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Sharps K, Foster J, Vieno M, Beck R, Hayes F. Ozone pollution contributes to the yield gap for beans in Uganda, East Africa, and is co-located with other agricultural stresses. Sci Rep 2024; 14:8026. [PMID: 38580752 PMCID: PMC10997645 DOI: 10.1038/s41598-024-58144-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 03/26/2024] [Indexed: 04/07/2024] Open
Abstract
Air quality negatively impacts agriculture, reducing the yield of staple food crops. While measured data on African ground-level ozone levels are scarce, experimental studies demonstrate the damaging impact of ozone on crops. Common beans (Phaseolus vulgaris), an ozone-sensitive crop, are widely grown in Uganda. Using modelled ozone flux, agricultural surveys, and a flux-effect relationship, this study estimates yield and production losses due to ozone for Ugandan beans in 2015. Analysis at this scale allows the use of localised data, and results can be presented at a sub-regional level. Soil nutrient stress, drought, flood risk, temperature and deprivation were also mapped to investigate where stresses may coincide. Average bean yield losses due to ozone were 17% and 14% (first and second growing season respectively), equating to 184 thousand tonnes production loss. However, for some sub-regions, losses were up to 27.5% and other crop stresses also coincided in these areas. This methodology could be applied widely, allowing estimates of ozone impact for countries lacking air quality and/or experimental data. As crop productivity is below its potential in many areas of the world, changing agricultural practices to mitigate against losses due to ozone could help to reduce the crop yield gap.
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Affiliation(s)
- K Sharps
- UK Centre for Ecology & Hydrology, Environment Centre Wales, Deiniol Road, Bangor, Gwynedd, LL57 2UW, UK.
| | - J Foster
- UK Centre for Ecology & Hydrology, Environment Centre Wales, Deiniol Road, Bangor, Gwynedd, LL57 2UW, UK
| | - M Vieno
- UK Centre for Ecology & Hydrology, Bush Estate, Penicuik, Midlothian, EH26 0QB, UK
| | - R Beck
- UK Centre for Ecology & Hydrology, Bush Estate, Penicuik, Midlothian, EH26 0QB, UK
| | - F Hayes
- UK Centre for Ecology & Hydrology, Environment Centre Wales, Deiniol Road, Bangor, Gwynedd, LL57 2UW, UK
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Jarrard CP, Watso JC, Atkins WC, McKenna ZJ, Foster J, Huang M, Belval LN, Crandall CG. Sex Differences in Sympathetic Responses to Lower Body Negative Pressure. Med Sci Sports Exerc 2024:00005768-990000000-00456. [PMID: 38233995 DOI: 10.1249/mss.0000000000003392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
INTRODUCTION Trauma-induced hemorrhage is a leading cause of death in prehospital settings. Experimental data demonstrate that females have a lower tolerance to simulated hemorrhage (i.e., central hypovolemia). However, the mechanism(s) underpinning these responses are unknown. Therefore, this study aimed to compare autonomic cardiovascular responses during central hypovolemia between the sexes. We hypothesized that females would have a lower tolerance and smaller increase in muscle sympathetic nerve activity (MSNA) to simulated hemorrhage. METHODS Data from 17 females and 19 males, aged 19-45, were retrospectively analyzed. Participants completed a progressive lower-body negative pressure (LBNP) protocol to presyncope to simulate hemorrhagic tolerance with continuous measures of MSNA and beat-to-beat hemodynamic variables. We compared responses at baseline, at two LBNP stages (40 mmHg and 50 mmHg), and at immediately before presyncope. In addition, we compared responses at relative percentages (33%, 66%, and 100%) of hemorrhagic tolerance, calculated via the cumulative stress index (i.e., the sum of the product of time and pressure at each LBNP stage). RESULTS Females had lower tolerance to central hypovolemia (female: 561 ± 309 vs. male: 894 ± 304 min*mmHg [time*LBNP]; p = 0.003). At LBNP 40 mmHg and 50 mmHg, females had lower diastolic blood pressures (main effect of sex: p = 0.010). For the relative LBNP analysis, females exhibited lower MSNA burst frequency (main effect of sex: p = 0.016) accompanied by a lower total vascular conductance (sex: p = 0.028; main effect of sex). CONCLUSIONS Females have a lower tolerance to central hypovolemia, which was accompanied by lower diastolic blood pressure at 40 and 50 mmHg LBNP. Notably, females had attenuated MSNA responses when assessed as relative LBNP tolerance time.
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Affiliation(s)
| | | | | | | | | | | | - Luke N Belval
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, TX
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3
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Foster J, McKenna ZJ, Atkins WC, Jarrard CP, Crandall CG. Identifying the Optimal Heat Exposure Metric for Predicting the Physiological Response to Dry or Humid Heat Stress in Young and Older Adults: A Randomized Controlled Study. Environ Health Perspect 2024; 132:17701. [PMID: 38214893 PMCID: PMC10786203 DOI: 10.1289/ehp13733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 10/31/2023] [Accepted: 11/27/2023] [Indexed: 01/13/2024]
Affiliation(s)
- Josh Foster
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, USA
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Centre for Human and Applied Physiological Sciences, King’s College London, London, UK
| | - Zachary J. McKenna
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, USA
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Whitey C. Atkins
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, USA
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Caitlin P. Jarrard
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, USA
- Applied Clinical Research Department, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Craig G. Crandall
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, USA
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Atkins WC, Romero SA, Moralez G, Huang M, Cramer MN, Foster J, McKenna ZJ, Crandall CG. Attrition of Well-Healed Burn Survivors to a 6-Month Community-Based Exercise Program: A Retrospective Evaluation. J Burn Care Res 2023; 44:1478-1484. [PMID: 37166163 PMCID: PMC10628515 DOI: 10.1093/jbcr/irad063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Indexed: 05/12/2023]
Abstract
The purpose of this study was to evaluate whether burn survivors have lower adherence compared to non-burned control individuals during a 6-month community-based exercise program. In burn survivors, we sought to answer if there was a relation between the size of the burn injury and dropout frequency. Fifty-two burn survivors and 15 non-burned controls (n = 67) were recruited for a 6-month community-based (ie, non-supervised), progressive, exercise training program. During the exercise program, 27% (ie, 4 of the 15 enrolled) of the non-burned individuals dropped out of the study, while 37% (ie, 19 of the 52) of the burn survivors dropped out from the study. There was no difference in the percentage of individuals who dropped out between groups (P = .552). There was no difference in size of the burn injury, expressed as percent body surface area burned (%BSA) between the burn survivors that dropped out versus those who completed the exercise regimen (P = .951). We did not observe a relation between %BSA burned and dropouts (log odds = -0.15-0.01(%BSA), B = -0.01, SE = 0.015, P = .541). There was no effect of %BSA burned on the probability of dropout [Exp (B) = 0.991, 95% CI (0.961, 1.020)] and there were no differences in the percentage of individuals who dropped out of the study based on %BSA burned (χ2(1) = 0.44, P = .51). These data demonstrate that burn survivors have similar exercise adherence relative to a non-burned group and the extent of a burn injury does not affect exercise program adherence.
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Affiliation(s)
- Whitley C Atkins
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas. Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital and University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Steven A Romero
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas. Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital and University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, Texas, USA
| | - Gilbert Moralez
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas. Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital and University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Department of Applied Clinical Research, School of Health Professions, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Mu Huang
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas. Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital and University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Office of Science, Medicine, and Health, American Heart Association, Dallas, Texas, USA
| | - Matthew N Cramer
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas. Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital and University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Josh Foster
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas. Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital and University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Zachary J McKenna
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas. Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital and University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Craig G Crandall
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas. Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital and University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Department of Applied Clinical Research, School of Health Professions, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Rivas E, Foster J, Crandall CG, Finnerty CC, Suman-Vejas OE. Key Exercise Concepts in the Rehabilitation from Severe Burns. Phys Med Rehabil Clin N Am 2023; 34:811-824. [PMID: 37806699 PMCID: PMC10731385 DOI: 10.1016/j.pmr.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
This article presents information on the benefits of exercise in counteracting the detrimental effects of bed rest, and/or severe burns. Exercise is key for maintaining physical function, lean body mass, metabolic recovery, and psychosocial health after major burn injuries. The details of an exercise training program conducted in severely burned persons are presented, as well as information on the importance of proper regulation of body temperature during exercise or physical activity. The sections on exercise and thermoregulation are followed by a section on the role of exercise in scarring and contractures. Finally, gaps in the current knowledge of exercise, thermoregulation, and contractures are presented.
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Affiliation(s)
- Eric Rivas
- Microgravity Research, In-Space Solutions, Axiom Space Headquarters, 1290 Hercules Avenue, Houston, TX 77058, USA
| | - Josh Foster
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Institute for Exercise and Environmental Medicine (IEEM), Texas Health Presbyterian Hospital Dallas, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
| | - Craig G Crandall
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Institute for Exercise and Environmental Medicine (IEEM), Texas Health Presbyterian Hospital Dallas, 7232 Greenville Avenue, Suite 435, Dallas, TX 75231, USA
| | - Celeste C Finnerty
- Department of Surgery, Division of Surgical Sciences, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555-1220, USA
| | - Oscar E Suman-Vejas
- Department of Surgery, Division of Surgical Sciences, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555-1220, USA.
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Foster J, Mckenna ZJ, Atkins WC, Jarrard CP, Crandall CG. Aging Increases Enterocyte Damage during a 3-Hour Exposure to Very Hot and Dry Heat: A Preliminary Study. Biology (Basel) 2023; 12:1088. [PMID: 37626974 PMCID: PMC10451985 DOI: 10.3390/biology12081088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 08/01/2023] [Accepted: 08/02/2023] [Indexed: 08/27/2023]
Abstract
Profound heat stress can damage the gastrointestinal barrier, leading to microbial translocation from the gut and subsequent systemic inflammation. Despite the greater vulnerability of older people to heat wave-related morbidity and mortality, it is unknown if age modulates gastrointestinal barrier damage and inflammation during heat stress. Therefore, the aim of this study was to determine if aging impacted enterocyte damage and systemic inflammatory responses to a 3-h exposure to very hot and dry (47 °C, 15% humidity) heat with accompanying activities of daily living (intermittent activity at 3 METS). Data from 16 young (age 21 to 39 years) and 16 older (age 65 to 76 years) humans were used to address this aim. In each group, log-transformed plasma concentrations of intestinal fatty acid binding protein (I-FABPlog), interleukin-8 (IL-8log), and tissue factor (TFlog) were assessed as indices of enterocyte damage, systemic inflammation, and blood coagulation, respectively, before and after the 3-h heat exposure. In the younger cohort, I-FABPlog concentration did not increase from pre to post heat exposure (p = 0.264, d = 0.20), although it was elevated in the older group (p = 0.014, d = 0.67). The magnitude of the increase in I-FABPlog was greater in the older participants (p = 0.084, d = 0.55). Across all participants, there was no correlation between the change in core temperature and the change in IFABPlog. There was no change in IL-8log in the younger group (p = 0.193, d = 0.23) following heat exposure, but we observed a decrease in IL-8log in the older group (p = 0.047, d = 0.48). TFlog decreased in the younger group (p = 0.071, d = 0.41), but did not change in the older group (p = 0.193, d = 0.15). Our data indicate that I-FABPlog concentration (an index of enterocyte damage) is increased in older humans during a 3-h extreme heat exposure. Future studies should determine whether this marker reflects increased gastrointestinal barrier permeability in older individuals during heat exposure.
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Affiliation(s)
- Josh Foster
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, The University of Texas Southwestern Medical Center, Dallas, TX 75231, USA; (Z.J.M.); (W.C.A.); (C.P.J.); (C.G.C.)
- Centre for Human and Applied Physiological Sciences, Faculty of Life Sciences and Medicine, King’s College London, London SE1 1UL, UK
| | - Zachary J. Mckenna
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, The University of Texas Southwestern Medical Center, Dallas, TX 75231, USA; (Z.J.M.); (W.C.A.); (C.P.J.); (C.G.C.)
| | - Whitley C. Atkins
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, The University of Texas Southwestern Medical Center, Dallas, TX 75231, USA; (Z.J.M.); (W.C.A.); (C.P.J.); (C.G.C.)
| | - Caitlin P. Jarrard
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, The University of Texas Southwestern Medical Center, Dallas, TX 75231, USA; (Z.J.M.); (W.C.A.); (C.P.J.); (C.G.C.)
| | - Craig G. Crandall
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, The University of Texas Southwestern Medical Center, Dallas, TX 75231, USA; (Z.J.M.); (W.C.A.); (C.P.J.); (C.G.C.)
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McKenna ZJ, Foster J, Atkins WC, Belval LN, Watso JC, Jarrard CP, Orth BD, Crandall CG. Age alters the thermoregulatory responses to extreme heat exposure with accompanying activities of daily living. J Appl Physiol (1985) 2023; 135:445-455. [PMID: 37410904 PMCID: PMC10538984 DOI: 10.1152/japplphysiol.00285.2023] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 06/15/2023] [Accepted: 06/27/2023] [Indexed: 07/08/2023] Open
Abstract
Older adults are at greater risk for heat-related morbidity and mortality, due in part to age-related reductions in heat dissipating capabilities. Previous studies investigating the impact of age on responses to heat stress used approaches that lack activities of daily living and therefore may not accurately depict the thermal/physiological strain that would occur during actual heatwaves. We sought to compare the responses of young (18-39 yr) and older (≥65 yr) adults exposed to two extreme heat simulations. Healthy young (n = 20) and older (n = 20) participants underwent two 3-h extreme heat exposures on different days: 1) DRY (47°C and 15% humidity) and 2) HUMID (41°C and 40% humidity). To mimic heat generation comparable with activities of daily living, participants performed 5-min bouts of light physical activity dispersed throughout the heat exposure. Measurements included core and skin temperatures, heart rate, blood pressure, local and whole body sweat rate, forearm blood flow, and perceptual responses. Δ core temperature (Young: 0.68 ± 0.27°C vs. Older: 1.37 ± 0.42°C; P < 0.001) and ending core temperature (Young: 37.81 ± 0.26°C vs. Older: 38.15 ± 0.43°C; P = 0.005) were greater in the older cohort during the DRY condition. Δ core temperature (Young: 0.58 ± 0.25°C vs. Older: 1.02 ± 0.32°C; P < 0.001), but not ending core temperature (Young: 37.67 ± 0.34°C vs. Older: 37.83 ± 0.35°C; P = 0.151), was higher in the older cohort during the HUMID condition. We demonstrated that older adults have diminished thermoregulatory responses to heat stress with accompanying activities of daily living. These findings corroborate previous reports and confirm epidemiological data showing that older adults are at a greater risk for hyperthermia.NEW & NOTEWORTHY Using an experimental model of extreme heat exposure that incorporates brief periods of light physical activity to simulate activities of daily living, the extent of thermal strain reported herein more accurately represents what would occur during actual heatwave conditions. Despite matching metabolic heat generation and environmental conditions, we show that older adults have augmented core temperature responses, likely due to age-related reductions in heat dissipating mechanisms.
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Affiliation(s)
- Zachary J McKenna
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, United States
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Josh Foster
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, United States
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Whitley C Atkins
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, United States
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Luke N Belval
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, United States
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Joseph C Watso
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, United States
- Department of Applied Clinical Research, University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Caitlin P Jarrard
- Cardiovascular and Applied Physiology Laboratory, Department of Nutrition and Integrative Physiology, Florida State University, Tallahassee, Florida, United States
| | - Bonnie D Orth
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, United States
| | - Craig G Crandall
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, United States
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, United States
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Foster J. Invited Perspective: Cooling Centers and Heat Waves-Can Current Data Inform Guidance? Environ Health Perspect 2023; 131:61303. [PMID: 37262029 DOI: 10.1289/ehp12830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Josh Foster
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital and the University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Foster J, Balmain BN, Wilhite DP, Watso JC, Babb TG, Cramer MN, BelvaL LN, Crandall CG. Inhibiting regional sweat evaporation modifies the ventilatory response to exercise: interactions between core and skin temperature. J Appl Physiol (1985) 2023; 134:1011-1021. [PMID: 36892886 PMCID: PMC10110718 DOI: 10.1152/japplphysiol.00597.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 02/27/2023] [Accepted: 03/03/2023] [Indexed: 03/10/2023] Open
Abstract
In humans, elevated body temperatures can markedly increase the ventilatory response to exercise. However, the impact of changing the effective body surface area (BSA) for sweat evaporation (BSAeff) on such responses is unclear. Ten healthy adults (9 males, 1 female) performed eight exercise trials cycling at 6 W/kg of metabolic heat production for 60 min. Four conditions were used where BSAeff corresponded to 100%, 80%, 60%, and 40% of BSA using vapor-impermeable material. Four trials (one at each BSAeff) were performed at 25°C air temperature, and four trials (one at each BSAeff) at 40°C air temperature, each with 20% humidity. The slope of the relation between minute ventilation and carbon dioxide elimination (V̇E/V̇co2 slope) assessed the ventilatory response. At 25°C, the V̇E/V̇co2 slope was elevated by 1.9 and 2.6 units when decreasing BSAeff from 100 to 80 and to 40% (P = 0.033 and 0.004, respectively). At 40°C, V̇E/V̇co2 slope was elevated by 3.3 and 4.7 units, when decreasing BSAeff from 100 to 60 and to 40% (P = 0.016 and P < 0.001, respectively). Linear regression analyses using group average data from each condition demonstrated that end-exercise mean body temperature (integration of core and mean skin temperature) was better associated with the end-exercise ventilatory response, compared with core temperature alone. Overall, we show that impeding regional sweat evaporation increases the ventilatory response to exercise in temperate and hot environmental conditions, and the effect is mediated primarily by increases in mean body temperature.NEW & NOTEWORTHY Exercise in the heat increases the slope of the relation between minute ventilation and carbon dioxide elimination (V̇E/V̇co2 slope) in young healthy adults. An indispensable role for skin temperature in modulating the ventilatory response to exercise is noted, contradicting common belief that internal/core temperature acts independently as a controller of ventilation during hyperthermia.
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Affiliation(s)
- Josh Foster
- Thermal and Vascular Physiology Laboratory, Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, and University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Bryce N Balmain
- Pulmonary Physiology Laboratory, Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, and University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Daniel P Wilhite
- Pulmonary Physiology Laboratory, Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, and University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Joseph C Watso
- Thermal and Vascular Physiology Laboratory, Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, and University of Texas Southwestern Medical Center, Dallas, Texas, United States
- Cardiovascular and Applied Physiology Laboratory, Department of Nutrition & Integrative Physiology, Florida State University, Tallahassee, Florida, United States
| | - Tony G Babb
- Pulmonary Physiology Laboratory, Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, and University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Matthew N Cramer
- Thermal and Vascular Physiology Laboratory, Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, and University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Luke N BelvaL
- Thermal and Vascular Physiology Laboratory, Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, and University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Craig G Crandall
- Thermal and Vascular Physiology Laboratory, Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, and University of Texas Southwestern Medical Center, Dallas, Texas, United States
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Foster J, Watso J, Crandall CG. Evidence for Chronotropic Incompetence in Well-healed Burn Survivors. J Burn Care Res 2023; 44:431-437. [PMID: 35460226 PMCID: PMC10211491 DOI: 10.1093/jbcr/irac056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Indexed: 11/13/2022]
Abstract
Due to various pathophysiological responses associated with a severe burn injury, we hypothesized that burn survivors exhibit chronotropic incompetence. To test this hypothesis, a graded peak oxygen consumption (V̇O2peak) test was performed in 94 adults (34 nonburned, 31 burn survivors with 14-35% body surface area grafted, and 29 burn survivors with >35% body surface area grafted). The threshold of 35% body surface area grafted was determined by receiver operating characteristic (ROC) curve analysis. Peak exercise heart rates (HRmax) were compared against age-predicted HRmax within each group. The proportion of individuals not meeting their age-predicted HRmax (within 5 b/min) were compared between groups. Age-predicted HRmax was not different from measured HRmax in the nonburned and moderate burn groups (P = .09 and .22, respectively). However, measured HRmax was 10 ± 6 b/min lower than the age-predicted HRmax in those with a large burn injury (P < .001). While 56 and 65% of individuals in the nonburned and moderate burn group achieved a measured HRmax within 5 b/min or greater of age-predicted HRmax, only 21% of those in the large burn group met this criterion (P < .001). These data provide preliminary evidence of chronotropic incompetence in individuals with severe burn injury covering >35% body surface area.
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Affiliation(s)
- Josh Foster
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Joseph Watso
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Craig G Crandall
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Chen A, Sharon E, Van Tine B, Moore N, Foster J, Glod J, Hu J, Rosenberger C, O'Sullivan Coyne G, Doroshow J. 49MO Atezolizumab and bevacizumab in patients treated with prior atezolizumab in alveolar soft tissue sarcoma (ASPS). ESMO Open 2023. [DOI: 10.1016/j.esmoop.2023.101086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Watso JC, Huang M, Hendrix JM, Belval LN, Moralez G, Cramer MN, Foster J, Hinojosa-Laborde C, Crandall CG. Comparing the Effects of Low-Dose Ketamine, Fentanyl, and Morphine on Hemorrhagic Tolerance and Analgesia in Humans. PREHOSP EMERG CARE 2023; 27:600-612. [PMID: 36689353 PMCID: PMC10329983 DOI: 10.1080/10903127.2023.2172493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 01/09/2023] [Accepted: 01/19/2023] [Indexed: 01/24/2023]
Abstract
Hemorrhage is a leading cause of preventable battlefield and civilian trauma deaths. Ketamine, fentanyl, and morphine are recommended analgesics for use in the prehospital (i.e., field) setting to reduce pain. However, it is unknown whether any of these analgesics reduce hemorrhagic tolerance in humans. We tested the hypothesis that fentanyl (75 µg) and morphine (5 mg), but not ketamine (20 mg), would reduce tolerance to simulated hemorrhage in conscious humans. Each of the three analgesics was evaluated independently among different cohorts of healthy adults in a randomized, crossover (within drug/placebo comparison), placebo-controlled fashion using doses derived from the Tactical Combat Casualty Care Guidelines for Medical Personnel. One minute after an intravenous infusion of the analgesic or placebo (saline), we employed a pre-syncopal limited progressive lower-body negative pressure (LBNP) protocol to determine hemorrhagic tolerance. Hemorrhagic tolerance was quantified as a cumulative stress index (CSI), which is the sum of products of the LBNP and the duration (e.g., [40 mmHg x 3 min] + [50 mmHg x 3 min] …). Compared with ketamine (p = 0.002 post hoc result) and fentanyl (p = 0.02 post hoc result), morphine reduced the CSI (ketamine (n = 30): 99 [73-139], fentanyl (n = 28): 95 [68-130], morphine (n = 30): 62 [35-85]; values expressed as a % of the respective placebo trial's CSI; median [IQR]; Kruskal-Wallis test p = 0.002). Morphine-induced reductions in tolerance to central hypovolemia were not well explained by a prediction model including biological sex, body mass, and age (R2=0.05, p = 0.74). These experimental data demonstrate that morphine reduces tolerance to simulated hemorrhage while fentanyl and ketamine do not affect tolerance. Thus, these laboratory-based data, captured via simulated hemorrhage, suggest that morphine should not be used for a hemorrhaging individual in the prehospital setting.
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Affiliation(s)
- Joseph Charles Watso
- Department of Nutrition & Integrative Physiology, Florida State University, Tallahassee, Florida, USA
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, USA
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Department of Applied Clinical Research, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Mu Huang
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, USA
- Department of Applied Clinical Research, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Office of Science, Medicine, and Health, American Heart Association, Dallas, Texas, USA
| | - Joseph Maxwell Hendrix
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, USA
- Department of Anesthesiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Luke Norman Belval
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, USA
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Gilbert Moralez
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, USA
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Department of Applied Clinical Research, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Matthew Nathaniel Cramer
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, USA
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Josh Foster
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, USA
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | | | - Craig Gerald Crandall
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, USA
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Department of Applied Clinical Research, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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McKenna ZJ, Moralez G, Romero SA, Hieda M, Huang M, Cramer MN, Sarma S, MacNamara JP, Jaffery MF, Atkins WC, Foster J, Crandall CG. Cardiac remodeling in well-healed burn survivors after 6 months of unsupervised progressive exercise training. J Appl Physiol (1985) 2023; 134:405-414. [PMID: 36633867 PMCID: PMC9902219 DOI: 10.1152/japplphysiol.00630.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 01/05/2023] [Accepted: 01/08/2023] [Indexed: 01/13/2023] Open
Abstract
Aerobic exercise is important in the rehabilitation of individuals with prior burn injuries, but no studies have examined whether adult burn survivors demonstrate cardiac remodeling to long-term aerobic exercise training. In this study, we tested the hypothesis that 6 months of progressive exercise training improves cardiac magnetic resonance imaging-based measures of cardiac structure and function in well-healed burn survivors. Secondary analyses explored relations between burn surface area and changes in cardiac structure in the cohort of burn survivors. V̇o2peak assessments and cardiac magnetic resonance imaging were performed at baseline and following 6 months of progressive exercise training from 19 well-healed burn survivors and 10 nonburned control participants. V̇o2peak increased following 6 months of training in both groups (Control: Δ5.5 ± 5.8 mL/kg/min; Burn Survivors: Δ3.2 ± 3.6 mL/kg/min, main effect of training, P < 0.001). Left ventricle (LV) mass (Control: Δ1.7 ± 3.1 g/m2; Burn survivors: Δ1.8 ± 2.7 g/m2), stroke volume (Control: Δ5.8 ± 5.2 mL/m2; Burn Survivors: Δ2.8 ± 4.2 mL/m2), and ejection fraction (Control: Δ2.4 ± 4.0%; Burn Survivors: Δ2.2 ± 4.3%) similarly increased following 6 months of exercise training in both cohorts (main effect of training P < 0.05 for all indexes). LV end-diastolic volume increased in the control group (Δ6.5 ± 4.5 mL/m2) but not in the cohort of burn survivors (Δ1.9 ± 2.7 mL/m2, interaction, P = 0.040). Multiple linear regression analyses revealed that burn surface area had little to no effect on changes in ventricular mass or end-diastolic volumes in response to exercise training. Our findings provide initial evidence of physiological cardiac remodeling, which is not impacted by burn size, in response to exercise training in individuals with well-healed burn injuries.NEW & NOTEWORTHY Aerobic exercise is important in the rehabilitation of individuals with prior burn injuries, but no studies have examined whether adult burn survivors demonstrate cardiac remodeling to long-term aerobic exercise training. In this study, we tested the hypothesis that 6 months of progressive exercise training would improve cardiac magnetic resonance imaging-based measures of cardiac structure and function in well-healed burn survivors. Our findings highlight the ability of exercise training to modify cardiac structure and function in well-healed burn survivors and nonburned sedentary controls alike.
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Affiliation(s)
- Zachary J McKenna
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas
| | - Gilbert Moralez
- Department of Applied Clinical Research, School of Health Professions, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Steven A Romero
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, Texas
| | | | - Mu Huang
- Office of Science, Medicine, and Health, American Heart Association, Dallas, Texas
| | - Matthew N Cramer
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas
| | - Satyam Sarma
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas
| | - James P MacNamara
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas
| | - Manall F Jaffery
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas
| | - Whitley C Atkins
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas
| | - Josh Foster
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas
| | - Craig G Crandall
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas
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Smallcombe JW, Foster J, Hodder SG, Jay O, Flouris AD, Havenith G. Quantifying the impact of heat on human physical work capacity; part IV: interactions between work duration and heat stress severity. Int J Biometeorol 2022; 66:2463-2476. [PMID: 36197554 PMCID: PMC9684271 DOI: 10.1007/s00484-022-02370-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 09/13/2022] [Accepted: 09/15/2022] [Indexed: 06/16/2023]
Abstract
High workplace temperatures negatively impact physical work capacity (PWC). Although PWC loss models with heat based on 1-h exposures are available, it is unclear if further adjustments are required to accommodate repeated work/rest cycles over the course of a full work shift. Therefore, we examined the impact of heat stress exposure on human PWC during a simulated work shift consisting of six 1-h work-rest cycles. Nine healthy males completed six 50-min work bouts, separated by 10-min rest intervals and an extended lunch break, on four separate occasions: once in a cool environment (15 °C/50% RH) and in three different air temperature and relative humidity combinations (moderate, 35 °C/50% RH; hot, 40 °C/50% RH; and very hot, 40 °C/70%). To mimic moderate to heavy workload, work was performed on a treadmill at a fixed heart rate of 130 beats·min-1. During each work bout, PWC was quantified as the kilojoules expended above resting levels. Over the shift, work output per cycle decreased, even in the cool climate, with the biggest decrement after the lunch break and meal consumption. Expressing PWC relative to that achieved in the cool environment for the same work duration, there was an additional 5(± 4)%, 7(± 6)%, and 16(± 7)% decrease in PWC when work was performed across a full work shift for the moderate, hot, and very hot condition respectively, compared with 1-h projections. Empirical models to predict PWC based on the level of heat stress (Wet-Bulb Globe Temperature, Universal Thermal Climate Index, Psychrometric Wet-Bulb Temperature, Humidex, and Heat Index) and the number of work cycles performed are presented.
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Affiliation(s)
- James W Smallcombe
- Environmental Ergonomics Research Centre, Loughborough University, Loughborough, LE11 3TU, Leicestershire, UK
- Thermal Ergonomics Laboratory, University of Sydney, Sydney, NSW, Australia
| | - Josh Foster
- Environmental Ergonomics Research Centre, Loughborough University, Loughborough, LE11 3TU, Leicestershire, UK
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital and University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Simon G Hodder
- Environmental Ergonomics Research Centre, Loughborough University, Loughborough, LE11 3TU, Leicestershire, UK
| | - Ollie Jay
- Thermal Ergonomics Laboratory, University of Sydney, Sydney, NSW, Australia
| | - Andreas D Flouris
- FAME Laboratory, Department of Physical Education and Sport Science, University of Thessaly, Trikala, Greece
| | - George Havenith
- Environmental Ergonomics Research Centre, Loughborough University, Loughborough, LE11 3TU, Leicestershire, UK.
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Mistry PK, Kishnani P, Wanner C, Dong D, Bender J, Batista JL, Foster J. Rare lysosomal disease registries: lessons learned over three decades of real-world evidence. Orphanet J Rare Dis 2022; 17:362. [PMID: 36244992 PMCID: PMC9573793 DOI: 10.1186/s13023-022-02517-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 09/04/2022] [Indexed: 12/24/2022] Open
Abstract
Lysosomal storage disorders (LSD) are rare diseases, caused by inherited deficiencies of lysosomal enzymes/transporters, that affect 1 in 7000 to 1 in 8000 newborns. Individuals with LSDs face long diagnostic journeys during which debilitating and life-threatening events can occur. Clinical trials and classical descriptions of LSDs typically focus on common manifestations, which are not representative of the vast phenotypic heterogeneity encountered in real-world experience. Additionally, recognizing that there was a limited understanding of the natural history, disease progression, and real-world clinical outcomes of rare LSDs, a collaborative partnership was pioneered 30 years ago to address these gaps. The Rare Disease Registries (RDR) (for Gaucher, Fabry, Mucopolysaccharidosis type I, and Pompe), represent the largest observational database for these LSDs. Over the past thirty years, data from the RDRs have helped to inform scientific understanding and the development of comprehensive monitoring and treatment guidelines by creating a framework for data collection and establishing a standard of care, with an overarching goal to improve the quality of life of affected patients. Here, we highlight the history, process, and impact of the RDRs, and discuss the lessons learned and future directions.
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Affiliation(s)
- P K Mistry
- Department of Medicine, Yale Liver Center, Yale University School of Medicine, 333 Cedar Street, PO Box 208019, New Haven, CT, 06520, USA.
| | - P Kishnani
- Division of Medical Genetics, Department of Pediatrics, Duke University, Durham, USA
| | - C Wanner
- University Hospital of Würzburg, Würzburg, Germany
| | - D Dong
- Global Operations and Advocacy Lead, Rare Disease Registries, Sanofi, Cambridge, MA, USA
| | - J Bender
- Head of Global Rare Disease Registries, Sanofi, Cambridge, MA, USA
| | - J L Batista
- Epidemiology/Biostatistics, Sanofi, Cambridge, MA, USA
| | - J Foster
- Data Management, Sanofi, Cambridge, MA, USA
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Foster J, Watso JC, Crandall CG. Evidence For Chronotropic Incompetence In Burn Survivors During Maximal Cycling Exercise. Med Sci Sports Exerc 2022. [DOI: 10.1249/01.mss.0000876300.48222.d0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Watso JC, Belval LN, Cimino FA, Orth BD, Hendrix JM, Huang M, Johnson E, Foster J, Hinojosa-Laborde C, Crandall CG. Low-dose morphine reduces tolerance to central hypovolemia in healthy adults without affecting muscle sympathetic outflow. Am J Physiol Heart Circ Physiol 2022; 323:H89-H99. [PMID: 35452317 PMCID: PMC9190738 DOI: 10.1152/ajpheart.00091.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 04/19/2022] [Accepted: 04/20/2022] [Indexed: 11/22/2022]
Abstract
Hemorrhage is a leading cause of preventable battlefield and civilian trauma deaths. Low-dose (i.e., an analgesic dose) morphine is recommended for use in the prehospital (i.e., field) setting. Morphine administration reduces hemorrhagic tolerance in rodents. However, it is unknown whether morphine impairs autonomic cardiovascular regulation and consequently reduces hemorrhagic tolerance in humans. Thus, the purpose of this study was to test the hypothesis that low-dose morphine reduces hemorrhagic tolerance in conscious humans. Thirty adults (15 women/15 men; 29 ± 6 yr; 26 ± 4 kg·m-2, means ± SD) completed this randomized, crossover, double-blinded, placebo-controlled trial. One minute after intravenous administration of morphine (5 mg) or placebo (saline), we used a presyncopal limited progressive lower-body negative pressure (LBNP) protocol to determine hemorrhagic tolerance. Hemorrhagic tolerance was quantified as a cumulative stress index (mmHg·min), which was compared between trials using a Wilcoxon matched-pairs signed-rank test. We also compared muscle sympathetic nerve activity (MSNA; microneurography) and beat-to-beat blood pressure (photoplethysmography) during the LBNP test using mixed-effects analyses [time (LBNP stage) × trial]. Median LBNP tolerance was lower during morphine trials (placebo: 692 [473-997] vs. morphine: 385 [251-728] mmHg·min, P < 0.001, CI: -394 to -128). Systolic blood pressure was 8 mmHg lower during moderate central hypovolemia during morphine trials (post hoc P = 0.02; time: P < 0.001, trial: P = 0.13, interaction: P = 0.006). MSNA burst frequency responses were not different between trials (time: P < 0.001, trial: P = 0.80, interaction: P = 0.51). These data demonstrate that low-dose morphine reduces hemorrhagic tolerance in conscious humans. Thus, morphine is not an ideal analgesic for a hemorrhaging individual in the prehospital setting.NEW & NOTEWORTHY In this randomized, crossover, placebo-controlled trial, we found that tolerance to simulated hemorrhage was lower after low-dose morphine administration. Such reductions in hemorrhagic tolerance were observed without differences in MSNA burst frequency responses between morphine and placebo trials. These data, the first to be obtained in conscious humans, demonstrate that low-dose morphine reduces hemorrhagic tolerance. Thus, morphine is not an ideal analgesic for a hemorrhaging individual in the prehospital setting.
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Affiliation(s)
- Joseph C Watso
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
- Department of Applied Clinical Research, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Luke N Belval
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Frank A Cimino
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas
| | - Bonnie D Orth
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas
| | - Joseph M Hendrix
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas
- Department of Anesthesiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Mu Huang
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas
- Department of Applied Clinical Research, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Elias Johnson
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas
| | - Josh Foster
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Carmen Hinojosa-Laborde
- United States Army Institute of Surgical Research, Joint Base San Antonio Fort Sam Houston, Houston, Texas
| | - Craig G Crandall
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
- Department of Applied Clinical Research, University of Texas Southwestern Medical Center, Dallas, Texas
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Watso JC, Belval LN, Cimino Iii FA, Orth BD, Hendrix JM, Huang M, Johnson E, Foster J, Hinojosa-Laborde C, Crandall CG. Low-Dose Morphine Reduces Pain Perception and Blood Pressure, but Not Muscle Sympathetic Outflow, Responses During the Cold Pressor Test. Am J Physiol Heart Circ Physiol 2022; 323:H223-H234. [PMID: 35714174 PMCID: PMC9273278 DOI: 10.1152/ajpheart.00092.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Our knowledge about how low-dose (analgesic) morphine affects autonomic cardiovascular regulation is primarily limited to animal experiments. Notably, it is unknown if low-dose morphine affects human autonomic cardiovascular responses during painful stimuli in conscious humans. Therefore, we tested the hypothesis that low-dose morphine reduces perceived pain and subsequent sympathetic and cardiovascular responses in humans during an experimental noxious stimulus. Twenty-nine participants (14F/15M; 29±6 y; 26±4 kg•m-2, mean ± SD) completed this randomized, crossover, placebo-controlled trial during two laboratory visits. During each visit, participants completed a cold pressor test (CPT; hand in ~0.4 °C ice bath for two minutes) before and ~35 minutes after drug/placebo administration (5 mg IV morphine or saline). We compared pain perception (100 mm visual analog scale), muscle sympathetic nerve activity (MSNA; microneurography; 14 paired recordings), and beat-to-beat blood pressure (BP; photoplethysmography) between trials (at both pre- and post-drug/placebo time points) using paired, two-tailed t-tests. Before drug/placebo infusion, perceived pain (p=0.92), Δ MSNA burst frequency (n=14, p=0.21), and Δ mean BP (p=0.39) during the CPT were not different between trials. After the drug/placebo infusion, morphine versus placebo attenuated perceived pain (morphine: 43±20 vs. placebo: 57±24 mm,p<0.001) and Δ mean BP (morphine: 10±7 vs. placebo: 13±8 mmHg,p=0.003), but not Δ MSNA burst frequency (morphine: 10±11 vs. placebo: 13±11 bursts/minute,p=0.12), during the CPT. Reductions in pain perception and Δ mean BP were only weakly related (r=0.34,p=0.07; post-morphine CPT minus post-placebo CPT). These data provide valuable information regarding how low-dose morphine affects autonomic cardiovascular responses during an experimental painful stimulus.
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Affiliation(s)
- Joseph C Watso
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, United States.,Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, United States.,Department of Applied Clinical Research, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Luke N Belval
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, United States.,Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Frank A Cimino Iii
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, United States
| | - Bonnie D Orth
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, United States
| | - Joseph M Hendrix
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, United States.,Department of Anesthesiology, University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Mu Huang
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, United States.,Department of Applied Clinical Research, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Elias Johnson
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, United States
| | - Josh Foster
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, United States.,Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | | | - Craig G Crandall
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, United States.,Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, United States.,Department of Applied Clinical Research, University of Texas Southwestern Medical Center, Dallas, TX, United States
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Jackson L, Mcneeley E, Techarukpong NC, Mugeta F, Aaron K, Mudano A, Merchant J, Warren K, Foster J, Saag K, Danila M. POS1147 CHALLENGES IN CONDUCTING PRAGMATIC CARE STRATEGY STUDIES IN OSTEOPOROSIS: PATIENT PERCEPTIONS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.2473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundLarge pragmatic osteoporosis studies to improve outcomes are needed. Direct-to-patient studies have highest generalizability but achieving sufficient sample size is difficult; recruitment challenges represent an important consideration given limited participant eligibility and interest. The Fracture Liaison Service (FLS), a team approach to post-fracture care, is a secondary fracture prevention method that has significantly improved outcomes internationally.ObjectivesOur goal was to evaluate the interest, barriers, and lessons learned in recruiting participants for a future trial assessing remote FLS approaches for post-fracture care.MethodsWe used ICD10 fracture codes to identify patients > 50 years of age with a documented hip/pelvis, spine, humerus, or wrist fracture in the previous 1 year. We excluded patients with i) prescriptions for osteoporosis medications (e.g., bisphosphonates, parathyroid hormone analogs, denosumab, romosozumab, raloxifene) in the prior 1 year; ii) an ICD10 code for end-stage renal disease, non-osteoporotic metabolic bone disease, malignant neoplasm, or motor vehicle accident. In December 2021, research assistants reviewed electronic health records (EHR) of potentially eligible patients for evidence of additional serious illness limiting life expectancy to < 1 year or non-ambulatory status prior to fracture. Research assistants called preliminary eligible patients that met inclusion and exclusion criteria and asked them to complete a survey by phone. Interest in a FLS future clinical trial was evaluated using a Likert scale (1=“Definitely would not volunteer”, to 5=“Definitely would volunteer”). We used descriptive statistics to analyze baseline demographic, clinical characteristics, and interest. This pilot was approved by the UAB Institutional Review Board (IRB-300008310-005).ResultsWe identified 1,577 patients > 50 years of age with a fracture. After applying exclusion criteria, we identified 869 preliminary eligible patients. Over 3 weeks, we screened the medical records of a random sample of half of the preliminary eligible patient cohort (n=414), of whom we contacted 271 patients determined potentially eligible, and successfully reached 141 (52% of those contacted) by phone. A total of 108 (77% of those reached) persons, mean (SD) age 69.5 (11.5) years, 40% men, 21% Black or non-white Hispanics completed the survey. Among those contacted, 68 (63%, interest rate) said they would be very or highly interested in participating in a future clinical trial evaluating FLS approaches. Among the 40 (37%) people who said they were not sure, unlikely or very unlikely to volunteer the most common reasons cited were “I don’t want to participate in a study” (33%); “I don’t feel well enough to participate” (10%); “I don’t understand what the study is for” (3%). From this pilot, we calculated a refined eligibility/interest rate of 9.1% among those patients preliminarily identified as eligible using administrative data alone.ConclusionBased on our pilot, we estimate that approximately 9% of eligible patients with fractures will be interested in enrolling in a future comparative effectiveness study to prevent recurrent fragility fractures. We identified several potential modifiable barriers to clinical trial recruitment. Patient perceptions collected from this pilot will inform enrollment strategies, which can be incorporated early when planning direct-to-patient pragmatic osteoporosis studies to achieve recruitment goals.Disclosure of InterestsLesley Jackson: None declared, Ellen McNeeley: None declared, Norma C. Techarukpong: None declared, Faith Mugeta: None declared, Kiara Aaron: None declared, Amy Mudano: None declared, Jeanne Merchant: None declared, Kellie Warren: None declared, Jeff Foster: None declared, Kenneth Saag Grant/research support from: Amgen, Horizon, LG Chem, Radius, SOBI, Maria Danila Grant/research support from: Pfizer, Horizon
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Foster J, Belval LN, Watso JC, Cimino FA, Orth BD, Sarma S, MacNamara JP, Crandall CG. Cardiac Adjustments During a Hot and Humid Heatwave Simulation in Older Adults. FASEB J 2022. [DOI: 10.1096/fasebj.2022.36.s1.r4749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Josh Foster
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, and University of Texas Southwestern Medical CenterDallasTX
| | - Luke N. Belval
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, and University of Texas Southwestern Medical CenterDallasTX
| | - Joseph C. Watso
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, and University of Texas Southwestern Medical CenterDallasTX
| | - Frank A. Cimino
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, and University of Texas Southwestern Medical CenterDallasTX
| | - Bonnie D. Orth
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, and University of Texas Southwestern Medical CenterDallasTX
| | - Satyam Sarma
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, and University of Texas Southwestern Medical CenterDallasTX
| | - James P. MacNamara
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, and University of Texas Southwestern Medical CenterDallasTX
| | - Craig G. Crandall
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, and University of Texas Southwestern Medical CenterDallasTX
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Watso JC, Belval LN, Foster J, Cimino FA, Orth BD, MacNamara JP, Sarma S, Crandall CG. Cardiac Adjustments During a Very Hot and Dry Heatwave Simulation in Older Adults. FASEB J 2022. [DOI: 10.1096/fasebj.2022.36.s1.r2364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | | | - Josh Foster
- University of Texas Southwestern Medical CenterDallasTX
| | | | - Bonnie D. Orth
- Institute for Exercise and Environmental MedicineDallasTX
| | | | - Satyam Sarma
- University of Texas Southwestern Medical CenterDallasTX
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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23
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Foster J, Smallcombe JW, Hodder S, Jay O, Flouris AD, Havenith G. Quantifying the impact of heat on human physical work capacity; part II: the observed interaction of air velocity with temperature, humidity, sweat rate, and clothing is not captured by most heat stress indices. Int J Biometeorol 2022; 66:507-520. [PMID: 34743228 PMCID: PMC8850241 DOI: 10.1007/s00484-021-02212-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 10/14/2021] [Accepted: 10/16/2021] [Indexed: 05/20/2023]
Abstract
Increasing air movement can alleviate or exacerbate occupational heat strain, but the impact is not well defined across a wide range of hot environments, with different clothing levels. Therefore, we combined a large empirical study with a physical model of human heat transfer to determine the climates where increased air movement (with electric fans) provides effective body cooling. The model allowed us to generate practical advice using a high-resolution matrix of temperature and humidity. The empirical study involved a total of 300 1-h work trials in a variety of environments (35, 40, 45, and 50 °C, with 20 up to 80% relative humidity) with and without simulated wind (3.5 vs 0.2 m∙s-1), and wearing either minimal clothing or a full body work coverall. Our data provides compelling evidence that the impact of fans is strongly determined by air temperature and humidity. When air temperature is ≥ 35 °C, fans are ineffective and potentially harmful when relative humidity is below 50%. Our simulated data also show the climates where high wind/fans are beneficial or harmful, considering heat acclimation, age, and wind speed. Using unified weather indices, the impact of air movement is well captured by the universal thermal climate index, but not by wet-bulb globe temperature and aspirated wet-bulb temperature. Overall, the data from this study can inform new guidance for major public and occupational health agencies, potentially maintaining health and productivity in a warming climate.
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Affiliation(s)
- Josh Foster
- Environmental Ergonomics Research Centre, Loughborough University, Loughborough, LE11 3TU, UK
| | - James W Smallcombe
- Environmental Ergonomics Research Centre, Loughborough University, Loughborough, LE11 3TU, UK
| | - Simon Hodder
- Environmental Ergonomics Research Centre, Loughborough University, Loughborough, LE11 3TU, UK
| | - Ollie Jay
- Thermal Ergonomics Laboratory, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | | | - George Havenith
- Environmental Ergonomics Research Centre, Loughborough University, Loughborough, LE11 3TU, UK.
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Foster J, Smallcombe JW, Hodder S, Jay O, Flouris AD, Nybo L, Havenith G. Quantifying the impact of heat on human physical work capacity; part III: the impact of solar radiation varies with air temperature, humidity, and clothing coverage. Int J Biometeorol 2022; 66:175-188. [PMID: 34709466 PMCID: PMC8727397 DOI: 10.1007/s00484-021-02205-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 10/05/2021] [Accepted: 10/07/2021] [Indexed: 05/03/2023]
Abstract
Heat stress decreases human physical work capacity (PWC), but the extent to which solar radiation (SOLAR) compounds this response is not well understood. This study empirically quantified how SOLAR impacts PWC in the heat, considering wide, but controlled, variations in air temperature, humidity, and clothing coverage. We also provide correction equations so PWC can be quantified outdoors using heat stress indices that do not ordinarily account for SOLAR (including the Heat Stress Index, Humidex, and Wet-Bulb Temperature). Fourteen young adult males (7 donning a work coverall, 7 with shorts and trainers) walked for 1 h at a fixed heart rate of 130 beats∙min-1, in seven combinations of air temperature (25 to 45°C) and relative humidity (20 or 80%), with and without SOLAR (800 W/m2 from solar lamps). Cumulative energy expenditure in the heat, relative to the work achieved in a cool reference condition, was used to determine PWC%. Skin temperature was the primary determinant of PWC in the heat. In dry climates with exposed skin (0.3 Clo), SOLAR caused PWC to decrease exponentially with rising air temperature, whereas work coveralls (0.9 Clo) negated this effect. In humid conditions, the SOLAR-induced reduction in PWC was consistent and linear across all levels of air temperature and clothing conditions. Wet-Bulb Globe Temperature and the Universal Thermal Climate Index represented SOLAR correctly and did not require a correction factor. For the Heat Stress Index, Humidex, and Wet-Bulb Temperature, correction factors are provided enabling forecasting of heat effects on work productivity.
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Affiliation(s)
- Josh Foster
- Environmental Ergonomics Research Centre, Loughborough University, Loughborough, LE11 3TU, UK
| | - James W Smallcombe
- Environmental Ergonomics Research Centre, Loughborough University, Loughborough, LE11 3TU, UK
- Thermal Ergonomics Laboratory, University of Sydney, Sydney, NSW, Australia
| | - Simon Hodder
- Environmental Ergonomics Research Centre, Loughborough University, Loughborough, LE11 3TU, UK
| | - Ollie Jay
- Thermal Ergonomics Laboratory, University of Sydney, Sydney, NSW, Australia
| | | | - Lars Nybo
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - George Havenith
- Environmental Ergonomics Research Centre, Loughborough University, Loughborough, LE11 3TU, UK.
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Peterson C, Kim YC, Ensign LM, Jun AS, Foster J. Induction of the integrated stress response in the rat cornea. Exp Eye Res 2021; 210:108722. [PMID: 34370978 DOI: 10.1016/j.exer.2021.108722] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 07/13/2021] [Accepted: 08/05/2021] [Indexed: 11/19/2022]
Abstract
Keratoconus (KC), a progressive, degenerative corneal disease, represents the second leading indication for corneal transplantation globally. We have previously demonstrated that components of the Integrated Stress Response (ISR) are upregulated in human keratoconic donor tissue, and treatment of normal tissue with ISR agonists attenuates collagen production. With no consistently accepted animal models available for translational KC research, we sought to establish an in vivo model based on ISR activation to elucidate its role in the development of the KC phenotype. Four-week-old female SD rats were treated with topical SAL003 formulated as a nanosuspension or vehicle every 48 h for four doses. Animals were subject to monitoring for ocular inflammation and discomfort before being euthanized at 1, 14, or 28 days after treatment was withdrawn. Schirmer's tear test, intraocular pressure, and body weight measurements were obtained at baseline and prior to euthanasia. Globes were subject to routine histopathology, immunohistochemistry for ATF4, and qPCR for Col1a1 expression. ANOVAs and Student's t tests were used to assess statistical significance (α = 0.05). SAL003 treatment did not produce any adverse ocular or systemic phenotype but did result in decreased keratocyte density. Col1a1 transcripts were reduced, corresponding to nuclear ATF4 expression within the axial cornea. In vivo topical treatment with a gel-formulated ISR agonist recapitulates key features of the activated ISR including nuclear ATF4 expression and decreased extracellular matrix (ECM) production. Exogenous ISR agonists may present one approach to establishing a rodent model for keratoconus, a charge essential for future evaluations of pathogenesis and therapeutic interventions.
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Affiliation(s)
- C Peterson
- Department of Molecular & Comparative Pathobiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Y C Kim
- Center for Nanomedicine at the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - L M Ensign
- Center for Nanomedicine at the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - A S Jun
- Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - J Foster
- Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Morris NB, Piil JF, Morabito M, Messeri A, Levi M, Ioannou LG, Ciuha U, Pogačar T, Kajfež Bogataj L, Kingma B, Casanueva A, Kotlarski S, Spirig C, Foster J, Havenith G, Sotto Mayor T, Flouris AD, Nybo L. The HEAT-SHIELD project — Perspectives from an inter-sectoral approach to occupational heat stress. J Sci Med Sport 2021; 24:747-755. [DOI: 10.1016/j.jsams.2021.03.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 02/11/2021] [Accepted: 03/01/2021] [Indexed: 02/07/2023]
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Foster J, Smallcombe JW, Hodder SG, Jay O, Flouris AD, Morris NB, Nybo L, Havenith G. Aerobic fitness as a parameter of importance for labour loss in the heat. J Sci Med Sport 2021; 24:824-830. [DOI: 10.1016/j.jsams.2021.05.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 03/16/2021] [Accepted: 05/02/2021] [Indexed: 02/07/2023]
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28
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Foster J, Smallcombe JW, Hodder S, Jay O, Flouris AD, Nybo L, Havenith G. An advanced empirical model for quantifying the impact of heat and climate change on human physical work capacity. Int J Biometeorol 2021; 65:1215-1229. [PMID: 33674931 PMCID: PMC8213606 DOI: 10.1007/s00484-021-02105-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 01/14/2021] [Accepted: 02/23/2021] [Indexed: 05/20/2023]
Abstract
Occupational heat stress directly hampers physical work capacity (PWC), with large economic consequences for industries and regions vulnerable to global warming. Accurately quantifying PWC is essential for forecasting impacts of different climate change scenarios, but the current state of knowledge is limited, leading to potential underestimations in mild heat, and overestimations in extreme heat. We therefore developed advanced empirical equations for PWC based on 338 work sessions in climatic chambers (low air movement, no solar radiation) spanning mild to extreme heat stress. Equations for PWC are available based on air temperature and humidity, for a suite of heat stress assessment metrics, and mean skin temperature. Our models are highly sensitive to mild heat and to our knowledge are the first to include empirical data across the full range of warm and hot environments possible with future climate change across the world. Using wet bulb globe temperature (WBGT) as an example, we noted 10% reductions in PWC at mild heat stress (WBGT = 18°C) and reductions of 78% in the most extreme conditions (WBGT = 40°C). Of the different heat stress indices available, the heat index was the best predictor of group level PWC (R2 = 0.96) but can only be applied in shaded conditions. The skin temperature, but not internal/core temperature, was a strong predictor of PWC (R2 = 0.88), thermal sensation (R2 = 0.84), and thermal comfort (R2 = 0.73). The models presented apply to occupational workloads and can be used in climate projection models to predict economic and social consequences of climate change.
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Affiliation(s)
- Josh Foster
- Environmental Ergonomics Research Centre, School of Design and Creative Arts Loughborough University, Loughborough, Leicestershire, LE11 3TU, UK
| | - James W Smallcombe
- Environmental Ergonomics Research Centre, School of Design and Creative Arts Loughborough University, Loughborough, Leicestershire, LE11 3TU, UK
| | - Simon Hodder
- Environmental Ergonomics Research Centre, School of Design and Creative Arts Loughborough University, Loughborough, Leicestershire, LE11 3TU, UK
| | - Ollie Jay
- Thermal Ergonomics Laboratory, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | | | - Lars Nybo
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - George Havenith
- Environmental Ergonomics Research Centre, School of Design and Creative Arts Loughborough University, Loughborough, Leicestershire, LE11 3TU, UK.
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29
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Shadbolt T, Sainsbury AW, Foster J, Bernhard T. Risks from poorly planned conservation translocations. Vet Rec 2021; 188:269. [PMID: 33835551 DOI: 10.1002/vetr.373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- T Shadbolt
- Disease Risk Analysis and Health Surveillance, Institute of Zoology, Zoological Society of London, London, NW1 4RY
| | - A W Sainsbury
- Disease Risk Analysis and Health Surveillance, Institute of Zoology, Zoological Society of London, London, NW1 4RY
| | - J Foster
- Amphibian and Reptile Conservation, Witley Centre, Witley, Godalming, Surrey, GU8 5QA
| | - T Bernhard
- Natural England, Eastleigh House, Upper Market Street, Eastleigh, Hampshire, SO50 9YN
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Khanna P, Khanna D, Cutter G, Foster J, Melnick J, Jaafar S, Biggers S, Rahman F, Kuo HC, Feese M, Saag K. POS0135 REDUCING IMMUNOGENICITY OF PEGLOTICASE (RECIPE) WITH CONCOMITANT USE OF MYCOPHENOLATE MOFETIL IN PATIENTS WITH REFRACTORY GOUT: A PHASE II RANDOMIZED CONTROLLED TRIAL. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.3111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Pegloticase is a recombinant, pegylated uricase, used for treatment of gout patients who fail oral urate lowering therapy (ULT). Its use has been limited due to immunogenicity leading to infusion reactions.1Objectives:We evaluated if co-administration of an immunomodulatory agent could prolong the efficacy of pegloticase.Methods:Participants were recruited in a Phase II, double-blind, placebo-controlled trial over 18 months and randomized in a 3:1 ratio by site. Inclusion criteria were: a) Age ≥ 18 years who met 2015 ACR/EULAR gout classification criteria and b) chronic refractory gout defined as symptoms inadequately controlled with ULT or contraindications. After a 2-week run-in of mycophenolate mofetil (MMF) 1000 mg twice daily or matching placebo (PBO), they received a combination of pegloticase 8 mg biweekly with MMF or PBO for 12 weeks. Subsequent to this MMF or PBO were discontinued but pegloticase was continued for another 12 weeks. The primary endpoint was proportion of patients who sustained a serum urate (SU) level of ≤ 6 mg/dl at 12 weeks. Secondary endpoints included 24-week durability of SU ≤ 6 mg/dl and rate of adverse events (AEs). Fisher’s exact test and Wilcoxon two-sample test were used for analyses along with Kaplan-Meier estimates and log-rank tests to compare survival curves between groups. Hypothesis tests were two-tailed and p-value (p) < 0.05 indicated statistical significance.Results:Of 42 subjects screened, 35 were randomized, and 32 who received at least one dose of pegloticase were included in modified intention to treat analyses. Subjects were predominantly men (88%), mean age of 55.2 years (SD=9.7). Mean duration of gout was 13.4 years (SD=9.0), mean baseline sUA was 9.2 mg/dL (SD=1.6). Tophi were present in 88% and majority were on optimized ULT - 59% on allopurinol and 16% on febuxostat, with 63% reporting > 1 flare in the past year. At baseline both arms (MMF vs. PBO) had similar comorbidities – (82% vs 70%), diabetes mellitus/metabolic syndrome (14% vs 20%), coronary artery disease/peripheral vascular disease (41% vs.70%), BMI>30 (86% vs. 90%) and renal insufficiency (defined as eGFR < 90 mL/min; 73% vs. 70%). At 12 weeks, 19 of 22 (86%) in the MMF arm achieved SU ≤ 6 mg/dl compared to 4 of 10 (40%) in PBO arm (p-value = 0.01). At 24 weeks, the SU was ≤ 6 mg/dl in 68% of MMF arm vs. 30% in PBO (p-value = 0.06), and rates of AEs per month were similar between groups with the PBO arm having more infusion reactions (30% vs. 0%). The MMF arm had higher AEs compared to placebo: musculoskeletal (41% vs. 10%), gastrointestinal (18% vs. 10%), and infections (9% vs. 0%). Figure 1 shows that the percentage of subjects maintaining a sUA < 6 mg/dL at 12 weeks was significantly higher (p=0.02) in the MMF arm, and a significant difference (p=0.03) at 24 weeks indicates sustained benefit from MMF.Conclusion:To our knowledge this is the first randomized-controlled proof of concept trial to demonstrate the ability of an immunomodulatory agent in prolonging the efficacy of pegloticase. Short-term concomitant use of MMF therapy with pegloticase was well tolerated and showed a clinically meaningful improvement in the targeted SU ≤6 mg/dL at 12 and 24 weeks. This study suggests an innovative approach to utilize pegloticase therapy in patients with chronic gout.References:[1]Sundy et al. Efficacy and tolerability of pegloticase for the treatment of chronic gout in patients refractory to conventional treatment: two randomized controlled trials. JAMA. 2011;306(7):711-20.Figure 1.Proportion of subjects maintaining serum urate (SU) ≤ 6 mg/dL over 24 week study period in mycophenolate mofetil + pegloticase vs. placebo + pegloticaseDisclosure of Interests:Puja Khanna Consultant of: Horizon Pharmaceuticals, Swedish Orphan Biovitrum A, Grant/research support from: Selecta, 2)DYVE, Dinesh Khanna Consultant of: Horizon Pharmaceuticals, Gary Cutter: None declared, Jeff Foster: None declared, Josh Melnick: None declared, Sara Jaafar: None declared, Stephanie Biggers: None declared, Fazlur Rahman: None declared, Hui-Chen Kuo: None declared, Michelle Feese: None declared, Kenneth Saag Consultant of: AbbVie, Inc., Bayer, Daiichi Sankyo Company LTD, Gilead Services, Inc., Horizon Pharma plc, Mallinkrodt, Radius Health, Inc., Roche/Genentech, Shanton Pharma Co., LTD, Teijin, Dyve Bioscience, LG Chem, Regeneron Pharmaceuticals., Swedish Orphan Biovitrum AB, Takeda Pharmaceuticals America, Inc.,
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Foster J, Lloyd AB, Havenith G. Non-contact infrared assessment of human body temperature: The journal Temperature toolbox. Temperature (Austin) 2021; 8:306-319. [PMID: 34901315 PMCID: PMC8654479 DOI: 10.1080/23328940.2021.1899546] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 03/02/2021] [Accepted: 03/03/2021] [Indexed: 12/19/2022] Open
Abstract
The assessment of human internal/core temperature (T core) is relevant in many scientific disciplines, but also for public health authorities when attempting to identify individuals with fever. Direct assessment of T core is often invasive, impractical on a large scale, and typically requires close contact between the observer and the target subject. Non-contact infrared thermometry (NCIT) represents a practical solution in which T core can potentially be assessed from a safe distance and in mass screening scenarios, by measuring skin temperature at specific anatomical locations. However, the COVID-19 pandemic has clearly demonstrated that these devices are not being used correctly, despite expert guided specifications available in International Standard Organization (ISO) documents. In this review, we provide an overview of the most pertinent factors that should be considered by users of NCIT. This includes the most pertinent methodological and physiological factors, as well as an overview on the ability of NCIT to track human T core. For practical use, we provide a checklist based on relevant ISO standards which are simple to follow and should be consulted prior to using NCIT for assessment of human T core. Our intention is for users of NCIT to adopt this checklist, which may improve the performance of NCIT for its ability to track T core.
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Affiliation(s)
- Josh Foster
- Environmental Ergonomics Research Centre, School of Design and Creative Arts, Loughborough University, Loughborough, Leicestershire, UK
| | - Alex Bruce Lloyd
- Environmental Ergonomics Research Centre, School of Design and Creative Arts, Loughborough University, Loughborough, Leicestershire, UK
| | - George Havenith
- Environmental Ergonomics Research Centre, School of Design and Creative Arts, Loughborough University, Loughborough, Leicestershire, UK
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Foster J, Hodder SG, Goodwin J, Havenith G. Occupational Heat Stress and Practical Cooling Solutions for Healthcare and Industry Workers During the COVID-19 Pandemic. Ann Work Expo Health 2020; 64:915-922. [PMID: 32955080 PMCID: PMC7543286 DOI: 10.1093/annweh/wxaa082] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 07/06/2020] [Accepted: 07/29/2020] [Indexed: 12/16/2022] Open
Abstract
Treatment and management of severe acute respiratory syndrome coronavirus-2, which causes coronavirus disease (COVID-19), requires increased adoption of personal protective equipment (PPE) to be worn by workers in healthcare and industry. In warm occupational settings, the added burden of PPE threatens worker health and productivity, a major lesson learned during the West-African Ebola outbreak which ultimately constrained disease control. In this paper, we comment on the link between COVID-19 PPE and occupational heat strain, cooling solutions available to mitigate occupational heat stress, and practical considerations surrounding their effectiveness and feasibility. While the choice of cooling solution depends on the context of the work and what is practical, mitigating occupational heat stress benefits workers in the healthcare and industrial sectors during the COVID-19 disease outbreak.
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Affiliation(s)
- Josh Foster
- Environmental Ergonomics Research Centre, Loughborough University, Design School, Loughborough, UK
| | - Simon G Hodder
- Environmental Ergonomics Research Centre, Loughborough University, Design School, Loughborough, UK
| | - James Goodwin
- Environmental Ergonomics Research Centre, Loughborough University, Design School, Loughborough, UK
| | - George Havenith
- Environmental Ergonomics Research Centre, Loughborough University, Design School, Loughborough, UK
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33
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Foster J, Hodder SG, Lloyd AB, Havenith G. Individual Responses to Heat Stress: Implications for Hyperthermia and Physical Work Capacity. Front Physiol 2020; 11:541483. [PMID: 33013476 PMCID: PMC7516259 DOI: 10.3389/fphys.2020.541483] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 08/18/2020] [Indexed: 12/11/2022] Open
Abstract
Background Extreme heat events are increasing in frequency, severity, and duration. It is well known that heat stress can have a negative impact on occupational health and productivity, particularly during physical work. However, there are no up-to-date reviews on how vulnerability to heat changes as a function of individual characteristics in relation to the risk of hyperthermia and work capacity loss. The objective of this narrative review is to examine the role of individual characteristics on the human heat stress response, specifically in relation to hyperthermia risk and productivity loss in hot workplaces. Finally, we aim to generate practical guidance for industrial hygienists considering our findings. Factors included in the analysis were body mass, body surface area to mass ratio, body fat, aerobic fitness and training, heat adaptation, aging, sex, and chronic health conditions. Findings We found the relevance of any factor to be dynamic, based on the work-type (fixed pace or relative to fitness level), work intensity (low, moderate, or heavy work), climate type (humidity, clothing vapor resistance), and variable of interest (risk of hyperthermia or likelihood of productivity loss). Heat adaptation, high aerobic fitness, and having a large body mass are the most protective factors during heat exposure. Primary detrimental factors include low fitness, low body mass, and lack of heat adaptation. Aging beyond 50 years, being female, and diabetes are less impactful negative factors, since their independent effect is quite small in well matched participants. Skin surface area to mass ratio, body composition, hypertension, and cardiovascular disease are not strong independent predictors of the heat stress response. Conclusion Understanding how individual factors impact responses to heat stress is necessary for the prediction of heat wave impacts on occupational health and work capacity. The recommendations provided in this report could be utilized to help curtail hyperthermia risk and productivity losses induced by heat.
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Affiliation(s)
- Josh Foster
- Environmental Ergonomics Research Centre, Loughborough University, Loughborough, United Kingdom
| | - Simon G Hodder
- Environmental Ergonomics Research Centre, Loughborough University, Loughborough, United Kingdom
| | - Alex B Lloyd
- Environmental Ergonomics Research Centre, Loughborough University, Loughborough, United Kingdom
| | - George Havenith
- Environmental Ergonomics Research Centre, Loughborough University, Loughborough, United Kingdom
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Morris NB, Jay O, Flouris AD, Casanueva A, Gao C, Foster J, Havenith G, Nybo L. Sustainable solutions to mitigate occupational heat strain - an umbrella review of physiological effects and global health perspectives. Environ Health 2020; 19:95. [PMID: 32887627 PMCID: PMC7487490 DOI: 10.1186/s12940-020-00641-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 08/12/2020] [Indexed: 05/19/2023]
Abstract
BACKGROUND Climate change is set to exacerbate occupational heat strain, the combined effect of environmental and internal heat stress on the body, threatening human health and wellbeing. Therefore, identifying effective, affordable, feasible and sustainable solutions to mitigate the negative effects on worker health and productivity, is an increasingly urgent need. OBJECTIVES To systematically identify and evaluate methods that mitigate occupational heat strain in order to provide scientific-based guidance for practitioners. METHODS An umbrella review was conducted in biomedical databases employing the following eligibility criteria: 1) ambient temperatures > 28 °C or hypohydrated participants, 2) healthy adults, 3) reported psychophysiological (thermal comfort, heart rate or core temperature) and/or performance (physical or cognitive) outcomes, 4) written in English, and 5) published before November 6, 2019. A second search for original research articles was performed to identify interventions of relevance but lacking systematic reviews. All identified interventions were independently evaluated by all co-authors on four point scales for effectiveness, cost, feasibility and environmental impact. RESULTS Following screening, 36 systematic reviews fulfilled the inclusion criteria. The most effective solutions at mitigating occupational heat strain were wearing specialized cooling garments, (physiological) heat acclimation, improving aerobic fitness, cold water immersion, and applying ventilation. Although air-conditioning and cooling garments in ideal settings provide best scores for effectiveness, the limited applicability in certain industrial settings, high economic cost and high environmental impact are drawbacks for these solutions. However, (physiological) acclimatization, planned breaks, shading and optimized clothing properties are attractive alternative solutions when economic and ecological sustainability aspects are included in the overall evaluation. DISCUSSION Choosing the most effective solution or combinations of methods to mitigate occupational heat strain will be scenario-specific. However, this paper provides a framework for integrating effectiveness, cost, feasibility (indoors and outdoor) and ecologic sustainability to provide occupational health and safety professionals with evidence-based guidelines.
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Affiliation(s)
- Nathan B. Morris
- Department of Nutrition, Exercise and Sports, Section for Integrative Physiology, University of Copenhagen, Copenhagen N, Denmark
| | - Ollie Jay
- Thermal Ergonomics Laboratory, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Andreas D. Flouris
- FAME Laboratory, School of Exercise Science, University of Thessaly, Thessaly, Greece
| | - Ana Casanueva
- Federal Office of Meteorology and Climatology, MeteoSwiss, Zurich Airport, Zurich, Switzerland
- Meteorology Group, Department of Applied Mathematics and Computer Sciences, University of Cantabria, Santander, Spain
| | - Chuansi Gao
- Thermal Environment Laboratory, Division of Ergonomics and Aerosol Technology, Department of Design Sciences, Faculty of Engineering, Lund University, Lund, Sweden
| | - Josh Foster
- Environmental Ergonomics Research Centre, Loughborough Design School, Loughborough University, Loughborough, UK
| | - George Havenith
- Environmental Ergonomics Research Centre, Loughborough Design School, Loughborough University, Loughborough, UK
| | - Lars Nybo
- Department of Nutrition, Exercise and Sports, Section for Integrative Physiology, University of Copenhagen, Copenhagen N, Denmark
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MacNally S, Smith C, Spaulding J, Foster J, Oliver JB. Glancing-angle-deposited silica films for ultraviolet wave plates. Appl Opt 2020; 59:A155-A161. [PMID: 32225368 DOI: 10.1364/ao.59.00a155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 12/03/2019] [Indexed: 06/10/2023]
Abstract
Birefringent silica films are formed by glancing-angle deposition to fabricate quarter- and half-wave plates at a wavelength of 351 nm. A multilayer design is implemented to achieve low-loss transmittance with a high 351-nm laser-induced damage threshold.
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Parker S, Foster J, Whiddon C, Pacholke H. Optimizing Skin Dose for Post-Mastectomy Chestwall VMAT Radiation Therapy. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Smallcombe JW, Foster J, Hodder S, Jay O, Flouris AD, Griggs K, Dorman L, Havenith G. Impact of Fan Use on Physical Work Capacity in Extreme Heat. Med Sci Sports Exerc 2019. [DOI: 10.1249/01.mss.0000560531.57940.a8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Foster J, Smallcombe J, Hodder S, Jay O, Flouris A, Havenith G. A New Paradigm To Quantify The Reduction Of Physical Work Capacity In The Heat. Med Sci Sports Exerc 2019. [DOI: 10.1249/01.mss.0000560530.50316.94] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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White TG, Oliver MT, Mabey P, Kühn-Kauffeldt M, Bott AFA, Döhl LNK, Bell AR, Bingham R, Clarke R, Foster J, Giacinti G, Graham P, Heathcote R, Koenig M, Kuramitsu Y, Lamb DQ, Meinecke J, Michel T, Miniati F, Notley M, Reville B, Ryu D, Sarkar S, Sakawa Y, Selwood MP, Squire J, Scott RHH, Tzeferacos P, Woolsey N, Schekochihin AA, Gregori G. Supersonic plasma turbulence in the laboratory. Nat Commun 2019; 10:1758. [PMID: 30988285 PMCID: PMC6465398 DOI: 10.1038/s41467-019-09498-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 03/08/2019] [Indexed: 11/13/2022] Open
Abstract
The properties of supersonic, compressible plasma turbulence determine the behavior of many terrestrial and astrophysical systems. In the interstellar medium and molecular clouds, compressible turbulence plays a vital role in star formation and the evolution of our galaxy. Observations of the density and velocity power spectra in the Orion B and Perseus molecular clouds show large deviations from those predicted for incompressible turbulence. Hydrodynamic simulations attribute this to the high Mach number in the interstellar medium (ISM), although the exact details of this dependence are not well understood. Here we investigate experimentally the statistical behavior of boundary-free supersonic turbulence created by the collision of two laser-driven high-velocity turbulent plasma jets. The Mach number dependence of the slopes of the density and velocity power spectra agree with astrophysical observations, and supports the notion that the turbulence transitions from being Kolmogorov-like at low Mach number to being more Burgers-like at higher Mach numbers.
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Affiliation(s)
- T G White
- Department of Physics, University of Oxford, Parks Road, Oxford, OX1 3PU, UK.
- Department of Physics, University of Nevada, Reno, NV, 89557, USA.
| | - M T Oliver
- Department of Physics, University of Oxford, Parks Road, Oxford, OX1 3PU, UK
- Department of Physics, University of Nevada, Reno, NV, 89557, USA
| | - P Mabey
- Department of Physics, University of Oxford, Parks Road, Oxford, OX1 3PU, UK
- LULI-CNRS, Ecole Polytechnique, CEA: Université Paris-Saclay; UPMC Univ Paris 06: Sorbonne Universitiés, F-91128, Palaiseau cedex, France
| | | | - A F A Bott
- Department of Physics, University of Oxford, Parks Road, Oxford, OX1 3PU, UK
| | - L N K Döhl
- York Plasma Institute, Department of Physics, University of York, Heslington, York, YO10 5DD, UK
| | - A R Bell
- Department of Physics, University of Oxford, Parks Road, Oxford, OX1 3PU, UK
| | - R Bingham
- Central Laser Facility, STFC Rutherford Appleton Laboratory, Harwell Oxford, Didcot, OX11 0QX, UK
- Department of Physics, SUPA, University of Strathclyde, Glasgow, G4 0NG, UK
| | - R Clarke
- Central Laser Facility, STFC Rutherford Appleton Laboratory, Harwell Oxford, Didcot, OX11 0QX, UK
| | - J Foster
- AWE, Aldermaston, Reading, West Berkshire, RG7 4PR, UK
| | - G Giacinti
- Max-Planck-Institut für Kernphysik, Postfach 103980, 69029, Heidelberg, Germany
| | - P Graham
- AWE, Aldermaston, Reading, West Berkshire, RG7 4PR, UK
| | - R Heathcote
- Central Laser Facility, STFC Rutherford Appleton Laboratory, Harwell Oxford, Didcot, OX11 0QX, UK
| | - M Koenig
- LULI-CNRS, Ecole Polytechnique, CEA: Université Paris-Saclay; UPMC Univ Paris 06: Sorbonne Universitiés, F-91128, Palaiseau cedex, France
- Graduate School of Engineering, Osaka University, Suita, Osaka, 564-0871, Japan
| | - Y Kuramitsu
- Graduate School of Engineering, Osaka University, Suita, Osaka, 564-0871, Japan
| | - D Q Lamb
- Department of Astronomy and Astrophysics, University of Chicago, 5640S. Ellis Ave, Chicago, IL, 60637, USA
| | - J Meinecke
- Department of Physics, University of Oxford, Parks Road, Oxford, OX1 3PU, UK
| | - Th Michel
- LULI-CNRS, Ecole Polytechnique, CEA: Université Paris-Saclay; UPMC Univ Paris 06: Sorbonne Universitiés, F-91128, Palaiseau cedex, France
| | - F Miniati
- Department of Physics, University of Oxford, Parks Road, Oxford, OX1 3PU, UK
| | - M Notley
- Central Laser Facility, STFC Rutherford Appleton Laboratory, Harwell Oxford, Didcot, OX11 0QX, UK
| | - B Reville
- School of Mathematics and Physics, Queens University Belfast, Belfast, BT7 1NN, UK
| | - D Ryu
- Department of Physics, School of Natural Sciences, UNIST, Ulsan, 44919, Korea
| | - S Sarkar
- Department of Physics, University of Oxford, Parks Road, Oxford, OX1 3PU, UK
| | - Y Sakawa
- Institute of Laser Engineering, Osaka, 565-0871, Japan
| | - M P Selwood
- Central Laser Facility, STFC Rutherford Appleton Laboratory, Harwell Oxford, Didcot, OX11 0QX, UK
| | - J Squire
- Theoretical Astrophysics, 350-17, California Institute of Technology, Pasadena, CA, 91125, USA
- Physics Department, University of Otago, Dunedin, 9016, New Zealand
| | - R H H Scott
- Central Laser Facility, STFC Rutherford Appleton Laboratory, Harwell Oxford, Didcot, OX11 0QX, UK
| | - P Tzeferacos
- Department of Astronomy and Astrophysics, University of Chicago, 5640S. Ellis Ave, Chicago, IL, 60637, USA
| | - N Woolsey
- York Plasma Institute, Department of Physics, University of York, Heslington, York, YO10 5DD, UK
| | - A A Schekochihin
- Department of Physics, University of Oxford, Parks Road, Oxford, OX1 3PU, UK
| | - G Gregori
- Department of Physics, University of Oxford, Parks Road, Oxford, OX1 3PU, UK.
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Duffton A, McCrea I, Allwood-Spiers S, Hay L, Devlin L, Sankaralingam M, Thomson M, McLoone P, McJury M, Foster J, Paterson C. OC-0415 MERINO study: Defining a standardised delineation method for repeated GTV assessment using DW MRI. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)30835-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Paterson C, McCrea I, Hay L, Allwood-Speirs S, Devlin L, Sankaralingam M, McLoone P, Wilson C, Grose D, James A, Lamb C, Rizwanullah M, Schipani S, Nixon I, Thomson M, McJury M, Foster J, Duffton A. EP-1137 DW MRI as biomarker of response during RT for intermed/high risk SCC oropharynx: a feasibility study. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31557-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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42
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Norris A, Crossland W, Tedeschi L, Foster J, Muir J, Pinchak W. 419 Effect of Differing Rates of Quebracho (Schinopsis balansae) Extract provided in a Limit-Fed High Roughage Total Mixed Ration Upon Digestibility and Nitrogen Balance. J Anim Sci 2018. [DOI: 10.1093/jas/sky404.448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- A Norris
- Texas A&M University, College Station,College Station, TX, United States
| | - W Crossland
- Texas Tech University,Lubbock, TX, United States
| | - L Tedeschi
- Department of Animal Science, Texas A&M University-College Station,College Station, TX, United States
| | - J Foster
- Texas A&M AgriLife Research,Beeville, College station, TX, United States
| | - J Muir
- Texas A&M AgriLife Research,Stephenville, TX, United States
| | - W Pinchak
- Texas A&M AgriLife Research,Beeville, College station, TX, United States
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Bagley A, Grosshans D, Philip N, McAleer M, McGovern S, Foster J, Mahajan A, Paulino A. Efficacy of Proton Therapy on Locoregional Control in Neuroblastoma. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.1352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Foster J, Cochrane E, Khatami MH, Habibi SA, de Haan H, Forrester SG. A mutational and molecular dynamics study of the cys-loop GABA receptor Hco-UNC-49 from Haemonchus contortus: Agonist recognition in the nematode GABA receptor family. Int J Parasitol Drugs Drug Resist 2018; 8:534-539. [PMID: 30361167 PMCID: PMC6287672 DOI: 10.1016/j.ijpddr.2018.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 10/01/2018] [Accepted: 10/04/2018] [Indexed: 11/04/2022]
Abstract
The UNC-49 receptor is a unique nematode γ-aminobutyric acid (GABA)-gated chloride channel that may prove to be a novel target for the development of nematocides. Here we have characterized various charged amino acid residues in and near the agonist binding site of the UNC-49 receptor from the parasitic nematode Haemonchus contorts. Utilizing the Caenorhabditis elegans GluCl crystal structure as a template, a model was generated and various charged residues [D83 (loop D), E131 (loop A), H137 (pre-loop E), R159 (Loop E), E185 (Loop B) and R241 (Loop C)] were investigated based on their location and conservation. These residues may contribute to structure, function, and molecular interactions with agonists. It was found that all residues chosen were important for receptor function to varying degrees. Results of the mutational analysis and molecular simulations suggest that R159 may be interacting with D83 by an ionic interaction that may be crucial for general GABA receptor function. We have used the results from this study as well as knowledge of residues involved in GABA receptor binding to identify sequence patterns that may assist in understanding the function of lesser known GABA receptor subunits from parasitic nematodes. Key functional residues were investigated in the Hco-UNC-49 receptor. A glutamic acid in the binding pocket (loop B) is essential for agonist recognition. Interaction between residues in different binding loops are important for function.
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Affiliation(s)
- Josh Foster
- Faculty of Science, University of Ontario Institute of Technology, 2000 Simcoe Street North, Oshawa, ON, L1H 7K4, Canada
| | - Everett Cochrane
- Faculty of Science, University of Ontario Institute of Technology, 2000 Simcoe Street North, Oshawa, ON, L1H 7K4, Canada
| | - Mohammad Hassan Khatami
- Faculty of Science, University of Ontario Institute of Technology, 2000 Simcoe Street North, Oshawa, ON, L1H 7K4, Canada
| | - Sarah A Habibi
- Faculty of Science, University of Ontario Institute of Technology, 2000 Simcoe Street North, Oshawa, ON, L1H 7K4, Canada
| | - Hendrick de Haan
- Faculty of Science, University of Ontario Institute of Technology, 2000 Simcoe Street North, Oshawa, ON, L1H 7K4, Canada
| | - Sean G Forrester
- Faculty of Science, University of Ontario Institute of Technology, 2000 Simcoe Street North, Oshawa, ON, L1H 7K4, Canada.
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Rudran B, Reader C, Foster J, Hodivala-Dilke K, Sosabowski J, Marshall J. P1.03-19 Antibody Blockade of Integrin Alpha-V-Beta-6 (avb6) as a Novel Treatment for NSCLC. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Affiliation(s)
- J Foster
- College of Medicine and Dentistry, James Cook University, Townsville, Torres and Cape Tuberculosis Control Unit, Thursday Island, Queensland Health
| | - E McBryde
- Torres and Cape Tuberculosis Control Unit, Thursday Island, Queensland Health, Infectious Disease and Epidemiology, Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, QLD, Australia
| | - M Taune
- Daru General Hospital, Daru, Western Province, Papua New Guinea
| | - D Peniyamina
- Cairns and Hinterland Hospital and Health Service, Cairns, QLD, Australia ,
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Abstract
BACKGROUND Acetaminophen is an over-the-counter drug used to treat pain and fever, but it has also been shown to reduce core temperature (T c) in the absence of fever. However, this side effect is not well examined in humans, and it is unknown if the hypothermic response to acetaminophen is exacerbated with cold exposure. OBJECTIVE To address this question, we mapped the thermoregulatory responses to acetaminophen and placebo administration during exposure to acute cold (10 °C) and thermal neutrality (25 °C). METHODS Nine healthy Caucasian males (aged 20-24 years) participated in the experiment. In a double-blind, randomised, repeated measures design, participants were passively exposed to a thermo-neutral or cold environment for 120 min, with administration of 20 mg/kg lean body mass acetaminophen or a placebo 5 min prior to exposure. T c, skin temperature (T sk), heart rate, and thermal sensation were measured every 10 min, and mean arterial pressure was recorded every 30 min. Data were analysed using linear mixed effects models. Differences in thermal sensation were analysed using a cumulative link mixed model. RESULTS Acetaminophen had no effect on T c in a thermo-neutral environment, but significantly reduced T c during cold exposure, compared with a placebo. T c was lower in the acetaminophen compared with the placebo condition at each 10-min interval from 80 to 120 min into the trial (all p < 0.05). On average, T c decreased by 0.42 ± 0.13 °C from baseline after 120 min of cold exposure (range 0.16-0.57 °C), whereas there was no change in the placebo group (0.01 ± 0.1 °C). T sk, heart rate, thermal sensation, and mean arterial pressure were not different between conditions (p > 0.05). CONCLUSION This preliminary trial suggests that acetaminophen-induced hypothermia is exacerbated during cold stress. Larger scale trials seem warranted to determine if acetaminophen administration is associated with an increased risk of accidental hypothermia, particularly in vulnerable populations such as frail elderly individuals.
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Affiliation(s)
- Josh Foster
- Institute for Sport and Physical Activity Research, University of Bedfordshire, Bedford, UK. .,Environmental Ergonomics Research Centre, Loughborough University, Loughborough, UK.
| | - Alexis R Mauger
- Endurance Research Group, School of Sport and Exercise Sciences, University of Kent, Chatham Maritime, UK
| | - Andrew Govus
- Department of Health Sciences, Swedish Winter Sports Research Centre, Mid Sweden University, Östersund, Sweden
| | - David Hewson
- Institute for Health Research, University of Bedfordshire, Luton, UK
| | - Lee Taylor
- ASPETAR, Qatar Orthopaedic and Sports Medicine Hospital, Athlete Health and Performance Research Centre, Aspire Zone, Doha, Qatar.,School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
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48
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Tzeferacos P, Rigby A, Bott AFA, Bell AR, Bingham R, Casner A, Cattaneo F, Churazov EM, Emig J, Fiuza F, Forest CB, Foster J, Graziani C, Katz J, Koenig M, Li CK, Meinecke J, Petrasso R, Park HS, Remington BA, Ross JS, Ryu D, Ryutov D, White TG, Reville B, Miniati F, Schekochihin AA, Lamb DQ, Froula DH, Gregori G. Laboratory evidence of dynamo amplification of magnetic fields in a turbulent plasma. Nat Commun 2018; 9:591. [PMID: 29426891 PMCID: PMC5807305 DOI: 10.1038/s41467-018-02953-2] [Citation(s) in RCA: 83] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 01/09/2018] [Indexed: 11/25/2022] Open
Abstract
Magnetic fields are ubiquitous in the Universe. The energy density of these fields is typically comparable to the energy density of the fluid motions of the plasma in which they are embedded, making magnetic fields essential players in the dynamics of the luminous matter. The standard theoretical model for the origin of these strong magnetic fields is through the amplification of tiny seed fields via turbulent dynamo to the level consistent with current observations. However, experimental demonstration of the turbulent dynamo mechanism has remained elusive, since it requires plasma conditions that are extremely hard to re-create in terrestrial laboratories. Here we demonstrate, using laser-produced colliding plasma flows, that turbulence is indeed capable of rapidly amplifying seed fields to near equipartition with the turbulent fluid motions. These results support the notion that turbulent dynamo is a viable mechanism responsible for the observed present-day magnetization.
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Affiliation(s)
- P Tzeferacos
- Department of Physics, University of Oxford, Parks Road, Oxford, OX1 3PU, UK
- Department of Astronomy and Astrophysics, University of Chicago, 5640 S. Ellis Ave, Chicago, IL, 60637, USA
| | - A Rigby
- Department of Physics, University of Oxford, Parks Road, Oxford, OX1 3PU, UK
| | - A F A Bott
- Department of Physics, University of Oxford, Parks Road, Oxford, OX1 3PU, UK
| | - A R Bell
- Department of Physics, University of Oxford, Parks Road, Oxford, OX1 3PU, UK
| | - R Bingham
- Rutherford Appleton Laboratory, Chilton, Didcot, OX11 0QX, UK
- Department of Physics, University of Strathclyde, Glasgow, G4 0NG, UK
| | - A Casner
- CEA, DAM, DIF, 91297, Arpajon, France
| | - F Cattaneo
- Department of Astronomy and Astrophysics, University of Chicago, 5640 S. Ellis Ave, Chicago, IL, 60637, USA
| | - E M Churazov
- Max Planck Institute for Astrophysics, Karl-Schwarzschild-Strasse 1, 85741, Garching, Germany
- Space Research Institute (IKI), Profsouznaya 84/32, Moscow, 117997, Russia
| | - J Emig
- Lawrence Livermore National Laboratory, Livermore, CA, 94550, USA
| | - F Fiuza
- SLAC National Accelerator Laboratory, 2575 Sand Hill Road, Menlo Park, CA, 94025, USA
| | - C B Forest
- Physics Department, University of Wisconsin-Madison, 1150 University Avenue, Madison, WI, 53706, USA
| | - J Foster
- AWE, Aldermaston, Reading, West Berkshire, RG7 4PR, UK
| | - C Graziani
- Department of Astronomy and Astrophysics, University of Chicago, 5640 S. Ellis Ave, Chicago, IL, 60637, USA
| | - J Katz
- Laboratory for Laser Energetics, University of Rochester, 250 E. River Rd, Rochester, NY, 14623, USA
| | - M Koenig
- Laboratoire pour l'Utilisation de Lasers Intenses, UMR7605, CNRS CEA, Université Paris VI Ecole Polytechnique, 91128, Palaiseau Cedex, France
| | - C-K Li
- Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - J Meinecke
- Department of Physics, University of Oxford, Parks Road, Oxford, OX1 3PU, UK
| | - R Petrasso
- Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - H-S Park
- Lawrence Livermore National Laboratory, Livermore, CA, 94550, USA
| | - B A Remington
- Lawrence Livermore National Laboratory, Livermore, CA, 94550, USA
| | - J S Ross
- Lawrence Livermore National Laboratory, Livermore, CA, 94550, USA
| | - D Ryu
- Department of Physics, UNIST, Ulsan, 689-798, Korea
| | - D Ryutov
- Lawrence Livermore National Laboratory, Livermore, CA, 94550, USA
| | - T G White
- Department of Physics, University of Oxford, Parks Road, Oxford, OX1 3PU, UK
| | - B Reville
- School of Mathematics and Physics, Queens University Belfast, Belfast, BT7 1NN, UK
| | - F Miniati
- Department of Physics, ETH Zürich, Wolfgang-Pauli-Strasse 27, Zürich, CH-8093, Switzerland
| | - A A Schekochihin
- Department of Physics, University of Oxford, Parks Road, Oxford, OX1 3PU, UK
| | - D Q Lamb
- Department of Astronomy and Astrophysics, University of Chicago, 5640 S. Ellis Ave, Chicago, IL, 60637, USA
| | - D H Froula
- Laboratory for Laser Energetics, University of Rochester, 250 E. River Rd, Rochester, NY, 14623, USA
| | - G Gregori
- Department of Physics, University of Oxford, Parks Road, Oxford, OX1 3PU, UK.
- Department of Astronomy and Astrophysics, University of Chicago, 5640 S. Ellis Ave, Chicago, IL, 60637, USA.
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Mountjoy M, Costa A, Budgett R, Dvorak J, Engebretsen L, Miller S, Moran J, Foster J, Carr J. Health promotion through sport: international sport federations’ priorities, actions and opportunities. Br J Sports Med 2017; 52:54-60. [DOI: 10.1136/bjsports-2017-097900] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2017] [Revised: 05/14/2017] [Accepted: 05/17/2017] [Indexed: 11/03/2022]
Abstract
ObjectiveTo identify areas of priority and activity for international sportsfederations (IFs) with respect to athlete health and safety, and global health. Results serve to direct the work of the Association of Summer Olympic IF Medical and Scientific Consultative Group, the International Olympic Committee and to influence IFs’ planning and priorities.MethodsThe 28 IFs participating in the Summer Olympic Games (2016) were asked to rank the relative importance of 11 health-related topics and to report their activities or research initiatives on 27 identified topics using an electronic survey. A comparison with a similar survey (2012) was made.ResultsThe response rate was 100%. In general, the ‘fight against doping’ had the highest priority followed by ‘image as a safe sport’. The topics with the lowest importance ratings were ‘increasing the number of elite athletes’, and ‘health of the general population’. Despite ranking ‘health of your athletes,’ as a top priority, IFs are not addressing all aspects of athlete health. In comparison with 2012, there was a significant decrease in priority for IFs is ‘health of the general population’.ConclusionDespite the widespread knowledge of the importance of the promotion of physical activity (sport) on global health, the decreasing priority and programming of the IFs on physical activity promotion is concerning. Although IFs have prioritised the protection of the health of elite athletes, there are gaps in programming demonstrating that IFs are missing important areas of athlete health. Improving recreational athlete health programming could also benefit population health as well as improve IF fan base and sport participation.
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Bunyan M, Crowley J, Smedley N, Mutti MF, Cashen A, Thompson T, Foster J. Feasibility of training nurses in motivational interviewing to improve patient experience in mental health inpatient rehabilitation: a pilot study. J Psychiatr Ment Health Nurs 2017; 24:221-231. [PMID: 28248447 DOI: 10.1111/jpm.12382] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/24/2017] [Indexed: 11/30/2022]
Abstract
UNLABELLED WHAT IS KNOWN ON THE SUBJECT?: Recently, concerns have been raised about how well United Kingdom National Health Service nurses care for their patients and their level of compassion. Motivational interviewing (MI) is an established approach to helping people make positive behaviour changes, through directive, person-centred counselling within a collaborative relationship between clinician and recipient. Based on evidence that MI may influence nursing practice positively, an investigation into the feasibility of training nurses on mental health inpatient rehabilitation wards ('rehabilitation') in MI to improve patient experience was reported. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: This pilot study demonstrates that training rehabilitation nurses in MI is feasible and provides preliminary evidence suggesting that a larger study to examine efficacy is warranted, including a calculation of sample size required to draw robust statistical conclusions. Nurses evaluated the training as highly relevant to their work. Patients responded well to interviews and focus groups with support from experts-by-experience; they were generally fairly satisfied with the rehabilitation ward and slight improvements in their experience were found following MI training for nurses but not at 6-month follow-up. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Rehabilitation nurses may face conflicting demands between ensuring patients with severe difficulties meet their basic needs and working with them to develop greater independence. Qualitative findings question whether nurse-patient interactions are fully valued as nursing interventions in inpatient rehabilitation. Learning MI might be a useful way of helping nurses think in detail about their interactions with patients and how to improve communications with their patients. The principles of MI should be incorporated into pre-registration training. ABSTRACT Introduction There is limited research addressing the experiences of patients in inpatient rehabilitation (rehabilitation), who often spend long periods in hospital, and the nursing approaches utilized. Aim Based on evidence that motivational interviewing (MI) may improve nursing practice, this was a pilot study evaluating the feasibility of training rehabilitation nurses in MI and measuring patient experience. Method Nurses underwent training and supervision focusing on MI spirit. Quantitative and qualitative measures were taken pretraining, 2 months post-training and 8 months post-training. Expert-by-experience research assistants facilitated patients' participation in the study. Results This study showed that training rehabilitation nurses in MI was feasible and relevant to their work. Patients participated in interviews and focus groups with support and potential improvements that require further empirical investigation in patient experience were found following the MI training. Discussion This pilot study establishes the feasibility of a larger study addressing efficacy. Tentative qualitative findings question whether interactions between nurses and patients are valued in rehabilitation and support MI as a promising skill set for rehabilitation nurses. Implications for practice Bringing MI into inpatient rehabilitation provoked reflection on nursing practice. Dilemmas for nurses about balancing safety with promoting autonomy and communicating constructively with patients emerged as important.
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Affiliation(s)
- M Bunyan
- Oxleas NHS Foundation Trust, Dartford, UK
| | - J Crowley
- Faculty of Education and Health, University of Greenwich, London, UK
| | - N Smedley
- Oxleas NHS Foundation Trust, Dartford, UK
| | - M-F Mutti
- Oxleas NHS Foundation Trust, Dartford, UK
| | - A Cashen
- Oxleas NHS Foundation Trust, Dartford, UK
| | - T Thompson
- Faculty of Education and Health, University of Greenwich, London, UK
| | - J Foster
- Faculty of Education and Health, University of Greenwich, London, UK
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