Effect of fatigue and hypohydration on gait characteristics during treadmill exercise in the heat while wearing firefighter thermal protective clothing.

This study compared the gait characteristics of individuals walking in heat while wearing firefighting equipment in fatigued and non-fatigued states. Nineteen subjects performed a 50-min treadmill protocol in a heated room while gait patterns were recorded using a digital video camcorder. Forty gait cycles were analyzed near the beginning (9 min) and at the end (39-49 min) of exercise. Spatio-temporal gait variables including step frequency, step length, swing time, stance time, cycle time and double-support time were determined. Gait variability was quantified by the standard deviation (SD) and coefficient of variation (CV) of each variable. Left-right symmetry was calculated using the symmetry index (SI) and symmetry angle (SA). Paired t-tests (alpha = 0.05) were performed to identify difference between the beginning and the end of the protocol for each measured variable. Spatio-temporal gait characteristics did not differ between the beginning and the end of exercise. Gait variability of the double-support time increased at the end as measured by both SD (P = 0.037) and CV (P = 0.030) but no change was observed for other variables. Left-right symmetry measured using either SI or SA did not differ between sessions. In summary, spatio-temporal gait characteristics and symmetry while wearing firefighting equipment are insensitive to physiological fatigue. Prolonged walking in heat while wearing firefighting equipment may increase gait variability and therefore the likelihood of a fall. Future studies are needed to confirm the potential relationship between fatigue and gait variability and to investigate the possible influence of individual variation

Association of Over-The-Counter Pharmaceutical Sales with Influenza-Like-Illnesses to Patient Volume in an Urgent Care Setting

We studied the association between OTC pharmaceutical sales and volume of patients with influenza-like-illnesses (ILI) at an urgent care center over one year. OTC pharmaceutical sales explain 36% of the variance in the patient volume, and each standard deviation increase is associated with 4.7 more patient visits to the urgent care center (p<0.0001). Cross-correlation function analysis demonstrated that OTC pharmaceutical sales are significantly associated with patient volume during non-flu season (p<0.0001), but only the sales of cough and cold (p<0.0001) and thermometer (p<0.0001) categories were significant during flu season with a lag of two and one days, respectively. Our study is the first study to demonstrate and measure the relationship between OTC pharmaceutical sales and urgent care center patient volume, and presents strong evidence that OTC sales predict urgent care center patient volume year round. © 2013 Liu et al

Seizure during hyperbaric oxygen therapy for carbon monoxide toxicity: a case series and five-year experience.

BACKGROUND: Hyperbaric oxygen (HBO) therapy is recommended to reduce the delayed neurologic sequelae resulting from carbon monoxide (CO) toxicity. Although HBO is generally well tolerated, there exists a risk of seizure in all patients that may be increased in patients with predisposing factors including: fever, hypothermia, prior seizure, or brain injury. CASE REPORT: We present two cases of patients without known risk factors who experienced seizures associated with HBO therapy during treatment for CO toxicity. CONCLUSION: This facility\u27s 5-year experience and a review of the germane literature are also presented to elucidate the risk factors and incidence of seizures in patients treated with HBO for CO toxicity

Influenza vaccine effectiveness among outpatients in the US Influenza Vaccine Effectiveness Network by study site 2011‐2016

BackgroundInfluenza vaccination is recommended for all US residents aged ≥6 months. Vaccine effectiveness (VE) varies by age, circulating influenza strains, and the presence of high‐risk medical conditions. We examined site‐specific VE in the US Influenza VE Network, which evaluates annual influenza VE at ambulatory clinics in geographically diverse sites.MethodsAnalyses were conducted on 27 180 outpatients ≥6 months old presenting with an acute respiratory infection (ARI) with cough of ≤7‐day duration during the 2011‐2016 influenza seasons. A test‐negative design was used with vaccination status defined as receipt of ≥1 dose of any influenza vaccine according to medical records, registries, and/or self‐report. Influenza infection was determined by reverse‐transcription polymerase chain reaction. VE estimates were calculated using odds ratios from multivariable logistic regression models adjusted for age, sex, race/ethnicity, time from illness onset to enrollment, high‐risk conditions, calendar time, and vaccination status‐site interaction.ResultsFor all sites combined, VE was statistically significant every season against all influenza and against the predominant circulating strains (VE = 19%‐50%) Few differences among four sites in the US Flu VE Network were evident in five seasons. However, in 2015‐16, overall VE in one site was 24% (95% CI = −4%‐44%), while VE in two other sites was significantly higher (61%, 95% CI = 49%‐71%; P = .002, and 53%, 95% CI = 33,67; P = .034).ConclusionWith few exceptions, site‐specific VE estimates aligned with each other and overall VE estimates. Observed VE may reflect inherent differences in community characteristics of the sites and highlights the importance of diverse settings for studying influenza vaccine effectiveness.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/155981/1/irv12741_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/155981/2/irv12741.pd

Cognitive function following treadmill exercise in thermal protective clothing.

Occupational injuries are common among firefighters who perform strenuous physical exertion in extreme heat. The thermal protective clothing (TPC) worn by firefighters inhibits normal thermoregulation, placing the firefighter at risk of hypohydration and hyperthermia that may result in cognitive decline. We tested whether cognitive function changes after treadmill exercise in TPC. In an initial study (Cog 1), ten healthy volunteers performed up to 50 min of treadmill exercise while wearing TPC in a heated room. A battery of neurocognitive tests evaluating short-term memory, sustained and divided attention, and reaction time was administered immediately before and after exercise. In a follow-up study (Cog 2), 19 healthy volunteers performed a similar exercise protocol with the battery of cognitive tests administered pre-exercise, immediately post-exercise, and serially up to 120 min after exercise. Subjects performed 46.4 ± 4.6 and 48.1 ± 3.6 min of exercise in the Cog 1 and Cog 2, respectively. In both studies heart rate approached age predicted maximum, body mass was reduced 1.0-1.5 kg, and body core temperature increased to levels similar to what is seen after fire suppression. Neurocognitive test scores did not change immediately after exercise. Recall on a memory test was reduced 60 and 120 min after exercise. The mean of the 10 slowest reaction times increased in the 120 min after exercise. Fifty minutes of treadmill exercise in TPC resulted in near maximal physiologic strain but alterations in neurocognitive performance were not noted until an hour or more following exercise in TPC

ILI Patient Volume vs. Cough and Cold, Chest Rub, and Thermometer Sales Volume (7dMA).

<p>Seven day moving average (7dMA) of sales volume of Cough and Cold medications (A), Chest Rubs (B), and Thermometers (C) in comparison with and volume of patients with influenza-like-illness (ILI) at the UPMC Urgent Care from July 1, 2010 to July 31, 2011. Volume of patients with ILI is blue and on the left y-axis, and the three different categories of OTC pharmaceutical sales are on the right y-axis.</p