Physiological tolerance times while wearing explosive ordnance disposal protective clothing in simulated environmental extremes

Individualized monitoring of heat illness risk: novel adaptive physiological strain index to assess exercise-heat strain from athletes to fully encapsulated workers

Objective. Exercise-heat strain estimation approaches often involve combinations of body core temperature (Tcore), skin temperature (Tsk) and heart rate (HR). A successful existing measure is the 'Physiological Strain Index' (PSI), which combines HR and Tcore values to estimate strain. However, depending on variables such as aerobic fitness and clothing, the equation's 'maximal/critical' Tcore must be changed to accurately represent the strain, in part because high Tsk (small Tcore-Tsk) can increase cardiovascular strain and thereby negatively affect performance. Here, an 'adaptive PSI' (aPSI) is presented where the original PSI Tcorecriticalvalue is 'adapted' dynamically by the delta between Tcore and Tsk.Approach. PSI and aPSI were computed for athletes (ELITE,N= 11 male and 8 female, 8 km time-trial) and soldiers in fully encapsulating personal protective equipment (PPE,N= 8 male, 2 km approach-march). While these were dissimilar events, it was anticipated given that the clothing and work rates would elicit similar very-high exercise-heat strain values.Main results. Mean end HR values were similar (∼180 beats min-1) with higher Tcore = 40.1 ± 0.4 °C for ELITE versus PPE 38.4 ± 0.6 °C (P< 0.05). PSI end values were different between groups (P< 0.01) and appeared 'too-high' for ELITE (11.4 ± 0.8) and 'too-low' for PPE (7.6 ± 2.0). However, aPSI values were not different (9.9 ± 1.4 versus 9.0 ± 2.5 versus;p> 0.05) indicating a 'very high' level of exercise-heat strain for both conditions.Significance. A simple adaptation of the PSI equation, which accounts for differences in Tcore-to-Tsk gradients, provides a physiological approach to dynamically adapt PSI to provide a more accurate index of exercise-heat strain under very different working conditions.

Association between physiological and perceptual heat strain while wearing stab-resistant body armor

In this study, we explored the association between physiological and perceptual heat strain while wearing stab-resistant body armor (SRBA). Human trials were performed on ten participants in warm and hot environments. Physiological responses (core temperature, skin temperature, and heart rate), and perceptual responses (thermal sensation vote, thermal comfort vote, restriction of perceived exertion (RPE), wetness of skin, and wetness of clothing) were recorded throughout the trials, and subsequently, the physiological strain index (PSI), and perceptual strain index (PeSI) were calculated. The results indicated that the PeSI showed a significant moderate association with the PSI, and was capable of predicting PSI for low (PSI = 3) and high (PSI = 7) levels of physiological strain with the areas under the curves of 0.80 and 0.64, respectively. Moreover, Bland-Altman analysis indicated that the majority of the PSI ranged within the 95% confidence interval, and the mean difference between PSI and PeSI was 0.14 ± 2.02 with the lower 95% limit and upper 95% limit being -3.82 to 4.10, respectively. Therefore, the subjective responses could be used as an indicator for predicting physiological strain while wearing SRBA. This study could provide fundamental knowledge for the usage of SRBA, and the development of physiological heat strain assessment.

Characterizing the Effects of Explosive Ordnance Disposal Operations on the Human Body While Wearing Heavy Personal Protective Equipment

OBJECTIVE

To provide a comprehensive characterization of explosive ordnance disposal (EOD) personal protective equipment (PPE) by evaluating its effects on the human body, specifically the poses, tasks, and conditions under which EOD operations are performed.

BACKGROUND

EOD PPE is designed to protect technicians from a blast. The required features of protection make EOD PPE heavy, bulky, poorly ventilated, and difficult to maneuver in. It is not clear how the EOD PPE wearer physiologically adapts to maintain physical and cognitive performance during EOD operations.

METHOD

Fourteen participants performed EOD operations including mobility and inspection tasks with and without EOD PPE. Physiological measurement and kinematic data recording were used to record human physiological responses and performance.

RESULTS

All physiological measures were significantly higher during the mobility and the inspection tasks when EOD PPE was worn. Participants spent significantly more time to complete the mobility tasks, whereas mixed results were found in the inspection tasks. Higher back muscle activations were seen in participants who performed object manipulation while wearing EOD PPE.

CONCLUSION

EOD operations while wearing EOD PPE pose significant physical stress on the human body. The wearer's mobility is impacted by EOD PPE, resulting in decreased speed and higher muscle activations.

APPLICATION

The testing and evaluation methodology in this study can be used to benchmark future EOD PPE designs. Identifying hazards posed by EOD PPE lays the groundwork for developing mitigation plans, such as exoskeletons, to reduce physical and cognitive stress caused by EOD PPE on the wearers without compromising their operational performance.

Modified Stroop Task Performance When Wearing Protective Clothing in the Heat: An Evaluation of the Maximum Adaptability Model

INTRODUCTION

This exploratory study investigated whether performance in a behavioural inhibition task followed the shape proposed by the Maximum Adaptability Model during progressive exertional heat stress-that is, an initial improvement in cognitive performance is followed by a plateau, and subsequent decline once body temperature continues to rise unabated.

METHODS

Seventeen adult males walked on a treadmill at 4 km•h^-1 (1% grade) for up to 120 min, in three protective clothing ensembles, across three simulated environments. The simulated environments were equivalent to wet bulb globe temperatures 21, 30 and 37°C. Cognitive function was assessed using a modified colour-word Stroop Task, with performance expressed as inverse efficiency scores in the simple (congruent) and more complex (incongruent) task conditions. The Stroop Task was completed before a trial, at termination, and every 30 min during walking, and core body temperature was continuously measured. Data were modelled using Bayesian penalised regression, with core body temperature included as a non-linear term (i.e., second degree polynomial).

RESULTS

We did not find any evidence that core body temperature had an effect on congruent or incongruent inverse efficiency scores, and no evidence that the relationship between these variables followed the shaped described by the Maximum Adaptability Model. There was, however, evidence that higher pre-exercise serum osmolality values were associated with slower congruent (β = 9.19) and incongruent (β = 8.67) inverse efficiency scores. The posterior probability that these effects were greater than zero was 0.971 and 0.952, respectively.

CONCLUSIONS

In young, fit men, performance in the behavioural inhibition task was unaffected by increases in body temperature up to 39°C and did not follow the shape proposed by the Maximum Adaptability Model. A secondary finding of the study was that pre-exercise hydration status affected performance in the inhibition task. Future studies are needed to confirm this result.

Capsule Endoscopy: Pitfalls and Approaches to Overcome

Capsule endoscopy of the gastrointestinal tract is an innovative technology that serves to replace conventional endoscopy. Wireless capsule endoscopy, which is mainly used for small bowel examination, has recently been used to examine the entire gastrointestinal tract. This method is promising for its usefulness and development potential and enhances convenience by reducing the side effects and discomfort that may occur during conventional endoscopy. However, capsule endoscopy has fundamental limitations, including passive movement via bowel peristalsis and space restriction. This article reviews the current scientific aspects of capsule endoscopy and discusses the pitfalls and approaches to overcome its limitations. This review includes the latest research results on the role and potential of capsule endoscopy as a non-invasive diagnostic and therapeutic device.

Thermoregulation is not impaired in breast cancer survivors during moderate-intensity exercise performed in warm and hot environments

This study aimed to assess how female breast cancer survivors (BCS) respond physiologically, hematologically, and perceptually to exercise under heat stress compared to females with no history of breast cancer (CON). Twenty-one females (9 BCS and 12 CON [age; 54 ± 7 years, stature; 167 ± 6 cm, body mass; 68.1 ± 7.62 kg, and body fat; 30.9 ± 3.8%]) completed a warm (25℃, 50% relative humidity, RH) and hot (35℃, 50%RH) trial in a repeated-measures crossover design. Trials consisted of 30 min of rest, 30 min of walking at 4 metabolic equivalents, and a 6-minute walk test (6MWT). Physiological measurements (core temperature (Tre ), skin temperature (Tskin ), heart rate (HR), and sweat analysis) and perceptual rating scales (ratings of perceived exertion, thermal sensation [whole body and localized], and thermal comfort) were taken at 5- and 10-min intervals throughout, respectively. Venous blood samples were taken before and after to assess; IL-6, IL-10, CRP, IFN-γ, and TGF-β1 . All physiological markers were higher during the 35 versus 25℃ trial; Tre (~0.25℃, p = 0.002), Tskin (~3.8℃, p < 0.001), HR (~12 beats·min-1 , p = 0.023), and whole-body sweat rate (~0.4 L·hr-1 , p < 0.001), with no difference observed between groups in either condition (p > 0.05). Both groups covered a greater 6MWT distance in 25 versus 35℃ (by ~200 m; p = 0.003). Nevertheless, the control group covered more distance than BCS, regardless of environmental temperature (by ~400 m, p = 0.03). Thermoregulation was not disadvantaged in BCS compared to controls during moderate-intensity exercise under heat stress. However, self-paced exercise performance was reduced for BCS regardless of environmental temperature.

Contribution of Dietary Composition on Water Turnover Rates in Active and Sedentary Men

Body water turnover is a marker of hydration status for measuring total fluid gains and losses over a 24-h period. It can be particularly useful in predicting (and hence, managing) fluid loss in individuals to prevent potential physical, physiological and cognitive declines associated with hypohydration. There is currently limited research investigating the interrelationship of fluid balance, dietary intake and activity level when considering body water turnover. Therefore, this study investigates whether dietary composition and energy expenditure influences body water turnover. In our methodology, thirty-eight males (19 sedentary and 19 physically active) had their total body water and water turnover measured via the isotopic tracer deuterium oxide. Simultaneous tracking of dietary intake (food and fluid) is carried out via dietary recall, and energy expenditure is estimated via accelerometery. Our results show that active participants display a higher energy expenditure, water intake, carbohydrate intake and fibre intake; however, there is no difference in sodium or alcohol intake between the two groups. Relative water turnover in the active group is significantly greater than the sedentary group (Mean Difference (MD) [95% CI] = 17.55 g·kg^-1·day^-1 [10.90, 24.19]; p = < 0.001; g[95% CI] = 1.70 [0.98, 2.48]). A penalised linear regression provides evidence that the fibre intake (p = 0.033), water intake (p = 0.008), and activity level (p = 0.063) predict participants' relative body water turnover (R²= 0.585). In conclusion, water turnover is faster in individuals undertaking regular exercise than in their sedentary counterparts, and is, in part, explained by the intake of water from fluid and high-moisture content foods. The nutrient analysis of the participant diets indicates that increased dietary fibre intake is also positively associated with water turnover rates. The water loss between groups also contributes to the differences observed in water turnover; this is partly related to differences in sweat output during increased energy expenditure from physical activity.

The physiological strain index does not reliably identify individuals at risk of reaching a thermal tolerance limit

PURPOSE

The physiological strain index (PSI) was developed to assess individuals' heat strain, yet evidence supporting its use to identify individuals at potential risk of reaching a thermal tolerance limit (TTL) is limited. The aim of this study was to assess whether PSI can identify individuals at risk of reaching a TTL.

METHODS

Fifteen females and 21 males undertook a total of 136 trials, each consisting of two 40-60 minute periods of treadmill walking separated by ~ 15 minutes rest, wearing permeable or impermeable clothing, in a range of climatic conditions. Heart rate (HR), skin temperature (T_sk), rectal temperature (T_re), temperature sensation (TS) and thermal comfort (TC) were measured throughout. Various forms of the PSI-index were assessed including the original PSI, PSI_fixed, adaptive-PSI (aPSI) and a version comprised of a measure of heat storage (PSI_HS). Final physiological and PSI values and their rate of change (ROC) over a trial and in the last 10 minutes of a trial were compared between trials completed (C, 101 trials) and those terminated prematurely (TTL, 35 trials).

RESULTS

Final PSI_original, PSI_fixed, aPSI, PSI_HS did not differ between TTL and C (p > 0.05). However, differences between TTL and C occurred in final T_sk, T_re-T_sk, TS, TC and ROC in PSI_fixed, T_re, T_sk and HR (p < 0.05).

CONCLUSION

These results suggest the PSI, in the various forms, does not reliably identify individuals at imminent risk of reaching their TTL and its validity as a physiological safety index is therefore questionable. However, a physiological-perceptual strain index may provide a more valid measure.

Optimizing the Use of Phase Change Material Vests Worn During Explosives Ordnance Disposal Operations in Hot Conditions

Phase change material (PCM) cooling garments’ efficacy is limited by the duration of cooling provided. The purpose of this study was to evaluate the effect of replacing a PCM vest during a rest period on physiological and perceptual responses during explosive ordnance disposal (EOD) related activity. Six non-heat acclimated males undertook three trials (consisting of 2 × 3 × 16.5 min activity cycles interspersed with one 10 min rest period) in 40°C, 12% relative humidity whilst wearing a ≈38 kg EOD suit. Participants did not wear a PCM cooling vest (NoPCM); wore one PCM vest throughout (PCM1) or changed the PCM vest in the 10 min rest period (PCM2). Rectal temperature (T_re), mean skin temperature (T_skin), heart rate (HR), Physiological Strain Index (PSI), ratings of perceived exertion, temperature sensation and thermal comfort were compared at the end of each activity cycle and at the end of the trial. Data displayed as mean [95% CI]. After the rest period, a rise in T_re was attenuated in PCM2 compared to NoPCM and PCM1 (−0.57 [−0.95, −0.20]°C and −0.46 [−0.81, −0.11]°C, respectively). A rise in HR and T_skin was also attenuated in PCM2 compared to NoPCM and PCM1 (−23 [−29, −16] beats⋅min^–1 and −17 [−28, −6.0] beats⋅min^–1; −0.61 [−1.21, −0.10]°C and −0.89 [−1.37, −0.42]°C, respectively). Resulting in PSI being lower in PCM2 compared to NoPCM and PCM1 (−2.2 [−3.1, −1.4] and –0.8 [−1.3,−0.4], respectively). More favorable perceptions were also observed in PCM2 vs. both NoPCM and PCM1 (p < 0.01). Thermal perceptual measures were similar between NoPCM and PCM1 and the rise in T_re after the rest period tended to be greater in PCM1 than NoPCM. These findings suggest that replacing a PCM vest better attenuates rises in both physiological and perceptual strain compared to when a PCM vest is not replaced. Furthermore, not replacing a PCM vest that has exhausted its cooling capacity, can increase the level of heat strain experienced by the wearer.

Analysis of the Effectiveness of Decontamination Fluids on the Level of Biological Contamination of Firefighter Suits

The scope of tasks of chemical and ecological rescue procedures includes prevention of terrorist attacks with biological weapons. After each action, firefighters are obliged to clean and disinfect their outfits to prevent the potential spreading of harmful microorganisms. This study aimed to analyze the effectiveness of decontamination fluids used to disinfect firefighter's suits. Two types of clothes were analyzed: special combat clothing (NOMEX), and the heavy gas-tight chemical type 1a suit. Swabbed places were cut out and sterilized mechanically using detergent and alcohol. Each time, smears were made on sterile glass, fixed in pure ethanol and stained using the Gram method. After this, the staining samples were air dried and photographed under a light microscope at magnification 1000×. Each smear was made in triplicate and the relative number of stained microorganisms was analyzed using ImageJ software. The results showed that detergent significantly decreased the number of pathogens in the chest area on the NOMEX suit and the type 1a-gas-tight clothing and was more effective than alcohol, especially in case of the NOMEX suit. In conclusion, the detergent was more efficient in decontaminating the NOMEX outfit than the heavy gas-tight clothing, whose surface was better cleaned by the alcohol.

Effect of previous lowering of skin temperature on the time of safe exposure to a hot environment: a case study

Objective. The purpose of the study was to determine the influence of initial conditions of a microclimate on volunteers' permissible exposure limits to a hot and humid environment. Materials and methods. Eighteen experimental studies with the participation of three volunteers were performed under controlled microclimate conditions (two climate chambers). The skin temperature and body core temperature were measured after they had stabilized in the following microclimate conditions: temperature of 17, 21 and 23 °C, relative humidity of 50% and hot microclimate conditions, i.e., temperature of 35 and 42 °C, humidity of 80% and physical work load at 30 W. The time needed to reach a body core temperature of 38 °C was determined under hot conditions. Heat accumulation was calculated. Results. Lowering volunteers' skin temperature under conditions of stabilized physiological parameters prolongs the time necessary for the body core temperature to reach 38 °C during physical work in a hot and humid environment. Conclusions. Appropriate acclimatization before exposure may prolong the time of safe work in a hot environment, e.g., during activities of rescue services.

Gastrointestinal diagnosis using non-white light imaging capsule endoscopy

Capsule endoscopy (CE) has proved to be a powerful tool in the diagnosis and management of small bowel disorders since its introduction in 2001. However, white light imaging (WLI) is the principal technology used in clinical CE at present, and therefore, CE is limited to mucosal inspection, with diagnosis remaining reliant on visible manifestations of disease. The introduction of WLI CE has motivated a wide range of research to improve its diagnostic capabilities through integration with other sensing modalities. These developments have the potential to overcome the limitations of WLI through enhanced detection of subtle mucosal microlesions and submucosal and/or transmural pathology, providing novel diagnostic avenues. Other research aims to utilize a range of sensors to measure physiological parameters or to discover new biomarkers to improve the sensitivity, specificity and thus the clinical utility of CE. This multidisciplinary Review summarizes research into non-WLI CE devices by organizing them into a taxonomic structure on the basis of their sensing modality. The potential of these capsules to realize clinically useful virtual biopsy and computer-aided diagnosis (CADx) is also reported.

Validity of a noninvasive estimation of deep body temperature when wearing personal protective equipment during exercise and recovery

BACKGROUND

Deep body temperature is a critical indicator of heat strain. However, direct measures are often invasive, costly, and difficult to implement in the field. This study assessed the agreement between deep body temperature estimated from heart rate and that measured directly during repeated work bouts while wearing explosive ordnance disposal (EOD) protective clothing and during recovery.

METHODS

Eight males completed three work and recovery periods across two separate days. Work consisted of treadmill walking on a 1% incline at 2.5, 4.0, or 5.5 km/h, in a random order, wearing EOD protective clothing. Ambient temperature and relative humidity were maintained at 24 °C and 50% [Wet bulb globe temperature (WBGT) (20.9 ± 1.2) °C] or 32 °C and 60% [WBGT (29.0 ± 0.2) °C] on the separate days, respectively. Heart rate and gastrointestinal temperature (T_GI) were monitored continuously, and deep body temperature was also estimated from heart rate (ECTemp).

RESULTS

The overall systematic bias between T_GI and ECTemp was 0.01 °C with 95% limits of agreement (LoA) of ±0.64 °C and a root mean square error of 0.32 °C. The average error statistics among participants showed no significant differences in error between the exercise and recovery periods or the environmental conditions. At T_GI levels of (37.0-37.5) °C, (37.5-38.0) °C, (38.0-38.5) °C, and > 38.5 °C, the systematic bias and ± 95% LoA were (0.08 ± 0.58) °C, (- 0.02 ± 0.69) °C, (- 0.07 ± 0.63) °C, and (- 0.32 ± 0.56) °C, respectively.

CONCLUSIONS

The findings demonstrate acceptable validity of the ECTemp up to 38.5 °C. Conducting work within an ECTemp limit of 38.4 °C, in conditions similar to the present study, would protect the majority of personnel from an excessive elevation in deep body temperature (> 39.0 °C).

A new occupational heat tolerance test: A feasibility study

Heat tolerance tests identify those susceptible to heat illnesses and monitor heat adaptations. Currently, tolerance tests do not replicate the uncompensable heat strain environments experienced in some occupations. In addition, tests can take up to 2 h to complete, and cannot offer intra and inter individual comparisons, due to the use of a fixed exercise intensity. This study aimed to assess the validity and reliability of a new heat occupational tolerance test (HOTT: 40 min at 6 W kg^-1 metabolic heat production, 50 °C 10% RH, in protective clothing) to the standard heat tolerance test (HTT: 2 h walk at 5 km h^-1 1% gradient, 40 °C 40% RH, in shorts and t-shirt). Eighteen participants (age: 21 ± 3 yrs, body mass: 81.3 ± 5.9 kg) completed trials to assess the validity and/or reliability of the HOTT. Peak rectal temperature (T_re) displayed strong agreement and low measurement error (0.19 °C) between HTT (38.7 ± 0.4 °C) and HOTT (38.6 ± 0.4 °C). Strong agreement was also displayed for physiological and perceptual measures between the two HOTT trials, including peak T_re (38.5 ± 0.4 °C vs. 38.5 ± 0.4 °C) and peak heart rate (182 ± 20 b min^-1 vs. 182 ± 21 b min^-1). The HOTT is the first tolerance test that assesses individuals' responses whilst wearing protective clothing in high temperatures. It can consistently identify individuals' levels of heat tolerance within a reduced time frame. In addition, it allows for participant monitoring over time and comparisons between individuals to be made. A continuum based approach is recommended when assessing individuals' responses to the HOTT.

Internal and external cooling methods and their effect on body temperature, thermal perception and dexterity

Objective

The present study aimed to compare a range of cooling methods possibly utilised by occupational workers, focusing on their effect on body temperature, perception and manual dexterity.

Methods

Ten male participants completed eight trials involving 30 min of seated rest followed by 30 min of cooling or control of no cooling (CON) (34°C, 58% relative humidity). The cooling methods utilised were: ice cooling vest (CV₀), phase change cooling vest melting at 14°C (CV₁₄), evaporative cooling vest (CV_EV), arm immersion in 10°C water (AI), portable water-perfused suit (WPS), heliox inhalation (HE) and ice slushy ingestion (SL). Immediately before and after cooling, participants were assessed for fine (Purdue pegboard task) and gross (grip and pinch strength) manual dexterity. Rectal and skin temperature, as well as thermal sensation and comfort, were monitored throughout.

Results

Compared with CON, SL was the only method to reduce rectal temperature (P = 0.012). All externally applied cooling methods reduced skin temperature (P<0.05), though CV₀ resulted in the lowest skin temperature versus other cooling methods. Participants felt cooler with CV₀, CV₁₄, WPS, AI and SL (P<0.05). AI significantly impaired Purdue pegboard performance (P = 0.001), but did not affect grip or pinch strength (P>0.05).

Conclusion

The present study observed that ice ingestion or ice applied to the skin produced the greatest effect on rectal and skin temperature, respectively. AI should not be utilised if workers require subsequent fine manual dexterity. These results will help inform future studies investigating appropriate pre-cooling methods for the occupational worker.

An Overt Chemical Protective Garment Reduces Thermal Strain Compared with a Covert Garment in Warm-Wet but Not Hot-Dry Environments

Objectives: A commercial chemical, biological, radiological and nuclear (CBRN) protective covert garment has recently been developed with the aim of reducing thermal strain. A covert CBRN protective layer can be worn under other clothing, with equipment added for full chemical protection when needed. However, it is unknown whether the covert garment offers any alleviation to thermal strain during work compared with a traditional overt ensemble. Therefore, the aim of this study was to compare thermal strain and work tolerance times during work in an overt and covert ensemble offering the same level of CBRN protection.

Methods: Eleven male participants wore an overt (OVERT) or covert (COVERT) CBRN ensemble and walked (4 km·h⁻¹, 1% grade) for a maximum of 120 min in either a wet bulb globe temperature [WBGT] of 21, 30, or 37°C (Neutral, WarmWet and HotDry, respectively). The trials were ceased if the participants' gastrointestinal temperature reached 39°C, heart rate reached 90% of maximum, walking time reached 120 min or due to self-termination.

Results: All participants completed 120 min of walking in Neutral. Work tolerance time was greater in OVERT compared with COVERT in WarmWet (P < 0.001, 116.5[9.9] vs. 88.9[12.2] min, respectively), though this order was reversed in HotDry (P = 0.003, 37.3[5.3] vs. 48.4[4.6] min, respectively). The rate of change in mean body temperature and mean skin temperature was greater in COVERT (0.025[0.004] and 0.045[0.010]°C·min⁻¹, respectively) compared with OVERT (0.014[0.004] and 0.027[0.007]°C·min⁻¹, respectively) in WarmWet (P < 0.001 and P = 0.028, respectively). However, the rate of change in mean body temperature and mean skin temperature was greater in OVERT (0.068[0.010] and 0.170[0.026]°C·min⁻¹, respectively) compared with COVERT (0.059[0.004] and 0.120[0.017]°C·min⁻¹, respectively) in HotDry (P = 0.002 and P < 0.001, respectively). Thermal sensation, thermal comfort, and ratings of perceived exertion did not differ between garments at trial cessation (P > 0.05).

Conclusion: Those dressed in OVERT experienced lower thermal strain and longer work tolerance times compared with COVERT in a warm-wet environment. However, COVERT may be an optimal choice in a hot-dry environment. These findings have practical implications for those making decisions on the choice of CBRN ensemble to be used during work.

Mine rescuers' heat load during the expenditure of physical effort in a hot environment, using ventilated underwear and selected breathing apparatus

Mine rescuers' heat load under the same physical effort load (25% of the maximal oxygen uptake), using three types of breathing apparatus, in newly developed heat-removing underwear and outerwear was assessed for typical work conditions of mine rescuers, under milder and harsher ambient conditions of 32 and 38 °C, respectively, both at relative humidity of 85% and air velocity of 1.0 m/s. Expending physical effort at the same load while using different kinds of breathing apparatus resulted in a similar heat load. Under both milder and harsher ambient conditions, heat storage and sweating intensity were greater than the average limit value recommended by hygienic standards, which indicates that the use of breathing apparatus significantly hinders heat exchange with the environment. The developed clothing for mine rescuers was highly rated, and was considered by most people to be better than that used currently.

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.

Intraocular Pressure Is a Poor Predictor of Hydration Status following Intermittent Exercise in the Heat

Current hydration assessments involve biological fluids that are either compromised in dehydrated individuals or require laboratory equipment, making timely results unfeasible. The eye has been proposed as a potential site to provide a field-based hydration measure. The present study evaluated the efficacy and sensitivity of intraocular pressure (IOP) to assess hydration status. Twelve healthy males undertook two 150 min walking trials in 40°C 20% relative humidity. One trial matched fluid intake to body mass loss (control, CON) and the other had fluid restricted (dehydrated, DEH). IOP (rebound tonometry) and hydration status (nude body mass and serum osmolality) were determined every 30 min. Body mass and serum osmolality were significantly (p < 0.05) different between trials at all-time points following baseline. Body mass losses reached 2.5 ± 0.2% and serum osmolality 299 ± 5 mOsmol.kg⁻¹ in DEH. A significant trial by time interaction was observed for IOP (p = 0.042), indicating that over the duration of the trials IOP declined to a greater extent in the DEH compared with the CON trial. Compared with baseline measurements IOP was reduced during DEH (150 min: −2.7 ± 1.9 mm Hg; p < 0.05) but remained stable in CON (150 min: −0.3 ± 2.4 mm Hg). However, using an IOP value of 13.2 mm Hg to predict a 2% body mass loss resulted in only 57% of the data being correctly classified (sensitivity 55% and specificity 57%). The use of ΔIOP (−2.4 mm Hg) marginally improved the predictive ability with 77% of the data correctly classified (sensitivity: 55%; specificity: 81%). The present study provides evidence that the large inter-individual variability in baseline IOP and in the IOP response to progressive dehydration, prevents the use of IOP as an acute single assessment marker of hydration status.

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

OBJECTIVE

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.

METHODS

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.

RESULTS

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.

CONCLUSIONS

Modifying the PeSI did not improve the subjective prediction of physiological strain. However, RPE provided an equally accurate prediction of physiological strain, particularly when high-to-very high levels of strain were observed. Therefore, given its predictive performance and user-friendliness, the evidence suggests that RPE in isolation is a practical and cost-effective tool able to estimate physiological strain during exertional-heat stress under these work conditions.

Heat strain imposed by personal protective ensembles: quantitative analysis using a thermoregulation model

The objective of this paper is to study the effects of personal protective equipment (PPE) and specific PPE layers, defined as thermal/evaporative resistances and the mass, on heat strain during physical activity. A stepwise thermal manikin testing and modeling approach was used to analyze a PPE ensemble with four layers: uniform, ballistic protection, chemical protective clothing, and mask and gloves. The PPE was tested on a thermal manikin, starting with the uniform, then adding an additional layer in each step. Wearing PPE increases the metabolic rates [Formula: see text], thus [Formula: see text] were adjusted according to the mass of each of four configurations. A human thermoregulatory model was used to predict endurance time for each configuration at fixed [Formula: see text] and at its mass adjusted [Formula: see text]. Reductions in endurance time due to resistances, and due to mass, were separately determined using predicted results. Fractional contributions of PPE's thermal/evaporative resistances by layer show that the ballistic protection and the chemical protective clothing layers contribute about 20 %, respectively. Wearing the ballistic protection over the uniform reduced endurance time from 146 to 75 min, with 31 min of the decrement due to the additional resistances of the ballistic protection, and 40 min due to increased [Formula: see text] associated with the additional mass. Effects of mass on heat strain are of a similar magnitude relative to effects of increased resistances. Reducing resistances and mass can both significantly alleviate heat strain.

Load carriage, human performance, and employment standards

The focus of this review is on the physiological considerations necessary for developing employment standards within occupations that have a heavy reliance on load carriage. Employees within military, fire fighting, law enforcement, and search and rescue occupations regularly work with heavy loads. For example, soldiers often carry loads >50 kg, whilst structural firefighters wear 20–25 kg of protective clothing and equipment, in addition to carrying external loads. It has long been known that heavy loads modify gait, mobility, metabolic rate, and efficiency, while concurrently elevating the risk of muscle fatigue and injury. In addition, load carriage often occurs within environmentally stressful conditions, with protective ensembles adding to the thermal burden of the workplace. Indeed, physiological strain relates not just to the mass and dimensions of carried objects, but to how those loads are positioned on and around the body. Yet heavy loads must be borne by men and women of varying body size, and with the expectation that operational capability will not be impinged. This presents a recruitment conundrum. How do employers identify capable and injury-resistant individuals while simultaneously avoiding discriminatory selection practices? In this communication, the relevant metabolic, cardiopulmonary, and thermoregulatory consequences of loaded work are reviewed, along with concomitant impediments to physical endurance and mobility. Also emphasised is the importance of including occupation-specific clothing, protective equipment, and loads during work-performance testing. Finally, recommendations are presented for how to address these issues when evaluating readiness for duty.

The effects of metabolic work rate and ambient environment on physiological tolerance times while wearing explosive and chemical personal protective equipment

This study evaluated the physiological tolerance times when wearing explosive and chemical (>35 kg) personal protective equipment (PPE) in simulated environmental extremes across a range of differing work intensities. Twelve healthy males undertook nine trials which involved walking on a treadmill at 2.5, 4, and 5.5 km·h⁻¹ in the following environmental conditions, 21, 30, and 37°C wet bulb globe temperature (WBGT). Participants exercised for 60 min or until volitional fatigue, core temperature reached 39°C, or heart rate exceeded 90% of maximum. Tolerance time, core temperature, skin temperature, mean body temperature, heart rate, and body mass loss were measured. Exercise time was reduced in the higher WBGT environments (WBGT37 < WBGT30 < WBGT21; P < 0.05) and work intensities (5.5 < 4 < 2.5 km·h⁻¹; P < 0.001). The majority of trials (85/108; 78.7%) were terminated due to participant's heart rate exceeding 90% of their maximum. A total of eight trials (7.4%) lasted the full duration. Only nine (8.3%) trials were terminated due to volitional fatigue and six (5.6%) due to core temperatures in excess of 39°C. These results demonstrate that physiological tolerance times are influenced by the external environment and workload and that cardiovascular strain is the limiting factor to work tolerance when wearing this heavy multilayered PPE.

Heat strain evaluation of overt and covert body armour in a hot and humid environment

The aim of this study was to elucidate the thermophysiological effects of wearing lightweight non-military overt and covert personal body armour (PBA) in a hot and humid environment. Eight healthy males walked on a treadmill for 120 min at 22% of their heart rate reserve in a climate chamber simulating 31 °C (60%RH) wearing either no armour (control), overt or covert PBA in addition to a security guard uniform, in a randomised controlled crossover design. No significant difference between conditions at the end of each trial was observed in core temperature, heart rate or skin temperature (P > 0.05). Covert PBA produced a significantly greater amount of body mass change (-1.81 ± 0.44%) compared to control (-1.07 ± 0.38%, P = 0.009) and overt conditions (-1.27 ± 0.44%, P = 0.025). Although a greater change in body mass was observed after the covert PBA trial; based on the physiological outcome measures recorded, the heat strain encountered while wearing lightweight, non-military overt or covert PBA was negligible compared to no PBA.

PRACTITIONER SUMMARY

The wearing of bullet proof vests or body armour is a requirement of personnel engaged in a wide range of occupations including police, security, customs and even journalists in theatres of war. This randomised controlled crossover study is the first to examine the thermophysiological effects of wearing lightweight non-military overt and covert personal body armour (PBA) in a hot and humid environment. We conclude that the heat strain encountered while wearing both overt and covert lightweight, non-military PBA was negligible compared to no PBA.

A comparison between conductive and infrared devices for measuring mean skin temperature at rest, during exercise in the heat, and recovery

Purpose

Skin temperature assessment has historically been undertaken with conductive devices affixed to the skin. With the development of technology, infrared devices are increasingly utilised in the measurement of skin temperature. Therefore, our purpose was to evaluate the agreement between four skin temperature devices at rest, during exercise in the heat, and recovery.

Methods

Mean skin temperature (T-sk) was assessed in thirty healthy males during 30 min rest (24.0 ± 1.2°C, 56 ± 8%), 30 min cycle in the heat (38.0 ± 0.5°C, 41 ± 2%), and 45 min recovery (24.0 ± 1.3°C, 56 ± 9%). T-sk was assessed at four sites using two conductive devices (thermistors, iButtons) and two infrared devices (infrared thermometer, infrared camera).

Results

Bland–Altman plots demonstrated mean bias ± limits of agreement between the thermistors and iButtons as follows (rest, exercise, recovery): -0.01 ± 0.04, 0.26 ± 0.85, -0.37 ± 0.98°C; thermistors and infrared thermometer: 0.34 ± 0.44, -0.44 ± 1.23, -1.04 ± 1.75°C; thermistors and infrared camera (rest, recovery): 0.83 ± 0.77, 1.88 ± 1.87°C. Pairwise comparisons of T-sk found significant differences (p < 0.05) between thermistors and both infrared devices during resting conditions, and significant differences between the thermistors and all other devices tested during exercise in the heat and recovery.

Conclusions

These results indicate poor agreement between conductive and infrared devices at rest, during exercise in the heat, and subsequent recovery. Infrared devices may not be suitable for monitoring T-sk in the presence of, or following, metabolic and environmental induced heat stress.

Flexible and capsule endoscopy for screening, diagnosis and treatment

Endoscopy dates back to the 1860s, but many of the most significant advancements have been made within the past decade. With the integration of robotics, the ability to precisely steer and advance traditional flexible endoscopes has been realized, reducing patient pain and improving clinician ergonomics. Additionally, wireless capsule endoscopy, a revolutionary alternative to traditional scopes, enables inspection of the digestive system with minimal discomfort for the patient or the need for sedation, mitigating some of the risks of flexible endoscopy. This review presents a research update on robotic endoscopic systems, including both flexible scope and capsule technologies, detailing actuation methods and therapeutic capabilities. A future perspective on endoscopic potential for screening, diagnostic and therapeutic gastrointestinal procedures is also presented.