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Tetzlaff EJ, Cassan C, Goulet N, Gorman M, Hogya B, Kenny GP. "Breaking down in tears, soaked in sweat, and sick from the heat": Media-based composite narratives of first responders working during the 2021 Heat Dome. Am J Ind Med 2024; 67:442-452. [PMID: 38460501 DOI: 10.1002/ajim.23576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 01/15/2024] [Accepted: 02/19/2024] [Indexed: 03/11/2024]
Abstract
BACKGROUND During the summer of 2021, a deadly, unprecedented multiday Heat Dome engulfed western Canada. As a result of this extreme heat event (EHE), emergency dispatchers received an unparalleled increase in incoming 911 calls for ambulance, police, and fire (as first responders) services to attend to hundreds of heat-vulnerable community members succumbing to the heat. With 103 all-time heat records broken during this EHE and indoor temperatures of nearly 40°C, the first responders attending these calls faced extensive job demands and highly challenging operating conditions. Initial investigations have explored the health system-level impacts; however, little has been done to explore the impact on the first responders themselves. Therefore, this study aimed to improve our understanding of EHEs' impacts on the operational capabilities and health of first responders, specifically police, fire, ambulance, and dispatch services. METHODS A systematized review and content analysis of media articles published on the 2021 Heat Dome in Canada was conducted (n = 2909), and four media-based composite narratives were developed highlighting police, fire, ambulance, and dispatch services. The Job Demands-Resources (JD-R) model was applied as a theoretical framework for occupational burnout. RESULTS The media-based composite narratives highlighted that first responders faced record-breaking call volumes, increased mental-health-related claims, and exhaustive heat-related physiological stress. Using the JD-R model as a theoretical framework for occupational burnout, we identified three measures of stressful job demand: work overload (e.g., the surge in call volume, firefighters responding to medical emergencies), emotional demands (e.g., severe medical emergencies, sudden deaths, unresponsive patients, distraught family members), and physical demands (e.g., resuscitation in personal protective equipment, heat-related illness). CONCLUSION The experiences described underscore the importance of supporting first responders during work in extreme heat conditions. These findings have important implications for addressing rising rates of burnout during and following public health crises, such as EHEs, a problem that is increasingly being recognized as a threat to the Canadian public healthcare system.
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Affiliation(s)
- Emily J Tetzlaff
- Human and Environmental Physiology Research Unit, School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
- Heat Division, Climate Change and Innovation Bureau, Healthy Environments and Consumer Safety Branch, Safe Environments Directorate, Health Canada, Ottawa, Ontario, Canada
| | - Casey Cassan
- Human and Environmental Physiology Research Unit, School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Nicholas Goulet
- Human and Environmental Physiology Research Unit, School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
- Heat Division, Climate Change and Innovation Bureau, Healthy Environments and Consumer Safety Branch, Safe Environments Directorate, Health Canada, Ottawa, Ontario, Canada
| | - Melissa Gorman
- Heat Division, Climate Change and Innovation Bureau, Healthy Environments and Consumer Safety Branch, Safe Environments Directorate, Health Canada, Ottawa, Ontario, Canada
| | - Brooks Hogya
- BC Emergency Health Services, Provincial Health Services Authority, Vancouver, British Columbia, Canada
| | - Glen P Kenny
- Human and Environmental Physiology Research Unit, School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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Ioannou LG, Tsoutsoubi L, Gkiata P, Brown HA, Periard JD, Mekjavic IB, Kenny GP, Nybo L, Flouris AD. Effect of sportswear on performance and physiological heat strain during prolonged running in moderately hot conditions. Scand J Med Sci Sports 2024; 34:e14520. [PMID: 37839051 DOI: 10.1111/sms.14520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 09/01/2023] [Accepted: 10/01/2023] [Indexed: 10/17/2023]
Abstract
INTRODUCTION This study examined the impact of different upper-torso sportswear technologies on the performance and physiological heat strain of well-trained and national-level athletes during prolonged running in moderately hot conditions. METHODS A randomized crossover design was employed in which 20 well-trained (n = 16) and national-level (n = 4) athletes completed four experimental trials in moderately hot conditions (35°C, 30% relative humidity). In each trial, participants ran at 70% of their peak oxygen uptake (70% V̇O2peak ) for 60 min, while wearing a different upper-body garment: cotton t-shirt, t-shirt with sweat-wicking fabric, compression t-shirt, and t-shirt with aluminum dots lining the inside of the upper back of the garment. Running speed was adjusted to elicit the predetermined oxygen consumption associated with 70% V̇O2peak . Physiological (core and skin temperatures, total body water loss, and urine specific gravity) and perceptual (thermal comfort and sensation, ratings of perceived exertion, and garment cooling functionality) parameters along with running speed at 70% V̇O2peak were continuously recorded. RESULTS No significant differences were observed between the four garments for running speed at 70% V̇O2peak , physiological heat strain, and perceptual responses (all p > 0.05). The tested athletes reported larger areas of perceived suboptimal cooling functionality in the cotton t-shirt and the t-shirt with aluminum dots relative to the sweat-wicking and compression t-shirts (d: 0.43-0.52). CONCLUSION There were not differences among the tested garments regarding running speed at 70% V̇O2peak , physiological heat strain, and perceptual responses in well-trained and national-level endurance athletes exercising in moderate heat.
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Affiliation(s)
- Leonidas G Ioannou
- FAME Laboratory, Department of Physical Education and Sport Science, University of Thessaly, Trikala, Greece
| | - Lydia Tsoutsoubi
- FAME Laboratory, Department of Physical Education and Sport Science, University of Thessaly, Trikala, Greece
| | - Paraskevi Gkiata
- FAME Laboratory, Department of Physical Education and Sport Science, University of Thessaly, Trikala, Greece
| | - Harry A Brown
- Research Institute for Sport and Exercise (UCRISE), University of Canberra, Bruce, Australian Capital Territory, Australia
| | - Julien D Periard
- Research Institute for Sport and Exercise (UCRISE), University of Canberra, Bruce, Australian Capital Territory, Australia
| | - Igor B Mekjavic
- Department of Automatics, Biocybernetics and Robotics, Jozef Stefan Institute, Ljubljana, Slovenia
| | - Glen P Kenny
- Human and Environmental Physiology Research Unit, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Lars Nybo
- Department of Nutrition, Exercise and Sports, August Krogh Building, University of Copenhagen, Copenhagen, Denmark
| | - Andreas D Flouris
- FAME Laboratory, Department of Physical Education and Sport Science, University of Thessaly, Trikala, Greece
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Ioannou LG, Foster J, Morris NB, Piil JF, Havenith G, Mekjavic IB, Kenny GP, Nybo L, Flouris AD. Occupational heat strain in outdoor workers: A comprehensive review and meta-analysis. Temperature (Austin) 2022; 9:67-102. [PMID: 35655665 PMCID: PMC9154804 DOI: 10.1080/23328940.2022.2030634] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 01/11/2022] [Accepted: 01/13/2022] [Indexed: 12/29/2022] Open
Abstract
The present comprehensive review (i) summarizes the current knowledge on the impacts of occupational heat stress on outdoor workers, (ii) provides a historical background on this issue, (iii) presents a meta-analysis of published data, (iv) explores inter-individual and intra-individual factors, (v) discusses the available heat mitigation strategies, (vi) estimates physical work capacity, labour productivity, and metabolic rate for the year 2030, and (vii) provides an overview of existing policy and legal frameworks on occupational heat exposure. Meta-analytic findings from 38 field studies that involved monitoring 2,409 outdoor workers across 41 jobs in 21 countries suggest that occupational heat stress increases the core (r = 0.44) and skin (r = 0.44) temperatures, as well as the heart rate (r = 0.38) and urine specific gravity (r = 0.13) of outdoor workers (all p < 0.05). Moreover, it diminishes the capacity of outdoor workers for manual labour (r = -0.82; p < 0.001) and is responsible for more than two thirds of the reduction in their metabolic rate. Importantly, our analysis shows that physical work capacity is projected to be highly affected by the ongoing anthropogenic global warming. Nevertheless, the metabolic rate and, therefore, labour productivity are projected to remain at levels higher than the workers' physical work capacity, indicating that people will continue to work more intensely than they should to meet their financial obligations for food and shelter. In this respect, complementary measures targeting self-pacing, hydration, work-rest regimes, ventilated garments, and mechanization can be adopted to protect outdoor workers.
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Affiliation(s)
- Leonidas G. Ioannou
- FAME Laboratory, Department of Physical Education and Sport Science, University of Thessaly, Trikala, Greece
| | - Josh Foster
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas and University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Nathan B. Morris
- Department of Human Physiology & Nutrition, University of Colorado, Springs, Colorado, USA
| | - Jacob F. Piil
- Department of Nutrition, Exercise and Sports, August Krogh Building, University of Copenhagen, Copenhagen, Denmark
| | - George Havenith
- Environmental Ergonomics Research Centre, Loughborough Design School, Loughborough University, Loughborough, UK
| | - Igor B. Mekjavic
- Department of Automation, Biocybernetics and Robotics, Jozef Stefan Institute, Ljubljana, Slovenia
| | - Glen P. Kenny
- Human and Environmental Physiology Research Unit, School of Human Kinetics, University of Ottawa, Ottawa, Ontario, Canada
| | - Lars Nybo
- Department of Nutrition, Exercise and Sports, August Krogh Building, University of Copenhagen, Copenhagen, Denmark
| | - Andreas D. Flouris
- FAME Laboratory, Department of Physical Education and Sport Science, University of Thessaly, Trikala, Greece
- Human and Environmental Physiology Research Unit, School of Human Kinetics, University of Ottawa, Ottawa, Ontario, Canada
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Kaltsatou A, Notley SR, Flouris AD, Kenny GP. An exploratory survey of heat stress management programs in the electric power industry. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2021; 18:436-445. [PMID: 34406910 DOI: 10.1080/15459624.2021.1954187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Workers in the electric power industry commonly perform physically demanding jobs in hot environments, which combined with the protective clothing worn, places them at risk of disease and health problems related to occupational heat stress. With climate change fueling an increase in the occurrence of hot weather, a targeted approach to heat stress management within the industry is needed. To better understand current heat management practices and identify opportunities for refinement, we conducted an exploratory survey among 33 electric utility companies operating in the United States (n = 32) and Canada (n = 1). Forty-six employees responsible for health and safety of company workers completed 26 questions assessing heat stress as a workplace hazard and heat management practices within five categories: (1) use and administration of heat stress management program; (2) surveillance of heat stress and heat strain; (3) job evaluation and heat-mitigation guidance; (4) education and training programs; and (5) treatment of heat-related illness. While a majority of the respondents (87.0%) indicated heat stress is a workplace hazard and their organization has a heat stress management program (78.3%), less than half reported performing real-time monitoring of heat stress in the workplace (47.8%) or tracking worker heat strain (19.6%) (i.e., physiological response to heat stress). However, most organizations indicated they conducted pre-job evaluations for heat stress (71.7%) and implemented an employee training program on managing heat stress (73.9%). The latter included instruction on various short- and long-term heat-mitigation guidance for workers (e.g., use of work exposure limits, hydration protocols) and the prevention (52.2%) and treatment (63.1%) of heat-related illnesses. Altogether, our survey demonstrates that although many companies employ some form of a heat management program, the basic components defining the programs vary and are lacking for some companies. To maximize worker health and safety during work in hot environments, a consensus-based approach, which considers the five basic components of a heat management program, should be employed to formulate effective practices and methodologies for creating an industry-specific heat management strategy.
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Affiliation(s)
- Antonia Kaltsatou
- FAME Laboratory, Department of Exercise Science, University of Thessaly, Trikala, Greece
| | - Sean R Notley
- Human and Environmental Physiology Research Unit, School of Human Kinetics, University of Ottawa, Ottawa, Canada
| | - Andreas D Flouris
- FAME Laboratory, Department of Exercise Science, University of Thessaly, Trikala, Greece
| | - Glen P Kenny
- Human and Environmental Physiology Research Unit, School of Human Kinetics, University of Ottawa, Ottawa, Canada
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Notley SR, Akerman AP, Friesen BJ, Poirier MP, Sigal RJ, Flouris AD, Boulay P, McCourt E, Ruzicka M, Kenny GP. Heat Tolerance and Occupational Heat Exposure Limits in Older Men with and without Type 2 Diabetes or Hypertension. Med Sci Sports Exerc 2021; 53:2196-2206. [PMID: 33988544 DOI: 10.1249/mss.0000000000002698] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE To mitigate rises in core temperature >1°C, the American Conference of Governmental Industrial Hygienists (ACGIH) recommends upper limits for heat stress (Action Limit Values; ALV), defined by wet-bulb globe temperature (WBGT) and a worker's metabolic rate. However, these limits are based on data from young men and are assumed to be suitable for all workers, irrespective of age or health status. We therefore explored the impact of aging, type 2 diabetes (T2D), and hypertension (HTN), on tolerance to prolonged, moderate-intensity work above and below these limits. METHODS Core temperature and heart rate were assessed in healthy, non-heat acclimatized young (18-30 y, n=13) and older (50-70 y) men (n=14), and non-heat acclimatized older men with T2D (n=10) or HTN (n=13) during moderate-intensity (metabolic rate: 200 W/m2) walking for 180 min (or until termination) in environments above (28 and 32°C WBGT) and below (16 and 24°C WBGT) the ALV for continuous work at this intensity (25°C WBGT). RESULTS Work tolerance in the 32°C WBGT was shorter in men with T2D (median [IQR]; 109 [91, 173] min; p=0.041) and HTN (109 [91, 173] min; p=0.010) compared to healthy older men (180 [133, 180] min). However, aging, T2D, and HTN did not significantly influence (i) core temperature or heart rate reserve, irrespective of WBGT, (ii) the probability that core temperature exceeded recommended limits (>1°C) under the ALV, and (iii) work duration before core temperature exceeded recommended limits (>1°C) above the ALV. CONCLUSION These findings demonstrate that T2D and HTN attenuate tolerance to uncompensable heat stress (32°C WBGT); however, these chronic diseases do not significantly impact thermal and cardiovascular strain, or the validity of ACIGH recommendations during moderate-intensity work.
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Affiliation(s)
- Sean R Notley
- Human and Environmental Physiology Research Unit, School of Human Kinetics, University of Ottawa, Ottawa, Canada Departments of Medicine, Cardiac Sciences and Community Health Sciences Faculties of Medicine and Kinesiology, University of Calgary, Canada Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada FAME Laboratory, Department of Exercise Science, University of Thessaly, Greece Faculté des sciences de l'activité physique, Université de Sherbrooke, Sherbrooke, Québec, Canada Hypertension Program, Division of Nephrology, University of Ottawa, Ottawa, Canada
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D'Souza AW, Notley SR, Brown EK, Poirier MP, Kenny GP. The Hexoskin physiological monitoring shirt does not impair whole-body heat loss during exercise in hot-dry conditions. Appl Physiol Nutr Metab 2018; 44:332-335. [PMID: 30336069 DOI: 10.1139/apnm-2018-0370] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Using direct calorimetry, we determined if the Hexoskin shirt (Carré Technologies Inc., Que., Canada), a wearable device for monitoring physiological strain, would compromise whole-body heat loss and exacerbate body heat storage during moderate-intensity activity in hot-dry conditions. The shirt did not impair heat dissipation and resulted in similar body heat storage when worn alone relative to a semi-nude condition (214 vs. 211 kJ) or when worn underneath a work uniform compared with a cotton undershirt (307 vs. 318 kJ).
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Affiliation(s)
- Andrew W D'Souza
- Human and Environmental Physiology Research Unit, School of Human Kinetics, University of Ottawa, Ottawa, ON K1N 6N5, Canada.,Human and Environmental Physiology Research Unit, School of Human Kinetics, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | - Sean R Notley
- Human and Environmental Physiology Research Unit, School of Human Kinetics, University of Ottawa, Ottawa, ON K1N 6N5, Canada.,Human and Environmental Physiology Research Unit, School of Human Kinetics, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | - Erin K Brown
- Human and Environmental Physiology Research Unit, School of Human Kinetics, University of Ottawa, Ottawa, ON K1N 6N5, Canada.,Human and Environmental Physiology Research Unit, School of Human Kinetics, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | - Martin P Poirier
- Human and Environmental Physiology Research Unit, School of Human Kinetics, University of Ottawa, Ottawa, ON K1N 6N5, Canada.,Human and Environmental Physiology Research Unit, School of Human Kinetics, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | - Glen P Kenny
- Human and Environmental Physiology Research Unit, School of Human Kinetics, University of Ottawa, Ottawa, ON K1N 6N5, Canada
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Carballo-Leyenda B, Villa JG, López-Satué J, Rodríguez-Marroyo JA. Impact of Different Personal Protective Clothing on Wildland Firefighters' Physiological Strain. Front Physiol 2017; 8:618. [PMID: 28894421 PMCID: PMC5581537 DOI: 10.3389/fphys.2017.00618] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 08/09/2017] [Indexed: 11/13/2022] Open
Abstract
Wildfire firefighting is an extremely demanding occupation performed under hot environment. The use of personal protective clothing (PPC) is needed to protect subjects from the thermal exposure. However, the additional use of PPC may increase the wildland firefighters' physiological strain, and consequently limit their performance. The aim of this study was to analyze the effect of four different PPC on the physiological strain of wildland firefighters under moderate conditions (30°C and 30% RH). Eight active and healthy wildland firefighters performed a submaximal walking test wearing a traditional short sports gear and 4 different PPC. The materials combination (viscose, Nomex, Kevlar, P-140 and fire resistant cotton) used during the PPC manufacturing process was different. During all tests, to simulate a real scenario subjects wore a backpack pump (20 kg). Heart rate, respiratory gas exchange, gastrointestinal temperature, blood lactate concentration, perceived exertion and temperature and humidity underneath the PPC were recorded throughout tests. Additionally, parameters of heat balance were estimated. Wearing a PPC did not cause a significant increase in the subjects' physiological response. The gastrointestinal temperature increment, the relative humidity of the microclimate underneath the PPC, the sweat residue in PPC, the sweat efficiency, the dry heat exchange and the total clothing insulation were significantly affected according to the PPC fabric composition. These results suggest that the PPC composition affect the moisture management. This might be taken into account to increase the wildland firefighters' protection in real situations, when they have to work close to the flames.
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Affiliation(s)
- Belén Carballo-Leyenda
- Department of Physical Education and Sports, Institute of Biomedicine, University of LeónLeón, Spain
| | - José G. Villa
- Department of Physical Education and Sports, Institute of Biomedicine, University of LeónLeón, Spain
| | | | - Jose A. Rodríguez-Marroyo
- Department of Physical Education and Sports, Institute of Biomedicine, University of LeónLeón, Spain
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Butts CL, Smith CR, Ganio MS, McDermott BP. Physiological and perceptual effects of a cooling garment during simulated industrial work in the heat. APPLIED ERGONOMICS 2017; 59:442-448. [PMID: 27890156 DOI: 10.1016/j.apergo.2016.10.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 08/02/2016] [Accepted: 10/04/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Evaluate physiological and perceptual responses using a phase change cooling (PCC) garment during simulated work in the heat. METHODS Twenty males wearing compression undergarments, coverall suit, gloves, and hard-hat, completed two randomly assigned trials (with PCC inserts or control, CON) of simulated industrial tasks in the heat (34.2 ± 0.05 °C, 54.7 ± 0.3%RH). Trials consisted of two 20 min work bouts, a maximum performance bout, and 10 min of recovery. RESULTS Physiological strain index (PSI) was lower during PCC after the second work bout and during recovery (all P < 0.05). PCC reduced heat storage (27.0 ± 7.6 W m-2) compared to CON (42.7 ± 9.9 W m-2, P < 0.001). Perceptual strain index (PeSI) was reduced with PCC compared to CON (P < 0.001), however performance outcomes were not different between trials (P = 0.10). CONCLUSIONS PCC during work in the heat attenuated thermal, physiological, and perceptual strain. This PCC garment could increase safety and reduce occupational heat illness risk.
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Affiliation(s)
- Cory L Butts
- Human Performance Laboratory, University of Arkansas, 155 Stadium Dr HPER 321, Fayetteville, AR 72701, USA.
| | - Cody R Smith
- Human Performance Laboratory, University of Arkansas, 155 Stadium Dr HPER 321, Fayetteville, AR 72701, USA.
| | - Matthew S Ganio
- Human Performance Laboratory, University of Arkansas, 155 Stadium Dr HPER 321, Fayetteville, AR 72701, USA.
| | - Brendon P McDermott
- Human Performance Laboratory, University of Arkansas, 155 Stadium Dr HPER 321, Fayetteville, AR 72701, USA.
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MEADE ROBERTD, POIRIER MARTINP, FLOURIS ANDREASD, HARDCASTLE STEPHENG, KENNY GLENP. Do the Threshold Limit Values for Work in Hot Conditions Adequately Protect Workers? Med Sci Sports Exerc 2016; 48:1187-96. [DOI: 10.1249/mss.0000000000000886] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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