Thermal effects on cognition: a new quantitative synthesis

Prevalence of occupational heat stress across the seasons and its management amongst healthcare professionals in the UK

Occupational heat stress (OHS) is an issue in healthcare facilities (HCFs) in the United Kingdom (UK). The aims of this study were to evaluate perceived levels of OHS during two seasons and its perceived consequences on healthcare professionals (HCPs) and to assess the efficacy of heat stress management (HSM) policies. An anonymous online survey was distributed to HCPs working in HCFs in the UK. The survey returned 1014 responses (87% women). Descriptive statistics and content analysis of survey data identified that OHS in HCFs is frequently experienced throughout the year and concerned most HCPs. Over 90% perceived OHS impairs their performance and 20% reported heat-related absenteeism. Awareness of HSM policies was poor and 73% deemed them not adequate. To help reduce the financial loss and impact on staff performance, health and well-being and patient safety, it is recommended that revisions and widespread dissemination of HSM policies are made.

Risk of Dehydration Due to Sweating While Wearing Personal 2 Protective Equipment in COVID-19 Clinical Care: A Pilot Study

Objective: The objectives of this study were (a) to determine the physical impact of the personal protective equipment (PPE) used in COVID-19 care, specifically the impact on the hydration state of the temperature and the comfort of the healthcare workers who use it, and (b) to show the high-fidelity simulated environment as an appropriate place to test the experimental designs to be developed in real environments for COVID-19. Background: All healthcare staff use full PPE in the care of COVID-19 patients. There are problems, such as excessive sweating, which have not been quantified thus far. Methods: A descriptive pilot design was used in a simulated high-fidelity setting. There was paired activity, with mild–moderate physical activity, between 45 and 60 min continuously, with the COVID-19 PPE. Sixteen intensive care nurses were selected. The before–after differential of weight, thirst, weight use of the PPE, body temperature, thermal body image, general and facial warmth sensation, and perspiration sensation were measured. Results: All subjects lost weight in the form of sweat with both PPEs during the simulation scenario, with a mean of 200 g (0.28% of initial weight), and increased thirst sensation. Body thermal image increased by 0.54 °C in people using the full COVID-19 PPE. Conclusions: The use of PPE in the management of critically ill COVID-19 patients generates weight loss related to excessive sweating. The weight loss shown in this pilot test is far from the clinical limits of dehydration. The use of ventilated PPE, such as PAPR, reduce the body temperature and heat sensation experienced by the users of it; at the same time, it improves the comfort of those who wear it. The simulated environment is a suitable place to develop the piloting of applicable research methodologies in future studies in a real environment.

The Impact of Thermal Stress on Cognition and the Use of Cooling Wear for Alleviation - an Explorative Study

Increased ambient temperatures during the care of severely burned patients are essential for mitigating hypothermia and minimizing the impact of the consecutive hypermetabolism. For involved medical staff, those conditions may lead to impaired concentration, possibly negatively affecting an optimal patient care. Yet, alleviation strategies are lacking. As a novel coping strategy, cooling wear may be an effective means. This explorative study aimed to investigate the effect of high ambient temperatures on the concentration capacity and cooling wear to alleviate thermal stress. The effects of high ambient temperatures and the additional use of cooling wear on the concentration capacity of medical staff were investigated in six subjects during two simulated burn surgeries. Each individual served as his/her own control undergoing one simulation with and one without cooling wear. Concentration capacity was measured before and after each simulation with a standardized test. The results suggested that high ambient temperatures, as used in burn medicine, negatively affect human concentration capacity. The initial assessment of concentration capacity yielded homogenous values. After heat exposure, subjects wearing cooling wear showed a higher concentration capacity and a lower error rate compared to subjects without cooling wear. Summing up, temperature-related decrements in vigilance and performance among medical personnel may impair the patients' outcome. As an opportunity to withstand thermal stress and improve medical care and safety, cooling wear showed promising results and may be used as heat alleviator. Burn medicine may particularly benefit from further development and rigorous investigation of cooling strategies.

Personal protective equipment in the COVID-19 pandemic and the use of cooling-wear as alleviator of thermal stress : A pilot study in plastic surgery staff members

Background

High temperatures at workplaces lead to health-related risks and premature exhaustion. The coronavirus disease 2019 (COVID-19) pandemic requires many health professionals to perform under unfavorable conditions. Personal protective equipment (PPE) causes thermal stress and negatively affects performance.

Patients, materials and methods

This pilot project investigated the effects of PPE and additional cooling wear on physiological parameters and concentration of six healthy staff members of the Plastic Surgery Department of the Medical University of Graz, Austria during simulated patient care. In this study two 1‑hour cycles with patient care-related tasks with PPE and PPE + cooling-wear, respectively, were conducted. A third cycle with scrubs exclusively served as baseline/negative control. The assessment occurred immediately pre-cycles and post-cycles.

Results

Pre-cycle assessments showed no significant differences between the cycles. After PPE cycle, increased physical stress levels and decrements in concentration capacity were observed. Physiological parameters were significantly less affected in the cooling cycle, while concentration capacity slightly increased.

Conclusion

COVID-19 PPE causes considerable thermal stress, ultimately affecting human performance. As opportunity to withstand thermal stress, and improve patients’ and professionals’ safety, cooling-wear can be considered relevant. Medical personnel performing in exceptional situations may particularly benefit from further development and investigation of cooling strategies.

Specifying and Mitigating Thermal Stress Effects on Cognition During Personal Protective Equipment Use

OBJECTIVE

To report present understanding concerning selected task and environmental factors influencing the changing performance capacity associated with use of personal protective equipment (PPE).

BACKGROUND

Much knowledge is available concerning change in complex cognitive capacities under the effects of thermal stress. Our science can inform critical care facilities as to remediation strategies such as work-rest schedules to minimize performance error in highly cognitively demanding circumstances such as intensive care units.

METHOD

The present exposition draws from the state-of-the-art understanding concerning thermal stress effects on cognition and workload in complex and demanding tasks.

RESULTS

The summation and synthesis of HF/E findings provides important insights into combinatorial effects of forms of stress, typically dealt with only as discrete sources in traditional standards and regulations. The identified interaction between ascending thermal stress and cognitive task demand provides an instance of the plurality of ways HF/E can specify performance limitations in safety-critical circumstances, as witnessed in the current pandemic.

CONCLUSION

Accumulated HF/E insights provide systematic ways in which to address and ameliorate the combined forces of physical and cognitive stress on medical personnel constrained to use varying forms of PPE. These principles extend beyond this specific domain to all who are required to work in differential and isolated microclimates.

APPLICATION

To minimize the possibility of critical and life-threatening error in intensive care facilities which necessitate PPE use, we need principled work-rest ratio and heat stress mitigation guidance. To promote health, we need to champion healthy work practices in our health workers. HF/E insights can help achieve this important goal.

Diminishing Cognitive Capacities in an Ever Hotter World: Evidence From an Applicable Power-Law Description

OBJECTIVE

Modeling and evaluating a series of power law descriptions for boundary conditions of undiminished cognitive capacities under thermal stress.

BACKGROUND

Thermal stress degrades cognition, but precisely which components are affected, and to what degree, has yet to be fully determined. With increasing global temperatures, this need is becoming urgent. Power-law distributions have proven their utility in describing differing natural mechanisms, including certain orders of human performance, but never as a rationalization of stress-altered states of attention.

METHOD

From a survey of extant empirical data, absolute thresholds for thermal tolerance for varying forms of cognition were identified. These thresholds were then modeled using a rational power-law description. The implications of the veracity of that description were then identified and analyzed.

RESULTS

Cognitive performance thresholds under thermal stress are advanced as power-law relationships, t = f(T) = c[(T - T_ref)/T_ref]^-α. Coherent scaling parameters for diverse cognitive functionalities are specified that are consistent with increases in deep (core) body temperature. Therefore, scale invariance provides a "universal constant," viz, 20% detriment in mental performance per 10% increase in T deviation, from a comfortable reference temperature T_ref.

CONCLUSION

We know the thermal range within which humans can survive is quite narrow. The presented power-law descriptions imply that if making correct decisions is critical for our future existence, then our functional thermal limits could be much more restricted than previously thought.

APPLICATION

We provide our present findings, such that others can both assess and mitigate the effects of adverse thermal loads on cognition, in whatever human scenario they occur.

The Effects of Hydration Status on Cognitive Performances among Young Adults in Hebei, China: A Randomized Controlled Trial (RCT)

Background: Dehydration may affect cognitive performances as water accounts for 75% of brain mass. The purpose of this study is to investigate the effects of dehydration and water supplementation on cognitive performances, and to explore the changes of brain structures and functions using MRI. Methods and Analysis: A double-blinded randomized controlled trial has been designed and will be implemented among 64 college students aged 18⁻23 years from Baoding, China. Subjects will be asked to restrict water for 36 h. The first morning urine will be collected and urine osmolality measured. The fasting blood samples will be collected and osmolality and copeptin will be measured. Three MRI sequences, including fMRI, ASL and 3D BRAVO will be taken to observe the changes of whole brain volume, ventricular volume, BOLD response and the cortex thickness. Cognitive performances and mood will be performed with software and questionnaires, respectively. Subjects in the water supplementation groups 1, 2, 3 will drink 200, 500 and 1000 mL of water, respectively, while subjects in the no water supplementation group will not drink any water. After 90 min, urine and blood samples, MRI scans, cognitive performances and mood will be performed. One-way ANOVA will be used to study the differences among groups. Ethics and Dissemination: The study protocol has been approved by the Peking University Institutional Review Committee. Ethical approval project identification code is IRB00001052-16071. Results will be published according to the CONSORT statement and will be reported in peer-reviewed journals.

Cold-Blooded Attention: Finger Temperature Predicts Attentional Performance

Thermal stress has been shown to increase the chances of unsafe behavior during industrial and driving performances due to reductions in mental and attentional resources. Nonetheless, establishing appropriate safety standards regarding environmental temperature has been a major problem, as modulations are also be affected by the task type, complexity, workload, duration, and previous experience with the task. To bypass this attentional and thermoregulatory problem, we focused on the body rather than environmental temperature. Specifically, we measured tympanic, forehead, finger and environmental temperatures accompanied by a battery of attentional tasks. We considered a 10 min baseline period wherein subjects were instructed to sit and relax, followed by three attentional tasks: a continuous performance task (CPT), a flanker task (FT) and a counting task (CT). Using multiple linear regression models, we evaluated which variable(s) were the best predictors of performance. The results showed a decrement in finger temperature due to instruction and task engagement that was absent when the subject was instructed to relax. No changes were observed in tympanic or forehead temperatures, while the environmental temperature remained almost constant for each subject. Specifically, the magnitude of the change in finger temperature was the best predictor of performance in all three attentional tasks. The results presented here suggest that finger temperature can be used as a predictor of alertness, as it predicted performance in attentional tasks better than environmental temperature. These findings strongly support that peripheral temperature can be used as a tool to prevent unsafe behaviors and accidents.