured individuals do not experience a decline in wealth. Conclusions Newly ill/uninsured households appear to be one illness away from financial catastrophe. Newly ill insured households who are matched to uninsured households appear to be protected against financial loss, at least in the near term. PMID:19840132

Neutrophils in critical illness.

PubMed

McDonald, Braedon

2018-03-01

During critical illness, dramatic alterations in neutrophil biology are observed including abnormalities of granulopoeisis and lifespan, cell trafficking and antimicrobial effector functions. As a result, neutrophils transition from powerful antimicrobial protectors into dangerous mediators of tissue injury and organ dysfunction. In this article, the role of neutrophils in the pathogenesis of critical illness (sepsis, trauma, burns and others) will be explored, including pathological changes to neutrophil function during critical illness and the utility of monitoring aspects of the neutrophil phenotype as biomarkers for diagnosis and prognostication. Lastly, we review findings from clinical trials of therapies that target the harmful effects of neutrophils, providing a bench-to-bedside perspective on neutrophils in critical illness.

Effects of heat acclimation on time perception.

PubMed

Tamm, Maria; Jakobson, Ainika; Havik, Merle; Timpmann, Saima; Burk, Andres; Ööpik, Vahur; Allik, Jüri; Kreegipuu, Kairi

2015-03-01

Cognitive performance is impaired during prolonged exercise in hot environment compared to temperate conditions. These effects are related to both peripheral markers of heats stress and alterations in CNS functioning. Repeated-exposure to heat stress results in physiological adaptations, and therefore improvement in exercise capacity and cognitive functioning are observed. The objective of the current study was to clarify the factors contributing to time perception under heat stress and examine the effect of heat acclimation. 20 young healthy male subjects completed three exercise tests on a treadmill: H1 (at 60% VO(2)peak until exhaustion at 42°C), N (at 22°C; duration equal to H1) and H2 (walk until exhaustion at 42°C) following a 10-day heat acclimation program. Core temperature (T(C)) and heart rate (HR), ratings of perceived fatigue and exertion were obtained continuously during the exercise, and blood samples of hormones were taken before, during and after the exercise test for estimating the prolactin, growth hormone and cortisol response to acute exercise-heat stress. Interval production task was performed before, during and after the exercise test. Lower rate of rise in core temperature, heart rate, hormone response and subjective ratings indicated that the subjects had successfully acclimated. Before heat acclimation, significant distortions in produced intervals occurred after 60 minutes of exercise relative to pre-trial coefficients, indicating speeded temporal processing. However, this effect was absent after in acclimated subjects. Blood prolactin concentration predicted temporal performance in both conditions. Heat acclimation slows down the increase in physiological measures, and improvement in temporal processing is also evident. The results are explained within the internal clock model in terms of the pacemaker-accumulator functioning. Copyright © 2014 Elsevier B.V. All rights reserved.

Correctional Officers and the Incarcerated Mentally Ill: Responses to Psychiatric Illness in Prison

PubMed Central

Galanek, Joseph D.

2014-01-01

Based on ethnographic fieldwork in a U.S. men’s prison, I investigate how this social and cultural context structures relations between correctional officers and inmates with severe mental illness. Utilizing interpretivist perspectives, I explore how these relations are structured by trust, respect, and meanings associated with mental illness. Officers’ discretionary responses to mentally ill inmates included observations to ensure psychiatric stability and flexibility in rule enforcement and were embedded within their role to ensure staff and inmate safety. Officers identified housing, employment, and social support as important for inmates’ psychiatric stability as medications. Inmates identified officers’ observation and responsiveness to help seeking as assisting in institutional functioning. These findings demonstrate that this prison’s structures and values enable officers’ discretion with mentally ill inmates, rather than solely fostering custodial responses to these inmates’ behaviors. These officers’ responses to inmates with mental illness concurrently support custodial control and the prison’s order. PMID:25219680

Analyses of Helsinki 2012 European Athletics Championships injury and illness surveillance to discuss elite athletes risk factors.

PubMed

Edouard, Pascal; Depiesse, Frédéric; Branco, Pedro; Alonso, Juan-Manuel

2014-09-01

To further analyze newly incurred injuries and illnesses (I&Is) during Athletics International Championships to discuss risk factors. Prospective recording of newly occurred injuries and illnesses. The 2012 European Athletics (EA) Championships in Helsinki, Finland. National team and local organizing committee physicians and physiotherapists and 1342 registered athletes. Incidence and characteristics of new injuries and illnesses. Ninety-three percent of athletes were covered by medical teams, with a response rate of 91%. One hundred thirty-three injuries were reported (incidence of 98.4 injuries per 1000 registered athletes). Sixty-two injuries (47%) resulted in time loss from sport. The most common diagnosis was hamstring strain (11.4% of injuries and 21% of time-loss injuries). Injury risk was higher in males and increased with age. The highest incidences of injuries were found in combined events and middle- and long-distance events. Twenty-seven illnesses were reported (4.0 illnesses per 1000 athlete days). The most common diagnoses were upper respiratory tract infection (33.3%) and gastroenteritis/diarrhea (25.9%). During outdoor EA Championships, injury and illness incidences were slightly lower and injury characteristics were comparable with those during outdoor World Athletics Championships. During elite athletics Championships, gender (male), age (older than 30 years), finals, and some events (combined events and middle- and long-distance races) seem to be injury risk factors. Illness risk factors remain unclear. As in previous recommendations, preventive interventions should focus on overuse injuries, hamstring strains, and adequate rehabilitation of previous injuries, decreasing risk of infectious diseases transmission, appropriate event scheduling, sports clothes, and heat acclimatization.

Negative Illness Perceptions are Associated with a Pro-nociceptive Modulation Profile and Augmented Pelvic Pain.

PubMed

Grinberg, Keren; Granot, Michal; Lowenstein, Lior; Abramov, Liora; Weissman-Fogel, Irit

2018-05-25

A patient's personal interpretations of a health threat or "illness perceptions" (IPs) are associated with their clinical outcomes. This study explored whether IPs are associated with pain severity and ability to modulate pain in women with chronic pelvic pain syndrome (CPPS), as well as the predictive value of IPs on Myofascial Physical Therapy (MPT) success. Illness Perceptions Questionnaire - Revised (IPQ-R), mechanical and heat pain thresholds, mechanical temporal summation (mTS), and conditioned pain modulation (CPM) were evaluated in CPPS patients (n=39) before, and 3 months after MPT. CPPS severity was obtained by the Brief Pain Inventory (BPI). Stronger perceptions of illness chronicity were correlated with less efficient CPM (r=0.488, P=0.002) and increased mechanical pain intensity (r=0.405, P=0.02). Lower perceptions of control over illness were associated with enhanced mTS (r=0.399, P=0.01). Higher BPI scores were correlated with emotional representations ("negative emotional representations") and severe consequences due to CPPS. Regression analyses revealed that negative IPs predict less efficient MPT. Cognitive representations play a unique role in CPPS expression and MPT outcomes. The interplay between negative IPs and a pro-nociceptive modulation profile, mediated by enhanced facilitatory and reduced inhibitory processes, may be involved in the manifestation of CPPS.

Dyspnea on exertion in obese women: association with an increased oxygen cost of breathing.

PubMed

Babb, Tony G; Ranasinghe, Kamalini G; Comeau, Laurie A; Semon, Trisha L; Schwartz, Belinda

2008-07-15

Although exertional dyspnea in obesity is an important and prolific clinical concern, the underlying mechanism remains unclear. To investigate whether dyspnea on exertion in otherwise healthy obese women was associated with an increase in the oxygen cost of breathing or cardiovascular deconditioning. Obese women with and without dyspnea on exertion participated in two independent experiments (n = 16 and n = 14). All participants underwent pulmonary function testing, hydrostatic weighing, ratings of perceived breathlessness during cycling at 60 W, and determination of the oxygen cost of breathing during eucapnic voluntary hyperpnea at 40 and 60 L/min. Cardiovascular exercise capacity, fat distribution, and respiratory mechanics were determined in 14 women in experiment 2. Data were analyzed between groups by independent t test, and the relationship between the variables was determined by regression analysis. In both experiments, breathlessness during 60 W cycling was markedly increased in over 37% of the obese women (P < 0.01). Age, height, weight, lung function, and %body fat were not different between the groups in either experiment. In contrast, the oxygen cost of breathing was significantly (P < 0.01) and markedly (38-70%) greater in the obese women with dyspnea on exertion. The oxygen cost of breathing was significantly (P < 0.001) correlated with the rating of perceived breathlessness obtained during the 60 W exercise in experiment 1 (r(2) = 0.57) and experiment 2 (r(2) = 0.72). Peak cardiovascular exercise capacity, fat distribution, and respiratory mechanics were not different between groups in experiment 2. Dyspnea on exertion is prevalent in otherwise healthy obese women, which seems to be strongly associated with an increased oxygen cost of breathing. Exercise capacity is not reduced in obese women with dyspnea on exertion.

[Poor tolerance of exertion during sports and bronchial hyperreactivity].

PubMed

Potiron-Josse, M; Boutet, S; Ginet, J

1992-11-01

135 sportsmen and women, 55 girls, 80 boys, aged from 7 to 30 years, from various sports, who complained of bad tolerance of exertion were examined with an exercise test and isocapnic spontaneous hyperventilation. 61, about 45%, during a hyperventilation test had a fall of V.E.M.S. greater than or equal to 20%, showing bronchial hyperreactivity. After three tests, this fall index was greater than or equal to 50%. 68% of the positive responses were seen in boys and 2/3 of the subjects with a positive response were atopics. No other argument could be maintained from the questioning or clinical history to predict the positive or negative character of the hyperventilation (age, sporting level, symptoms, previous asthma or asthmatic, allergy). H.S.V.I. of the chests of a sporting population that complains of exertion intolerance, therefore allows verification of an H.R.B. assessment of its severity and to follow evolution after treatment.

Frontoethmoidal Schwannoma with Exertional Cerebrospinal Fluid Rhinorrhea: Case Report and Review of Literature.

PubMed

Yoneoka, Yuichiro; Akiyama, Katsuhiko; Seki, Yasuhiro; Hasegawa, Go; Kakita, Akiyoshi

2018-03-01

Frontoethmoidal schwannomas are rare. No case manifesting exertional cerebrospinal fluid (CSF) rhinorrhea has ever been reported to the best of our knowledge. In this report, we describe an extremely rare case of frontoethmoidal schwannoma extending through the olfactory groove with exertional CSF rhinorrhea as the initial symptom. A 50-year-old woman was presented to our clinic for frequent nasal discharge on exertion. A postcontrast computed tomographic scan demonstrated heterogeneously enhanced tumor from the anterior cranial fossa to the anterior ethmoid sinus. A gadolinium-enhanced T1-weighted magnetic resonance image revealed a well-defined heterogeneously enhanced tumor situated in the midline anterior cranial fossa and anterior ethmoid sinus. After the resection, the defect of the right anterior skull base was reconstructed with a fascia graft and adipose tissue taken from the abdomen, as well as a pedicle periosteum flap. A histologic examination revealed the tumor as schwannoma. Her rhinorrhea completely resolved. She regained her sense of smell and taste 1 month after the operation. According to previous reports, olfactory groove, and paraolfactory groove/periolfactory groove schwannomas can be divided into 4 types: subfrontal, nasoethmoidal, frontoethmoidal, and ethmofrontal. Among them, a frontoethmoidal schwannoma can manifest exertional CSF rhinorrhea as an initial symptom. Copyright © 2018 Elsevier Inc. All rights reserved.

Heat shock proteins and toll-like receptors.

PubMed

Asea, Alexzander

2008-01-01

Researchers have only just begun to elucidate the relationship between heat shock proteins (HSP) and Toll-like receptors (TLR). HSP were originally described as an intracellular molecular chaperone of naïve, aberrantly folded, or mutated proteins and primarily implicated as a cytoprotective protein when cells are exposed to stressful stimuli. However, recent studies have ascribed novel functions to the Hsp70 protein depending on its localization: Surface-bound Hsp70 specifically activate natural killer (NK) cells, while Hsp70 released into the extracellular milieu specifically bind to Toll-like receptors (TLR) 2 and 4 on antigen-presenting cells (APC) and exerts immunoregulatory effects, including upregulation of adhesion molecules, co-stimulatory molecule expression, and cytokine and chemokine release-a process known as the chaperokine activity of Hsp70. This chapter discusses the most recent advances in the understanding of heat shock protein (HSP) and TLR interactions in general and highlights recent findings that demonstrate Hsp70 is a ligand for TLR and its biological significance.

Dependency in Critically Ill Patients

PubMed Central

Yang, Rumei

2016-01-01

By necessity, critically ill patients admitted to intensive care units (ICUs) have a high level of dependency, which is linked to a variety of negative feelings, such as powerlessness. However, the term dependency is not well defined in the critically ill patients. The concept of “dependency” in critically ill patients was analyzed using a meta-synthesis approach. An inductive process described by Deborah Finfgeld-Connett was used to analyze the data. Overarching themes emerged that reflected critically ill patients’ experience and meaning of being in dependency were (a) antecedents: dependency in critically ill patients was a powerless and vulnerable state, triggered by a life-threatening crisis; (b) attributes: the characteristic of losing “self” was featured by dehumanization and disembodiment, which can be alleviated by a “self”-restoring process; and (c) outcomes: living with dependency and coping with dependency. The conceptual model explicated here may provide a framework for understanding dependency in critically ill patients. PMID:28462328

Creatine Use and Exercise Heat Tolerance in Dehydrated Men

PubMed Central

Watson, Greig; Casa, Douglas J; Fiala, Kelly A; Hile, Amy; Roti, Melissa W; Healey, Julie C; Armstrong, Lawrence E; Maresh, Carl M

2006-01-01

Context: Creatine monohydrate (CrM) use is highly prevalent in team sports (eg, football, lacrosse, ice hockey) and by athletes at the high school, college, professional, and recreational levels. Concerns have been raised about whether creatine use is associated with increased cramping, muscle injury, heat intolerance, and risk of dehydration. Objective: To assess whether 1 week of CrM supplementation would compromise hydration status, alter thermoregulation, or increase the incidence of symptoms of heat illness in dehydrated men performing prolonged exercise in the heat. Design: Double-blind, randomized, crossover design. Setting: Human Performance Laboratory. Patients or Other Participants: Twelve active males, age = 22 ± 1 year, height = 180 ± 3 cm, mass = 78.8 ± 1.2 kg, body fat = 9 ± 1%, V̇o2peak = 50.9 ± 1 ml·kg−1·min−1. Intervention(s): Subjects consumed 21.6 g·d−1 of CrM or placebo for 7 days, underwent 48 ± 10 days of washout between treatments, and then crossed over to the alternate treatment in the creatine group. On day 7 of each treatment, subjects lost 2% body mass by exercising in 33.5°C and then completed an 80-minute exercise heat-tolerance test (33.5°C ± 0.5°C, relative humidity = 41 ± 12%). The test consisted of four 20-minute sequences of 4 minutes of rest, alternating a 3-minute walk and 1-minute high-intensity run 3 times, and walking for 4 minutes. Main Outcome Measures: Thermoregulatory, cardiorespiratory, metabolic, urinary, and perceptual responses. Results: On day 7, body mass had increased 0.88 kg. No interaction or treatment differences for placebo versus CrM during the exercise heat-tolerance test were noted in thermoregulatory (rectal temperature, 39.3 ± 0.4°C versus 39.4 ± 0.4°C) cardiorespiratory (V̇o2, 21.4 ± 2.7 versus 20.0 ± 1.8 ml·kg−1·min−1; heart rate, 192 ± 10 versus 192 ± 11 beats·min−1; mean arterial pressure, 90 ± 9 versus 88 ± 5 mm Hg), metabolic (lactate, 6.7 ± 2.7 versus 7.0 �

Occupational hazards and illnesses of Filipino women workers in export processing zones.

PubMed

Lu, Jinky Leilanie

2008-01-01

This was a baseline study on occupational exposure and health problems among women workers in export processing zones. Physical, chemical, and ergonomic hazards were evaluated and measured through workplace ambient monitoring, survey questionnaires, and interviews with 500 respondents in 24 companies (most were female at 88.8%). The top 5 hazards were ergonomic hazards (72.2%), heat (66.6%), overwork (66.6%), poor ventilation (54.8%), and chemical exposure (50.8%). The most common illnesses were gastrointestinal problems (57.4%), backache (56%), headache (53.2%), and fatigue/weakness (53.2%). Logistic regression showed an association between certain work-related factors and occupational illnesses, and psychosocial problems. Highly significant associations were hearing loss with years spent in the company (p=.005) and gender (p=.006), headache and dizziness with poor ventilation (p=.000), backache with prolonged work (p=.003). These results will have implications for policy and program formulation for women workers' concerns and issues in export zones.

Supraphysiological doses of performance enhancing anabolic-androgenic steroids exert direct toxic effects on neuron-like cells

PubMed Central

Basile, John R.; Binmadi, Nada O.; Zhou, Hua; Yang, Ying-Hua; Paoli, Antonio; Proia, Patrizia

2013-01-01

Anabolic-androgenic steroids (AAS) are lipophilic hormones often taken in excessive quantities by athletes and bodybuilders to enhance performance and increase muscle mass. AAS exert well known toxic effects on specific cell and tissue types and organ systems. The attention that androgen abuse has received lately should be used as an opportunity to educate both athletes and the general population regarding their adverse effects. Among numerous commercially available steroid hormones, very few have been specifically tested for direct neurotoxicity. We evaluated the effects of supraphysiological doses of methandienone and 17-α-methyltestosterone on sympathetic-like neuron cells. Vitality and apoptotic effects were analyzed, and immunofluorescence staining and western blot performed. In this study, we demonstrate that exposure of supraphysiological doses of methandienone and 17-α-methyltestosterone are toxic to the neuron-like differentiated pheochromocytoma cell line PC12, as confirmed by toxicity on neurite networks responding to nerve growth factor and the modulation of the survival and apoptosis-related proteins ERK, caspase-3, poly (ADP-ribose) polymerase and heat-shock protein 90. We observe, in contrast to some previous reports but in accordance with others, expression of the androgen receptor (AR) in neuron-like cells, which when inhibited mitigated the toxic effects of AAS tested, suggesting that the AR could be binding these steroid hormones to induce genomic effects. We also note elevated transcription of neuritin in treated cells, a neurotropic factor likely expressed in an attempt to resist neurotoxicity. Taken together, these results demonstrate that supraphysiological exposure to the AAS methandienone and 17-α-methyltestosterone exert neurotoxic effects by an increase in the activity of the intrinsic apoptotic pathway and alterations in neurite networks. PMID:23675320

The Stigma of Mental Illness

ERIC Educational Resources Information Center

Overton, Stacy L.; Medina, Sondra L.

2008-01-01

Stigma surrounding major mental illness creates many barriers. People who experience mental illness face discrimination and prejudice when renting homes, applying for jobs, and accessing mental health services. The authors review the current literature regarding stigma and mental illness. They define stigma and review theories that explain its…

Perceived Exertion: An Old Exercise Tool Finds New Applications.

ERIC Educational Resources Information Center

Monahan, Terry

1988-01-01

Perceived exertion scales, based on subjective perception of energy output, are gaining respect as prescribing and monitoring tools for individual exercise programs. A review of recent literature indicates growing research interest in applications for individuals who are elderly, inactive, or subject to medical conditions such as angina. (IAH)

The acoustic radiation force on a heated (or cooled) rigid sphere - Theory

NASA Technical Reports Server (NTRS)

Lee, C. P.; Wang, T. G.

1984-01-01

A finite amplitude sound wave can exert a radiation force on an object due to second-order effect of the wave field. The radiation force on a rigid small sphere (i.e., in the long wavelength limit), which has a temperature different from that of the environment, is presently studied. This investigation assumes no thermally induced convection and is relevant to material processing in the absence of gravity. Both isotropic and nonisotropic temperature profiles are considered. In this calculation, the acoustic effect and heat transfer process are essentially decoupled because of the long wavelength limit. The heat transfer information required for determining the force is contained in the parameters, which are integrals over the temperature distribution.

Estimating the Prevalence of Heat-Related Symptoms and Sun Safety-Related Behavior among Latino Farmworkers in Eastern North Carolina.

PubMed

Kearney, Gregory D; Hu, Hui; Xu, Xiaohui; Hall, Marla B; Balanay, Jo Anne G

2016-01-01

In hot weather, thermal heat generated by the body, combined with environmental heat from the sun, can lead outdoor workers to experience heat-related stress, severe illness, or even death. The aims of this study were to estimate the prevalence of heat-related symptoms and potential risk factors associated with sun safety-related behavior among Latino farmworkers. Data from interviewer-administered questionnaires were collected from a cross-sectional survey among farmworkers (N = 158) from August to September 2013. Data analysis assessed associations between work activities, sun safety behavior, and the prevalence of heat-related illness (HRI) symptoms among workers. Nearly two thirds (72%) of farmworkers experienced at least one HRI symptom and lacked proper cooling methods when working outdoors. Most workers reported wearing long-sleeved shirts (85%), long pants (98%), and baseball caps (93%). The prevalence of having one HRI symptom was 72% and 27% among workers having three or more HRI symptoms. The majority of farmworkers experience symptoms of HRI and are not provided with proper shade protection when working outdoors. Increased emphasis on administrative controls, particularly educating field supervisors and workers on how to avoid and recognize HRI, should be a priority.

World survey of mental illness stigma.

PubMed

Seeman, Neil; Tang, Sabrina; Brown, Adalsteinn D; Ing, Alton

2016-01-15

To obtain rapid and reproducible opinions that address mental illness stigma around the world. Random global Web users were exposed to brief questions, asking whether they interacted daily with someone with mental illness, whether they believed that mental illness was associated with violence, whether it was similar to physical illness, and whether it could be overcome. Over a period of 1.7 years, 596,712 respondents from 229 countries completed the online survey. The response rate was 54.3%. China had the highest proportion of respondents in daily contact with a person with mental illness. In developed countries, 7% to 8% of respondents endorsed the statement that individuals with mental illness were more violent than others, in contrast to 15% or 16% in developing countries. While 45% to 51% of respondents from developed countries believed that mental illness was similar to physical illness, only 7% believed that mental illness could be overcome. To test for reproducibility, 21 repeats of the same questions were asked monthly in India for 21 months. Each time, 10.1 ± 0.11% s.e., of respondents endorsed the statement that persons who suffer from mental illness are more violent than others, indicating strong reproducibility of response. This study shows that surveys of constructs such as stigma towards mental illness can be carried out rapidly and repeatedly across the globe, so that the impact of policy interventions can be readily measured. The method engages English speakers only, mainly young, educated males. Copyright © 2015 Elsevier B.V. All rights reserved.

Cultural Variation in Implicit Mental Illness Stigma.

PubMed

Cheon, Bobby K; Chiao, Joan Y

2012-10-01

Culture shapes how individuals perceive and respond to others with mental illness. Prior studies have suggested that Asians and Asian Americans typically endorse greater stigma of mental illness compared to Westerners (White Europeans and Americans). However, whether these differences in stigma arise from cultural variations in automatic affective reactions or deliberative concerns of the appropriateness of one's reactions to mental illness remains unknown. Here we compared implicit and explicit attitudes toward mental illness among Asian and Caucasian Americans. Asian Americans showed stronger negative implicit attitudes toward mental illness relative to Caucasian Americans, suggesting that cultural variation in stigma of mental illness can be observed even when concerns regarding the validity and appropriateness of one's attitudes toward mental illness are minimized. Asian Americans also explicitly endorsed greater desire for social distance from mental illness relative to Caucasian Americans. These findings suggest that cultural variations in mental illness stigma may arise from cultural differences in automatic reactions to mental illness, though cultural variations in deliberative processing may further shape differences in these immediate reactions to mental illness.

Pressure garment design tool to monitor exerted pressures.

PubMed

Macintyre, Lisa; Ferguson, Rhona

2013-09-01

Pressure garments are used in the treatment of hypertrophic scarring following serious burns. The use of pressure garments is believed to hasten the maturation process, reduce pruritus associated with immature hypertrophic scars and prevent the formation of contractures over flexor joints. Pressure garments are normally made to measure for individual patients from elastic fabrics and are worn continuously for up to 2 years or until scar maturation. There are 2 methods of constructing pressure garments. The most common method, called the Reduction Factor method, involves reducing the patient's circumferential measurements by a certain percentage. The second method uses the Laplace Law to calculate the dimensions of pressure garments based on the circumferential measurements of the patient and the tension profile of the fabric. The Laplace Law method is complicated to utilise manually and no design tool is currently available to aid this process. This paper presents the development and suggested use of 2 new pressure garment design tools that will aid pressure garment design using the Reduction Factor and Laplace Law methods. Both tools calculate the pressure garment dimensions and the mean pressure that will be exerted around the body at each measurement point. Monitoring the pressures exerted by pressure garments and noting the clinical outcome would enable clinicians to build an understanding of the implications of particular pressures on scar outcome, maturation times and patient compliance rates. Once the optimum pressure for particular treatments is known, the Laplace Law method described in this paper can be used to deliver those average pressures to all patients. This paper also presents the results of a small scale audit of measurements taken for the fabrication of pressure garments in two UK hospitals. This audit highlights the wide range of pressures that are exerted using the Reduction Factor method and that manual pattern 'smoothing' can dramatically

Suicide in the Medically Ill.

ERIC Educational Resources Information Center

Hughes, Douglas; Kleespies, Phillip

2001-01-01

The relationship between medical illness and suicide seems to be multi-faceted. While medical illness is not the sole determinant of suicide, certain illnesses, such as HIV/AIDS and brain cancers, do appear to elevate the risk of suicide. Possible effective prevention efforts include education of primary care providers, and improved medication…

Illness perception ratings of high-risk newborns by mothers and clinicians: relationship to illness severity and maternal stress.

PubMed

Brooks, Stacey; Rowley, Simon; Broadbent, Elizabeth; Petrie, Keith J

2012-09-01

Patients' views of illness are often thought to differ from those of medical staff, although this is rarely assessed. This study examined the correspondence between mothers' and clinicians' perceptions of the same high-risk newborns, as well as with an objective measure of illness severity. We also investigated how mothers' perceptions were related to reported stress. Mothers of 99 high-risk infants admitted to either a neonatal intensive care or neonatal high dependency unit, which offers specialized but not intensive care, completed illness perception ratings of their baby's condition as well as perceived stress 3 to 5 days following admission. At the same time, a standardized measure of neonatal illness severity was calculated and the baby's primary neonatologist completed illness perceptions ratings. Unlike clinician ratings, mothers' illness perceptions were not significantly correlated with illness severity. Mothers generally rated babies in both units as sicker and having a more serious illness than did neonatologists. Whereas clinicians, compared with mothers, rated babies in intensive care as having an illness that would affect their life more and last for a longer time. Mothers rated medical treatment to be significantly more helpful than did clinicians, particularly for babies admitted to the high dependency unit. Mothers' stress was significantly associated with illness perceptions but unrelated to illness severity. Significant differences exist in the perceptions of illness severity, helpfulness of treatment, and the long-term effects of the baby's illness between parents and clinicians and this may lead to misunderstandings and misinterpretations in communication. PsycINFO Database Record (c) 2012 APA, all rights reserved.

Heat Acclimation by Post-Exercise Hot Water Immersion in the Morning Reduces Thermal Strain During Morning and Afternoon Exercise-Heat-Stress.

PubMed

Zurawlew, Michael J; Mee, Jessica A; Walsh, Neil P

2018-05-10

Recommendations state that to acquire the greatest benefit from heat acclimation the clock-time of heat acclimation sessions should match the clock-time of expected exercise-heat stress. It remains unknown if adaptations by post-exercise hot water immersion (HWI) demonstrate time of day dependent adaptations. Thus, we examined whether adaptations following post-exercise HWI completed in the morning were present during morning and afternoon exercise-heat stress. Ten males completed an exercise-heat stress test commencing in the morning (0945-h: AM) and afternoon (1445-h: PM; 40 min; 65% V̇O 2max treadmill run) before (PRE) and after (POST) heat acclimation. The 6-day heat acclimation intervention involved a daily, 40 min treadmill-run (65% V̇O 2max ) in temperate conditions followed by ≤ 40 min HWI (40°C; 0630-1100-h). Adaptations by 6-day post-exercise HWI in the morning were similar in the morning and afternoon. Reductions in resting rectal temperature (T re ; AM; -0.34 ± 0.24°C, PM; -0.27 ± 0.23°C; P = 0.002), T re at sweating onset (AM; -0.34 ± 0.24°C, PM; -0.31 ± 0.25°C; P = 0.001), and end-exercise T re (AM; -0.47 ± 0.33°C, PM; -0.43 ± 0.29°C; P = 0.001), heart rate (AM; -14 ± 7 beats∙min -1 , PM; -13 ± 6 beats∙min -1 ; P < 0.01), rating of perceived exertion (P = 0.01), and thermal sensation (P = 0.005) were not different in the morning compared to the afternoon. Morning heat acclimation by post-exercise hot water immersion induced adaptions at rest and during exercise-heat stress in the morning and mid-afternoon.

The Theory of Dyadic Illness Management.

PubMed

Lyons, Karen S; Lee, Christopher S

2018-02-01

Despite the importance of both members of the adult patient-care partner dyad, a majority of research on illness management is focused on the patient or the care partner. The basic principle of the Theory of Dyadic Illness Management is that illness management is a dyadic phenomenon; the theory focuses extensively on the dyad as an interdependent team. The way dyads appraise illness as a unit influences the ways in which they engage in behaviors to manage illness together in a recursive fashion that influences dyadic health. Optimizing the health of both members of the dyad is a goal of the theory. In turn, the health of the dyad can feedback to influence how they appraise and manage illness together. Finally, dyadic illness management is an inherently variable process that is influenced by several contextual factors. Supportive evidence and implications for practice and future research are presented.

Estimates of Foodborne Illness in the United States -- Burden of Foodborne Illness: Findings

MedlinePlus

... Pathogens causing the most foodborne illnesses, hospitalizations, and deaths each year Eight known pathogens are estimated to ... majority of domestically acquired foodborne illnesses, hospitalizations, and deaths. The tables below list the top five pathogens ...

How emotion context modulates unconscious goal activation during motor force exertion.

PubMed

Blakemore, Rebekah L; Neveu, Rémi; Vuilleumier, Patrik

2017-02-01

Priming participants with emotional or action-related concepts influences goal formation and motor force output during effort exertion tasks, even without awareness of priming information. However, little is known about neural processes underpinning how emotional cues interact with action (or inaction) goals to motivate (or demotivate) motor behaviour. In a novel functional neuroimaging paradigm, visible emotional images followed by subliminal action or inaction word primes were presented before participants performed a maximal force exertion. In neutral emotional contexts, maximum force was lower following inaction than action primes. However, arousing emotional images had interactive motivational effects on the motor system: Unpleasant images prior to inaction primes increased force output (enhanced effort exertion) relative to control primes, and engaged a motivation-related network involving ventral striatum, extended amygdala, as well as right inferior frontal cortex. Conversely, pleasant images presented before action (versus control) primes decreased force and activated regions of the default-mode network, including inferior parietal lobule and medial prefrontal cortex. These findings show that emotional context can determine how unconscious goal representations influence motivational processes and are transformed into actual motor output, without direct rewarding contingencies. Furthermore, they provide insight into altered motor behaviour in psychopathological disorders with dysfunctional motivational processes. Copyright © 2016 Elsevier Inc. All rights reserved.

Caffeine and theanine exert opposite effects on attention under emotional arousal.

PubMed

Giles, Grace E; Mahoney, Caroline R; Brunyé, Tad T; Taylor, Holly A; Kanarek, Robin B

2017-01-01

Tea is perceived as more relaxing than coffee, even though both contain caffeine. L-theanine in tea may account for the difference. Consumed together, caffeine and theanine exert similar cognitive effects to that of caffeine alone, but exert opposite effects on arousal, in that caffeine accentuates and theanine mitigates physiological and felt stress responses. We evaluated whether caffeine and theanine influenced cognition under emotional arousal. Using a double-blind, repeated-measures design, 36 participants received 4 treatments (200 mg caffeine + 0 mg theanine, 0 mg caffeine + 200 mg theanine, 200 mg caffeine + 200 mg theanine, 0 mg caffeine + 0 mg theanine) on separate days. Emotional arousal was induced by highly arousing negative film clips and pictures. Mood, salivary cortisol, and visual attention were evaluated. Caffeine accentuated global processing of visual attention on the hierarchical shape task (p < 0.05), theanine accentuated local processing (p < 0.05), and the combination did not differ from placebo. Caffeine reduced flanker conflict difference scores on the Attention Network Test (p < 0.05), theanine increased difference scores (p < 0.05), and the combination did not differ from placebo. Thus, under emotional arousal, caffeine and theanine exert opposite effects on certain attentional processes, but when consumed together, they counteract the effects of each other.

Acute Exertional Compartment Syndrome with Rhabdomyolysis: Case Report and Review of Literature

PubMed Central

Gaunder, Christopher; Schumer, Ross

2018-01-01

Patient: Male, 17 Final Diagnosis: Acute exertional compartment syndrome Symptoms: Foot drop • leg pain • paresthesia Medication: — Clinical Procedure: Fasciotomy Specialty: Orthopedics and Traumatology Objective: Rare disease Background: Acute exertional compartment syndrome (AECS) is a rare cause of leg pain often associated with a delay in diagnosis and potentially leading to irreversible muscle and nerve damage. Case Report: We present the case of a previously healthy, high-level athlete who presented with the acute onset of unilateral anterior leg pain and foot drop the day after a strenuous workout. He was diagnosed with compartment syndrome and rhabdomyolysis. His management included emergent fluid resuscitation, fasciotomies, debridement of necrotic muscle from his anterior compartment, and delayed primary closure. After six months of intensive outpatient physical therapy, including the use of blood flow restriction treatments, the patient returned to sports and received a NCAA Division I Football scholarship. Conclusions: We describe the details of this patient’s case and review the literature related to acute exertional compartment syndrome. The occurrence of acute compartment syndrome in the absence of trauma or fracture, though rare, can have devastating consequences following delays in treatment. AECS requires prompt diagnosis and surgical intervention to prevent these consequences. Diagnosis of atraumatic cases can be difficult, which is why awareness is equally as important as history and physical examination. While diagnosis is primarily clinical, it can be supported with direct intra-compartmental pressure measurements and maintaining a high index of suspicion in acute presentations of exertional limb pain. PMID:29415981

Short Duration Heat Acclimation in Australian Football Players

PubMed Central

Kelly, Monica; Gastin, Paul B.; Dwyer, Daniel B; Sostaric, Simon; Snow, Rodney J.

2016-01-01

This study examined if five sessions of short duration (27 min), high intensity, interval training (HIIT) in the heat over a nine day period would induce heat acclimation in Australian football (AF) players. Fourteen professional AF players were matched for VO2peak (mL·kg-1·min-1) and randomly allocated into either a heat acclimation (Acc) (n = 7) or Control (Con) group (n = 7). The Acc completed five cycle ergometer HIIT sessions within a nine day period on a cycle ergometer in the heat (38.7 ± 0.5 °C; 34.4 ± 1.3 % RH), whereas Con trained in thermo-neutral conditions (22.3 ± 0.2 °C; 35.8 ± 0. % RH). Four days prior and two days post HIIT participants undertook a 30 min constant load cycling test at 60% V̇O2peak in the heat (37.9 ± 0.1 °C; 28.5 ± 0.7 % RH) during which VO2, blood lactate concentration ([Lac-]), heart rate (HR), rating of perceived exertion (RPE), thermal comfort, core and skin temperatures were measured. Heat acclimation resulted in reduced RPE, thermal comfort and [Lac-] (all p < 0.05) during the submaximal exercise test in the heat. Heart rate was lower (p = 0.007) after HIIT, in both groups. Heat acclimation did not influence any other measured variables. In conclusion, five short duration HIIT sessions in hot dry conditions induced limited heat acclimation responses in AF players during the in-season competition phase. In practice, the heat acclimation protocol can be implemented in a professional team environment; however the physiological adaptations resulting from such a protocol were limited. Key points Some minor heat acclimation adaptations can be induced in professional AF players with five 27 min non-consecutive, short duration HIIT sessions in the heat. The heat acclimation protocol employed in this study was able to be implemented in a professional team sport environment during an actual competitive season. Elevating and maintaining a high core temperature sufficient for heat acclimation likely requires a longer heat

Short Duration Heat Acclimation in Australian Football Players.

PubMed

Kelly, Monica; Gastin, Paul B; Dwyer, Daniel B; Sostaric, Simon; Snow, Rodney J

2016-03-01

This study examined if five sessions of short duration (27 min), high intensity, interval training (HIIT) in the heat over a nine day period would induce heat acclimation in Australian football (AF) players. Fourteen professional AF players were matched for VO2peak (mL·kg(-1)·min(-1)) and randomly allocated into either a heat acclimation (Acc) (n = 7) or Control (Con) group (n = 7). The Acc completed five cycle ergometer HIIT sessions within a nine day period on a cycle ergometer in the heat (38.7 ± 0.5 °C; 34.4 ± 1.3 % RH), whereas Con trained in thermo-neutral conditions (22.3 ± 0.2 °C; 35.8 ± 0. % RH). Four days prior and two days post HIIT participants undertook a 30 min constant load cycling test at 60% V̇O2peak in the heat (37.9 ± 0.1 °C; 28.5 ± 0.7 % RH) during which VO2, blood lactate concentration ([Lac(-)]), heart rate (HR), rating of perceived exertion (RPE), thermal comfort, core and skin temperatures were measured. Heat acclimation resulted in reduced RPE, thermal comfort and [Lac(-)] (all p < 0.05) during the submaximal exercise test in the heat. Heart rate was lower (p = 0.007) after HIIT, in both groups. Heat acclimation did not influence any other measured variables. In conclusion, five short duration HIIT sessions in hot dry conditions induced limited heat acclimation responses in AF players during the in-season competition phase. In practice, the heat acclimation protocol can be implemented in a professional team environment; however the physiological adaptations resulting from such a protocol were limited. Key pointsSome minor heat acclimation adaptations can be induced in professional AF players with five 27 min non-consecutive, short duration HIIT sessions in the heat.The heat acclimation protocol employed in this study was able to be implemented in a professional team sport environment during an actual competitive season.Elevating and maintaining a high core temperature sufficient for heat acclimation likely requires a longer heat

The Chronically Ill Child in the School.

ERIC Educational Resources Information Center

Sexson, Sandra; Madan-Swain, Avi

1995-01-01

Examines the effects of chronic illness on the school-age population. Facilitating successful functioning of chronically ill youths is a growing problem. Focuses on problems encountered by the chronically ill student who has either been diagnosed with a chronic illness or who has survived such an illness. Discusses the role of the school…

Internalized stigma and quality of life domains among people with mental illness: the mediating role of self-esteem.

PubMed

Oliveira, Sandra E H; Carvalho, Helena; Esteves, Francisco

2016-01-01

People with mental illness who internalize stigma often experience reduced self-esteem and impaired quality of life (QOL). To propose a theoretical model in which self-esteem mediates the effects of internalized stigma on the multidimensional domains comprising QOL. In 403 inpatients and outpatients (DSM-IV, American Psychiatric Association, 1994), from hospital-based and community mental health facilities, self-report measures of internalized stigma (ISMI), self-esteem (RSES) and QOL (WHOQOL-Bref) were administrated. Structural equation modeling results supported the proposed model. Self-esteem fully mediated the relation between internalized stigma and the physical and the social relationships domains, and partially mediated the relationship between internalized stigma and psychological, environment and level of independence QOL domains. Such results provided empirical support and shed light upon previous research. Specifically the results emphasize the mediating role that self-esteem plays in the degree to which internalized stigma exerts a negative effect on specific QOL domains. Self-esteem appears to be a core element in reducing the negative effects of internalized stigma on aspects of QOL among people with mental illness. These findings suggest there is a crucial impact regarding clinical mental health interventions along with important theoretical implications.

The Effects of Heat Adaptation on Physiology, Perception and Exercise Performance in the Heat: A Meta-Analysis.

PubMed

Tyler, Christopher J; Reeve, Tom; Hodges, Gary J; Cheung, Stephen S

2016-11-01

Exercise performance and capacity are impaired in hot, compared to temperate, conditions. Heat adaptation (HA) is one intervention commonly adopted to reduce this impairment because it may induce beneficial exercise performance and physiological and perceptual adaptations. A number of investigations have been conducted on HA but, due to large methodological differences, the effectiveness of different HA regimens remain unclear. (1) To quantify the effect of different HA regimens on exercise performance and the physiological and perceptual responses to subsequent heat exposure. (2) To offer practical HA recommendations and suggestions for future HA research based upon a systematic and quantitative synthesis of the literature. PubMed was searched for original research articles published up to, and including, 16 February 2016 using appropriate first- and second-order search terms. English-language, peer-reviewed, full-text original articles using human participants were reviewed using the four-stage process identified in the PRISMA statement. Data for the following variables were obtained from the manuscripts by at least two of the authors: participant sex, maximal oxygen consumption and age; HA duration, frequency, modality, temperature and humidity; exercise performance and capacity; core and skin temperature; heart rate, stroke volume, cardiac output, skin blood flow, sweat onset temperature, body mass loss, sweat rate, perception of thirst, volitional fluid consumption, plasma volume changes; sweat concentrations of sodium, chloride and potassium; aldosterone, arginine vasopressin, heat shock proteins (Hsp), ratings of perceived exertion (RPE) and thermal sensation. Data were divided into three groups based upon the frequency of the HA regimen. Performance and capacity data were also divided into groups based upon the type of HA used. Hedges' g effect sizes and 95 % confidence intervals were calculated. Correlations were run where appropriate. Ninety-six articles

The Role of Cognitive Level and Sibling Illness in Children's Conceptualizations of Illness.

ERIC Educational Resources Information Center

Carandang, Maria L. A.; And Others

1979-01-01

Levels of illness conceptualization were studied among 72 children (6 1/2-15 years old), 36 with diabetic siblings. Results revealed a significant association between pretested Piagetian level of cognitive development and illness conceptualization. (Author/SBH)

Exertion and body discomfort perceived symptoms associated with carpentry tasks: an on-site evaluation.

PubMed

Dimov, M; Bhattacharya, A; Lemasters, G; Atterbury, M; Greathouse, L; Ollila-Glenn, N

2000-01-01

The purpose of this study was to determine how carpenters subjectively perceived the exertion level and body discomfort associated with their daily tasks. Two psychophysical instruments were utilized. The Borg Whole Body Physical Exertion Instrument, a measure of overall physical demand, and the Body Segment instrument (modified Bishop-Corlett Scale), a measure of body discomfort, were given to 73 carpenters at the end of a shift. Carpentry specialties evaluated included ceiling, drywall, formwork, finishing work, pile driving, fixtures, welding, and scaffolding. The mean Borg's exertion score for the subjects combining all specialties was 14.4 (+/-2.51 standard deviation), a score between "somewhat hard" and "hard." The perception of whole body physical exertion appeared to be a consequence of the specific task. There was no significant correlation between whole body physical exertion perception and age or the number of years as a carpenter. The findings from the body discomfort scale for the total group indicated that the three primary discomfort frequencies by body segment were mid-to-lower back (65.8%), knees (45.2%), and the neck (28.8%). The next highest discomfort rating by body segment (back, knee, right wrist, right leg/foot, and right shoulder) for those subjects in the top three job specialties represented (drywall, ceiling, and formwork; n = 38) resulted in significantly higher ratings for back (60.5%) than right leg/foot (34.2%) and right shoulder (31.6%). All other body segment ratings were not significantly different from one another using Tukey's studentized range test.

Differentiated Ratings of Perceived Exertion during Physical Exercise

DTIC Science & Technology

1982-01-01

the threshold Differentiated perceptions of exertion: part I. Mode of integration of anaerobic work. Int. Z. angew. Physiol. 27:311-328, 1969. of...a. (41) anaerobic metabolites Pandoll & Noble (43) se tiMs from muscles, joints, tendM Stamford & Noble (SO)* muscle temperature, mu lactate, EK pror...from a marathon run. Med. Set. leading to increased effort, leg fatigue, and respiratory distress during Sports 11:239-243, 1979. prolonged, strenuous

Motor performance of tongue with a computer-integrated system under different levels of background physical exertion

PubMed Central

Huo, Xueliang; Johnson-Long, Ashley N.; Ghovanloo, Maysam; Shinohara, Minoru

2015-01-01

The purpose of this study was to compare the motor performance of tongue, using Tongue Drive System, to hand operation for relatively complex tasks under different levels of background physical exertion. Thirteen young able-bodied adults performed tasks that tested the accuracy and variability in tracking a sinusoidal waveform, and the performance in playing two video games that require accurate and rapid movements with cognitive processing using tongue and hand under two levels of background physical exertion. Results show additional background physical activity did not influence rapid and accurate displacement motor performance, but compromised the slow waveform tracking and shooting performances in both hand and tongue. Slow waveform tracking performance by the tongue was compromised with an additional motor or cognitive task, but with an additional motor task only for the hand. Practitioner Summary We investigated the influence of task complexity and background physical exertion on the motor performance of tongue and hand. Results indicate the task performance degrades with an additional concurrent task or physical exertion due to the limited attentional resources available for handling both the motor task and background exertion. PMID:24003900

American College of Sports Medicine Roundtable on Exertional Heat Stroke - Return to Duty/Return to Play: Conference Proceedings

DTIC Science & Technology

2010-01-01

individuals with EHS experience long-term complica- tions that may include multisystem organ (liver, kidney, muscle ) and neurologic damage, as well as... reduced exercise capacity and heat intolerance (12,52,57,69). Animal and human research suggest late or untreated EHS may result in organ damage that...collection of information, including suggestions for reducing this burden, to Washington Headquarters Services, Directorate for Information Operations and

Advance Care Planning for Serious Illness

MedlinePlus

ADVANCE CARE PLANNING FOR SERIOUS ILLNESS Making plans for the health care you want during a serious illness is called “advance care planning.” Planning involves learning about your illness, understanding choices ...

The mentally ill: the way they perceive their own illness and their expectations from the society.

PubMed

Lawska, W; Zieba, M; Lyznicka, M; Sułek, J; Półtorakk, M

2006-09-01

People diagnosed as mentally ill face the suffering of their own disease as well as the social stigmatization, which, in turn, can aggravate their psychopathological symptoms and exacerbate their social isolation. Mental diseases and their symptoms cause an ill person to seem recondite for the people around. She or he feels different from everybody else, thus requires special care, sensitivity, and respect from the others. A supportive and full of acceptation environment is indispensable to optimize socio-professional therapy and rehabilitation of the ill. The society should possess some knowledge of mental diseases and respect the dignity and human rights of the ill. The aim of our work was to show how the mentally ill perceive their illness as well as specify the patients' expectations concerning their relations with the healthy people from their environment. This work consists of a theoretical part, a research which contains the results of a questionnaire, and conclusions. There were 52 patients who took part in the research. They were all aware of their illness, although the research was held during the lighter phase of the disease or its remission. The analysis of the collected data indicates that the ill perceived their disease as a burden and obstacle to fulfilling their principal aims. The disease also engendered negative emotional reactions in them and significantly impaired the quality of their life.

Forces exerted by a correlated fluid on embedded inclusions.

PubMed

Bitbol, Anne-Florence; Fournier, Jean-Baptiste

2011-06-01

We investigate the forces exerted on embedded inclusions by a fluid medium with long-range correlations, described by an effective scalar field theory. Such forces are the basis for the medium-mediated Casimir-like force. To study these forces beyond thermal average, it is necessary to define them in each microstate of the medium. Two different definitions of these forces are currently used in the literature. We study the assumptions underlying them. We show that only the definition that uses the stress tensor of the medium gives the sought-after force exerted by the medium on an embedded inclusion. If a second inclusion is embedded in the medium, the thermal average of this force gives the usual Casimir-like force between the two inclusions. The other definition can be used in the different physical case of an object that interacts with the medium without being embedded in it. We show in a simple example that the two definitions yield different results for the variance of the Casimir-like force.

Healthcare disparities in critical illness.

PubMed

Soto, Graciela J; Martin, Greg S; Gong, Michelle Ng

2013-12-01

To summarize the current literature on racial and gender disparities in critical care and the mechanisms underlying these disparities in the course of acute critical illness. MEDLINE search on the published literature addressing racial, ethnic, or gender disparities in acute critical illness, such as sepsis, acute lung injury, pneumonia, venous thromboembolism, and cardiac arrest. Clinical studies that evaluated general critically ill patient populations in the United States as well as specific critical care conditions were reviewed with a focus on studies evaluating factors and contributors to health disparities. Study findings are presented according to their association with the prevalence, clinical presentation, management, and outcomes in acute critical illness. This review presents potential contributors for racial and gender disparities related to genetic susceptibility, comorbidities, preventive health services, socioeconomic factors, cultural differences, and access to care. The data are organized along the course of acute critical illness. The literature to date shows that disparities in critical care are most likely multifactorial involving individual, community, and hospital-level factors at several points in the continuum of acute critical illness. The data presented identify potential targets as interventions to reduce disparities in critical care and future avenues for research.

Chronic illness and Hmong shamans.

PubMed

Helsel, Deborah; Mochel, Marilyn; Bauer, Robert

2005-04-01

Among the challenges health care personnel in California's central valley face has been finding ways to help Hmong Americans manage chronic illness. Interviews were conducted with 11 Hmong shamans diagnosed with diabetes or hypertension and were qualitatively analyzed to ascertain respondents' understanding and management of their illnesses. Hmong shamans are influential individuals within their communities and are often the resource persons to whom patients turn for information on health. Understanding the shamans' perspective on chronic illness was seen as a gateway to understanding how the broader Hmong American community perceived these conditions. The concept of chronic illness was not well understood, resulting in sporadic medication and dietary regimens, limited awareness of potential complications, and a persistent impression that these illnesses could be cured rather than managed. Suggestions for patient educators include family and community involvement in care regimens and the use of descriptive terminology to identify the disease.

Exertional dyspnea as a symptom of infrarenal aortic occlusive disease.

PubMed

Schott, Stacey L; Carreiro, Fernanda Porto; Harkness, James R; Malas, Mahmoud B; Sozio, Stephen M; Zakaria, Sammy

2014-06-01

Advanced atherosclerosis of the aorta can cause severe ischemia in the kidneys, refractory hypertension, and claudication. However, no previous reports have clearly associated infrarenal aortic stenosis with shortness of breath. A 77-year-old woman with hypertension and hyperlipidemia presented with exertional dyspnea. Despite extensive testing and observation, no apparent cause for this patient's dyspnea was found. Images revealed severe infrarenal aortic stenosis. After the patient underwent stenting of the aortic occlusion, she had immediate symptomatic improvement and complete resolution of her dyspnea within one month. Twelve months after vascular intervention, the patient remained asymptomatic. In view of the distinct and lasting elimination of dyspnea after angioplasty and stenting of a nearly occluded infrarenal aortic lesion, we hypothesize that infrarenal aortic stenosis might be a treatable cause of exertional dyspnea. Clinicians should consider infrarenal aortic stenosis as a possible cause of dyspnea. Treatment of the stenosis might relieve symptoms.

Suicide and Terminal Illness.

ERIC Educational Resources Information Center

Marzuk, Peter M.

1994-01-01

Reviews epidemiology of suicide among terminally ill. Discusses clinical assessment and management of suicidal terminally ill, emphasizing differences from evaluation and treatment of other suicidal individuals. Focuses on methodological issues inherent in studying treatment and characteristics of this population. Suggests blurring of line between…

The relationship between physical ill-health and mental ill-health in adults with intellectual disabilities.

PubMed

Dunham, A; Kinnear, D; Allan, L; Smiley, E; Cooper, S-A

2018-05-01

People with intellectual disabilities face a much greater burden and earlier onset of physical and mental ill-health than the general adult population. Physical-mental comorbidity has been shown to result in poorer outcomes in the general population, but little is known about this relationship in adults with intellectual disabilities. To identify whether physical ill-health is associated with mental ill-health in adults with intellectual disabilities and whether the extent of physical multi-morbidity can predict the likelihood of mental ill-health. To identify any associations between types of physical ill-health and mental ill-health. A total of 1023 adults with intellectual disabilities underwent comprehensive health assessments. Binary logistic regressions were undertaken to establish any association between the independent variables: total number of physical health conditions, physical conditions by International Classification of Disease-10 chapter and specific physical health conditions; and the dependent variables: problem behaviours, mental disorders of any type. All regressions were adjusted for age, gender, level of intellectual disabilities, living arrangements, neighbourhood deprivation and Down syndrome. The extent of physical multi-morbidity was not associated with mental ill-health in adults with intellectual disabilities as only 0.8% of the sample had no physical conditions. Endocrine disease increased the risk of problem behaviours [odds ratio (OR): 1.22, 95% confidence interval (CI): 1.02-1.47], respiratory disease reduced the risk of problem behaviours (OR: 0.73, 95% CI: 0.54-0.99) and mental ill-health of any type (OR: 0.73, 95% CI: 0.58-0.92), and musculoskeletal disease reduced the risk of mental ill-health of any type (OR: 0.84, 95% CI: 0.73-0.98). Ischaemic heart disease increased the risk of problem behaviours approximately threefold (OR: 3.29, 95% CI: 1.02-10.60). The extent of physical multi-morbidity in the population with intellectual

Measurements of the Exerted Pressure by Pelvic Circumferential Compression Devices

PubMed Central

Knops, Simon P; van Riel, Marcel P.J.M; Goossens, Richard H.M; van Lieshout, Esther M.M; Patka, Peter; Schipper, Inger B

2010-01-01

Background: Data on the efficacy and safety of non-invasive Pelvic Circumferential Compression Devices (PCCDs) is limited. Tissue damage may occur if a continuous pressure on the skin exceeding 9.3 kPa is sustained for more than two or three hours. The aim of this study was to gain insight into the pressure build-up at the interface, by measuring the PCCD-induced pressure when applying pulling forces to three different PCCDs (Pelvic Binder® , SAM-Sling ® and T-POD® ) in a simplified model. Methods: The resulting exerted pressures were measured at four ‘anatomical’ locations (right, left, posterior and anterior) in a model using a pressure measurement system consisting of pressure cuffs. Results: The exerted pressure varied substantially between the locations as well as between the PCCDs. Maximum pressures ranged from 18.9-23.3 kPa and from 19.2-27.5 kPa at the right location and left location, respectively. Pressures at the posterior location stayed below 18 kPa. At the anterior location pressures varied markedly between the different PCCDs. Conclusion: The circumferential compression by the different PCCDs showed high pressures measured at the four locations using a simplified model. Difference in design and functional characteristics of the PCCDs resulted in different pressure build-up at the four locations. When following the manufacturer’s instructions, the exerted pressure of all three PCCDs tested exceeded the tissue damaging level (9.3 kPa). In case of prolonged use in a clinical situation this might put patients at risk for developing tissue damage. PMID:20361001

Shallow and Deep Latent Heating Modes Over Tropical Oceans Observed with TRMM PR Spectral Latent Heating Data

NASA Technical Reports Server (NTRS)

Takayabu, Yukari N.; Shige, Shoichi; Tao, Wei-Kuo; Hirota, Nagio

2010-01-01

The global hydrological cycle is central to the Earth's climate system, with rainfall and the physics of its formation acting as the key links in the cycle. Two-thirds of global rainfall occurs in the Tropics. Associated with this rainfall is a vast amount of heat, which is known as latent heat. It arises mainly due to the phase change of water vapor condensing into liquid droplets; three-fourths of the total heat energy available to the Earth's atmosphere comes from tropical rainfall. In addition, fresh water provided by tropical rainfall and its variability exerts a large impact upon the structure and motions of the upper ocean layer. Three-dimensional distributions of latent heating estimated from Tropical Rainfall Measuring Mission Precipitation Radar (TRMM PR)utilizing the Spectral Latent Heating (SLH) algorithm are analyzed. Mass-weighted and vertically integrated latent heating averaged over the tropical oceans is estimated as approx.72.6 J/s (approx.2.51 mm/day), and that over tropical land is approx.73.7 J/s (approx.2.55 mm/day), for 30degN-30degS. It is shown that non-drizzle precipitation over tropical and subtropical oceans consists of two dominant modes of rainfall systems, deep systems and congestus. A rough estimate of shallow mode contribution against the total heating is about 46.7 % for the average tropical oceans, which is substantially larger than 23.7 % over tropical land. While cumulus congestus heating linearly correlates with the SST, deep mode is dynamically bounded by large-scale subsidence. It is notable that substantial amount of rain, as large as 2.38 mm day-1 in average, is brought from congestus clouds under the large-scale subsiding circulation. It is also notable that even in the region with SST warmer than 28 oC, large-scale subsidence effectively suppresses the deep convection, remaining the heating by congestus clouds. Our results support that the entrainment of mid-to-lower-tropospheric dry air, which accompanies the large

Parvovirus B19 and Other Illnesses

MedlinePlus

... Cheek Rash Parvovirus B19 and Other Illnesses References Parvovirus B19 and Other Illnesses Recommend on Facebook Tweet Share ... disease is the most common illness caused by parvovirus B19 infection. Learn More Parvovirus B19 infection can cause ...

Mental Illness and Mental Healthcare Receipt among Hospitalized Veterans with Serious Physical Illnesses.

PubMed

Garrido, Melissa M; Prigerson, Holly G; Neupane, Suvam; Penrod, Joan D; Johnson, Christopher E; Boockvar, Kenneth S

2017-03-01

Psychosocial distress among patients with limited life expectancy influences treatment decisions, treatment adherence, and physical health. Veterans may be at elevated risk of psychosocial distress at the end of life, and understanding their mental healthcare needs may help identify hospitalized patients to whom psychiatric services should be targeted. To examine mental illness prevalence and mental health treatment rates among a national sample of hospitalized veterans with serious physical illnesses. Design, Subjects, and Measurements: This was a retrospective study of 11,286 veterans hospitalized in a Veterans Health Administration acute care facility in fiscal year 2011 with diagnoses of advanced cancer, congestive heart failure, chronic obstructive pulmonary disease, and/or advanced HIV/AIDS. Prevalent and incident mental illness diagnoses during and before hospitalization and rates of psychotherapy and psychotropic use among patients with incident depression and anxiety were measured. At least one-quarter of the patients in our sample had a mental illness or substance use disorder. The most common diagnoses at hospitalization were depression (11.4%), followed by alcohol abuse or dependence (5.5%), and post-traumatic stress disorder (4.9%). Of the 831 patients with incident past-year depression and 258 with incident past-year anxiety, nearly two-thirds received at least some psychotherapy or guideline-concordant medication within 90 days of diagnosis. Of 191 patients with incident depression and 47 with incident anxiety at time of hospitalization, fewer than half received mental healthcare before discharge. Many veterans hospitalized with serious physical illnesses have comorbid mental illnesses and may benefit from depression and anxiety treatment.