Joanne N. Caldwell

To Cool, But Not Too Cool : That Is the Question-Immersion Cooling for Hyperthermia

INTRODUCTION Patient cooling time can impact upon the prognosis of heat illness. Although ice-cold-water immersion will rapidly extract heat, access to ice or cold water may be limited in hot climates. Indeed, some have concerns regarding the sudden cold-water immersion of hyperthermic individuals, whereas others believe that cutaneous vasoconstriction may reduce convective heat transfer from the core. It was hypothesized that warmer immersion temperatures, which induce less powerful vasoconstriction, may still facilitate rapid cooling in hyperthermic individuals. METHODS Eight males participated in three trials and were heated to an esophageal temperature of 39.5 degrees C by exercising in the heat (36 degrees C, 50% relative humidity) while wearing a water-perfusion garment (40 degrees C). Subjects were cooled using each of the following methods: air (20-22 degrees C), cold-water immersion (14 degrees C), and temperate-water immersion (26 degrees C). RESULTS The time to reach an esophageal temperature of 37.5 degrees C averaged 22.81 min (air), 2.16 min (cold), and 2.91 min (temperate). Whereas each of the between-trial comparisons was statistically significant (P < 0.05), cooling in temperate water took only marginally longer than that in cold water, and one cannot imagine that the 45-s cooling time difference would have any meaningful physiological or clinical implications. CONCLUSION It is assumed that this rapid heat loss was due to a less powerful peripheral vasoconstrictor response, with central heat being more rapidly transported to the skin surface for dissipation. Although the core-to-water thermal gradient was much smaller with temperate-water cooling, greater skin and deeper tissue blood flows would support a superior convective heat delivery. Thus, a sustained physiological mechanism (blood flow) appears to have countered a less powerful thermal gradient, resulting in clinically insignificant differences in heat extraction between the cold and temperate cooling trials.

The cholinergic blockade of both thermally and non-thermally induced human eccrine sweating.

Thermally induced eccrine sweating is cholinergically mediated, but other neurotransmitters have been postulated for psychological (emotional) sweating. However, we hypothesized that such sweating is not noradrenergically driven in passively heated, resting humans. To test this, nine supine subjects were exposed to non‐thermal stimuli (palmar pain, mental arithmetic and static exercise) known to evoke sweating. Trials consisted of the following four sequential phases: thermoneutral rest; passive heating to elevate (by ∼1.0°C) and clamp mean body temperature and steady‐state sweating (perfusion garment and footbath); an atropine sulphate infusion (0.04 mg kg−1) with thermal clamping sustained; and following clamp removal. Sudomotor responses from glabrous (hairless) and non‐glabrous skin surfaces were measured simultaneously (precursor and discharged sweating). When thermoneutral, these non‐thermal stimuli elicited significant sweating only from the palm (P < 0.05). Passive heating induced steady‐state sweating ranging from 0.20 ± 0.04 (volar hand) to 1.40 ± 0.14 mg cm−2 min−1 (forehead), with each non‐thermal stimulus provoking greater secretion (P < 0.05). Atropine suppressed thermal sweating, and it also eliminated the sudomotor responses to these non‐thermal stimuli when body temperatures were prevented from rising (P > 0.05). However, when the thermal clamp was removed, core and skin temperatures became further elevated and sweating was restored (P < 0.05), indicating that the blockade had been overcome, presumably through elevated receptor competition. These observations establish the dependence of both thermal and non‐thermal eccrine sweating from glabrous and non‐glabrous surfaces on acetylcholine release, and challenge theories concerning the psychological modulation of sweating. Furthermore, no evidence existed for the significant participation of non‐cholinergic neurotransmitters during any of these stimulations.

The Interaction of Body Armor, Low-Intensity Exercise, and Hot-Humid Conditions on Physiological Strain and Cognitive Function

OBJECTIVE This project was aimed at evaluating the impact of combat armor on physiological and cognitive functions during low-intensity exercise in hot-humid conditions (36 degrees C and 60% relative humidity). METHODS Nine males participated in three trials (2.5 hours), walking at two speeds and wearing different protective equipment: control (combat uniform and cloth hat); torso armor with uniform and cloth hat; and full armor (uniform, torso armor, and helmet). RESULTS As time progressed, core temperatures increased and deviated significantly among trials, rising at 0.37 degrees C h(-1) (control), 0.41 degrees C h(-1) (torso armor), and 0.51 degrees C h(-1) (full armor). Heart rates also progressively diverged, and subjects lost significantly more sweat during the two armored trials. However, cognitive-function tests revealed neither significant main effects nor time by treatment interactions. CONCLUSION The combat armor and helmet significantly increased thermal and cardiovascular strain, but these were unlikely to lead to either exertional heat illness or impaired cognitive function during uneventful urban, military patrols in hot-humid conditions.

Sweat secretion from palmar and dorsal surfaces of the hands during passive and active heating

INTRODUCTION It is generally accepted that the palmar (volar) and dorsal surfaces of human hands display different sudomotor responses to mental or thermal stimuli. We tested the hypothesis that, during thermal stimulation, secretion from the dorsal surfaces would always exceed that from the volar aspect of the hand. METHODS Sweat secretion from 10 hand sites and the forehead was examined (ventilated capsules) in 10 subjects during passive heating (climate chamber: 36 degrees C, 60% relative humidity, water-perfusion suit: 40 degrees C) immediately followed by incremental cycling to volitional fatigue. RESULTS This treatment significantly increased core temperature (39.3 degrees C), heart rate (178 bpm), and sweat rate at all sites. Mean sweat secretion during exercise was greater at the forehead (2.90 mg x cm(-2) x min(-1); +/- 0.19) than the hand (1.49 mg x cm(-2) min(-1); +/- 0.27). While no significant differences in sweating were observed among dorsal sites, a nonuniform secretion pattern was observed across the volar surface, with sweating at the palm being the lowest, and that from the volar aspect of the distal phalanges being equivalent to the dorsal hand. These differences became more evident as exercise progressed. Mean hand sweat rate during exercise was 41.7 ml x h(-1), with sweating from the palm accounting for only about 6% of sweat secretion. CONCLUSION Sweat secretion from both the palmar and dorsal surfaces of the hand increases during exercise in the heat, although this occurs in a nonuniform fashion. It is possible that a greater sweat gland density on the fingers may account for variations across the volar surface. However, higher dorsal sweating with lower gland counts (high glandular flow) may be attributable to either larger sweat glands, or to a greater cholinergic sensitivity of these glands.

Heat strain during military training activities: The dilemma of balancing force protection and operational capability

ABSTRACT Military activities in hot environments pose 2 competing demands: the requirement to perform realistic training to develop operational capability with the necessity to protect armed forces personnel against heat-related illness. To ascertain whether work duration limits for protection against heat-related illness restrict military activities, this study examined the heat strain and risks of heat-related illness when conducting a military activity above the prescribed work duration limits. Thirty-seven soldiers conducted a march (10 km; ∼5.5 km h−1) carrying 41.8 ± 3.6 kg of equipment in 23.1 ± 1.8°C wet-bulb globe temperature. Body core temperature was recorded throughout and upon completion, or withdrawal, participants rated their severity of heat-related symptoms. Twenty-three soldiers completed the march in 107 ± 6.4 min (Completers); 9 were symptomatic for heat exhaustion, withdrawing after 71.6 ± 10.1 min (Symptomatic); and five were removed for body core temperature above 39.0°C (Hyperthermic) after 58.4 ± 4.5 min. Body core temperature was significantly higher in the Hyperthermic (39.03 ± 0.26°C), than Symptomatic (38.34 ± 0.44°C; P = 0.007) and Completers (37.94 ± 0.37°C; P<0.001) after 50 min. Heat-related symptom severity was significantly higher among Symptomatic (28.4 ± 11.8) compared to Completers (15.0 ± 9.8, P = 0.006) and Hyperthermic (13.0 ± 9.6, P = 0.029). The force protection provided by work duration limits may be preventing the majority of personnel from conducting activities in hot environments, thereby constraining a commanders mandate to develop an optimised military force. The dissociation between heat-related symptoms and body core temperature elevation suggests that the physiological mechanisms underpinning exhaustion during exertional heat stress should be re-examined to determine the most appropriate physiological criteria for prescribing work duration limits.

Water-displacement plethysmography: a technique for the simultaneous thermal manipulation and measurement of whole-hand and whole-foot blood flows

The purpose of this project was to design, construct and validate water-displacement plethysmographs for the forearm, hand and foot that could clamp segmental skin temperature whilst simultaneously measuring cutaneous blood flow. Two experiments were performed. In the first, the forearm plethysmograph was validated against a mercury-in-silastic plethysmograph under thermoneutral conditions, with and without forearm heating. Cutaneous vascular conductance was elevated almost three-fold by this treatment, however, there were no significant differences between the two forms of plethysmography in either state (P > 0.05). In study two, hand and foot blood flows were measured under clamped thermoneutral conditions, but with three local skin temperature treatments (5, 25, 40 °C). The hand had significantly higher blood flows than the foot at both 25 °C (4.07 versus 2.20 mL.100 mL( - 1).min( - 1); P < 0.05) and 40 °C (8.20 versus 4.47 mL.100 mL( - 1).min( - 1); P < 0.05). The foot was maximally constricted during the two lower temperatures, yet the cutaneous thermal sensitivity of the hand was almost two-fold greater (P < 0.05). This evidence supports the significant role played by these appendages in heat loss and conservation, and these plethysmographs will now be used to map cutaneous vascular responses (forearm, hand, calf, foot) across combinations of core and local skin temperatures.

The impact of thermal pre-conditioning on cutaneous vasomotor and shivering thresholds

The mean body temperature of resting, normothermic humans falls within the zone that separates the temperature thresholds for shivering and sweating; the vasomotor zone. Whilst these thresholds are often defined by their corresponding deep-body or mean body temperatures, it is well known that these are not set temperatures or points. Nevertheless, our knowledge concerning the factors that determine or modify these thresholds is imprecise. Therefore, the aim of this experiment was to investigate the effects of a deliberate modification of the pre-exposure mean body temperature on the subsequent vasomotor and shivering threshold temperatures. Mean body temperature was first displaced upwards, then slowly driven in the opposite direction, permitting the separate determination of these thermoeffector thresholds.

A vascular mechanism to explain thermally mediated variations in deep‐body cooling rates during the immersion of profoundly hyperthermic individuals

What is the central question of this study? Does the cold‐water immersion (14°C) of profoundly hyperthermic individuals induce reductions in cutaneous and limb blood flow of sufficient magnitude to impair heat loss relative to the size of the thermal gradient? What is the main finding and its importance? The temperate‐water cooling (26°C) of profoundly hyperthermic individuals was found to be rapid and reproducible. A vascular mechanism accounted for that outcome, with temperature‐dependent differences in cutaneous and limb blood flows observed during cooling. Decisions relating to cooling strategies must be based upon deep‐body temperature measurements that have response dynamics consistent with the urgency for cooling.

Indirect hand and forearm vasomotion: regional variations in cutaneous thermosensitivity during normothermia and mild hyperthermia

In this experiment, hand and forearm vasomotor activity was investigated during localised, but stable heating and cooling of the face, hand and thigh, under open-loop (clamped) conditions. It was hypothesised that facial stimulation would provoke the most potent vascular changes. Nine individuals participated in two normothermic trials (mean body temperature clamp: 36.6°C; water-perfused suit and climate chamber) and two mildly hyperthermic trials (37.9°C). Localised heating (+5°C) and cooling (-5°C) stimuli were applied to equal surface areas of the face, hand and thigh (perfusion patches: 15min), while contralateral forearm or hand blood flows (venous-occlusion plethysmography) were measured (separate trials). Thermal sensation and discomfort votes were recorded before and during each thermal stimulation. When hyperthermic, local heating induced more sensitive vascular responses, with the combined thermosensitivity of both limb segments averaging 0.011mL·100mL-1·min-1·mmHg-1·°C-1, and 0.005mL·100mL-1·min-1·mmHg-1·°C-1 during localised cooling (P<0.05). Inter-site comparisons among the stimulated sites yielded minimal evidence of variations in local thermal sensation, and no differences were observed for vascular conductance (P>0.05). Therefore, regional differences in vasomotor and sensory sensitivity appeared not to exist. When combined with previous observations of sudomotor sensitivity, it seems that, during mild heating and cooling, regional representations within the somatosensory cortex may not translate into meaningful differences in thermal sensation or the central integration of thermoafferent signals. It was concluded that inter-site variations in the cutaneous thermosensitivity of these thermolytic effectors have minimal physiological significance over the ranges investigated thus far.

Predicting endurance time in a repetitive lift and carry task using linear mixed models

Objectives Repetitive manual handling tasks account for a substantial portion of work-related injuries. However, few studies report endurance time in repetitive manual handling tasks. Consequently, there is little guidance to inform expected work time for repetitive manual handling tasks. We aimed to investigate endurance time and oxygen consumption of a repetitive lift and carry task using linear mixed models. Methods Fourteen male soldiers (age 22.4 ± 4.5 yrs, height 1.78 ± 0.04 m, body mass 76.3 ± 10.1 kg) conducted four assessment sessions that consisted of one maximal box lifting session and three lift and carry sessions. The relationships between carry mass (range 17.5–37.5 kg) and the duration of carry, and carry mass and oxygen consumption, were assessed using linear mixed models with random effects to account for between-subject variation. Results Results demonstrated that endurance time was inversely associated with carry mass (R2 = 0.24), with significant individual-level variation (R2 = 0.85). Normalising carry mass to performance in a maximal box lifting test improved the prediction of endurance time (R2 = 0.40). Oxygen consumption presented relative to total mass (body mass, external load and carried mass) was not significantly related to lift and carry mass (β1 = 0.16, SE = 0.10, 95%CI: -0.04, 0.36, p = 0.12), indicating that there was no change in oxygen consumption relative to total mass with increasing lift and carry mass. Conclusion Practically, these data can be used to guide work-rest schedules and provide insight into methods assessing the physical capacity of workers conducting repetitive manual handling tasks.