Inconsistency in the Standard of Care–Toward Evidence-Based Management of Exertional Heat Stroke

Tokyo 2020 Summer Olympics are projected to experience environmental heat stress that surpasses the environmental conditions observed in the Atlanta (1996), Athens (2004), Beijing (2008), and Rio (2016) Summer Olympics. This raises particular concerns for athletes who will likely to be exposed to extreme heat during the competitions. Therefore, in mass-participation event during warm season, it is vital for the hosting organization to build preparedness and resilience against heat, including appropriate treatment, and management strategies for exertional heat stroke (EHS). However, despite the existing literature regarding the evidence-based management of EHS, rectal thermometry and whole-body cold-water immersion are not readily accepted by medical professionals outside of the sports, and military medicine professionals. Current Japanese medical standard is no exception in falling behind on evidence-based management of EHS. Therefore, the first aim of this paper is to elucidate the inconsistency between the standard of care provided in Japan for EHS and what has been accepted as the gold standard by the scientific literature. The second aim of this paper is to provide optimal EHS management strategies that should be implemented at the Tokyo 2020 Summer Olympics from organizational level to maximize the safety of athletes and to improve organizational resilience to heat. The risk of extreme heat is often neglected until a catastrophic incidence occurs. It is vital for the Japanese medical leadership and athletic communities to re-examine the current EHS management strategies and implement evidence-based countermeasure for EHS to expand the application of scientific knowledge

Parental gender influences their intention to HPV vaccinate their children, and the association between HPV and COVID-19 vaccination intentions

Oka E., Ueda Y., Yagi A., et al. Parental gender influences their intention to HPV vaccinate their children, and the association between HPV and COVID-19 vaccination intentions. Vaccine: X 17, 100441 (2024); https://doi.org/10.1016/j.jvacx.2024.100441.Purpose: The coronavirus disease of 2019 (COVID-19) pandemic has increased public awareness of infectious diseases and interest in vaccines, including the human papilloma virus (HPV) vaccine. We investigated differences between parental gender and intentions to vaccinate their child for HPV and COVID-19. Methods: We analyzed data from Japan's COVID-19 and Society Internet Survey (JACSIS), a web-based cross-sectional survey of 2,444 respondents in 2021. Results: Females were more knowledgeable and more afraid of HPV and COVID-19 than males. The proportions of females in favor of, or against, HPV vaccination was higher than among males. The fathers’ intention for HPV vaccination was significantly associated with the child's gender, knowledge regarding HPV, and intention to inoculate with the COVID-19 vaccine. The mothers’ intention was also associated with her knowledge of HPV and her intention to seek the COVID-19 vaccine, but it included a greater fear of HPV infection. Both male and female parents favored the COVID-19 vaccine over the HPV vaccine. Parents approving of COVID-19 vaccination believed in the overall efficacy of vaccines and were more receptive to opinions from the administration and physicians, even if the parent was currently against HPV vaccination. Conclusions: Mothers were more knowledgeable about HPV and more favorable to vaccinate their child for HPV than fathers. The intention to have children COVID-19 vaccinated was also higher than for HPV vaccination. During this period of heightened public interest in vaccines due to the COVID-19 pandemic, this is a good time to educate and inform the public about HPV

Ethical dilemmas and validity issues related to the use of new cooling technologies and early recognition of exertional heat illness in sport

The Tokyo 2020 Olympic Games is expected to be among the hottest Games in modern history, increasing the chances for exertional heat stroke (EHS) incidence, especially in non-acclimatised athletes/workers/spectators. The urgent need to recognise EHS symptoms to protect all attendees'' health has considerably accelerated research examining the most effective cooling strategies and the development of wearable cooling technology and real-time temperature monitoring. While these technological advances will aid the early identification of EHS cases, there are several potential ethical considerations for governing bodies and sports organisers. For example, the impact of recently developed cooling wearables on health and performance is unknown. Concerning improving athletic performance in a hot environment, there is uncertainty about this technology''s availability to all athletes. Furthermore, the real potential to obtain real-time core temperature data will oblige medical teams to make crucial decisions around their athletes continuing their competitions or withdraw. Therefore, the aim of this review is (1) to summarise the practical applications of the most novel cooling strategies/technologies for both safety (of athletes, spectators and workers) and performance purposes, and (2) to inform of the opportunities offered by recent technological developments for the early recognition and diagnosis of EHS. These opportunities are presented alongside several ethical dilemmas that require sports governing bodies to react by regulating the validity of recent technologies and their availability to all

Multicolor and multi-spot observations of Starlink's Visorsat

This study provides the results of simultaneous multicolor observations for the first Visorsat (STARLINK-1436) and the ordinary Starlink satellite, STARLINK-1113 in the $U$, $B$, $V$, $g'$, $r$, $i$, $R_{\rm C}$, $I_{\rm C}$, $z$, $J$, $H$, and $K_s$ bands to quantitatively investigate the extent to which Visorsat reduces its reflected light. Our results are as follows: (1) in most cases, Virorsat is fainter than STARLINK-1113, and the sunshade on Visorsat, therefore, contributes to the reduction of the reflected sunlight; (2) the magnitude at 550 km altitude (normalized magnitude) of both satellites often reaches the naked-eye limiting magnitude ($<$ 6.0); (3) from a blackbody radiation model of the reflected flux, the peak of the reflected components of both satellites is around the $z$ band; and (4) the albedo of the near infrared range is larger than that of the optical range. Under the assumption that Visorsat and STARLINK-1113 have the same reflectivity, we estimate the covering factor, $C_{\rm f}$, of the sunshade on Visorsat, using the blackbody radiation model: the covering factor ranges from $0.18 \leq C_{\rm f} \leq 0.92$. From the multivariable analysis of the solar phase angle (Sun-target-observer), the normalized magnitude, and the covering factor, the phase angle versus covering factor distribution presents a moderate anti-correlation between them, suggesting that the magnitudes of Visorsat depend not only on the phase angle but also on the orientation of the sunshade along our line of sight. However, the impact on astronomical observations from Visorsat-designed satellites remains serious. Thus, new countermeasures are necessary for the Starlink satellites to further reduce reflected sunlight.Comment: 31 pages, 9 figures, published in PAS

Heat Safety in the Workplace:Modified Delphi Consensus to Establish Strategies and Resources to Protect U.S Workers

The purpose of this consensus document was to develop feasible, evidence‐based occupational heat safety recommendations to protect the US workers that experience heat stress. Heat safety recommendations were created to protect worker health and to avoid productivity losses associated with occupational heat stress. Recommendations were tailored to be utilized by safety managers, industrial hygienists, and the employers who bear responsibility for implementing heat safety plans. An interdisciplinary roundtable comprised of 51 experts was assembled to create a narrative review summarizing current data and gaps in knowledge within eight heat safety topics: (a) heat hygiene, (b) hydration, (c) heat acclimatization, (d) environmental monitoring, (e) physiological monitoring, (f) body cooling, (g) textiles and personal protective gear, and (h) emergency action plan implementation. The consensus‐based recommendations for each topic were created using the Delphi method and evaluated based on scientific evidence, feasibility, and clarity. The current document presents 40 occupational heat safety recommendations across all eight topics. Establishing these recommendations will help organizations and employers create effective heat safety plans for their workplaces, address factors that limit the implementation of heat safety best‐practices and protect worker health and productivity

Hipotermia associada à anestesia geral e fatores de risco envolvidos: uma revisão integrativa

INTRODUÇÃO:A hipotermia intraoperatória é definida como a temperatura central menor que 36°C, em pacientes com anestesia geral. Essa situação frequentemente está associada com fatores adversos como infecção pós-operatória, eventos cardiovasculares, hemorragia perioperatória e necessidade de transfusão. OBJETIVOS: Avaliar a hipotermia pós anestesia geral e elucidar os fatores de risco associados. METODOLOGIA: Trata-se de uma revisão integrativa na base de dados PUBMED utilizando os descritores “RISK AND HYPOTHERMIA AND ANESTHESIA AND GENERAL’’ para artigos publicados entre 2019 e 2024. RESULTADOS: A hipotermia intraoperatória (HI) possui uma prevalência de 39,8%, os neonatos e lactentes são estatisticamente mais associados à HI. Fatores como a temperatura ambiente do centro cirúrgico inferior a 26°C e a administração de mais de 1 litro de líquido ao paciente durante a cirurgia são fatores preditivos à hipotermia. Por outro lado, pacientes que possuem idade mais avançada (&gt;66 anos) apresentam baixo limiar de vasoconstrição, facilitando diretamente a instalação do quadro hipotérmico nessa faixa etária. Além disso, o grau da cirurgia e complicações prévias como baixa temperatura corporal pré-operatória e combinação de anestesias locais e regionais também possuem grande significância na HI. CONCLUSÃO: A hipotermia apresenta alta prevalência nas cirurgias com anestesia geral, sendo os neonatos e lactantes os mais afetados. Cuidados pré-operatórios são fundamentais na prevenção