Heat strain of Japanese firefighters wearing personal protective equipment: a review for developing a test method

The aim of this review was to develop a test method for the evaluation of heat strain for structural firefighters wearing personal protective equipment (PPE) in Japan. We analysed a series of our laboratory's questionnaires and experimental studies and reviewed international standards on test methods. We investigated the actual average working conditions (total firefighting time on one incidence, working time with full PPE, maximum temperature and humidity during firefighting) at structural firefighting site in Japan by conducting a large-scale questionnaire survey of Japanese firefighters. We discussed test subjects (firefighters vs. non-firefighters; body size; physical fitness), exercise intensity (absolutes vs. relative; light vs. heavy) and duration, experimental temperature and relative humidity, experimental clothing items including station uniforms (shorts vs. long), and measurement variables (physiological and subjective responses), and suggested a standard test method to evaluate the heat strain of firefighters in hot and humid environments.Practitioner summary: We reviewed studies on human wear trials of firefighting personal protective equipment (PPE) in hot environments and suggested a standard test method to evaluate the heat strain of firefighters. The test method can be internationally utilised to examine the comfort functions and heat stress of PPE in hot, humid environments.

Human Disease/Clinical Medical Sciences in Dentistry: Current state and future directions of undergraduate teaching in the UK and Ireland

In March 2017, a group of teachers of human disease/clinical medical science (HD/CMSD) representing the majority of schools from around the UK and Republic of Ireland met to discuss the current state of teaching of human disease and also to discuss how the delivery of this theme might evolve to inform improved healthcare. This study outlines how the original teaching in medicine and surgery to dental undergraduate students has developed into the theme of HD/CMSD reflecting changing needs as well as guidance from the regulators, and how different dental schools have developed their approaches to reach their current state. Each school was also asked to share a strengths, weakness, opportunities and threats (SWOT) analysis of their programme and to outline how they thought their HD/CMSD programme may develop. The school representatives who coordinate the delivery and assessment of HD/CMSD in the undergraduate curriculum have extensive insight in this area and are well-placed to shape the HD/CMSD development for the future.

Comparison of firefighters and non-firefighters and the test methods used regarding the effects of personal protective equipment on individual mobility

The aims of this study were 1) to evaluate the current pilot test method and ascertain reliable measurements for a standard test method of mobility with personal protective equipment (PPE), such as physical performance and balance ability tests; 2) to compare two participant groups (firefighters versus non-firefighters) and to investigate whether non-firefighters are appropriate as a standard participant group in the field of PPE or not. Totally, 18 participants (nine professional firefighters and nine untrained males) performed the current pilot test method consisting of a balance test, completed prior to and after a performance test. Significant differences were found between PPE conditions and CON (the control clothing ensemble: T-shirt, shorts, and running shoes) for the functional balance test, physical performance test, heart rate, and subjective evaluations in firefighters group. Therefore, the present pilot test method is valid as a standard test method for assessing mobility while wearing PPE. Moreover, the present result shows that firefighters are more reliable than non-firefighters in testing of PPE with current test methods.

Treatment of the edentulous atrophic maxilla using zygomatic implants: evaluation of survival rates over 5-10 years

The aim of this retrospective observational cohort study was to analyse and report the 5-10-year survival rates of endosseous zygomatic implants used in the rehabilitation of the atrophic maxilla. Forty-three consecutive zygomatic implant placements in 25 patients were evaluated over a 5-10-year period. All zygomatic implant surgery was carried out under general anaesthesia. Nobel Biocare zygomatic machined-surface implants were used, and placement was undertaken using the modified sinus slot method. The main outcome measures and determinants for success were survival of the restored implants and the proportion of originally planned prostheses delivered to patients. Of the 25 patients treated, 12 were male and 13 were female; 19 were non-smokers, and the mean age at time of surgery was 64 years. Patients were treatment-planned for implant-retained bridgework, a removable prosthesis retained by fixed cast gold or milled titanium beams, or magnet-retained removable prostheses. A combination of zygomatic and conventional implants was used in all but one patient. In this study it was shown that the overall success rate for zygomatic implants was 86%, with six of the implants either failing to integrate or requiring removal due to persistent infection associated with the maxillary sinus. All patients received their planned prosthesis, although in six cases the method of retention required modification. This study illustrates that zygomatic implants are a successful and important treatment option when trying to restore the atrophic maxilla, with the potential to avoid additional augmentation/grafting procedures and resulting in a high long-term success rate.

The impact of firefighter personal protective equipment and treadmill protocol on maximal oxygen uptake

This study investigated the effects of firefighter personal protective equipment (PPE) on the determination of maximal oxygen uptake (VO(2max)) while using two different treadmill protocols: a progressive incline protocol (PIP) and a progressive speed protocol (PSP), with three clothing conditions (Light-light clothing; Boots-PPE with rubber boots; Shoes-PPE with running shoes). Bruce protocol with Light was performed for a reference test. Results showed there was no difference in VO(2max) between Bruce Light, PIP Light, and PSP Light. However, VO(2max) was reduced in Boots and Shoes with shortened maximal performance time (7 and 6 min reduced for PIP Boots and Shoes, respectively; 11 and 9 min reduced for PSP Boots and Shoes, respectively), whereas the increasing rate of VO(2) in Boots and Shoes during submaximal exercise was greater compared with Light. Wearing firefighter boots compared with wearing running shoes also significantly affected submaximal VO(2) but not VO(2max). These results suggest that firefighters' maximal performance determined from a typical VO(2max) test without wearing PPE may overestimate the actual performance capability of firefighters wearing PPE.

The use of language to express thermal sensation suggests heat acclimatization by Indonesian people

The purpose of this study was to explore whether there is evidence of heat acclimatization in the words used to express thermal sensation. A total of 458 urban Japanese and 601 Indonesians participated in a questionnaire. In addition, in a preliminary survey, 39 native English speakers in the UK participated. Our results showed that (1) for Indonesians, the closest thermal descriptor of a feeling of thermal comfort was 'cool' (75%) followed by 'slightly cool' (7%), 'slightly cold' (5%) and 'cold' (5%), while Japanese responses were distributed uniformly among descriptors 'cool', 'slightly cool', 'neither', 'slightly warm', and 'warm'; (2) the closest thermal descriptors of a feeling of discomfort for Indonesians were less affected by individual thermal susceptibility (vulnerability) than those for Japanese; (3) in the cases where 'cool' and 'slightly cold' were imagined in the mind, the descriptors were cognized as a thermal comfortable feeling by 97% and 57% of Indonesians, respectively; (4) the most frequently voted choice endorsing hot weather was 'higher than 32°C' for Indonesians and 'higher than 29°C' for Japanese respondents; for cold weather, 'lower than 15°C' for Japanese and 'lower than 20°C' for Indonesians. In summary, the descriptor 'cool' in Indonesians connotes a thermally comfortable feeling, but the inter-zone between hot and cold weather that was judged in the mind showed a upward shift when compared to that of Japanese. It is suggested that linguistic heat acclimatization exists on a cognitive level for Indonesians and is preserved in the words of thermal descriptors.

Effects of firefighters' self-contained breathing apparatus' weight and its harness design on the physiological and subjective responses

To examine the effects of firefighters' self-contained breathing apparatus' (SCBA) weight and its harness design on the physiological and subjective responses, eight male students performed treadmill exercise under four conditions: the 8 kg firefighter protective clothing (PC) (Control), the PC + an 11 kg SCBA with an old harness (Test A), the PC + a 6.4 kg SCBA with an old harness (Test B) and the PC + a 6.4 kg SCBA with a new harness (Test C), at ambient temperatures (T(a)) of 22°C and 32°C. Besides highlighting the fact that a heavy SCBA had a significant effect on the oxygen consumption and metabolic rate, this experiment also found that in a T(a) of 32°C, in particular, the combined effect of 4.7 kg lighter SCBA and new harness design could reduce metabolic rate and improved subjective muscle fatigue and thermal discomfort.

PRACTITIONER SUMMARY

An effort to alleviate the physiological and subjective burden of firefighters by reducing the weight of SCBA and by using the new harness design has provided satisfactory results in reduced oxygen consumption and in improved subjective responses in a hot air environment.

Validity of infrared tympanic temperature for the evaluation of heat strain while wearing impermeable protective clothing in hot environments

The purpose of this study was to investigate the validity of infrared tympanic temperature (IR T(ty)) as a thermal index to evaluate the heat strain of workers in hot environments, in comparison with rectal temperatures at various depths (T(re-4, -8, and -16) for 4, 8 and 16 cm from the anal sphincter). Eight males underwent twelve experimental conditions: two activities (rest and exercise) × three clothing levels [Control, HDPE (high-density polyethylene coverall) and PVC (polyvinyl chloride coverall) condition] × two air temperatures (25 and 32℃ with 50%RH). The results showed that 1) in the conditions with most heat strain (HDPE or PVC condition at 32℃), IR T(ty) was equal to or even higher than T(re); 2) during exercise, physiological strain index (PSI) using IR T(ty) did not underestimate PSI-values using T(re-16), and overestimated those PSI-values from T(re-16) in HDPE and PVC conditions at 32℃; 3) during exercise, the relationships between IR T(ty) and heart and total sweat rate were stronger than those between T(re-16) and heart and total sweat rate. These results indicated that IR T(ty) is valid as a thermal index to evaluate the heat strain of workers wearing impermeable protective coveralls in hot environments. However, the application of IR T(ty) is limited only for strenuous works wearing encapsulated personal protective clothing with a hood in heat.

CT diagnosis of synovial chondromatosis of the temporomandibular joint

Synovial chondromatosis of the temporomandibular joint (TMJ) is a very rare condition. It is characterised by the presence of loose bodies in the joint space. Clinical signs, histopathological findings and radiography play an important role in the diagnostic process. Conventional X-rays have shown to be of limited value, for they fail to depict the intra-articular loose bodies in a significant amount of cases. Axial as well as coronal computer tomography (CT) is extremely useful in detecting loose bodies in the temporomandibular joint (TMJ). In this report we present and discuss a further case, and the use of CT in the diagnosis of TMJ-synovial chondromatosis is illustrated.