Estimating metabolic rate from International Organization for Standardization heart rate method and two walking equations

Assigning a value for metabolic rate is central to heat stress assessment. ISO 8996 describes a predictive method for walking based on the American College of Sports Medicine (ACSM) method and another generalized method based on average heart rate. In addition, the US Army uses the load carriage decision aid (LCDA) predictive equation to estimate metabolic rate. The purpose of this study was to assess the accuracy/bias and precision of the ISO heart rate method and the ACSM and LCDA equations. The laboratory database included metabolic rate, heart rate, treadmill speed, and grade during a progressive heat stress protocol. Treadmill speed and grade were set to represent one of three metabolic rates. Accuracy and precision were assessed with Bland-Altman plots. All three methods had good accuracy (low bias). For precision, the ISO heart rate method had a root mean square error (RMSE) of 34 W and 11% when adjusted for repeated measures. The RMSE for two equations was 20 W and 7%. Although the heart method had less accuracy, its application is more generalizable. The heart rate method should be used below the occupational exposure limit to avoid a bias toward higher predicted values due to heat strain.

A Novel Conceptual Model for Human Heat Tolerance

Human "heat tolerance" has no accepted definition or physiological underpinnings; rather, it is almost always discussed in relative or comparative terms. We propose to use environmental limits to heat balance accounting for metabolic rate and clothing, that is, the environments for which heat stress becomes uncompensable for a specified metabolic rate and clothing, as a novel metric for quantifying heat tolerance.

Distribution of upper limit of the prescriptive zone values for acclimatized and unacclimatized individuals

Heat stress has an adverse impact on worker health and well-being, and the effects will increase with more frequent and severe heat events associated with global warming. Acclimatization to heat stress is widely considered to be a critical mitigation strategy and wet bulb globe temperature- (WBGT-) based occupational standards and guidelines contain adjustments for acclimatization. The purpose here was to 1) compare the mean values for the upper limit of the prescriptive zone (ULPZ, below which the rise in core temperature is minimal) between unacclimatized and acclimatized men and women; 2) demonstrate that the change in the occupational exposure limit (ΔOEL) due to acclimatization is independent of metabolic rate; 3) examine the relation between ΔOEL and body surface area (BSA); and 4) compare the exposure-response curves between unacclimatized and acclimatized populations. Empirically derived ULPZ data for unacclimatized participants from Pennsylvania State University (PSU) and acclimatized participants from University of South Florida (USF) were used to explore the difference between unacclimatized and acclimatized heat exposure limits. The findings provide support for a constant 3°C WBGT OEL decrease to account for unacclimatized workers. Body surface area explained part of the difference in ULPZ values between men and women. In addition, the pooled PSU and USF data provide insight into the distribution of individual values for the ULPZ among young, healthy unacclimatized and acclimatized populations in support of occupational heat stress guidelines.NEW & NOTEWORTHY Occupational exposure limit guidelines using wet bulb globe temperature (WBGT) distinguish between acclimatized and unacclimatized workers with about a 3°C difference between them. For the first time, empirical data from two laboratories provide support for acclimatization state adjustments. Using a constant difference rather than increasing differences with metabolic rate better describes the limit for unacclimatized participants. Furthermore, the lower upper limit of the prescriptive zone (ULPZ) values set forth for women do not relate to fitness level but are partly explained by their smaller body surface area (BSA). An examination of individual ULPZ values suggests that many unacclimatized individuals should be able to sustain safe work at the exposure limit for acclimatized workers.

Core temperature and heart rate at the upper limit of the prescriptive zone

The expressed goal of limiting workplace heat stress exposures to a core temperature (Tc ) of 38°C traces back to a 1969 World Health Organization Technical Report (WHO Series 412). The actual goal was to limit exposures to the upper limit of the prescriptive zone (ULPZ). To explore the physiological strain at the ULPZ, progressive heat stress protocol data from Penn State University (PSU) and University of South Florida (USF) below and at the ULPZ were used to articulate the relation of Tc and heart rate (HR) to metabolic rate (MR) with consideration of acclimatization state, clothing, exposure condition (PreULPZ vs. ULPZ), and sex. Regression models demonstrated the association of MR and sex with Tc and HR. At the ULPZ, women had systematically higher values of Tc and HR than men at the same MR likely due to higher relative demands. There was no effect for acclimatization state and clothing. As expected for individuals, Tc was practically constant below the ULPZ and HR exhibited increasing values approaching the ULPZ. At 490 W, the high MR cited in the WHO document, the mean Tc for men was near the 38°C limit with systematically lower Tc at lower MRs.

Group Outcomes for Time-Weighted Averaging in WBGT-Based Heat Stress Exposure Assessment

The wet bulb globe temperature (WBGT)-based occupational exposure limits (OELs) were developed from steady exposures to heat stress at constant WBGT and metabolic rate (M). The exposure limits were based on compensable heat stress exposures at the upper limit of the prescriptive zone for most healthy people. Professional practice allows for using time-weighted averages (TWAs) of WBGT and M to account for heterogeneous heat stress exposures. The purpose of the current paper was to report on the effectiveness of time-weighted averaging to assess occupational heat stress using published studies. Our hypothesis was using TWA-WBGT and TWA-M was as protective as the recommended OELs for steady exposures. The current paper reports on 62 observations of work that alternate between at least two heat stress conditions (usually work and recovery) reported in 16 papers. The TWA-WBGT and TWA-M were determined for all observations. ΔLimit was the observed TWA-WBGT minus the exposure limit at the TWA-M based on acclimatization state. The observations were then classified as above or below ΔLimit = 0. Each observation was also classified as uncompensable if the mean core temperature for the group was greater than 38°C or a less tolerant individual was above 38.5°C. When comparing exposure classifications to outcome classifications using 2 × 2 tables, the sensitivity and specificity for all observations were 0.72 and 0.73, respectively. The sensitivity was much less than the expected value near 1.0, and the large difference called into question the ability of TWAs to represent actual heat stress. There was some suspicion that there were differences between acclimatized and unacclimatized observations. Before any of these findings are embedded in policy or practice, a more careful evaluation of TWAs is required. In conclusion, we believe that the use of TWAs for heat stress analysis was not fully evaluated, and we proposed a framework for evaluation.

Ability of Thermal Work Limit (TWL) to Assess Sustainable Heat Stress Exposures

Thermal Work Limit (TWL) recommends a maximum metabolic rate for a given environmental condition, clothing ensemble, and acclimatization state so that thermal equilibrium can be sustained at or below the limiting metabolic rate. The purpose of this paper was to assess the ability of TWL to recommend maximum sustainable levels of heat stress using an existing database of progressive heat stress trials using four levels of clothing (woven clothing, particle barrier, water barrier, and vapor barrier), three levels of relative humidity, and three levels of metabolic rate. Each trial had a compensable and an uncompensable observation plus and observation at the transition point from compensable to uncompensable. Each observation was classified as a case (steady increase in rectal temperature) or non-case (steady rectal temperature). The data were used to compare the difference between the observed metabolic rate (Mobs) and the limiting metabolic rate of TWL (i.e., ∆LimitTWL = Mobs - TWL), where ∆LimitTWL > 0 was above the TWL limit. The sensitivity and specificity for each of the four clothing ensembles were about 0.96 and about 0.20, respectively. Logistic regression for all the data found that ∆LimitTWL, clothing, metabolic rate, and water vapor pressure were significant predictors of outcome. The ln(odds) equations for each clothing ensemble predicted a probability of an uncompensable exposure. The probability of an uncompensable outcome (case) when ∆LimitTWL = 0 was 0.14 for work clothes and particle barrier, and 0.22 for water barrier and vapor barrier. The probability of a case at ∆LimitTWL = 0 was greater than the probability of a case for the wet bulb globe temperature-based exposure limits where the probability of a case was 0.01. That is, the TWL was less restrictive than WBGT but with higher risk.

Indicators to assess physiological heat strain – Part 1: Systematic review

In a series of three companion papers published in this Journal, we identify and validate the available thermal stress indicators (TSIs). In this first paper of the series, we conducted a systematic review (registration: INPLASY202090088) to identify all TSIs and provide reliable information regarding their use (funded by EU Horizon 2020; HEAT-SHIELD). Eight databases (PubMed, Agricultural and Environmental Science Collection, Web of Science, Scopus, Embase, Russian Science Citation Index, MEDLINE, and Google Scholar) were searched from database inception to 15 April 2020. No restrictions on language or study design were applied. Of the 879 publications identified, 232 records were considered for further analysis. This search identified 340 instruments and indicators developed between 200 BC and 2019 AD. Of these, 153 are nomograms, instruments, and/or require detailed non-meteorological information, while 187 can be mathematically calculated utilizing only meteorological data. Of these meteorology-based TSIs, 127 were developed for people who are physically active, and 61 of those are eligible for use in occupational settings. Information regarding the equation, operating range, interpretation categories, required input data, as well as a free software to calculate all 187 meteorology-based TSIs is provided. The information presented in this systematic review should be adopted by those interested in performing on-site monitoring and/or big data analytics for climate services to ensure appropriate use of the meteorology-based TSIs. Studies two and three in this series of companion papers present guidance on the application and validation of these TSIs, to guide end users of these indicators for more effective use.

Heat exposure limits for young unacclimatized males and females at low and high humidity

Little is known about the separate and combined influences of humidity conditions, sex, and aerobic fitness on heat tolerance in unacclimatized males and females. The purpose of the current study was to describe heat tolerance, in terms of critical WBGT (WBGT_crit), in unacclimatized young males and females in hot-dry (HD) and warm-humid (WH) environments. Eighteen subjects (9 M/9F; 21 ± 2 yr) were tested during exercise at 30% V̇O_2max in a controlled environmental chamber. Progressive heat stress exposures were performed with either (1) constant dry-bulb temperature (T_db) of 34 and 36 °C and increasing ambient water vapor pressure (P_a) (P_crit trials; WH); or (2) constant P_a of 12 and 16 mmHg and increasing T_db (T_crit trials; HD). Chamber T_db and P_a, and subject esophageal temperature (T_es), were continuously monitored throughout each trial. After a 30-min equilibration period, progressive heat stress continued until subject heat balance could no longer be maintained and a clear rise in T_es was observed. Absolute WBGT_crit and WBGT_crit adjusted to a metabolic rate of 300 W (WBGT₃₀₀), and the difference between WBGT_crit and occupational exposure limits (OEL; ΔOEL) was assessed. WBGT_crit, WBGT₃₀₀, and ΔOEL were higher in WH compared to HD (p < 0.0001) for females but were the same between environments for males (p ≥ 0.21). WBGT_crit was higher in females compared to males in WH (p < 0.0001) but was similar between sexes in HD (p = 0.44). When controlling for metabolic rate, WBGT₃₀₀ and ΔOEL were higher in males compared to females in WH and HD (both p < 0.0001). When controlling for sex, V̇O_2max was not associated with WBGT₃₀₀ or ΔOEL for either sex (r ≤ 0.12, p ≥ 0.49). These findings suggest that WBGT_crit is higher in females compared to males in WH, but not HD, conditions. Additionally, the WBGT_crit is lower in females, but not males, in HD compared to WH conditions.

Indicators to assess physiological heat strain – Part 2: Delphi exercise

In a series of three companion papers published in this Journal, we identify and validate the available thermal stress indicators (TSIs). In this second paper of the series, we identified the criteria to consider when adopting a TSI to protect individuals who work in the heat, and we weighed their relative importance using a Delphi exercise with 20 experts. Two Delphi iterations were adequate to reach consensus within the expert panel (Cronbach's α = 0.86) for a set of 17 criteria with varying weights that should be considered when adopting a TSI to protect individuals who work in the heat. These criteria considered physiological parameters such as core/skin/mean body temperature, heart rate, and hydration status, as well as practicality, cost effectiveness, and health guidance issues. The 17 criteria were distributed across three occupational health-and-safety pillars: (i) contribution to improving occupational health (55% of total importance), (ii) mitigation of worker physiological strain (35.5% of total importance), and (iii) cost-effectiveness (9.5% of total importance). Three criteria [(i) relationship of a TSI with core temperature, (ii) having categories indicating the level of heat stress experienced by workers, and (iii) using its heat stress categories to provide recommendations for occupational safety and health] were considered significantly more important when selecting a TSI for protecting individuals who work in the heat, accumulating 37.2 percentage points. These 17 criteria allow the validation and comparison of TSIs that presently exist as well as those that may be developed in the coming years.

Benchmarking Heat Index as an occupational exposure limit for heat stress

While wet bulb globe temperature (WBGT) is the long-accepted index to represent the environmental contributions to heat stress, Heat Index (HI) is a commonly reported index and is used for heat stress guidance. The purpose of this article was to propose an HI-based heat stress exposure limit. The data came from previous progressive heat stress studies that identified the critical conditions between sustainable and unsustainable exposures. The experimental trials included five clothing ensembles at three levels each of relative humidity (rh) and metabolic rate (M). The critical Heat Index (HI_crit) was used to characterize the trial exposure. An analysis of variance (ANOVA) assessed the effects of M, clothing, and rh on HI_crit. After proposing a relationship between HI_crit and M to represent a benchmark exposure limit based on HI (called HI_bel), the ability of the proposed relationship to discriminate between Sustainable and Unsustainable conditions was assessed using receiver operating characteristics curves (ROC curves). Based on the ANOVA results, the main effects of M, rh, and clothing on HI_crit were significant; the interaction between rh and clothing was not significant. There were differences in mean HI_crit among all the ensembles. For effects of relative humidity on HI_crit, the mean HI_crit at rh at 20% was 3 °C lower than the mean values for 50% and 70%. The benchmark exposure limit from the woven clothing data was HI_bel [°C] = 49-0.026 M [W]. In terms of the ability of HI_bel to discriminate, area under the ROC curve was 0.86, which was similar to WBGT-based exposure limits. Similar in purpose for WBGT-based exposure assessment, HI clothing adjustment values (HI_cav) of 1.5 °C (particle barrier coveralls), 6 °C (water barrier coveralls), and 18.5 °C (vapor barrier coveralls) were supported. It should also be noted that the effects of the sun and lack of acclimatization were not included in this analysis; where the sun might reasonably increase the effects of the ambient HI by an additional 3.5 °C and being unacclimatized by 5.5 °C.

Ability to Discriminate Between Sustainable and Unsustainable Heat Stress Exposures-Part 1: WBGT Exposure Limits

Objectives

Heat stress exposure limits based on wet-bulb globe temperature (WBGT) were designed to limit exposures to those that could be sustained for an 8-h day using limited data from Lind in the 1960s. In general, Sustainable exposures are heat stress levels at which thermal equilibrium can be achieved, and Unsustainable exposures occur when there is a steady increase in core temperature. This paper addresses the ability of the ACGIH® Threshold Limit Value (TLV®) to differentiate between Sustainable and Unsustainable heat exposures, to propose alternative occupational exposure limits, and ask whether an adjustment for body surface area improves the exposure decision.

Methods

Two progressive heat stress studies provided data on 176 trials with 352 pairs of Sustainable and Unsustainable exposures over a range of relative humidities and metabolic rates using 29 participants wearing woven cotton clothing. To assess the discrimination ability of the TLV, the exposure metric was the difference between the observed WBGT and the TLV adjusted for metabolic rate. Conditional logistic regression models and receiver operating characteristic curves (ROC) along with ROC's area under the curve (AUC) were used. Four alternative models for an occupational exposure limit were also developed and compared to the TLV.

Results

For the TLV, the odds ratio (OR) for Unsustainable was 2.5 per 1°C-WBGT [confidence interval (CI) 2.12-2.88]. The AUC for the TLV was 0.85 (CI 0.81-0.89). For the alternative models, the ORs were also about 2.5/°C-WBGT, with AUCs between 0.84 and 0.88, which were significantly different from the TLV's AUC but have little practical difference.

Conclusions

This study (1) confirmed that the TLV is appropriate for heat stress screening; (2) demonstrated the TLV's discrimination accuracy with an ROC AUC of 0.85; and (3) established the OR of 2.5/°C-WBGT for unsustainable exposures. The TLV has high sensitivity, but its specificity is very low, which is protective. There were no important improvements with alternative exposure limits, and there was weak evidence to support metabolic rate normalized to body surface area. In sum, the TLV is protective with an appropriate margin of safety for relatively constant occupational exposures to heat stress.

Estimation of metabolic heat input for refuge alternative thermal testing and simulation

Refuge alternatives provide shelter to miners trapped underground during a disaster. Manufacturers must demonstrate that their refuge alternatives meet the U.S. Mine Safety and Health Administration (MSHA) requirements for oxygen supply, carbon dioxide removal, and management of heat from the occupants and mechanical/chemical systems. In this study, miner size and activity level were used to determine the metabolic heat rate, oxygen requirements and carbon dioxide generation that are representative of miners in a refuge situation. A convenience sample of 198 male miners was used for the distribution of current U.S. coal miners, and the composite 95th percentile height and weight were determined to be 193 cm (76 in.) and 133 kg (293 lb). The resting metabolic rate (RMR) was determined to be representative of activity level in a refuge alternative. The highest likely metabolic heat generation ranged from 113 to 134 W, depending on occupancy. The highest required oxygen supply and carbon dioxide removal were estimated to be 23 L (0.81 cu ft) of oxygen per hour per person and 20 L (0.71 cu ft) of carbon dioxide per hour per person, which means the margin of safety is 50 percent or more compared with the MSHA requirements. The information on metabolic heat generation can be used to assess refuge alternative thermal environments by testing or simulation. The required oxygen supply and carbon dioxide removal can be used to assess refuge alternative requirements.

Heat stress risk profiles for three non-woven coveralls

The ACGIH® Threshold Limit Value® (TLV®) is used to limit heat stress exposures so that most workers can maintain thermal equilibrium. That is, the TLV was set to an upper limit of Sustainable exposures for most people. This article addresses the ability of the TLV to differentiate between Sustainable and Unsustainable heat exposures for four clothing ensembles over a range of environmental factors and metabolic rates (M). The four clothing ensembles (woven clothing, and particle barrier, water barrier and vapor barrier coveralls) represented a wide range of evaporative resistances. Two progressive heat stress studies provided data on 480 trials with 1440 pairs of Sustainable and Unsustainable exposures for the clothing over three levels of relative humidity (rh) (20, 50 and 70%), three levels of metabolic rate (115, 180, and 254 Wm^-2) using 29 participants. The exposure metric was the difference between the observed wet bulb globe temperature (WBGT) and the TLV. Risk was characterized by odds ratios (ORs), Receiver Operating Characteristic (ROC) curves, and dose-response curves for the four ensembles. Conditional logistic regression models provided information on ORs. Logistic regressions were used to determine ROC curves with area under the curve (AUC), model the dose-response curve, and estimate offsets from woven clothing. The ORs were about 2.5 per 1°C-WBGT for woven clothing, particle barrier, and water barrier and for vapor barrier at 50% rh. When using the published Clothing Adjustment Values (CAVs, also known as Clothing Adjustment Factors, CAFs) or the offsets that included different values for vapor barrier based on rh, the AUC for all clothing was 0.86. When the fixed CAVs of the TLV were used, the AUC was 0.81. In conclusion, (1) ORs and the shapes of the dose-response curves for the nonwoven coveralls were similar to woven clothing, and (2) CAVs provided a robust way to account for the risk of nonwoven clothing. The robust nature of CAV extended to the exclusion of different adjustments for vapor barrier by rh.

Effects of heat stress on risk perceptions and risk taking

Exposure to extreme heat at work is a serious occupational hazard, as exposure can result in heat-related illnesses, and it has been linked to increased risk of accidents and injuries. The current study aimed to examine whether heat exposure is related to changes in individuals' psychological process of risk evaluation, and whether acclimatization can mitigate the effect of heat exposure. A study with quasi-experiment research design was used to compare participants' risk perceptions and risk-taking behaviors at baseline, initial exposure to heat, and exposure after acclimatization across male participants who were exposed to heat (N = 6), and males (N = 5) and females (N = 6) who were in the control group who were exposed to ambient temperature. Results show that participants perceived the same risky behaviors to be less risky (p = 0.003) and demonstrated increased risk-taking behaviors (p = 0.001) after initial heat exposure. While their risk perceptions returned to baseline level after acclimatization, their risk-taking behaviors remained heightened (p = 0.031). Participants who were not exposed to heat showed no significant fluctuation in their risk perceptions and risk-taking. Our findings support that risk-related processes may explain the effects of heat exposure on increased accidents and injuries beyond its direct impact on heat-related illnesses.

Ability to Discriminate Between Sustainable and Unsustainable Heat Stress Exposures-Part 2: Physiological Indicators

Objectives

There are times when it is not practical to assess heat stress using environmental metrics and metabolic rate, and heat strain may provide an alternative approach. Heat strain indicators have been used for decades as tools for monitoring physiological responses to work in hot environments. Common indicators of heat strain are body core temperature (assessed here as rectal temperature Tre), heart rate (HR), and average skin temperature (Tsk). Data collected from progressive heat stress trials were used to (1) demonstrate if physiological heat strain indicators (PHSIs) at the upper limit of Sustainable heat stress were below generally accepted limits; (2) suggest values for PHSIs that demonstrate a Sustainable level of heat stress; (3) suggest alternative PHSIs; and (4) determine if metabolic rate was an effect modifier.

Methods

Two previous progressive heat stress studies included 176 trials with 352 pairs of Sustainable and Unsustainable exposures over a range of relative humidities and metabolic rates using 29 participants. To assess the discrimination ability of PHSIs, conditional logistic regression and stepwise logistic regression were used to find the best combinations of predictors of Unsustainable exposures. The accuracy of the models was assessed using receiver operating characteristic curves.

Results

Current recommendations for physiological heat strain limits were associated with probabilities of Unsustainable greater than 0.5. Screening limits for Sustainable heat stress were Tre of 37.5°C, HR of 105 bpm, and Tsk of 35.8°C. Tsk alone resulted in an area under the curve of 0.85 and the combination of Tsk and HR (area under the curve = 0.88) performed the best. The adjustment for metabolic rate was statistically significant for physiological strain index or ∆Tre-sk as main predictors, but its effect modification was negligible and could be ignored.

Conclusions

Based on the receiver operating characteristic curve, PHSIs (Tre, HR, and Tsk) can accurately predict Unsustainable heat stress exposures. Tsk alone or in combination with HR has a high sensitivity, and makes better discriminations than the other PHSIs under relatively constant exposure (metabolic rate and environment) for an hour or so. Screening limits with high sensitivity, however, have low thresholds that limit utility. To the extent that the observed strain is low, there is good evidence that the exposure is Sustainable.

Exertional heat illness and acute injury related to ambient wet bulb globe temperature

BACKGROUND

The Deepwater Horizon disaster cleanup effort provided an opportunity to examine the effects of ambient thermal conditions on exertional heat illness (EHI) and acute injury (AI).

METHODS

The outcomes were daily person-based frequencies of EHI and AI. Exposures were maximum estimated WBGT (WBGTmax) and severity. Previous day's cumulative effect was assessed by introducing previous day's WBGTmax into the model.

RESULTS

EHI and AI were higher in workers exposed above a WBGTmax of 20°C (RR 1.40 and RR 1.06/°C, respectively). Exposures above 28°C-WBGTmax on the day of the EHI and/or the day before were associated with higher risk of EHI due to an interaction between previous day's environmental conditions and the current day (RRs from 1.0-10.4).

CONCLUSIONS

The risk for EHI and AI were higher with increasing WBGTmax. There was evidence of a cumulative effect from the prior day's WBGTmax for EHI. Am. J. Ind. Med. 59:1169-1176, 2016. © 2016 Wiley Periodicals, Inc.

Heat index and adjusted temperature as surrogates for wet bulb globe temperature to screen for occupational heat stress

Ambient temperature and relative humidity are readily ava-ilable and thus tempting metrics for heat stress assessment. Two methods of using air temperature and relative humidity to create an index are Heat Index and Adjusted Temperature. The purposes of this article are: (1) to examine how well Heat Index and Adjusted Temperature estimated the wet bulb globe temperature (WBGT) index, and (2) to suggest how Heat Index and Adjusted Temperature can be used to screen for heat stress level. Psychrometric relationships were used to estimate values of actual WBGT for conditions of air temperature, relative humidity, and radiant heat at an air speed of 0.5 m/s. A relationship between Heat Index [°F] and WBGT [°C] was described by WBGT = -0.0034 HI(2) + 0.96 HI - 34. At lower Heat Index values, the equation estimated WBGTs that were ± 2 °C-WBGT around the actual value, and to about ± 0.5 °C-WBGT for Heat Index values > 100 °F. A relationship between Adjusted Temperature [°F] and WBGT [°C] was described by WBGT = 0.45 Tadj - 16. The actual WBGT was between 1 °C-WBGT below the estimated value and 1.4 °C-WBGT above. That is, there was a slight bias toward overestimating WBGT from Adjusted Temperature. Heat stress screening tables were constructed for metabolic rates of 180, 300, and 450 W. The screening decisions were divided into four categories: (1) < alert limit, (2) < exposure limit, (3) hourly time-weighted averages (TWAs) of work and recovery, and (4) a caution zone for an exposure > exposure limit at rest. The authors do not recommend using Heat Index or Adjusted Temperature instead of WBGT, but they may be used to screen for circumstances when a more detailed analysis using WBGT is appropriate. A particular weakness is accounting for radiant heat; and neither air speed nor clothing was considered.

Loss of heat acclimation and time to re-establish acclimation

Acclimation in a hot environment is one potent means to decrease the heat strain of work in a hot environment. However, with diminished heat exposure, positive adaptations of acclimation may be lost. This rate of loss is equivocal and, once established, could be used to prescribe the time for re-acclimation. The purpose of this study was to determine the rate of loss of heat acclimation over a period of 6 weeks and determine the time needed for re-acclimation after 2 weeks and 4 weeks of de-acclimation in ten healthy participants. All participants first underwent an initial acclimation period (a 3-day plateau in Tre was used to signify acclimation). Based on the mean time to acclimate in Phase 1 (mean time to acclimate = 6.1 ± 1.4 days), the loss of acclimation was mapped and participants were randomly assigned to one of two groups: one that underwent one 2-hr heat exposure at 1, 3, and 5 weeks post-acclimation, and one that underwent one 2-hr heat exposure session at 2,4, and 6 weeks. Complete loss of acclimation occurred in 6 weeks and, as expected, work HR and Tre increased with increasing time away from the heat (p<0.05). Based on the time for total loss of acclimation from Phase 1, participants in Phase 2 (n = 8) first underwent acclimation. Then, after either a 2-week or 4-week absence from the heat, participants returned to the laboratory for re-acclimation. While not statistically significant yet practically significant (p = 0.18; one-tailed confidence interval), average days for re-acclimation in the 2-week group tended to be fewer than in the 4-week group (days for re-acclimation = 3.8 ± 1.2 and 5.3 ± 1.9, respectively). Based on these general trends, for occupational settings, a re-acclimation period of 4 days is recommended after 2 weeks absence from the heat, 5 days for 4 weeks absence from the heat, and complete acclimation (6 days) after 6 weeks absence or more from the heat.

Empirical approach to outdoor WBGT from meteorological data and performance of two different instrument designs

The wet bulb globe temperature index (WBGT) is a common method to assess the environmental contribution to heat stress as part of an occupational exposure assessment. The two purposes of this study were (1) to compare empirical relationships of some meteorological conditions to WBGT, and (2) to evaluate a smaller globe and alternative method to assess natural wet bulb using a relative humidity sensor. Data were collected in six West-central Florida locations over multiple days for a total of 14 measurement days. Multiple linear regression was used to explore relationships relevant to the two purposes. It was clear that estimating WBGT directly from meteorological data or through estimates of the components of WBGT can be accomplished with a 95% confidence of ± 2°C-WBGT. The 50 mm globe size is a reasonable approximation of the standard size (150 mm). The relative humidity method of the waterless natural wet bulb provides a very good estimation of natural wet bulb temperature. The determination of WBGT from the electronic instruments (small globe with or without the relative humidity method) provided a good estimate of the WBGT.

Short-term heat stress exposure limits based on wet bulb globe temperature adjusted for clothing and metabolic rate

Most heat stress exposure assessments based on wet bulb globe temperature (WBGT) consider the environmental conditions, metabolic demands, and clothing requirements, and the exposure limit is for extended work periods (e.g., a typical workday). The U.S. Navy physiological heat exposure limit (PHEL) curves and rational models of heat stress also consider time as a job risk factor so that there is a limiting time for exposures above a conventional WBGT exposure limit. The PHEL charts have not been examined for different clothing and the rational models require personal computers. The current study examined the role of clothing in short-term (time limited) exposures and proposed a relationship between a Safe Exposure Time and WBGT adjusted for clothing and metabolic rate. Twelve participants worked at a metabolic rate of 380 W in three clothing ensembles [clothing adjustment factors]: (1) work clothes (0 degrees C-WBGT), (2) NexGen microporous coveralls (2.5 degrees C-WBGT), and (2) vapor-barrier coveralls (6.5 degrees C-WBGT) at five levels of heat stress (approximately at the clothing adjusted TLV plus 7.0, 8.0, 9.5, 11.5 and 15.0 degrees C-WBGT). The combinations of metabolic rate, clothing, and environment were selected in anticipation that the participants would reach a physiological limit in less than 120 min. WBGT-based clothing adjustment factors were used to account for different clothing ensembles, and no differences were found for ensemble, which meant that the clothing adjustment factor can be used in WBGT-based time limited exposures. An equation was proposed to recommend a Safe Exposure Time for exposures under 120 min. The recommended times were longer than the PHEL times or times from a rational model of heat stress.

Apparent evaporative resistance at critical conditions for five clothing ensembles

A limiting factor for clothing ensembles inherent during heat stress exposures is the evaporative resistance, which can be used to compare candidate ensembles and in rational models of heat exchange. In this study, the apparent total evaporative resistance of five clothing ensembles (cotton work clothes, cotton coveralls, and coveralls made of Tyvek 1424 and 1427, NexGen and Tychem QC was estimated empirically from wear trials using a progressive heat stress protocol and from clothing insulation adjustments based on ISO 9920 (2007) and wetness. The metabolic rate was moderate at 165 W m(-2) and relative humidity was held at 50%. Twenty-nine heat-acclimated participants (20 men and 9 women) completed trials for all clothing ensembles. A general linear mixed effects model (ensemble and participants as a random effect) was used to analyze the data. Significant differences (p < 0.0001) among ensembles were observed for apparent total evaporative resistance. As expected, Tychem QC had the highest apparent total evaporative resistance at 0.033 kPa m(2) W(-1). NexGen was next at 0.017 kPa m(2) W(-1). These were followed by Tyvek 1424 at 0.015 kPa m(2) W(-1), and Tyvek 1427, Cotton Coveralls and Work Clothes all at 0.013 kPa m(2) W(-1). This wear test method improves on past methods using the progressive protocol to determine evaporative resistance by including the effects of movement, air motion and wetness on the estimate of clothing insulation. The pattern of evaporative resistance is the same as that for critical WBGTs and a linear relationship between apparent total evaporative resistance and WBGT clothing adjustment factor is suggested. With the large sample size, a good estimate of sample variance associated with progressive method can be made, where the standard error is 0.0044 kPa m(2) W(-1) with a 95% confidence interval of 0.0040-0.0050 kPa m(2) W(-1).

WBGT clothing adjustment factors for four clothing ensembles and the effects of metabolic demands

This study measured the clothing adjustment factors (CAFs) for four clothing ensembles (Cotton Coveralls, Tyvek 1427 Coveralls, NexGen Coveralls, and Tychem QC Coveralls; all coveralls were worn without hoods) against a baseline of cotton work clothes to determine whether the CAFs would be affected by the metabolic rate. Fifteen participants wore one of the five ensembles while walking on a treadmill at low, moderate, and high rates of work in an environment maintained at 50% relative humidity. A climatic chamber was used to slowly increase the level of heat stress by increasing air temperature. When the participant's core temperature reached a steady-state, the dry bulb temperature was increased. The point at which the core temperature began to increase was defined as the inflection point, and the WBGT recorded 5 min before the inflection point was the critical WBGT for each ensemble. A three-way mixed effects linear model with ensemble by metabolic rate category interactions demonstrated that the CAF did not change with metabolic rate, so CAFs can be used over a wide range of metabolic rates. The data at the moderate metabolic rate were combined with data on 14 participants from a previous study under the same conditions. The CAFs in degrees C WBGT were 0 for cotton coveralls, 1.0 for Tyvek 1422A, and 2.5 for NexGen. Although the value of 7.5 for Tychem QC was found, the recommendation remained at 10 to account for the effects of humidity. The standard error for the determination of WBGT crit at 50% relative humidity was 1.60 degrees C WBGT.

Effects of Hoods and Flame-Retardant Fabrics on WBGT Clothing Adjustment Factors

Personal protective clothing (PPC) may include hoods and flame-retardant (FR) fabrics that may affect heat transfer and, thus, the critical wet bulb globe temperature (WBGT crit) to maintain thermal equilibrium. The purpose of this study was to compare the differences in WBGT crit for hooded vs. nonhooded versions of particle barrier and vapor barrier coveralls as well as for coveralls made of two flame-retardant fabrics (INDURA cotton and Nomex). Acclimated men (n = 11) and women (n = 4) walked on a treadmill in a climatic chamber at 180 W/m2 wearing four different ensembles: limited-use, particle barrier coveralls with and without a hood (Tyvek 1427), and limited-use vapor barrier coveralls with and without a hood (Tychem QC, polyethylene-coated Tyvek). Twelve of the participants wore one of two flame-retardant coveralls. All participants wore standard cotton clothing. Progressive exposure testing at 50% relative humidity (rh) was designed so that each subject established a physiological steady-state followed by a clear loss of thermal equilibrium. WBGT crit was the WBGT 5 min prior to a loss of thermal equilibrium. Hooded ensembles had a lower WBGT crit than the nonhooded ensembles. The difference suggested a clothing adjustment of 1 degrees C for hoods. There were no significant differences among the FR ensembles and cotton work cloths, and the proposed clothing adjustment for FR coveralls clothing is 0 degrees C.

Maximum sustainable work rate for five protective clothing ensembles with respect to moisture vapor transmission rate and air permeability

The fabrics associated with protective clothing affect heat stress, which influences productivity and risks of heat-related disorders. This study compared the work limiting effects of five protective coveralls and a semiclothed condition (t-shirt and shorts). Two fabric characteristics determined from bench tests, moisture vapor transmission rate (MVTR), and air permeability were also examined as possible predictors of ensemble performance. A progressive metabolic rate protocol was used where environmentalconditions (T(db) = 32 degrees C; T(pwb) = 26 degrees C) were held constant while treadmill speed was slowly increased. The limiting metabolic rate to just maintain thermal equilibrium was the critical point. At this point, critical speed and critical metabolic rate were noted and total evaporative resistance was calculated for each ensemble. Five acclimatized subjects wore each of the six clothing conditions in a random order. Statistically significant differences were found among the five protective garments and a semiclothed ensemble for critical treadmill speed (S(crit)), critical metabolic rate (M(crit)), and total evaporative resistance (R(e-t)). The semiclothed condition (S(crit) = 1.77 m/sec; M(crit) = 580 W; R(e-t) = 0.0099 kPa m2/W) and ensembles made from spunbonded, melt blown, spunbonded polypropylene (SMS) (1.72 m/sec; 560 W; 0.0135 kPa m2/W) and spunbonded polypropylene (1.67 m/sec; 550 W; 0.0126 kPa m2/W) were able to support higher work rates than fabrics made from Tyvek 1422-A (a nonwoven spunbonded olefin) (1.48 m/sec; 470 W; 0.0183 kPa m2/W) and a microporous film supported by spunbonded polypropylene (1.34 m/sec; 420 W; 0.0231 kPa m2/W). A tightly woven polyester ensemble (1.59 m/sec; 510 W; 0.0130 kPa m2/W) had intermediate values and was not significantly different from either group. Air permeability was a better predictor of fabric work limiting performance than MVTR. An air permeability on the order of 10,000 L/min cm2 bar would have little effect on maximum sustainable work.

WBGT clothing adjustments for four clothing ensembles under three relative humidity levels

Threshold limit values for heat stress and strain are based on an upper limit wet bulb globe temperature (WBGT) for ordinary work clothes, with clothing adjustment factors (CAF) for other clothing ensembles. The purpose of this study was to determine the CAF for four clothing ensembles (Cotton Coveralls, Tyvek 1424 Coveralls, NexGen Coveralls, and Tychem QC Coveralls) against a baseline of cotton work clothes and to determine what effect relative humidity may have. A climatic chamber was used to slowly increase the level of heat stress by increasing air temperature at three levels of relative humidity (20%, 50%, and 70%). Study participants wore one of the five ensembles while walking on a treadmill at a moderate metabolic rate of 155 W m-2 (about 300 W). Physiological data and environmental data were collected. When the participant's core temperature reached a steady state, the dry bulb temperature was increased at constant relative humidity. The point at which the core temperature began to increase was defined as the inflection point. The environmental temperature recorded 5 min before the inflection point was used to calculate the critical WBGT for each ensemble. A three-way analysis of variance with ensemble by humidity protocol interactions and a multiple comparison test were used to make comparisons among the mean values. Only the vapor-barrier ensemble (Tychem QC) demonstrated an interaction with humidity level. The following CAFs are proposed: Cotton Coveralls (0 degrees C-WBGT), Tyvek 1424 Coveralls (+1), NexGen Coveralls (+2), and Tychem QC Coveralls (+10).

The physical workload of nursing personnel: association with musculoskeletal discomfort

Direct care-nursing personnel around the world report high numbers of work-related musculoskeletal disorders. This cross-sectional study examined the association between the performance of high-risk patient-handling tasks and self-reported musculoskeletal discomfort in 113 nursing staff members in a veterans' hospital within the United States. Sixty-two percent of subjects reported a 7-day prevalence of moderately severe musculoskeletal discomfort. There was a significant association between wrist and knee pain and the number of highest-risk patient-handling tasks performed per hour interacting with the load lifted. On units where lifting devices are readily available, musculoskeletal risk may have shifted to the wrist and knee.

Effects on heat stress of a flame-retardant ensemble for aluminum smelters

A common belief is that a flame-retardant clothing ensemble will increase the level of heat stress over ordinary cotton work clothes. This is supported by bench tests on fabrics that indicate higher insulation and vapor resistance values for flame-retardant clothing. This research compared a flame-retardant clothing ensemble for an aluminum smelter (Zirpo wool shirt and FR8 denim pants) with typical cotton work clothing. Four young men walked on a treadmill at two work levels inside a climatic chamber under controlled conditions of heat stress. During each test, heart rate, core temperature, and skin temperatures were continuously monitored and recorded every 5 min. After a physiological steady state was achieved, temperature and humidity were slowly increased to maintain a relative humidity of 50%. The critical condition was the time when thermal regulatory control was lost (called the inflection point, marked by a steady increase in core temperature). The climatic conditions at the inflection point were used to assign a critical wet-bulb globe temperature (WBGT). A three-way analysis of variance examined the effects on critical WBGT of clothing, work level, subjects, and the interaction between clothing and work level. There were no significant findings. Therefore, there should be no difference in the level of heat stress between the two clothing ensembles under the same environmental and work conditions.

Heat stress and strain in an aluminum smelter

Studies of worker heat stress and strain in aluminum smelters have found that heat exposure likely to exceed the American Conference of Governmental Industrial Hygienists' threshold limit value (TLV) and that the dose-response relationship between heat stress and strain was weak. A heat stress model based on climatic data and a task analysis indicated exposures to heat stress in excess of the TLV during the July/August study period. To study the impact of working above the TLV, heat strain data (i.e., oral temperature, recovery heart rate, average heart rate) were collected. Recovery heart rates indicated high strain most of the time, and oral temperatures after peak demands were above the no-strain threshold of 37.5 degrees C about a quarter of the time, indicating that heat stress had an effect. About 95% of the readings were below 38.0 degrees C, the acute oral temperature threshold for a safe exposure. Average heart rates over 6- and 12-hour intervals were generally below acceptable limits of 120 and 110 bpm, respectively. Oral temperature and average heart rates indicated good control of heat stress exposures. Because recovery heart rates were high, some employees were working near their individual limits. The dose-response relationship for recovery heart rate and oral temperature were examined against the level of heat stress above the TLV. There was no relationship between oral temperature and heat stress level. There was an apparent trend toward higher recovery heart rates with heat stress. The lack of a dose-response relationship may be explained by brief periods of very high wet bulb globe temperatures that drove the time-weighted average up out of proportion to the physiological response.

Heat stress and protective clothing: an emerging approach from the United States

There is little doubt that heat stress affects many workers adversely and that protective clothing generally adds to the burden. The ACGIH threshold limit value for heat stress is the guiding document for evaluation of heat stress in the United States. Adjustment factors have been used to reflect the change in heat stress imposed by different clothing ensembles. While the first proposed factors started with limited experimental data and professional judgment, heat balance methods in the laboratory have yielded better estimates of adjustment factors and for a wider selection of ensembles. These same experiments have provided the starting point to accounting for nonporous clothing in heat balance evaluation schemes such as required sweat rate. Proposed changes to the ACGIH TLV have been mentioned and a framework for thinking about controls presented.

Continuing the search for WBGT clothing adjustment factors

The original concept for the heat stress limits adopted by the American Conference of Governmental Industrial Hygienists (ACGIH) was that the threshold for heat stress can be marked by environmental conditions (WBGT) that are adjusted for metabolic rate. The underlying data were based on ordinary work clothes. The Physical Agents Committee promoted clothing adjustment factors within the industrial hygiene community through a revision in the TLVs for heat stress in 1990. As approved, there were adjustment factors for three other clothing ensembles. To extend and further understand adjustment factors, adjustments for commercially available clothing ensembles and prototype ensembles have been examined. The fundamental principle of the assignment of an adjustment factor to an ensemble begins with establishing critical environmental conditions in which test subjects were just able to maintain thermal equilibrium. Four or five subjects for each ensemble walked on a tread-mill inside a climatic chamber under controlled conditions of heat stress. During each test, heart rate and core temperature were continuously monitored. After a physiological steady-state was achieved, temperature and humidity were slowly increased to maintain relative humidity at 20 percent, 50 percent, or 70 percent. Metabolic rate was assessed by measuring the rate of oxygen consumption. Reviewing a trial, the critical conditions were noted as the time when thermal regulatory control was lost (called the inflection point and marked by a steady increase in core temperature). The climatic conditions at the inflection point were used to assign a critical WBGT. A WBGT representative of each ensemble was assigned through a weighted average of different protocols. Clothing adjustment factors representing an equivalent increase in WBGT were computed by noting the difference between the representative WBGT of the cotton work clothes and the other clothing ensembles. The results suggested adjustment factors with reference to ordinary work clothes from the least stress at -2.1 to 5.5 degrees C-WBGT. The adjustment factors were reasonably well predicted by a linear regression based on a computed value for total evaporative resistance (r2 = 0.92).

Prediction of workplace wet bulb global temperature

The wet bulb globe temperature (WBGT) is the de facto standard to assess environmental contributions to heat stress. A practical problem emerges when the heat stress conditions vary over many locations or during the day. To address this problem, investigators have suggested empirical relationships and thermodynamic models. The purpose of this effort was to examine a thermodynamic model in the laboratory and to predict WBGTs in an aluminum smelter by both the empirical and thermodynamic models. In the laboratory, there was no real difference between the experimental data and the thermodynamic model. In the application to an aluminum smelter, there was a small overall tendency for the predicted values to be greater than the actual values, but there was no practical difference between the models. The empirical model provided a good match with a slight over-prediction by 0.5 degree C with a standard deviation of 3.0 degrees C. For the same data, the thermodynamic model had an average over-prediction of 0.7 degree C with a standard deviation of 2.8 degrees C. Either method of predicting WBGT was effective. The empirical method required less computation and was conceptually simpler.

Thermal characteristics of clothing ensembles for use in heat stress analysis

The Heat Stress Index was an early model for the assessment of heat stress. The International Organization for Standardization (ISO) standard for required sweat rate is the current generation of heat balance methods for occupational heat stress. The method assumes cotton clothing and works adequately for cotton/polyester blends. To extend the usefulness of the model, the thermal characteristics of a variety of commercially available and prototype protective clothing ensembles have been determined for application in the ISO method. The fundamental principle for assessing thermal characteristics of work clothing is establishing the critical environmental conditions in which test subjects were just able to maintain thermal equilibrium. Critical conditions were found for warm, humid conditions; hot, dry conditions; intermediate conditions of temperature and humidity; and/or moderate conditions in which metabolic rate was increased to a limiting thermal load. Typically, five subjects at each condition for each ensemble were used. Metabolic rate, average skin temperature, and the environmental conditions (air temperature and vapor pressure) were noted at the critical conditions, and the total insulation was estimated for each ensemble. From these values, the total evaporative resistance, the clothing factor for dry heat exchange (CFcl), and the clothing factor for evaporative cooling (CFpcl) were determined. When compared with reports of others on thermal characteristics the results agreed when pumping factors and clothing wetness were considered. The result was higher than expected values for CFcl and lower values for CFpcl.

Estimation of metabolic rate using qualitative job descriptors

This project developed two methods to estimate metabolic rate that can be used easily and provide acceptable precision. The methods were developed from the measurement of oxygen consumption on 80 typical jobs in automotive manufacturing. The Ready-Reference Method uses three easily identified, dichotomous characteristics to classify the job into one of four levels of metabolic rate. The characteristics are based on motion of the hands, weights or forces, and walking; standard error of estimate was 68 kcal/hour. The Component Method has four terms that account for hand motion, walking/carrying, lifting, and pushing/pulling. Hand motions and lifting factors are characterized by three or four categories with a reference value to make the determination easier by using more qualitative data. Walking/carrying and pushing/pulling data are noted as typical distances traveled in one minute. The standard error of estimate for this method was 62 kcal/hour. In addition to a smaller standard error of estimate, the further advantage of the Component Method over the Ready-Reference Method is an ability to point toward the largest contributors to metabolic rate.

Rationale for a personal monitor for heat strain

Worker heat-stress exposures can be controlled for short periods above the threshold limit value (TLV) by self-assessment, if the worker can avoid overexposure based on excessive heart rate and/or excessive core temperature. A socially acceptable surrogate for core temperature and a measure of heart rate are objective measures that can increase the reliability of the self-assessment decision. This article describes a surface-mounted temperature sensor developed to indicate when rectal temperature reaches a safe limit. Protective criteria were established for temperature sensor alert limits. A fixed threshold for heart rate may cause premature alerts during bursts of activity and miss lower, but sustained, heart rates that represent significant physiological strain. For these reasons, heart rate criteria based on seven moving-time averages also were developed. The criteria are based on a relationship between heart rate and endurance time. The temperature sensor and heart rate criteria form the basis of a real-time personal monitor for heat strain.

Physiological evaluation of liquid-barrier, vapor-permeable protective clothing ensembles for work in hot environments

Work clothes using fabrics with vapor-transmitting characteristics are in limited use in various industrial applications, and there is a growing interest in their purported ability to help reduce heat stress. This study was performed to compare two vapor-transmitting ensembles with other clothing ensembles previously tested. The evaluation was based on an established experimental protocol that determines the critical values of air temperature and water-vapor pressure so that an individual maintains thermal balance, while controlling other factors that contribute to worker heat stress (e.g., air motion and metabolism). There were no differences between the two vapor-transmitting garments in their effects on worker heat stress. When compared to the results of other studies, the two vapor-transmitting garments had critical environmental characteristics similar to two layers of cotton coveralls and they performed better from a heat stress standpoint than a disposable vapor-barrier suit worn over cloth coveralls.

Modeling carbon monoxide uptake during work

Acute carbon monoxide poisoning is the result of a diminished capacity of the blood to transport oxygen and sustain a level of metabolic activity. The diminished capacity is expressed in terms of the carboxyhemoglobin (COHb) level in the blood which is dependent upon the concentration of CO in the inhaled air. The rate of CO uptake or elimination is dependent upon the concentration of CO in the air as well as pulmonary diffusion capacity and alveolar ventilation which change with different metabolic rates. Coburn, Forster and Kane (CFK) developed a mathematical model to describe the uptake and elimination kinetics of CO in sedentary individuals. The CFK model was used in a mathematical simulation of CO uptake and elimination where the independent variables were inhaled CO concentration and metabolic rate. The metabolic rate was used to specify pulmonary diffusing capacity and alveolar ventilation. As the level of COHb increased the metabolic rate was decreased to a level compatible with the impaired oxygen transport. A physical fatigue limit was also included. The theoretical model was used to simulate conditions beyond the range of exposures permissible under experimental laboratory conditions.

Evaluation of Federal man tests for self-contained breathing apparatus

The transient pulmonary responses to four short duration man tests used in the Federal approval of breathing apparatus were measured. The pulmonary ventilation dropped 30 percent in the first thirty seconds in the periods assigned for samples and readings which were immediately preceded by work. A physiological deficit was incurred during the short duration man tests which meant that less O2 and ventilation were required when compared to steady state responses shown on approval tests. The scheduled man test activities for short duration breathing apparatus should be revised and made more vigorous to match the intended use of escape apparatus.