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Coehoorn CJ, St Martin P, Teran J, Cowart H, Waite L, Newman S. Firefighter uncompensable heat stress results in excessive upper body temperatures measured by infrared thermography: Implications for cooling strategies. APPLIED ERGONOMICS 2024; 120:104342. [PMID: 38959633 DOI: 10.1016/j.apergo.2024.104342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 06/26/2024] [Accepted: 06/28/2024] [Indexed: 07/05/2024]
Abstract
This research sought to evaluate the thermal zones of the upper body and firefighter personal protective equipment (PPE) immediately following uncompensable heat stress (0.03 °C increase/min). We hypothesized that the frontal portion of the head and the inside of the firefighter helmet would be the hottest as measured by infrared thermography. This hypothesis was due to previous research demonstrating that the head accounts for ∼8-10% of the body surface area, but it accounts for ∼20% of the overall body heat dissipation during moderate exercise. Twenty participants performed a 21-min graded treadmill exercise protocol (Altered Modified Naughton) in an environmental chamber (35 °C, 50 % humidity) in firefighter PPE. The body areas analyzed were the frontal area of the head, chest, abdomen, arm, neck, upper back, and lower back. The areas of the PPE that were analyzed were the inside of the helmet and the jacket. The hottest areas of the body post-exercise were the frontal area of the head (mean: 37.3 ± 0.4 °C), chest (mean: 37.5 ± 0.3 °C), and upper back (mean: 37.3 ± 0.4 °C). The coldest area of the upper body was the abdomen (mean: 36.1 ± 0.4 °C). The peak temperature of the inside of the helmet increased (p < 0.001) by 9.8 °C from 27.7 ± 1.6 °C to 37.4 ± 0.7 °C, and the inside of the jacket increased (p < 0.001) by 7.3 °C from 29.2 ± 1.7 °C to 36.5 ± 0.4 °C. The results of this study are relevant for cooling strategies for firefighters.
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Affiliation(s)
| | | | | | | | - Landon Waite
- Louisiana State University Health Shreveport, USA
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Zand S, Motlagh MS, Golmohammadi R, Aliabadi M, Tapak L, Babamiri M. Effects of wearing medical gowns at different temperatures on the physiological responses of female healthcare workers during the COVID-19 pandemic. Work 2024; 78:601-612. [PMID: 38339951 DOI: 10.3233/wor-230360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Using medical gowns with high protection against COVID-19 among healthcare workers (HCWs) may limit heat exchange, resulting in physiological challenges. OBJECTIVE This study aimed to compare the physiological and neurophysiological responses of female HCWs when using two typical medical gowns at different temperatures during the COVID-19 pandemic. METHODS Twenty healthy female HCWs participated in this study. Participants wore two types of medical gowns: Spunbond gown (SG) and laminate gown (LG). They walked on a treadmill in a controlled climate chamber for 30 minutes at three different temperatures (24, 28, and 32°C). Heart rate (HR), skin surface temperature (ST), clothing surface temperature (CT), ear temperature (ET), blood oxygen percentage (SaO2), galvanic skin response (GSR), and blood pressure were measured before and after walking on a treadmill. The study's results were analyzed using SPSS26. RESULTS The study found that LG led to an average increase of 0.575°C in CT compared to SG at the same temperatures (P < 0.03). The average HR increased by 6.5 bpm in LG at 28°C compared to SG at a comfortable temperature (P = 0.01). The average ET in SG and GSR in LG at 32°C increased by 0.39°C and 0.25μS, respectively, compared to the comfortable temperature (P < 0.02). CONCLUSION The study recommends maintaining a comfortable temperature range in hospitals to prevent physiological challenges among HCWs wearing medical gowns with high protection against COVID-19. This is important because using LG, compared to SG, at high temperatures can increase HR, ET, CT, and GSR.
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Affiliation(s)
- Sepideh Zand
- Center of Excellence for Occupational Health, Occupational Health and Safety Research Center, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Masoud Shafiee Motlagh
- Center of Excellence for Occupational Health, Occupational Health and Safety Research Center, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Rostam Golmohammadi
- Center of Excellence for Occupational Health, School of Public Health and Research Center for Health Sciences, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mohsen Aliabadi
- Center of Excellence for Occupational Health, Occupational Health and Safety Research Center, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Leili Tapak
- Department of Biostatistics, School of Public Health and Modeling of Noncommunicable Diseases Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mohammad Babamiri
- Department of Ergonomics, School of Public Health and Research Center for Health Sciences, Hamadan University of Medical Sciences, Hamadan, Iran
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Chau A, Hofmeyr R. Hypothesis-generating procedures and unmasking novel associations in large observational studies: are we doing harm while doing good? Anaesthesia 2023; 78:9-13. [PMID: 36178605 DOI: 10.1111/anae.15877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2022] [Indexed: 12/13/2022]
Affiliation(s)
- A Chau
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC, Canada.,Department of Anesthesia, BC Women's Hospital, Vancouver, BC, Canada.,Department of Anesthesia, St. Paul's Hospital, Vancouver, BC, Canada
| | - R Hofmeyr
- Department of Anaesthesia and Peri-operative Medicine, Groote Schuur Hospital, Cape Town, South Africa.,Department of Anaesthesia and Peri-operative Medicine, Faculty of Health Sciences, University of Cape Town, South Africa
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Reid MB. Redox Implications of Extreme Task Performance: The Case in Driver Athletes. Cells 2022; 11:cells11050899. [PMID: 35269521 PMCID: PMC8909750 DOI: 10.3390/cells11050899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 02/26/2022] [Accepted: 03/03/2022] [Indexed: 02/04/2023] Open
Abstract
Redox homeostasis and redox-mediated signaling mechanisms are fundamental elements of human biology. Physiological levels of reactive oxygen species (ROS) and reactive nitrogen species (RNS) modulate a range of functional processes at the cellular, tissue, and systemic levels in healthy humans. Conversely, excess ROS or RNS activity can disrupt function, impairing the performance of daily activities. This article analyzes the impact of redox mechanisms on extreme task performance. Such activities (a) require complex motor skills, (b) are physically demanding, (c) are performed in an extreme environment, (d) require high-level executive function, and (e) pose an imminent risk of injury or death. The current analysis utilizes race car driving as a representative example. The physiological challenges of this extreme task include physical exertion, g loading, vibration, heat exposure, dehydration, noise, mental demands, and emotional factors. Each of these challenges stimulates ROS signaling, RNS signaling, or both, alters redox homeostasis, and exerts pro-oxidant effects at either the tissue or systemic levels. These redox mechanisms appear to promote physiological stress during race car driving and impair the performance of driver athletes.
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Affiliation(s)
- Michael B Reid
- College of Health and Human Performance, University of Florida, Gainesville, FL 32611, USA
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Applicability of Physiological Monitoring Systems within Occupational Groups: A Systematic Review. SENSORS 2021; 21:s21217249. [PMID: 34770556 PMCID: PMC8587311 DOI: 10.3390/s21217249] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 10/24/2021] [Accepted: 10/25/2021] [Indexed: 12/17/2022]
Abstract
The emergence of physiological monitoring technologies has produced exceptional opportunities for real-time collection and analysis of workers' physiological information. To benefit from these safety and health prognostic opportunities, research efforts have explored the applicability of these devices to control workers' wellbeing levels during occupational activities. A systematic review is proposed to summarise up-to-date progress in applying physiological monitoring systems for occupational groups. Adhering with the PRISMA Statement, five databases were searched from 2014 to 2021, and 12 keywords were combined, concluding with the selection of 38 articles. Sources of risk of bias were assessed regarding randomisation procedures, selective outcome reporting and generalisability of results. Assessment procedures involving non-invasive methods applied with health and safety-related goals were filtered. Working-age participants from homogeneous occupational groups were selected, with these groups primarily including firefighters and construction workers. Research objectives were mainly directed to assess heat stress and physiological workload demands. Heart rate related variables, thermal responses and motion tracking through accelerometry were the most common approaches. Overall, wearable sensors proved to be valid tools for assessing physiological status in working environments. Future research should focus on conducting sensor fusion assessments, engaging wearables in real-time evaluation methods and giving continuous feedback to workers and practitioners.
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Bonell A, Nadjm B, Samateh T, Badjie J, Perry-Thomas R, Forrest K, Prentice AM, Maxwell NS. Impact of Personal Cooling on Performance, Comfort and Heat Strain of Healthcare Workers in PPE, a Study From West Africa. Front Public Health 2021; 9:712481. [PMID: 34540787 PMCID: PMC8440920 DOI: 10.3389/fpubh.2021.712481] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 08/10/2021] [Indexed: 01/25/2023] Open
Abstract
Background: Personal protective equipment (PPE) is an essential component of safely treating suspected or confirmed SARS-CoV-2 patients. PPE acts as a barrier to heat loss, therefore increasing the risk of thermal strain which may impact on cognitive function. Healthcare workers (HCWs) need to be able to prioritize and execute complex tasks effectively to ensure patient safety. This study evaluated pre-cooling and per-cooling methods on thermal strain, thermal comfort and cognitive function during simulated emergency management of an acutely unwell patient. Methods: This randomized controlled crossover trial was run at the Clinical Services Department of the Medical Research Unit The Gambia. Each participant attended two sessions (Cool and Control) in standard PPE. Cool involved pre-cooling with an ice slurry ingestion and per-cooling by wearing an ice-vest external to PPE. Results: Twelve participants completed both sessions. There was a significant increase in tympanic temperature in Control sessions at both 1 and 2 h in PPE (p = 0.01). No significant increase was seen during Cool. Effect estimate of Cool was -0.2°C (95% CI -0.43; 0.01, p = 0.06) post 1 h and -0.28°C (95% CI -0.57; 0.02, p = 0.06) post 2 h on tympanic temperature. Cool improved thermal comfort (p < 0.001), thermal sensation (p < 0.001), and thirst (p = 0.04). No difference on cognitive function was demonstrated using multilevel modeling. Discussion: Thermal strain in HCWs wearing PPE can be safely reduced using pre- and per-cooling methods external to PPE.
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Affiliation(s)
- Ana Bonell
- Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Banjul, Gambia
- Centre on Climate Change and Planetary Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Behzad Nadjm
- Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Banjul, Gambia
| | - Tida Samateh
- Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Banjul, Gambia
| | - Jainaba Badjie
- Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Banjul, Gambia
| | - Robyn Perry-Thomas
- Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Banjul, Gambia
| | - Karen Forrest
- Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Banjul, Gambia
| | - Andrew M. Prentice
- Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Banjul, Gambia
| | - Neil S. Maxwell
- Environmental Extremes Laboratory, University of Brighton, Eastbourne, United Kingdom
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The Effects of a Passive Exoskeleton on Human Thermal Responses in Temperate and Cold Environments. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18083889. [PMID: 33917655 PMCID: PMC8067969 DOI: 10.3390/ijerph18083889] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 03/29/2021] [Accepted: 03/30/2021] [Indexed: 11/17/2022]
Abstract
The exoskeleton as functional wearable equipment has been increasingly used in working environments. However, the effects of wearing an exoskeleton on human thermal responses are still unknown. In this study, 10 male package handlers were exposed to 10 °C (COLD) and 25 °C (TEMP) ambient temperatures while performing a 10 kg lifting task (LIFTING) and sedentary (REST) both with (EXO) and without the exoskeleton (WEXO). Thermal responses, including the metabolic rate and mean skin temperature (MST), were continuously measured. Thermal comfort, thermal sensation and sweat feeling were also recorded. For LIFTING, metabolic heat production is significant decrease with the exoskeleton support. The MST and thermal sensation significantly increase when wearing the exoskeleton, but thermal discomfort and sweating are only aggravated in TEMP. For REST, MST and thermal sensation are also increased by the exoskeleton, and there is no significant difference in the metabolic rate between EXO and WEXO. The thermal comfort is significantly improved by wearing the exoskeleton only in COLD. The results suggest that the passive exoskeleton increases the local clothing insulation, and the way of wearing reduces the “pumping effect”, which makes a difference in the thermal response between COLD and TEMP. Designers need to develop appropriate usage strategies according to the operative temperature.
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Byrne J, Ludington-Hoe SM. Theory of heat stress management: Development and application in the operating room. J Adv Nurs 2020; 77:1218-1227. [PMID: 33314328 DOI: 10.1111/jan.14668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 10/14/2020] [Accepted: 11/06/2020] [Indexed: 11/26/2022]
Abstract
AIM The Theory of Heat Stress Management addresses the phenomenon of occupational heat stress and applies the theory to surgical staff wearing personal protective equipment while performing surgery. This discussion paper relates development of the prescriptive middle range theory of heat stress management to inform and advance research and provide evidence to support new standards of care in clinical nursing practice. DESIGN The prescriptive middle range theory was developed by summarizing essential elements of the theory, describing the linkages among the dimensions of the theory, enumerating nursing interventions and physiological, psychological and cognitive outcomes, stating relevant assumptions, defining and identifying relationships between the concepts of heat stress management in observable and measurable terms. DATA SOURCES This discussion paper is based on the first author's experiences with occupational heat stress, observed improvements in surgical personnel's thermal comfort by using a cooling intervention and knowledge gained from an extensive integrated literature review and ongoing clinical research. IMPLICATIONS FOR NURSING The middle range theory was developed to create awareness of the impact heat stress has on the health and well-being of all healthcare personnel at risk for heat stress due to wearing personal protective equipment. Nurses need to recognize individuals in thermally stressful environments, evaluate and monitor individuals' physiological and psychological responses and promote comfort by providing interventions to alleviate occupational heat stress. CONCLUSION The Theory of Heat Stress Management combines dimensions specific to heat stress affecting surgical staff and provides a perspective that facilitates knowledge development, can enhance nursing practice and support exploration of the linkages and prescriptions of the theory through research. IMPACT The predictive middle-range Theory of Heat Stress Management will guide nurses to promote the health and well-being of healthcare workers and influence and improve clinical nursing practice, education, and research related to heat stress management.
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Affiliation(s)
- Jill Byrne
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, USA
| | - Susan M Ludington-Hoe
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, USA
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Chang KH, Chen YL, Dai SY. A Combined Tie-Fastening Method for the Reusable Surgical Gown with Two Neck Tie Belts to Improve Wearing Comfort. NURSING REPORTS 2020; 10:75-81. [PMID: 34968352 PMCID: PMC8608108 DOI: 10.3390/nursrep10020011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 11/11/2020] [Accepted: 11/12/2020] [Indexed: 11/16/2022] Open
Abstract
The reusable surgical gowns made of slippery materials have the tendency to slip down as they are being worn. The rear neck tie(s) can sometimes loosen, and this causes the surgical gown to slip down somewhat, making the surgical staff members feel uncomfortable. If the gowns have two rear neck ties with a tendency of loosening and allowing the gowns to slip down, the surgical staff members feel more uncomfortable when there is only one tie loosening but the other tie is tethering. To fasten the neck ties of the surgical gown with two neck tie belts, we propose a simplified method of fastening the two sets of tie belts together as one tie, instead of fastening them separately. The object of this study is to evaluate this combined tying method for its ability to secure the gown and its wearing comfort. We enrolled five volunteers to evaluate the tie loosening condition of the reusable surgical gowns with two sets of rear neck tie belts after a series of upper limb motion exercises while wearing and not wearing the X-ray protective apron beneath the gown. The amount of uppermost rear neck cloth edge separation was recorded before and after the exercise. We also evaluated the wearing comfort of five enrolled operating surgeons for comparing the original and this modified tying method while wearing and not wearing the X-ray protective apron. In the results, we found that combined tying tends to have significantly more rear gown separation (0.94 cm) than separate tying (0.27 cm) after vigorous upper extremities exercise. However, during the actual performance of the surgeries, the rear neck tie(s) loosening and wearing discomfort of the combined tying method was significantly less than using the separate tying method (loosening: 0% vs. 30%) (discomfort: 0% vs. 35%) while the X-ray protective apron was not worn. For reusable surgical gowns that have two rear neck ties, we suggest the two sets of rear neck ties could be fastened together as one combined tie in routine surgical practice. With this, tying could be performed easier and faster, and wearing comfort could be improved.
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Affiliation(s)
| | | | - Shu-Yi Dai
- Correspondence: ; Tel.: +886-5-2765041; Fax: +886-5-2765621
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