Intermittent microclimate cooling during exercise-heat stress in US army chemical protective clothing

Recent Advances in Thermoregulatory Clothing: Materials, Mechanisms, and Perspectives

Personal thermal management (PTM) is a promising approach for maintaining the thermal comfort zone of the human body while minimizing the energy consumption of indoor buildings. Recent studies have reported the development of numerous advanced textiles that enable PTM systems to regulate body temperature and are comfortable to wear. Herein, recent advancements in thermoregulatory clothing for PTM are discussed. These advances in thermoregulatory clothing have focused on enhancing the control of heat dissipation between the skin and the localized environment. We primarily summarize research on advanced clothing that controls the heat dissipation pathways of the human body, such as radiation- and conductance-controlled clothing. Furthermore, adaptive clothing such as dual-mode textiles, which can regulate the microclimate of the human body, as well as responsive textiles that address both thermal performance (warming and/or cooling) and wearability are discussed. Finally, we include a discussion on significant challenges and perspectives in this field, including large-scale production, smart textiles, bioinspired clothing, and AI-assisted clothing. This comprehensive review aims to further the development of sustainably manufactured advanced clothing with superior thermal performance and outstanding wearability for PTM in practical applications.

Human performance augmentation: the importance of integrative physiological quantification

In recent years, there has been an explosion of new approaches (technological, methodological, pharmacological, etc.) designed to improve physical performance for athletes, the military and in other applications. The goal of the present discussion is to review and quantify several ways in which physiology can provide important insights about which tools may lead to improved performance (and may therefore be worth resource investment) and which tools are less likely to provide meaningful enhancement. To address these objectives, we review examples of technological solutions/approaches in terms of the magnitude of their potential (or actual) influences: transformational, moderate, ineffective or undetermined. As one example, if there were a technology which significantly increased arterial oxygen partial pressure by 10%, this would be relatively meaningless in healthy people resting at sea level, where it would have a minimal effect on arterial oxygen content. However, there might be specific situations where such an effect would be very helpful, including at high altitude or in some patient populations. We discuss the importance of quantitative evaluation of putative approaches to performance enhancement and highlight the important role of integrative physiologists in the development and critical appraisal of these approaches.

Efficacy of cooling vests based on different heat-extraction concepts: The HEAT-SHIELD project

INTRODUCTION

A wide range of cooling vests for heat-strain mitigation purposes during physical work are available on the market. The decision regarding the optimal cooling vest/concept for a specific environment can be challenging by relying solely on the information provided by the manufacturers. The aim of this study was to investigate how different types of cooling vests would manifest/perform in a simulated industrial setting, in a warm and moderately humid environment with low air velocity.

METHODS

Ten young males completed six experimental trials, including a control trial (no vest) and five trials with vests of different cooling concepts. Once entering the climatic chamber (ambient temperature: 35 °C, relative humidity: 50 %), participants remained seated for 30 min to induce passive heating, after which they donned a cooling vest and started a 2.5-h of walk at 4.5 km·h^-1. During the trial, torso skin temperature (T_sk), microclimate temperature (T_micro) and relative humidity (RH_micro), as well as core temperature (rectal and gastrointestinal; T_c) and heart rate (HR) were measured. Before and after the walk, participants conducted different cognitive tests and provided subjective ratings throughout the walk.

RESULTS

The use of the vests attenuated the increase in HR (103 ± 12 bpm) when compared to control trial (116 ± 17 bpm, p < 0.05). Four vests maintained a lower torso T_sk (31.7 ± 1.5 °C) compared to control trial (36.1 ± 0.5 °C, p < 0.05). Two vests using PCM inserts attenuated the increase in T_c between 0.2 and 0.5 °C in relation to control trial (p < 0.05). Cognitive performance remained unchanged between the trials. Physiological responses were also well reflected in subjective reports.

CONCLUSION

Most vests could be considered as an adequate mitigation strategy for workers in industry under the conditions simulated in the present study.

Effects of liquid cooling garment on physiological and psychological strain of firefighter in hot and warm environments

This study aimed to explore the effects of a liquid cooling garment on the physiological and psychological strains of firefighters. Twelve participants wearing firefighting protective equipment with the liquid cooling garment (LCG group) and without the liquid cooling garment (CON group) were recruited to conduct human trials in a climate chamber. During the trials, physiological parameters (mean skin temperature (T_sk), core temperature (T_c), and heart rate (HR)) and psychological parameters (thermal sensation vote (TSV), thermal comfort vote (TCV), and rating of perceived exertion (RPE)) were measured continuously. The heat storage, sweating loss, physiological strain index (PSI), and perceptual strain index (PeSI) were calculated. The results indicated that the liquid cooling garment decreased the mean skin temperature (maximum value of 0.62 °C), scapula skin temperature (maximum value of 1.90 °C), sweating loss (26%), and PSI (0.95 scales) with a significant difference (p < 0.05) at some time points when compared with the CON group. Moreover, the liquid cooling garment had little influence (p > 0.05) on core temperature, heart rate, TSV, TCV, RPE, and PeSI. The association analysis indicated that psychological strain had the potential to predict physiological heat strain with an R² value of 0.86 between the PeSI and PSI. This study offers insights into the evaluation of cooling system performance, the design of next-generation cooling systems, and the improvement of firefighters' benefits.

Advanced Functional Materials for Intelligent Thermoregulation in Personal Protective Equipment

The exposure to extreme temperatures in workplaces involves physical hazards for workers. A poorly acclimated worker may have lower performance and vigilance and therefore may be more exposed to accidents and injuries. Due to the incompatibility of the existing standards implemented in some workplaces and the lack of thermoregulation in many types of protective equipment that are commonly fabricated using various types of polymeric materials, thermal stress remains one of the most frequent physical hazards in many work sectors. However, many of these problems can be overcome with the use of smart textile technologies that enable intelligent thermoregulation in personal protective equipment. Being based on conductive and functional polymeric materials, smart textiles can detect many external stimuli and react to them. Interconnected sensors and actuators that interact and react to existing risks can provide the wearer with increased safety, protection, and comfort. Thus, the skills of smart protective equipment can contribute to the reduction of errors and the number and severity of accidents in the workplace and thus promote improved performance, efficiency, and productivity. This review provides an overview and opinions of authors on the current state of knowledge on these types of technologies by reviewing and discussing the state of the art of commercially available systems and the advances made in previous research works.

Cooling efficiency of vests with different cooling concepts over 8-hour trials

As frequency and severity of heat waves are increasing, personal cooling systems are being considered as a tool to mitigate heat strain in workers in various occupational settings. This study assessed cooling capacities (C; W·h·m^-2) of various commercially available vests using different cooling concepts. Measurements were conducted over 8 h in a climatic chamber (Ta: 35 °C, RH: 35 %) using a thermal manikin (Ts: 35 °C). Cooling power (P) and duration of efficient cooling (t_c) determined the C value of each vest. Among the cooling concepts the active cooling vests were the most efficient, extracting 331 W·h·m^-2, followed by the vests with phase change material (PCM) inserts, hybrid and evaporative vests, extracting a maximum of 164 W·h·m^-2, 146 W·h·m^-2 and 113 W·h·m^-2, respectively. While some vests with PCM inserts provided intense but shorter cooling, evaporative vests provided mild but longer cooling throughout. Practitioner summary: The study assessed the cooling capacity of commercially available vests, using a thermal manikin. The vests present an affordable solution in various occupational settings where air-conditioning is not an option. A range of cooling capacities among different cooling concepts and vests of the same category were noted. Abbreviations: ACVs: air-cooled vests; LCVs: liquid-cooled vests; ECVs: evaporative cooling vests; HCVs: hybrid cooling vests; PCVs: phase-change cooling vests; PCM: phase change material; C: cooling capacity; Rt: thermal resistance; Re: evaporative resistance; Re (%): relative evaporative resistance; P: cooling power; P_max: maximal cooling power; P_avg: average cooling power; t_c: cooling duration; AUC: area under the curve; Ta: ambient temperature; RH: relative humidity; v_a: chamber air flow; Ts: manikin surface temperature.

Physiological interactions with personal-protective clothing, physically demanding work and global warming: An Asia-Pacific perspective

The Asia-Pacific contains over half of the world's population, 21 countries have a Gross Domestic Product <25% of the world's largest economy, many countries have tropical climates and all suffer the impact of global warming. That 'perfect storm' exacerbates the risk of occupational heat illness, yet first responders must perform physically demanding work wearing personal-protective clothing and equipment. Unfortunately, the Eurocentric emphasis of past research has sometimes reduced its applicability to other ethnic groups. To redress that imbalance, relevant contemporary research has been reviewed, to which has been added information applicable to people of Asian, Melanesian and Polynesian ancestry. An epidemiological triad is used to identify the causal agents and host factors of work intolerance within hot-humid climates, commencing with the size dependency of resting metabolism and heat production accompanying load carriage, followed by a progression from the impact of single-layered clothing through to encapsulating ensembles. A morphological hypothesis is presented to account for inter-individual differences in heat production and heat loss, which seems to explain apparent ethnic- and gender-related differences in thermoregulation, at least within thermally compensable states. The mechanisms underlying work intolerance, cardiovascular insufficiency and heat illness are reviewed, along with epidemiological data from the Asia-Pacific. Finally, evidence-based preventative and treatment strategies are presented and updated concerning moisture-management fabrics and barriers, dehydration, pre- and post-exercise cooling, and heat adaptation. An extensive reference list is provided, with >25 recommendations enabling physiologists, occupational health specialists, policy makers, purchasing officers and manufacturers to rapidly extract interpretative outcomes pertinent to the Asia-Pacific.

Effects of air-perfused rucksack on physiological and perceptual strain during low-intensity exercise in a hot environment

The upcoming Tokyo Olympic and Paralympic Games may be held amid extremely high wet-bulb globe temperature conditions. Many studies have focused on countermeasures to prevent the reduction in exercise performance in the heat. However, cooling strategies for managing heat stress of staff and spectators remain poorly understood. The present study investigated the effects of a lightweight fan cooling device, namely a commercially available air-perfused rucksack, on physiological and perceptual responses during low-intensity exercise in a hot environment. Ten males walked (5.5 km/h, 2.0% gradient) for 60 min in hot conditions (35°C, 50% relative humidity). All participants performed two trials with and without the air-perfused rucksack, respectively. Air was blown onto the upper back and neck via two fans attached on either side of the rucksack. Rectal temperature, neck skin temperature, heart rate, and physiological strain index were significantly lower during walking (P < 0.05) with the rucksack. Additionally, the ratings of perceived exertion, thermal sensation, and thermal comfort were significantly lower (P < 0.05) with the rucksack. These data suggest that the air-perfused rucksack may be effective for managing heat stress of staff and spectators at the Tokyo Olympic and Paralympic Games.

Abbreviations

CON: control trial; ES: effect sizes; FAN: fan cooling trial; HR: heart rate; _mT_sk: mean skin temperature; pre: pre-exercise; PSI: physiological strain index; RPE: rating of perceived exertion; SD: standard deviation; TC: thermal comfort; T_neck: neck skin temperature; T_re: rectal temperature; TS: thermal sensation.

The effect of cooling vests on physiological and perceptual responses: a systematic review

Humans in hot environments are exposed to health risks and thermal discomfort which seriously affect their physical, physiological and mental workload. This study aimed to assess the effects of using cooling vests (CVs) on physiological and perceptual responses in the workplace. Three main databases were searched using subject headings and appropriate Mesh terms. The article has been written according to the preferred reporting items for systematic reviews checklist. A total of 23,837 studies were identified for screening and 63 studies were eligible for data extraction. A statistically significant difference was observed in body temperature among hybrid cooling garments (HBCGs), phase-change materials (PCMs) and air-cooled garments (ACGs) at 31.56-37 °C (60% relative humidity), evaporative cooling garments at 25.8-28.1 °C and liquid cooling garments at 35 °C (49% relative humidity) compared to without CVs (p < 0.001). HBCGs (PCMs and ACGs) are effective means in hot, moderate, humid or dry environments.

Performance enhancement of hybrid personal cooling clothing in a hot environment: PCM cooling energy management with additional insulation

A novel design of personal cooling clothing incorporating additional insulation sandwiched between phase change materials (PCMs) and clothing outer layer is proposed. Performance of four personal cooling systems including clothing with only PCMs, clothing with PCMs and insulation (PCM + INS), clothing with PCMs and ventilation fans (HYB), and clothing with PCMs, ventilation fans and insulation (HYB + INS) was investigated. Effect of additional insulation on clothing cooling performance in terms of human physiological and perceptual responses was also examined. Human trials were carried out in a hot environment (i.e. 36 °C, RH = 59%). Results showed that significantly lower mean skin/torso temperatures were registered in HYB + INS as compared to HYB. In contrast, no significant effect of the use of insulation on both skin and body temperatures between PCM and PCM + INS was observed. Also, no significant difference in thermal sensations, thermal comfort, and skin wetness sensation was registered between cooling systems with and without additional insulation. Practitioner Summary: Hybrid personal cooling clothing has shown the ability to provide a relatively cool microclimate around the wearer' body while working in hot environments. The present work addresses the importance of cooling energy saving for PCMs in a hot environment. This work contributes to optimising cooling performance of hybrid personal cooling systems.

Thermoregulatory dysfunction in multiple sclerosis

Multiple sclerosis (MS) is a progressive neurologic disorder that disrupts axonal myelin in the central nervous system. Demyelination produces alterations in saltatory conduction, slowed conduction velocity, and a predisposition to conduction block. An estimated 60-80% of MS patients experience temporary worsening of clinical signs and neurologic symptoms with heat exposure (Uhthoff's phenomenon). This heat intolerance in MS is related to the detrimental effects of increased temperature on action potential propagation in demyelinated axons, resulting in conduction slowing and/or block. Additionally, MS may produce impaired neural control of autonomic and endocrine functions. Isolating and interpreting mechanisms responsible for autonomic dysfunction due to MS can be difficult as it may involve sensory impairments, altered neural integration within the central nervous system, impaired effector responses, or combinations of all of these factors. MS lesions occur in areas of the brain responsible for the control and regulation of body temperature and thermoregulatory effector responses, resulting in impaired neural control of sudomotor pathways or neural-induced changes in eccrine sweat glands, as evidenced by observations of reduced sweating responses in MS patients. Although not comprehensive, some evidence exists concerning treatments (cooling, precooling, and pharmacologic) for the MS patient to preserve function and decrease symptom worsening during heat stress. This review focuses on four main themes influencing current understanding of thermoregulatory dysfunction in MS: (1) heat intolerance; (2) central regulation of body temperature; (3) thermoregulatory effector responses; and (4) countermeasures to improve or maintain function during thermal stress.

The Pandolf load carriage equation is a poor predictor of metabolic rate while wearing explosive ordnance disposal protective clothing

This investigation aimed to quantify metabolic rate when wearing an explosive ordnance disposal (EOD) ensemble (~33kg) during standing and locomotion; and determine whether the Pandolf load carriage equation accurately predicts metabolic rate when wearing an EOD ensemble during standing and locomotion. Ten males completed 8 trials with metabolic rate measured through indirect calorimetry. Walking in EOD at 2.5, 4.0 and 5.5km·h^-1 was significantly (p < 0.05) greater than matched trials without the EOD ensemble by 49% (127W), 65% (213W) and 78% (345W), respectively. Mean bias (95% limits of agreement) between predicted and measured metabolism during standing, 2.5, 4 and 5.5km·h^-1 were 47W (19 to 75W); -111W (-172 to -49W); -122W (-189 to -54W) and -158W (-245 to -72W), respectively. The Pandolf equation significantly underestimated measured metabolic rate during locomotion. These findings have practical implications for EOD technicians during training and operation and should be considered when developing maximum workload duration models and work-rest schedules. Practitioner Summary: Using a rigorous methodological design we quantified metabolic rate of wearing EOD clothing during locomotion. For the first time we demonstrated that metabolic rate when wearing this ensemble is greater than that predicted by the Pandolf equation. These original findings have significant implications for EOD training and operation.

Effectiveness of a newly designed construction uniform for heat strain attenuation in a hot and humid environment

This study aims to evaluate the effectiveness of a newly designed construction uniform in combating heat stress. Ten male volunteers performed treadmill running in a climatic chamber maintained at 34.5 °C temperature, 75% relative humidity, 0.3 m/s air velocity, and solar radiation of 450 W/m(2) that simulates typical summer working environment of construction sites in Hong Kong. The participants were tested while wearing two kinds of construction uniforms: a commonly worn uniform A, or a newly designed uniform B. It was found during exercise that Tc (38.34 ± 0.14 vs 38.45 ± 0.11 °C, p = 0.03), Tsk (36.01 ± 0.36 vs 36.27 ± 0.34 °C, p = 0.03), HR (162.7 ± 10.1 vs 172.5 ± 9.2 bpm, p < 0.01), PSI (7.0 ± 0.4 vs 7.5 ± 0.5, p = 0.04), thermal sensation (1.7 ± 0.9 vs 2.6 ± 0.7, p = 0.02), and wetness sensation (1.9 ± 0.9 vs 2.6 ± 0.8, p < 0.01) was lower when wearing uniform B than that of uniform A. It was found during recovery that Tc (37.89 ± 0.13 vs 38.06 ± 0.13 °C, p < 0.01), Tsk (35.68 ± 0.37 vs 36.02 ± 0.41 °C, p < 0.01), HR (104.2 ± 10.1 vs 112.6 ± 10.7 bpm, p < 0.01), PSI (3.3 ± 0.7 vs 4.1 ± 1.0, p < 0.01), thermal sensation (0.1 ± 0.9 vs 1.0 ± 0.8, p = 0.02), and wetness sensation (1.1 ± 1.0 vs 2.3 ± 0.8, p = 0.02) was lower when wearing uniform B than that of uniform A. The findings of this study suggested the newly designed construction uniform could reduce thermoregulatory and cardiovascular strain, and improve thermal comfort while exercising in a hot and humid environment.

CAERvest® - a novel endothermic hypothermic device for core temperature cooling: safety and efficacy testing

INTRODUCTION

Cooling of the body is used to treat hyperthermic individuals with heatstroke or to depress core temperature below normal for neuroprotection. A novel, chemically activated, unpowered cooling device, CAERvest®, was investigated for safety and efficacy.

METHODS

Eight healthy male participants (body mass 79.9 ± 1.9 kg and body fat percentage 16.1 ± 3.8%) visited the laboratory (20 °C, 40% relative humidity) on four occasions. Following 30-min rest, physiological and perceptual measures were recorded. Participants were then fitted with the CAERvest® proof of concept (PoC) or prototype 1 (P1), 2 (P2) or 3 (P3) for 60 min. Temperature, cardiovascular and perceptual measures were recorded every 5 min. After cooling, the CAERvest® was removed and the torso checked for cold-related injuries.

RESULTS

Temperature measures significantly (p < 0.05) reduced pre to post in all trials. Larger reductions in core and skin temperatures were observed for PoC (-0.36 ± 0.18 and -1.55 ± 0.97 °C) and P3 (-0.36 ± 0.22 and -2.47 ± 0.82 °C), compared with P1 and P2. No signs of cold-related injury were observed at any stage.

CONCLUSION

This study demonstrates that the CAERvest® is an effective device for reducing body temperature in healthy normothermic individuals without presence of cold injury. Further research in healthy and clinical populations is warranted.

Ebola Response: Modeling the Risk of Heat Stress from Personal Protective Clothing

Introduction

A significant number of healthcare workers have responded to aid in the relief and containment of the 2013 Ebola virus disease (EVD) outbreak in West Africa. Healthcare workers are required to wear personal protective clothing (PPC) to impede the transmission of the virus; however, the impermeable design and the hot humid environment lead to risk of heat stress.

Objective

Provide healthcare workers quantitative modeling and analysis to aid in the prevention of heat stress while wearing PPC in West Africa.

Methods

A sweating thermal manikin was used to measure the thermal (R_ct) and evaporative resistance (R_et) of the five currently used levels of PPC for healthcare workers in the West Africa EVD response. Mathematical methods of predicting the rise in core body temperature (T_c) in response to clothing, activity, and environment was used to simulate different responses to PPC levels, individual body sizes, and two hot humid conditions: morning/evening (air temperature: 25°C, relative humidity: 40%, mean radiant temperature: 35°C, wind velocity: 1 m/s) and mid-day (30°C, 60%, 70°C, 1 m/s).

Results

Nearly still air (0.4 m/s) measures of R_ct ranged from 0.18 to 0.26 m² K/W and R_et ranged from 25.53 to 340.26 m² Pa/W.

Conclusion

Biophysical assessments and modeling in this study provide quantitative guidance for prevention of heat stress of healthcare workers wearing PPC responding to the EVD outbreak in West Africa.

A novel personal cooling system (PCS) incorporated with phase change materials (PCMs) and ventilation fans: An investigation on its cooling efficiency

Personal cooling systems (PCS) have been developed to mitigate the impact of severe heat stress for humans working in hot environments. It is still a great challenge to develop PCSs that are portable, inexpensive, and effective. We studied the performance of a new hybrid PCS incorporating both ventilation fans and phase change materials (PCMs). The cooling efficiency of the newly developed PCS was investigated on a sweating manikin in two hot conditions: hot humid (HH, 34°C, 75% RH) and hot dry (HD, 34°C, 28% RH). Four test scenarios were selected: fans off with no PCMs (i.e., Fan-off, the CONTROL), fans on with no PCMs (i.e., Fan-on), fans off with fully solidified PCMs (i.e., PCM+Fan-off), and fans on with fully solidified PCMs (i.e., PCM+Fan-on). It was found that the addition of PCMs provided a 54∼78min cooling in HH condition. In contrast, the PCMs only offered a 19-39min cooling in HD condition. In both conditions, the ventilation fans greatly enhanced the evaporative heat loss compared with Fan-off. The hybrid PCS (i.e., PCM+Fan-on) provided a continuous cooling effect during the three-hour test and the average cooling rate for the whole body was around 111 and 315W in HH and HD conditions, respectively. Overall, the new hybrid PCS may be an effective means of ameliorating symptoms of heat stress in both hot-humid and hot-dry environments.

Reducing heat stress under thermal insulation in protective clothing: microclimate cooling by a 'physiological' method

Heat stress caused by protective clothing limits work time. Performance improvement of a microclimate cooling method that enhances evaporative and to a minor extent convective heat loss was tested. Ten male volunteers in protective overalls completed a work-rest schedule (130 min; treadmill: 3 × 30 min, 3 km/h, 5% incline) with or without an additional air-diffusing garment (climatic chamber: 25°C, 50% RH, 0.2 m/s wind). Heat loss was supported by ventilating the garment with dry air (600 l/min, ≪5% RH, 25°C). Ventilation leads (M ± SD, n = 10, ventilated vs. non-ventilated) to substantial strain reduction (max. HR: 123 ± 12 b/min vs. 149 ± 24 b/min) by thermal relief (max. core temperature: 37.8 ± 0.3°C vs. 38.4 ± 0.4°C, max. mean skin temperature: 34.7 ± 0.8°C vs. 37.1 ± 0.3°C) and offers essential extensions in performance and work time under thermal insulation.

PRACTITIONER SUMMARY

Heat stress caused by protective clothing limits work time. Performance can be improved by a microclimate cooling method that supports evaporative and to a minor extent convective heat loss. Sweat evaporation is the most effective thermoregulatory mechanism for heat dissipation and can be enhanced by insufflating dry air into clothing.

Thermoregulatory, cardiovascular, and perceptual responses to intermittent cooling during exercise in a hot, humid outdoor environment

Decreasing core body temperature during exercise may improve exercise tolerance, facilitate acclimatization, and prevent heat illness during summer training. We sought to evaluate the effectiveness of intermittent superficial cooling on thermoregulatory, cardiovascular, and perceptual responses during exercise in a hot humid environment. We used a randomized, counterbalanced, repeated measures investigation with 2 conditions (control and cooling) during exercise and recovery outdoors on artificial turf in a hot, humid tropical climate in the sun (wet bulb globe temperature outdoors [WBGTo], 27.0 ± 0.8° C; range, 25.8-28.1° C) and in the shade (WBGTo, 25.4 ± 0.9° C; range, 24.3-26.8° C). Participants were 10 healthy males (age, 22.6 ± 1.6 years; height, 176.0 ± 6.9 cm; mass, 76.5 ± 7.8 kg; body fat, 15.6 ± 5.4%) who wore shorts and T-shirt (control) or "phase change cooling" vest (cooling) during 5-minute rest breaks during 60 minutes of intense American football training and conditioning exercises in the heat and 30 minutes of recovery in the shade. Throughout, we measured core (Tgi) and skin (Tchest) temperature, heart rate (HR), thermal and thirst sensations, and rating of perceived exertion. We found significant (p ≤ 0.001) hypohydration (-2.1%); for Tgi, we found no significant differences between conditions (p = 0.674) during exercise and progressive decreases during recovery (p < 0.001). For [INCREMENT]Tg,i we found no significant (p = 0.090) differences. For Tchest, we found significantly (p < 0.001) decreased skin temperature in the cooling condition (Tchest, 31.85 ± 0.43° C) compared with the control condition (Tchest, 34.38 ± 0.43° C) during exercise and significantly (p < 0.001) lower skin temperature in the cooling condition (Tchest, 31.24 ± 0.47° C) compared with the control condition (Tchest, 33.48 ± 0.47° C) during recovery. For HR, we found no significant difference (p = 0.586) between the conditions during exercise; however, we did find significantly (p < 0.001) lower HR during recovery. Thermal sensations were significantly (p = 0.026) decreased in the cooling (4.4 ± 0.2 points) compared with the control (5.0 ± 0.2 points) condition but not for other perceptual responses. The cooling effects of "phase change cooling" material were effective in reducing skin temperature but did not sufficiently reduce core body temperature or cardiovascular strain.

Ambient air cooling for concealed soft body armor in a hot environment

Concealed soft body armor inhibits convective and evaporative heat loss and increases heat storage, especially in hot environments. One option to potentially mitigate heat storage is to promote airflow under the soft body armor. The purpose of this study was to evaluate the effect of ambient air induction (∼100 liters per minute) on heat strain while wearing concealed soft body armor in a hot environment (wet bulb globe temperature = 30°C). A counter-balanced, repeated measures protocol was performed with nine healthy male volunteers. Participants were fitted with either a traditional or modified Level II concealed soft body armor. Participants performed cycles of 12 min of walking (1.25 liters per minute) and 3 min of arm curls (0.6 liters per minute) for a total of 60 min. Two-way repeated measures ANOVA was used to assess the mean differences in physiological measures (rectal temperature, heart rate, micro-environment [temperature and relative humidity]). Post hoc Bonferroni analysis and paired samples t-tests (alpha = 0.01) were conducted on omnibus significant findings. Perceptual measures (perceived exertion, thermal comfort) were analyzed using Wilcoxon Signed Ranks Tests. Modification led to an improvement in perceived exertion at 45 min (MOD: 10 ± 1; CON: 11 ± 2; p ≤ 0.001) and 60 min (MOD: 10 ± 2; CON: 12 ± 2; p ≤ 0.001) and a reduction in micro-environment temperature in MOD (1.0 ± 0.2°C, p = 0.03) compared to CON. Modification did not attenuate change in rectal temperature or heart rate (p < 0.01) during 60-min work bout. Change in rectal temperature approached significance between MOD and CON at the end of the work bout (MOD: 0.4 ± 0.2°C; CON: 0.7 ± 0.3°C; p = 0.048). The slope of rectal temperature was significantly greater (p = 0.04) under CON compared to MOD. These data suggest that air induction may provide small benefits while wearing concealed soft body armor, though improvements are needed to lessen physiological strain.

Thermal perceptions and skin temperatures during continuous and intermittent ventilation of the torso throughout and after exercise in the heat

OBJECTIVE

This study tested the hypothesis that intermittent cooling in air-perfused vests (APV) will not only maintain thermal balance but, due to cyclical activations of cutaneous thermoreceptors, also enhance thermal perceptions.

METHOD

Ten physically active males completed four conditions where they exercised (walking: 5 km h(-1), 2 % gradient) in a hot environment (~34.0 °C, 50 % RH) for 72 min, followed by a 33-min period of rest. They wore an APV throughout. The four conditions differed in respect to the profile of ambient air that was perfused through the APV: continuous perfusion (CP); intermittent perfusion of 6 min ON/OFF periods (IPonoff); a steady increase and decrease in flow rate in equal increments (IPramp); and an initial step-increase in the flow rate followed by an incremental decrease to zero flow rate (IPtriang). Whole body and torso thermal comfort (TC, TTC), whole body and torso temperature sensation (TS, TTS), whole body and torso skin temperature ([Formula: see text], [Formula: see text]), local relative humidity ([Formula: see text]) and rectal temperature (T re) were measured.

RESULTS

There were no significant differences in T re, absolute whole body and local [Formula: see text], TC, TTC and TS between the cooling profiles. However, TTS was cooler in CP and IPramp than IPonoff and IPtriang. Even though intermittent cooling did not significantly enhance thermal perceptions in CP, a trend existed for TC (P = 0.063) to become less favourable over time.

CONCLUSION

To reduce the power consumption and extend the battery life of an APV, it is recommended that an intermittent cooling profile should be adopted.

Methods of evaluating protective clothing relative to heat and cold stress: thermal manikin, biomedical modeling, and human testing

Personal protective equipment (PPE) refers to clothing and equipment designed to protect individuals from chemical, biological, radiological, nuclear, and explosive hazards. The materials used to provide this protection may exacerbate thermal strain by limiting heat and water vapor transfer. Any new PPE must therefore be evaluated to ensure that it poses no greater thermal strain than the current standard for the same level of hazard protection. This review describes how such evaluations are typically conducted. Comprehensive evaluation of PPE begins with a biophysical assessment of materials using a guarded hot plate to determine the thermal characteristics (thermal resistance and water vapor permeability). These characteristics are then evaluated on a thermal manikin wearing the PPE, since thermal properties may change once the materials have been constructed into a garment. These data may be used in biomedical models to predict thermal strain under a variety of environmental and work conditions. When the biophysical data indicate that the evaporative resistance (ratio of permeability to insulation) is significantly better than the current standard, the PPE is evaluated through human testing in controlled laboratory conditions appropriate for the conditions under which the PPE would be used if fielded. Data from each phase of PPE evaluation are used in predictive models to determine user guidelines, such as maximal work time, work/rest cycles, and fluid intake requirements. By considering thermal stress early in the development process, health hazards related to temperature extremes can be mitigated while maintaining or improving the effectiveness of the PPE for protection from external hazards.

Ice cooling vest on tolerance for exercise under uncompensable heat stress

This study was conducted to evaluate the effectiveness of a commercial, personal ice cooling vest on tolerance for exercise in hot (35°C), wet (65% relative humidity) conditions with a nuclear biological chemical suit (NBC). On three separate occasions, 10 male volunteers walked on a treadmill at 3 miles per hour and 2% incline while (a) seminude (denoted CON), (b) dressed with a nuclear, biological, chemical (NBC) suit with an ice vest (V) worn under the suit (denoted NBCwV); or (c) dressed with an NBC suit but without an ice vest (V) (denoted NBCwoV). Participants exercised for 120 min or until volitional fatigue, or esophageal temperature reached 39.5°C. Esophageal temperature (T(es)), heart rate (HR), thermal sensation, and ratings of perceived exertion were measured. Exercise time was significantly greater in CON compared with both NBCwoV and NBCwV (p < 0.05), whereas T(es), thermal sensation, heart rate, and rate of perceived exertion were lower (p < 0.05). Wearing the ice vest increased exercise time (NBCwoV, 103.6 ± 7.0 min; NBCwV, 115.9 ± 4.1 min) and reduced the level of thermal strain, as evidenced by a lower T(es) at end-exercise (NBCwoV, 39.03 ± 0.13°C; NBCwV, 38.74 ± 0.13°C) and reduced thermal sensation (NBCwoV, 6.4 ± 0.4; NBCwV, 4.8 ± 0.6). This was paralleled by a decrease in rate of perceived exertion (NBCwoV, 14.7 ± 1.6; NBCwV, 12.4 ± 1.6) (p < 0.05) and heat rate (NBCwoV, 169 ± 6; NBCwV, 159 ± 7) (p < 0.05). We show that a commercially available cooling vest can significantly reduce the level of thermal strain during work performed in hot environments.

Subjective perceptions and ergonomics evaluation of a liquid cooled garment worn under protective ensemble during an intermittent treadmill exercise

While a personal protective equipment (PPE) ensemble effectively provides workers with protection from occupational hazards, working in a vapour-resistant ensemble increases the risk of heat illness/injuries and physiological burdens. The purpose of this study was to investigate the effect of body cooling via a liquid-cooled garment (LCG) underneath a PPE ensemble on perceived thermal strain, physiological responses and ergonomics during an intermittent treadmill exercise in warm environmental conditions. The results of the present study indicated that the concomitant wearing of LCG underneath the PPE ensemble significantly reduced subjective perception of heat and alleviated overall increase in body temperature and heart rate while no impact of wearing LCG on ergonomic features was found. The extension of the present findings to practical applications in occupational settings requires further research on a LCG system design and performance evaluations while the LCG is incorporated within the PPE ensemble. STATEMENT OF RELEVANCE: Implementation of a LCG underneath PPE for body cooling was investigated, focusing on its impact on individuals' perceived thermal strain, physiological responses and ergonomics. The findings of the present study indicated that body cooling via a wearable LCG underneath PPE significantly alleviated both perceived thermal and physiological strain in uncompensable heat stress condition.

Effects of liquid cooling garments on recovery and performance time in individuals performing strenuous work wearing a firefighter ensemble

This study investigated the effects of body cooling using liquid cooling garments (LCG) on performance time (PT) and recovery in individuals wearing a fully equipped prototype firefighter ensemble (PFE) incorporating a self-contained breathing apparatus (SCBA). Six healthy male participants (three firefighters and three non-firefighters) completed six experimental sessions in an environmental chamber (35°C, 50% relative humidity), consisting of three stages of 15 min exercise at 75% VO2max, and 10 min rest following each exercise stage. During each session, one of the following six conditions was administered in a randomized order: control (no cooling, CON); air ventilation of exhaust SCBA gases rerouted into the PFE (AV); top cooling garment (TCG); TCG combined with AV (TCG+AV); a shortened whole body cooling garment (SCG), and SCG combined with AV (SCG+AV). Results showed that total PT completed was longer under SCG and SCG+AV compared with CON, AV, TCG, and TCG+AV (p<0.01). Magnitude of core temperature (Tc) elevation was significantly decreased when SCG was utilized (p<0.01), and heart rate recovery rate (10 min) was enhanced under SCG, SCG+AV, TCG, and TCG+AV compared with CON (p<0.05). Estimated Esw rate (kg·h(-1)) was the greatest in CON, 1.62 (0.37), and the least in SCG+AV 0.98 (0.44): (descending order: CON>AV>TCG=TCG+AV>SCG>SCG+AV) without a statistical difference between the conditions (p<0.05). Results of the present study suggest that the application of LCG underneath the PFE significantly improves the recovery during a short period of rest and prolongs performance time in subsequent bouts of exercise. LCG also appears to be an effective method for body cooling that promotes heat dissipation during uncompensable heat stress.

Thermoregulation in multiple sclerosis

Multiple sclerosis (MS) is a progressive neurological disorder that disrupts axonal myelin in the central nervous system. Demyelination produces alterations in saltatory conduction, slowed conduction velocity, and a predisposition to conduction block. An estimated 60-80% of MS patients experience temporary worsening of clinical signs and neurological symptoms with heat exposure. Additionally, MS may produce impaired neural control of autonomic and endocrine functions. This review focuses on five main themes regarding the current understanding of thermoregulatory dysfunction in MS: 1) heat sensitivity; 2) central regulation of body temperature; 3) thermoregulatory effector responses; 4) heat-induced fatigue; and 5) countermeasures to improve or maintain function during thermal stress. Heat sensitivity in MS is related to the detrimental effects of increased temperature on action potential propagation in demyelinated axons, resulting in conduction slowing and/or block, which can be quantitatively characterized using precise measurements of ocular movements. MS lesions can also occur in areas of the brain responsible for the control and regulation of body temperature and thermoregulatory effector responses, resulting in impaired neural control of sudomotor pathways or neural-induced changes in eccrine sweat glands, as evidenced by observations of reduced sweating responses in MS patients. Fatigue during thermal stress is common in MS and results in decreased motor function and increased symptomatology likely due to impairments in central conduction. Although not comprehensive, some evidence exists concerning treatments (cooling, precooling, and pharmacological) for the MS patient to preserve function and decrease symptom worsening during heat stress.

Evaluation of a carbon dioxide personal cooling device for workers in hot environments

This study tested the effectiveness of a carbon dioxide cooling device in reducing heat strain for workers in a hot and humid environment. Ten participants completed two trials in an environment of 30 degrees C WBGT (75% relative humidity) with a novel liquid carbon dioxide cooling shirt (CC) or no cooling (NC) in a randomized order. Mean time-weighted workload for each individual equaled 465 W (400 Kcals. h(-1)). In the CC condition, the work time was significantly increased by 32% (97 +/- 36 min) compared with NC (74 +/- 26 min) (p < 0.05). There was no significant difference in mean skin temperature over the trials. Rectal temperature (T(re)) was significantly different after 50 min (p < 0.05). Mean heart rate, the delta T(re) increase rate, and heat storage at 55 min (last point with n = 8) were significantly lower in CC (p < 0.05). Overall heat storage was 54 +/- 41 W and 72 +/- 40 W for CC and NC, respectively (p < 0.05). Participants also indicated favorable subjective responses for CC vs. NC (p < 0.05). These findings suggest that this novel cooling device would effectively attenuate heat strain and increase work productivity for personnel working in a hot and humid environment. Practical aspects of use such as cost, convenience, weight, cooling duration, and rise in ambient CO(2) concentration in confined spaces must also be considered.

Design process for developing a liquid cooling garment hood

A liquid cooling garment (LCG) protects astronauts by providing cooling effects and preventing them from overheating. The objectives of this project were to improve fit and comfort of the original LCG hood of the MACS-Delphi garment and develop a new prototype. The project was conducted by researchers with different backgrounds: apparel design and physiology and psychology. A design process framework developed by LaBat and Sokolowski (1999) was used in order to help facilitate the process and aid in communication during the multi-disciplinary collaboration. Four crucial problems were identified: 1) the tubing layout that circulates water did not conform to the shape of the head and tubing distribution was not maximised; 2) a difficult stitching method was being used to attach tubing; 3) fabric sources were inconsistent; 4) the hood did not fit properly. Each problem was addressed, improvements implemented and a revised hood was developed. The hood was tested in an environmental chamber and demonstrated effective cooling. Revisions implemented for the LCG hood may be applied to revisions of the whole-body LCG. STATEMENT OF RELEVANCE: The objectives of this project were to improve fit and comfort of the original LCG hood and develop a new prototype. The new prototype will increase safety of the astronauts by providing better heat extraction quality and improved fit and increased wearer comfort.

Palm cooling to reduce heat strain in subjects during simulated armoured vehicle transport

This study examined whether palm cooling (PC) could reduce heat strain, measured through changes in core, mean skin, mean body temperatures, and thermal sensation in resting hyperthermic subjects wearing chemical protective garments. Ten male subjects performed three exercise bouts (6.1 km h(-1), 2-4% grade) in a hot, dry environment [mean (SD) air temperature 42.2 (0.5 degrees C), relative humidity 36.5 (1%)] until core temperature reached 38.8 degrees C. Subjects then simulated transport in an armoured vehicle by resting in a seated position for 50 min with either no cooling (NC), (PC at 10 degrees C) or palm cooling with vacuum application around the hand (PCVAC, 10 degrees C, 7.47 kPa negative pressure). Core, skin, and mean body temperatures with PC and PCVAC were lower (P < 0.05) than NC from 15 to 50 min of cooling, and thermal sensation was lower (P < 0.05) from 30 to 50 min, with no differences in any variables between PC and PCVAC. Maximal heat extraction averaged 42 (12 W), and core temperature was reduced by 0.38 (0.21 degrees C) after 50 min of PC. Heat extraction with PC was modest compared to other cooling approaches in the literature.

Heat loss through the glabrous skin surfaces of heavily insulated, heat-stressed individuals

Insulation reduces heat exchange between a body and the environment. Glabrous (nonhairy) skin surfaces (palms of the hands, soles of the feet, face, and ears) constitute a small percentage of total body surface area but contain specialized vascular structures that facilitate heat loss. We have previously reported that cooling the glabrous skin surfaces is effective in alleviating heat stress and that the application of local subatmospheric pressure enhances the effect. In this paper, we compare the effects of cooling multiple glabrous skin surfaces with and without vacuum on thermal recovery in heavily insulated heat-stressed individuals. Esophageal temperatures (T(es)) and heart rates were monitored throughout the trials. Water loss was determined from pre- and post-trial nude weights. Treadmill exercise (5.6 km/h, 9-16% slope, and 25-45 min duration) in a hot environment (41.5 degrees C, 20-30% relative humidity) while wearing insulating pants and jackets was used to induce heat stress (T(es)>or=39 degrees C). For postexercise recovery, the subjects donned additional insulation (a balaclava, winter gloves, and impermeable boot covers) and rested in the hot environment for 60 min. Postexercise cooling treatments included control (no cooling) or the application of a 10 degrees C closed water circulating system to (a) the hand(s) with or without application of a local subatmospheric pressure, (b) the face, (c) the feet, or (d) multiple glabrous skin regions. Following exercise induction of heat stress in heavily insulated subjects, the rate of recovery of T(es) was 0.4+/-0.2 degrees C/h(n=12), but with application of cooling to one hand, the rate was 0.8+/-0.3 degrees C/h(n=12), and with one hand cooling with subatmospheric pressure, the rate was 1.0+/-0.2 degrees C/h(n=12). Cooling alone yielded two responses, one resembling that of cooling with subatmospheric pressure (n=8) and one resembling that of no cooling (n=4). The effect of treating multiple surfaces was additive (no cooling, DeltaT(es)=-0.4+/-0.2 degrees C; one hand, -0.9+/-0.3 degrees C; face, -1.0+/-0.3 degrees C; two hands, -1.3+/-0.1 degrees C; two feet, -1.3+/-0.3 degrees C; and face, feet, and hands, -1.6+/-0.2 degrees C). Cooling treatments had a similar effect on water loss and final resting heart rate. In heat-stressed resting subjects, cooling the glabrous skin regions was effective in lowering T(es). Under this protocol, the application of local subatmospheric pressure did not significantly increase heat transfer per se but, presumably, increased the likelihood of an effect.

Heat stress and bulkiness of chemical protective clothing impair performance of medical personnel in basic lifesaving tasks

The study examined the impact of chemical protective (CP) clothing on the performance of lifesaving tasks in thermoneutral and cold conditions. Eleven males performed pre-exercise followed by lifesaving tasks wearing either field combat uniform at 21 degrees C (U) or CP clothing at 21 degrees C (CPN) and -5 degrees C (CPC). The tasks were ventilating a doll (VA) and connecting an intravenous line (IV). Mean skin temperature was significantly higher for CPN compared to U and CPC during pre-exercise, VA and IV. Changes in blood pressure were significantly greater with CP clothing than without during VA and IV. The number of breaths per min (in VA) and time needed for IV increased by 19% (p < 0.05) and 18%, respectively, for CPN compared to U. Due to the cold, the additional increment was 5% and 17%, respectively, for CPC. Wearing of CP clothing in thermoneutral or in cold conditions may not prevent but, especially in the cold, significantly impede the performance of basic medical tasks. The findings of this study showed that performing medical tasks while wearing nuclear, biological and chemical protective clothing is impaired due to significant changes in physiological strain. This suggests that realistic training in local conditions as well as in cold conditions is needed to realise the restrictions due to protective clothing.