Cognitive function during exertional heat stress assessed using traditional and serious game technology

Firefighting is a physically demanding occupation requiring intermittent bouts of work resulting in increased levels of cardiovascular and thermal strain, while making decisions requiring higher order cognitive abilities e.g. working memory, sustained attention, reaction time, spatial awareness, and information processing. These activities can take place in dangerous conditions with elevated temperatures imposing external stressors on physiological and cognitive function. Previous research has examined the impact of heat stress on cognitive function in general, but the specific influence on firefighters wearing personal protective equipment (PPE) and self-contained breathing apparatus (SCBA) is not well understood. Specific domains of cognitive function can be assessed using computer-based neuropsychological testing batteries, such as the Cambridge Neuropsychological Automated Testing Battery (CANTAB). The CANTAB automatically records the response measures for each test and provides consistent feedback in between trials. Although the CANTAB is well established the cognitive domains it tests may not adequately capture the complexity of the specific decision making required of firefighters while on-duty. The use of serious game technology provides a possible solution to develop a more ecologically valid assessment tool capable of evaluating the specific decision making tasks required of firefighters at an emergency scenario. Thus, the current thesis aimed to evaluate the effects of exercise-induced heat stress on cognitive function in firefighters using the CANTAB testing battery and a recently developed serious game simulating the decision making tasks required of firefighters in a two-storey residential fire while walking on a treadmill. Additionally, the reliability of repeated CANTAB administrations during treadmill walking was measured and found to have reasonable overall reliability. Decrements in cognitive function (working memory and executive function were observed at a core temperature of 38.5??C and restored following an active cooling recovery protocol. However, when decision making was evaluated using the serious game scenario, task specific performance deficits were not seen during treadmill walking but impairment in memory recall was found following the active cooling recovery protocol. These findings provide fire service personnel with information regarding the cognitive implications of heat stress and the potential use of serious games to evaluate and train cognitive function during exposure to environmental stressors

Physiological demands and ventilatory requirements during simulated large structure firefighting tasks

The ability to measure the physiological demands and air requirements during simulated firefighting tasks while wearing full personal protective ensemble (PPE) and positive pressure self-contained breathing apparatus (SCBA) has been a difficult process based on undeveloped technology. The capability of integrating a portable Cosmed K4b2 breath by breath gas collection system with a standard SCBA has permitted a novel approach to investigate metabolic demands and ventilatory requirements while breathing through the same system that would be used in an actual fire scene. The purpose of this study was to determine the physiological demands and air requirements during three large structure firefighting scenarios: (1) maximal high rise stair climb, (2) 5th floor high rise scenario, and (3) subway system scenario. The hypotheses were that (a) the 5th floor high rise scenario would be the most physically demanding and that (b) the years of service as a firefighter would result in decreased total air consumption during the three scenarios. Thirty-three male and three female healthy firefighters performed each of the three tasks at an equivalent pace similar to what would be expected at a fire scene. Scenario (1) consisted of stair climbing until consuming 55% of a typical SCBA air cylinder and then descending to a safe exit. Scenario (2) comprised a 5 floor stair climb, hose drag and room search, forcible entry, victim rescue drag, and 5 floor descent. Scenario (3) involved a stair descent, tunnel walk, portable ladder walk, ladder setup, victim rescue drag, tunnel walk, and stair ascent. Average maximum floors climbed for scenario (1) and mean completion times for scenarios (2) and (3) were 20 ± 2.5 floors, 5 min 3 s ± 57 s, and 12 min 5 s ± 1 min 10 s, respectively. Mean VO2 during each of the scenarios were 3168 ± 878 ml/min, 2947 ± 461 ml/min, 2217 ± 371 ml/min, corresponding to a relative VO2 of 35.5 ± 9.1 ml/kg/min, 33.1 ± 4.6 ml/kg/min, and 25.2 ± 4.6 ml/kg/min. In relation to the peak treadmill oxygen uptake, the three scenarios revealed that firefighters were working at 70 ± 10%, 65 ± 10%, and 49 ± 8% of VO2peak, respectively. Average heart rate values for the three scenarios were 170 ± 13 bpm, 160 ± 14 bpm, and 139 ± 17 bpm, corresponding to 88 ± 4%, 88 ± 6%, and 76 ± 7% of HRpeak, respectively. These results indicate that the most physiologically demanding scenario was the maximal stair climb, followed by the 5th floor high rise and subway system scenarios. Respiratory exchange ratio was consistently greater than 1.0 during the maximal stair climb and 5th floor high rise scenarios indicating that a considerable amount of energy was derived from anaerobic metabolism. With regards to the air requirements for each of the scenarios, total air consumption revealed averaged values of 74.9 ± 6%, 48.0 ± 7.0%, and 59.9 ±5.6%, of the air in a typical 30-min cylinder, respectively. These data also revealed that increasing age of the firefighter as well as increasing years of experience as a firefighter result in significant correlations with greater air consumption to complete the given task (p < 0.05). Contrary to the hypotheses, the maximal stair climb scenario appeared to be the most physically demanding while increased years of service as a firefighter resulted in greater air consumption. Furthermore, it appears that firefighters who are able to produce more power per kg of body mass have greater performance times and more efficient air consumption. These data are instrumental in quantifying the physiological demands and air requirements during simulated firefighting tasks while breathing on a positive pressure SCBA

The effects of simulated wildland firefighting tasks on core temperature and cognitive function under very hot conditions

Background: The severity of wildland fires is increasing due to continually hotter and drier summers. Firefighters are required to make life altering decisions on the fireground, which requires analytical thinking, problem solving, and situational awareness. This study aimed to determine the effects of very hot (45&deg;C; HOT) conditions on cognitive function following periods of simulated wildfire suppression work when compared to a temperate environment (18&deg;C; CON). Methods: Ten male volunteer firefighters intermittently performed a simulated fireground task for 3 h in both the CON and HOT environments, with cognitive function tests (paired associates learning and spatial span) assessed at baseline (cog 1) and during the final 20-min of each hour (cog 2, 3, and 4). Reaction time was also assessed at cog 1 and cog 4. Pre- and post- body mass were recorded, and core and skin temperature were measured continuously throughout the protocol. Results: There were no differences between the CON and HOT trials for any of the cognitive assessments, regardless of complexity. While core temperature reached 38.7&deg;C in the HOT (compared to only 37.5&deg;C in the CON; p &lt; 0.01), core temperature declined during the cognitive assessments in both conditions (at a rate of -0.15 &plusmn; 0.20&deg;C&middot;hr-1 and -0.63 &plusmn; 0.12&deg;C&middot;hr-1 in the HOT and CON trial respectively). Firefighters also maintained their pre-exercise body mass in both conditions, indicating euhydration. Conclusions: It is likely that this maintenance of euhydration and the relative drop in core temperature experienced between physical work bouts was responsible for the preservation of firefighters\u27 cognitive function in the present study

The Effects of Simulated Wildland Firefighting Tasks on Core Temperature and Cognitive Function under Very Hot Conditions

Background The severity of wildland fires is increasing due to continually hotter and drier summers. Firefighters are required to make life altering decisions on the fireground, which requires analytical thinking, problem solving, and situational awareness. This study aimed to determine the effects of very hot (45°C; HOT) conditions on cognitive function following periods of simulated wildfire suppression work when compared to a temperate environment (18°C; CON). Methods Ten male volunteer firefighters intermittently performed a simulated fireground task for 3 h in both the CON and HOT environments, with cognitive function tests (paired associates learning and spatial span) assessed at baseline (cog 1) and during the final 20-min of each hour (cog 2, 3, and 4). Reaction time was also assessed at cog 1 and cog 4. Pre- and post- body mass were recorded, and core and skin temperature were measured continuously throughout the protocol. Results There were no differences between the CON and HOT trials for any of the cognitive assessments, regardless of complexity. While core temperature reached 38.7°C in the HOT (compared to only 37.5°C in the CON; p < 0.01), core temperature declined during the cognitive assessments in both conditions (at a rate of −0.15 ± 0.20°C·hr−1 and −0.63 ± 0.12°C·hr−1 in the HOT and CON trial respectively). Firefighters also maintained their pre-exercise body mass in both conditions, indicating euhydration. Conclusions It is likely that this maintenance of euhydration and the relative drop in core temperature experienced between physical work bouts was responsible for the preservation of firefighters' cognitive function in the present study

Profiling a decade of information systems frontiers’ research

This article analyses the first ten years of research published in the Information Systems Frontiers (ISF) from 1999 to 2008. The analysis of the published material includes examining variables such as most productive authors, citation analysis, universities associated with the most publications, geographic diversity, authors’ backgrounds and research methods. The keyword analysis suggests that ISF research has evolved from establishing concepts and domain of information systems (IS), technology and management to contemporary issues such as outsourcing, web services and security. The analysis presented in this paper has identified intellectually significant studies that have contributed to the development and accumulation of intellectual wealth of ISF. The analysis has also identified authors published in other journals whose work largely shaped and guided the researchers published in ISF. This research has implications for researchers, journal editors, and research institutions

Development and implementation of a nurse-based remote patient monitoring program for ambulatory disease management

IntroductionNumerous factors are intersecting in healthcare resulting in an increased focus on new tools and methods for managing care in patients' homes. Remote patient monitoring (RPM) is an option to provide care at home and maintain a connection between patients and providers to address ongoing medical issues.MethodsMayo Clinic developed a nurse-led RPM program for disease and post-procedural management to improve patient experience, clinical outcomes, and reduce health care utilization by more directly engaging patients in their health care. Enrolled patients are sent a technology package that includes a digital tablet and peripheral devices for the collection of symptoms and vital signs. The data are transmitted from to a hub integrated within the electronic health record. Care team members coordinate patient needs, respond to vital sign alerts, and utilize the data to inform and provide individualized patient assessment, patient education, medication management, goal setting, and clinical care planning.ResultsSince its inception, the RPM program has supported nearly 22,000 patients across 17 programs. Patients who engaged in the COVID-19 RPM program experienced a significantly lower rate of 30-day, all-cause hospitalization (13.7% vs. 18.0%, P = 0.01), prolonged hospitalization &gt;7 days (3.5% vs. 6.7%, P = 0.001), intensive care unit (ICU) admission (2.3% vs. 4.2%, P = 0.01), and mortality (0.5% vs. 1.7%, P = 0.01) when compared with those enrolled and unengaged with the technology. Patients with chronic conditions who were monitored with RPM upon hospital discharge were significantly less likely to experience 30-day readmissions (18.2% vs. 23.7%, P = 0.03) compared with those unmonitored. Ninety-five percent of patients strongly agreed or agreed they were likely to recommend RPM to a friend or family member.ConclusionsThe Mayo Clinic RPM program has generated positive clinical outcomes and is satisfying for patients. As technology advances, there are greater opportunities to enhance this clinical care model and it should be extended and expanded to support patients across a broader spectrum of needs. This report can serve as a framework for health care organizations to implement and enhance their RPM programs in addition to identifying areas for further evolution and exploration in developing RPM programs of the future

Safety and pharmacokinetics of multiple dose myo-inositol in preterm infants

BACKGROUND: Preterm infants with respiratory distress syndrome (RDS) given inositol had reduced bronchopulmonary dysplasia (BPD), death and severe retinopathy of prematurity (ROP). We assessed the safety and pharmacokinetics of daily inositol to select a dose providing serum levels previously associated with benefit, and to learn if accumulation occurred when administered throughout the normal period of retinal vascularization. METHODS: Infants ≤ 29 wk GA (n = 122, 14 centers) were randomized and treated with placebo or inositol at 10, 40, or 80 mg/kg/d. Intravenous administration converted to enteral when feedings were established, and continued to the first of 10 wk, 34 wk postmenstrual age (PMA) or discharge. Serum collection employed a sparse sampling population pharmacokinetics design. Inositol urine losses and feeding intakes were measured. Safety was prospectively monitored. RESULTS: At 80 mg/kg/d mean serum levels reached 140 mg/l, similar to Hallman's findings. Levels declined after 2 wk, converging in all groups by 6 wk. Analyses showed a mean volume of distribution 0.657 l/kg, clearance 0.058 l/kg/h, and half-life 7.90 h. Adverse events and comorbidities were fewer in the inositol groups, but not significantly so. CONCLUSION: Multiple dose inositol at 80 mg/kg/d was not associated with increased adverse events, achieves previously effective serum levels, and is appropriate for investigation in a phase III trial

Depression and sickness behavior are Janus-faced responses to shared inflammatory pathways

It is of considerable translational importance whether depression is a form or a consequence of sickness behavior. Sickness behavior is a behavioral complex induced by infections and immune trauma and mediated by pro-inflammatory cytokines. It is an adaptive response that enhances recovery by conserving energy to combat acute inflammation. There are considerable phenomenological similarities between sickness behavior and depression, for example, behavioral inhibition, anorexia and weight loss, and melancholic (anhedonia), physio-somatic (fatigue, hyperalgesia, malaise), anxiety and neurocognitive symptoms. In clinical depression, however, a transition occurs to sensitization of immuno-inflammatory pathways, progressive damage by oxidative and nitrosative stress to lipids, proteins, and DNA, and autoimmune responses directed against self-epitopes. The latter mechanisms are the substrate of a neuroprogressive process, whereby multiple depressive episodes cause neural tissue damage and consequent functional and cognitive sequelae. Thus, shared immuno-inflammatory pathways underpin the physiology of sickness behavior and the pathophysiology of clinical depression explaining their partially overlapping phenomenology. Inflammation may provoke a Janus-faced response with a good, acute side, generating protective inflammation through sickness behavior and a bad, chronic side, for example, clinical depression, a lifelong disorder with positive feedback loops between (neuro)inflammation and (neuro)degenerative processes following less well defined triggers

Pan-Cancer Analysis of lncRNA Regulation Supports Their Targeting of Cancer Genes in Each Tumor Context

Long noncoding RNAs (lncRNAs) are commonly dys-regulated in tumors, but only a handful are known toplay pathophysiological roles in cancer. We inferredlncRNAs that dysregulate cancer pathways, onco-genes, and tumor suppressors (cancer genes) bymodeling their effects on the activity of transcriptionfactors, RNA-binding proteins, and microRNAs in5,185 TCGA tumors and 1,019 ENCODE assays.Our predictions included hundreds of candidateonco- and tumor-suppressor lncRNAs (cancerlncRNAs) whose somatic alterations account for thedysregulation of dozens of cancer genes and path-ways in each of 14 tumor contexts. To demonstrateproof of concept, we showed that perturbations tar-geting OIP5-AS1 (an inferred tumor suppressor) andTUG1 and WT1-AS (inferred onco-lncRNAs) dysre-gulated cancer genes and altered proliferation ofbreast and gynecologic cancer cells. Our analysis in-dicates that, although most lncRNAs are dysregu-lated in a tumor-specific manner, some, includingOIP5-AS1, TUG1, NEAT1, MEG3, and TSIX, synergis-tically dysregulate cancer pathways in multiple tumorcontexts