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1.
IEEE J Biomed Health Inform ; 27(12): 5803-5814, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-37812534

RESUMO

We employed wearable multimodal sensing (heart rate and triaxial accelerometry) with machine learning to enable early prediction of impending exertional heat stroke (EHS). US Army Rangers and Combat Engineers (N = 2,102) were instrumented while participating in rigorous 7-mile and 12-mile loaded rucksack timed marches. There were three EHS cases, and data from 478 Rangers were analyzed for model building and controls. The data-driven machine learning approach incorporated estimates of physiological strain (heart rate) and physical stress (estimated metabolic rate) trajectories, followed by reconstruction to obtain compressed representations which then fed into anomaly detection for EHS prediction. Impending EHS was predicted from 33 to 69 min before collapse. These findings demonstrate that low dimensional physiological stress to strain patterns with machine learning anomaly detection enables early prediction of impending EHS which will allow interventions that minimize or avoid pathophysiological sequelae. We describe how our approach can be expanded to other physical activities and enhanced with novel sensors.


Assuntos
Golpe de Calor , Militares , Dispositivos Eletrônicos Vestíveis , Humanos , Golpe de Calor/diagnóstico , Exercício Físico , Estresse Fisiológico
2.
Br J Sports Med ; 56(8): 446-451, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35022161

RESUMO

OBJECTIVE: Exertional heat stroke (EHS), characterised by a high core body temperature (Tcr) and central nervous system (CNS) dysfunction, is a concern for athletes, workers and military personnel who must train and perform in hot environments. The objective of this study was to determine whether algorithms that estimate Tcr from heart rate and gait instability from a trunk-worn sensor system can forward predict EHS onset. METHODS: Heart rate and three-axis accelerometry data were collected from chest-worn sensors from 1806 US military personnel participating in timed 4/5-mile runs, and loaded marches of 7 and 12 miles; in total, 3422 high EHS-risk training datasets were available for analysis. Six soldiers were diagnosed with heat stroke and all had rectal temperatures of >41°C when first measured and were exhibiting CNS dysfunction. Estimated core temperature (ECTemp) was computed from sequential measures of heart rate. Gait instability was computed from three-axis accelerometry using features of pattern dispersion and autocorrelation. RESULTS: The six soldiers who experienced heat stroke were among the hottest compared with the other soldiers in the respective training events with ECTemps ranging from 39.2°C to 40.8°C. Combining ECTemp and gait instability measures successfully identified all six EHS casualties at least 3.5 min in advance of collapse while falsely identifying 6.1% (209 total false positives) examples where exertional heat illness symptoms were neither observed nor reported. No false-negative cases were noted. CONCLUSION: The combination of two algorithms that estimate Tcr and ataxic gate appears promising for real-time alerting of impending EHS.


Assuntos
Transtornos de Estresse por Calor , Golpe de Calor , Marcha , Transtornos de Estresse por Calor/diagnóstico , Golpe de Calor/diagnóstico , Temperatura Alta , Humanos , Temperatura
3.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 4636-4639, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33019027

RESUMO

Breathing rate was estimated from chest-worn accelerometry collected from 1,522 servicemembers during training by a wearable physiological monitor. A total of 29,189 hours of training and sleep data were analyzed. The primary purpose of the monitor was to assess thermal-work strain and avoid heat injuries. The monitor design was thus not optimized to estimate breathing rate. Since breathing rate cannot be accurately estimated during periods of high activity, a qualifier was applied to identify sedentary time periods, totaling 8,867 hours. Breathing rate was estimated for a total of 4,179 hours, or 14% of the total collection and 47% of the sedentary total, primarily during periods of sleep. The breathing rate estimation method was compared to an FDA 510(K)-cleared criterion breathing rate sensor (Zephyr, Annapolis MD, USA) in a controlled laboratory experiment, which showed good agreement between the two techniques. Contributions of this paper are to: 1) provide the first analysis of accelerometry-derived breathing rate on free-living data including periods of high activity as well as sleep, along with a qualifier that effectively identifies sedentary periods appropriate for estimating breathing rate; 2) test breathing rate estimation on a data set with a total duration that is more than 60 times longer than that of the largest previously reported study, 3) test breathing rate estimation on data from a physiological monitor that has not been expressly designed for that purpose.


Assuntos
Acelerometria , Taxa Respiratória , Humanos , Monitorização Fisiológica , Sono , Tórax
4.
J Emerg Med ; 57(2): e53-e56, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31005365

RESUMO

BACKGROUND: Exertional heat stroke (EHS) is a potentially life-threatening emergency requiring rapid reduction in core body temperature. Methods of cooling include cold water immersion, ice packs, cold water lavage, and chilled saline, among others. We report a case of EHS successfully cooled using an endovascular cooling device after traditional cooling methods failed to reduce core body temperature. CASE REPORT: A 24-year old soldier collapsed during a 12-mile foot march while training in southern Georgia. His initial rectal temperature was 43.1°C (109.6°F). External cooling measures (ice sheet application) were initiated on site and Emergency Medical Services were called to transport to the hospital. Paramedics obtained a repeat rectal temperature of 42.4°C (108.4°F). Ice sheet application and chilled saline infusion were continued throughout transport to the Emergency Department (ED). Total prehospital treatment time was 50 min. Upon ED arrival, the patient's rectal temperature was 41.2°C (106.2°F). He was intubated due to a Glasgow Coma Scale score of 4, and endovascular cooling was initiated. Less than 45 minutes later his core body temperature was 37.55°C (99.6°F). He was admitted to the intensive care unit, where his mental status rapidly improved. He was found to have rising liver enzymes, and there was concern for his developing disseminated intravascular coagulation, prompting transfer to a tertiary care center. He was subsequently discharged from the hospital 14 days after his initial injury without any persistent sequelae. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: The primary treatment for EHS is rapid reduction of core body temperature. When external cooling methods fail, endovascular cooling can be used to rapidly decrease core body temperature.


Assuntos
Golpe de Calor/terapia , Caminhada/lesões , Serviço Hospitalar de Emergência/organização & administração , Procedimentos Endovasculares/métodos , Georgia , Golpe de Calor/fisiopatologia , Humanos , Hipotermia Induzida/métodos , Masculino , Militares , Esforço Físico/fisiologia , Adulto Jovem
7.
Mil Med ; 174(6): ix-x, 2009 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-19585787

RESUMO

This Military Working Dog (MWD) was shot in the chest during combat operations in Iraq. Military Working Dogs are critical to the safety and well-being of deployed troops in combat operations and, as such, they are triaged and treated in our combat hospitals just like any other soldier; their speciation is not a factor in their triage status. This case familiarizes military physicians with the basic canine anatomy, positioning, and radiological technique they should be aware of before deploying. We also strive to raise awareness of the vital roles that these MWDs play for our forces, counterany concerns that may arise over the issue of treating these dogs in human facilities, and leave the reader feeling better prepared to handle the situation should they ever find themselves poised to save one of our four-legged warriors.


Assuntos
Cães/lesões , Medicina Militar/métodos , Traumatismos Torácicos/veterinária , Serviço Veterinário Militar/métodos , Ferimentos por Arma de Fogo/veterinária , Animais , Iraque , Militares , Radiografia , Traumatismos Torácicos/diagnóstico por imagem , Triagem , Estados Unidos , Ferimentos por Arma de Fogo/diagnóstico por imagem
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