Living in Western Australia induces some physiological adaptations of seasonal acclimatisation in the surgical burns team.

Seasonal acclimatization is known to result in adaptations that can improve heat tolerance. Staff who operate on burn injuries are exposed to thermally stressful conditions and seasonal acclimatization may improve their thermoeffector responses during surgery. Therefore, the aim of this study was to assess the physiological and perceptual responses of staff who operate on burn injuries during summer and winter, to determine whether they become acclimatized to the heated operating theater. Eight staff members had physiological and perceptual responses compared during burn surgeries conducted in thermoneutral (CON: 24.1 ± 1.2°C, 45 ± 7% relative humidity [RH]) and heated (HOT: 31.3 ± 1.6°C, 44 ± 7% RH) operating theaters, in summer and winter. Physiological parameters that were assessed included core temperature, heart rate, total sweat loss, sweat rate, and urinary specific gravity. Perceptual responses included ratings of thermal sensation and comfort. In summer, CON compared to winter CON, baseline (85 ± 15 bpm VS 94 ± 18 bpm), mean (84 ± 16 bpm VS 93 ± 18 bpm), and peak HR (94 ± 17 bpm VS 105 ± 19 bpm) were lower (p < 0.05), whereas core temperature was not different between seasons in either condition (p > 0.05). In HOT, ratings of discomfort were higher in summer (15 ± 3) than winter (13 ± 3; p > 0.05), but ratings of thermal sensation and sweat rate were similar between seasons (p > 0.05). The surgical team in burns in Western Australia can obtain some of the physiological adaptations that result from seasonal acclimatization, but not all. That is most likely due to a lower than required amount of outdoor heat exposure in summer, to induce all physiological and perceptual adaptations.

Heat exposure as a cause of injury and illness in mine industry workers.

The objective of this study was to explore the association between ambient temperature and injuries and illnesses experienced by mine industry workers. Eleven years of de-identified data from a mine industry company in Australia was explored in regards to injuries and illnesses occurring due to outdoor exposure. Each case was filtered for reported symptoms, and meteorological data to match the location of the mine site and date reported were sourced. Of the 18 931 injuries and illnesses observed over the 11-year period, 151 cases of heat-related illness due to outdoor exposure were reported. Twenty-five conditions/symptoms of heat-illness were found, with the most prevalent being dehydration (n = 81), followed by heat rash (n = 40), dizziness (n = 24), and headache (n = 23). The mean number of symptoms reported by each worker was 2 ± 1. There was a positive correlation between ambient temperature and injuries/illnesses (r2 = 0.89, P < 0.001), where, as temperature increased so did the number of reported heat-related illnesses. Underreporting of heat-related illness and injury in the mining industry is likely, which is a risk to the health and wellbeing of employees. Workers require industry specific training about the severity of heat stress and the associated prevention strategies.

A seasonal comparison of a 14-day swing on cognitive function and psycho-physiological responses in mine service workers.

This study assessed the effect of season on cognitive function and psycho-physiological responses during a 14-day swing in mine-service workers. Cognitive function, thermal sensation and comfort, rating of perceived exertion, fatigue, hydration, core temperature and heart rate were assessed throughout a shift, on three separate days over a swing. Working memory and processing efficiency did not differ between seasons (p > 0.05), however counting and recall latencies improved throughout the swing (p < 0.05). Participants reported greater fatigue post-shift compared to pre-shift (p < 0.05). Thermal sensation, thermal comfort, and hydration were significantly elevated in summer compared to winter (p < 0.05). Specifically, workers were significantly/minimally dehydrated in summer/winter (urinary specific gravity = 1.025 ± 0.007/1.018 ± 0.007). Although cognitive function and thermal strain were not impaired in summer compared to winter, it is essential to reinforce worker's knowledge regarding hydration requirements. Additional education and/or incorporating scheduled rest breaks for hydration should be considered to ensure the health and safety of mine workers.

Symptoms of heat illness and water consumption habits in mine industry workers over the summer months in Australia.

Mine industry workers (n=515) from various locations in Australia completed a questionnaire to assess the prevalence of symptoms associated with heat-related illness and water consumption habits during a summer season. Participants read from a pre-defined list and noted any heat-related symptoms that they had experienced. The most prevalent symptoms experienced were fatigue, headache, sweating, and dark coloured urine, with 77% of respondents reporting at least one symptom. Workers with shorter employment durations had higher rates of reporting multiple symptoms (rates ratios: 1.40-1.72). The most prevalent water consumption amounts over an 11-12 h shift were 2-4 L by 37.3% of total respondents, followed by 1-2 L by 36.5% of respondents. Employers should inform workers about the severe implications of heat-related illnesses, implement regular water breaks, and educate personnel about the importance of water intake. Providing employees with self-check methods of hydration status is recommended to increase awareness of their hydration status.

Seasonal influence on cognitive and psycho-physiological responses to a single 11-h day of work in outdoor mine industry workers.

This study investigated the seasonal effects that working outdoors had on various parameters in mining industry workers over the course of a work-shift. Workers (n = 27) were assessed in summer (33.3 ± 4.2°C, 38 ± 18% RH; n = 13, age = 46 ± 14 y, BMI = 29.1 ± 5.7 kg/m2) and winter (23.6 ± 5.1°C, 39 ± 20% RH; n = 14, age = 44 ± 12 y, BMI = 31.2 ± 4.1 kg/m2). Core temperature and heart-rate were measured continuously (analyzed at five time points), while perceptual measures, cognitive and manual dexterity performance were assessed at various times over an 11-h shift at the start of a 14-day swing. Hydration was assessed (urine specific gravity) pre- and post-shift. Working memory was impaired in summer compared to winter (-10%; p = 0.039), however did not change throughout the shift. Processing efficiency was significantly reduced at 12 pm (-12%; p = 0.005) and 5 pm (-21%; p < 0.001) compared to 9 am, irrespective of season (p > 0.05). Manual dexterity (dominant-hand) improved over the shift (+13%, p = 0.002), but was not different between seasons. Perceived fatigue had no main effect of season or shift. Core temperature, heart-rate, thermal sensation and rating of perceived exertion increased throughout the shift, with only core temperature and thermal sensation showing a seasonal effect (summer: +0.33°C, +18%, respectively; p < 0.002). Notably, 23% of workers in summer and 64% in winter started work significantly dehydrated, with 54% and 64% in summer and winter, respectively, finishing work with significant to serious dehydration. Impairment in working memory in summer combined with high levels of dehydration over the work-shift reinforces the need for workplace education on the importance of hydration and risk of occupation heat stress. Abbreviations: Core temperature: Tc; Fly-in fly-out: FIFO; Ratings of perceived exertion: RPE; Relative humidity: RH; Urinary specific gravity: USG; Wet bulb globe temperature: WBGT.

Comparing thermal strain in outdoor maintenance and indoor service workers in the mining industry during summer.

While working in the heat is a common practice within the Australian mining industry, it can lead to adverse effects on cognitive function, productivity, and physical health. This study aimed to compare the thermal strain experienced by maintenance workers and service workers in the mining industry during summer. Psycho-physiological parameters, manual dexterity, and cognitive function were assessed in maintenance workers (n = 12) and service workers (n = 12) employed at mine site villages in north-west Australia. Maintenance workers had the freedom to self-select their work intensity and predominantly worked outdoors (33.9±4.2°C, 38±18% RH), whereas service workers had to work to a fixed schedule and worked intermittently indoors (∼64% of work shift; 29.5±3.4°C, 48±8% RH) and outdoors (∼36%; 35.4±4.6°C, 47±21% RH). All workers underwent assessment at the beginning (day 2/3), middle (day 7/8), and end of their swing (day 13/14), at various time points throughout their 11-12 h shift. Service workers completed more steps (11282±1794 vs. 7774±2821; p<0.001), experienced a higher heart rate (p = 0.049) and reported higher ratings of perceived exertion (p<0.001), thermal discomfort (p<0.001), thermal sensation (p<0.001), and fatigue (p<0.012) compared to maintenance workers. Urinary specific gravity values were higher (less hydrated) in service workers (1.024±0.007) compared to maintenance workers (1.018±0.006; p = 0.007), with USG being overall higher post- compared to pre-shift (1.022±0.008 vs. 1.020±0.006; p<0.05). Core temperature, working memory capacity, processing speed and manual dexterity did not differ between occupations. Workers in hot environments who cannot self-select their work intensity should be educated about the importance of hydration before, during, and after their work-shifts and provided with more scheduled rest breaks during their shift. Employers should closely monitor workers for symptoms of heat illness, discomfort, and fatigue to ensure the health and safety of the workers.

Impact of living and working in the heat on cognitive and psycho-physiological responses in outdoor fly-in fly-out tradesmen: a mining industry study.

Objective: This study aimed to evaluate complex cognitive function, manual dexterity and psycho-physiological parameters in tradesmen working outdoors in the mining industry during summer and winter. Methods: Twenty-six males working in a mining village in the north-west of Australia were assessed pre- and post-an 11-h shift at the start, middle, and end of a 14-day swing in summer (average daily temperature: 33.9°C, 38% RH; n = 12) and winter (24.3°C, 36% RH; n = 14). Results: Working memory performance did not differ between seasons, over the swing or shift (p ≥ 0.053). Processing efficiency and manual dexterity performance did not differ between seasons (p ≥ 0.243), yet improved over the course of the swing (p ≤ 0.001) and shift (p ≤ 0.001). Core temperature, heart rate, thermal comfort, rating of perceived exertion and thermal sensation were not significantly different between seasons (p ≥ 0.076); however, average shift dehydration was greater in winter compared to summer (1.021 ± 0.005 vs. 1.018 ± 0.006; p = 0.014). Conclusion: The ability to self-regulate the intensity of activity likely helped outdoor workers to thermoregulate effectively, minimising thermal strain during their swings and shifts, in turn explaining unaltered cognitive function and manual dexterity performance between seasons. Regardless of season, workers should receive education on dehydration and workplace risks to protect their health.

Higher operating theatre temperature during burn surgery increases physiological heat strain, subjective workload, and fatigue of surgical staff.

Raising the ambient temperature of the operating theatre is common practice during burn surgeries to maintain the patient's core body temperature; however, the effects of operating in the heat on cognitive performance, manual dexterity, and perceived workload of surgical staff have not been assessed in a real-world context. Therefore, the aim was to assess the real-time impact of heat during burn surgeries on staff's cognitive function, manual dexterity, and perceptual measures (workload, thermal sensation, thermal comfort, perceived exertion, and fatigue) and physiological parameters (core temperature, heart-rate, fluid loss, and dehydration). Ten burn surgery staff members were assessed in CON (24.0±1.1°C, 45±6% relative humidity [RH]) and HOT (30.8±1.6°C, 39±7% RH) burn surgeries (average 150 min duration). Cognitive performance, manual dexterity, and perceptual measures were recorded pre- and post-surgery, while physiological parameters were recorded throughout surgery. HOT conditions did not significantly affect manual dexterity or cognitive function (p > .05), however HOT resulted in heat strain (increased heart-rate, core temperature, and fluid loss: p < .05), and increased subjective workload, discomfort, perceived exertion, and fatigue compared to CON conditions (p < .05). Cognitive function and manual dexterity were maintained in hot conditions, suggesting that operating in approximately 31°C heat is a safe approach for patient treatment. However, job burnout, which is positively correlated with perceived workload, and the impact of cumulative fatigue on the mental health of surgery staff, must be considered in the context of supporting an effective health workforce.

Repeated-sprint training in heat and hypoxia: Acute responses to manipulating exercise-to-rest ratio.

The aim of this study was to investigate acute performance and physiological responses to the manipulation of exercise-to-rest ratio (E:R) during repeated-sprint hypoxic training (RSH) in hot conditions. Twelve male team-sport players completed two experimental sessions at a simulated altitude of ∼3000 m (FIO2 0.144), air temperature of 40°C and relative humidity of 50%. Exercise involved either 3 × 5 × 10-s (E:R1:2) or 3 × 10 × 5-s (E:R1:4) maximal cycling sprints interspersed with active recoveries at 120W (20-s between sprints, 2.5 and 5-min between sets for E:R1:2 and E:R1:4 respectively). Sessions were matched for overall sprint and total session duration (47.5-min). Peak and mean power output, and total work were greater in E:R1:4 than E:R1:2 (p < 0.05). Peak core temperature was significantly higher in E:R1:4 than E:R1:2 (38.44 ± 0.33 vs. 38.20 ± 0.35°C, p = 0.028). Muscle deoxygenation magnitude during sprints was greater in E:R1:2 (28.2 ± 1.6 vs. 22.4 ± 4.6%, p < 0.001), while muscle reoxygenation did not differ between conditions (p > 0.05). These results indicate E:R1:4 increased mechanical power output and core temperature compared to E:R1:2. Both protocols had different effects on measures of muscle oxygenation, with E:R1:2 generating greater muscle oxygen extraction and E:R1:4 producing more muscle oxygenation flux, which are both important signals for peripheral adaptation. We conclude that the E:R manipulation during RSH in the heat might be used to target different physiological and performance outcomes, with these findings forming a strong base for future mechanistic investigation.Highlights During a typical repeated-sprint training session conducted in hot and hypoxic conditions, an exercise-to-rest ratio of 1:4 during sprint efforts displayed an increased mechanical power output compared to an exercise-to-rest ratio of 1:2. This represents a potentially useful increase in training stimulus.An exercise-to-rest ratio of 1:2 generated greater muscle oxygen extraction, while an exercise-to-rest ratio of 1:4 resulted in more muscle oxygenation flux and a higher core temperature, indicating key markers of environment-related physiological strain were varied between conditions.Exercise-to-rest ratio manipulation may be used to target different physiological and performance outcomes when prescribing repeated-sprint training in hot and hypoxic conditions.

Increased air temperature during repeated-sprint training in hypoxia amplifies changes in muscle oxygenation without decreasing cycling performance.

The present study aims to investigate the acute performance and physiological responses, with specific reference to muscle oxygenation, to ambient air temperature manipulation during repeated-sprint training in hypoxia (RSH). Thirteen male team-sport players completed one familiarisation and three experimental sessions at a simulated altitude of ∼3000 m (FIO2 0.144). Air temperatures utilised across the three experimental sessions were: 20°C, 35°C and 40°C (all 50% relative humidity). Participants performed 3 × 5 × 10-s maximal cycle sprints, with 20-s passive recovery between sprints, and 5 min active recovery between sets. There were no differences between conditions for cycling peak power, mean power, and total work (p>0.05). Peak core temperature (Tc) was not different between conditions (38.11 ± 0.36°C). Vastus lateralis muscle deoxygenation during exercise and reoxygenation during recovery was of greater magnitude in 35°C and 40°C than 20°C (p<0.001 for all). There was no condition × time interaction for Tc, skin temperature, pulse oxygen saturation, heart rate, rating of perceived exertion and thermal sensation (P>0.05). Exercise-induced increases in blood lactate concentration were higher in 35°C and 40°C than 20°C (p=0.010 and p=0.001, respectively). Integrating ambient temperatures up to 40°C into a typical RSH session had no detrimental effect on performance. Additionally, the augmented muscle oxygenation changes experienced during exercise and recovery in temperatures ≥35°C may indicate that the potency of RSH training is increased with additional heat. However, alterations to the training session may be required to generate a sufficient rise in Tc for heat training purposes.Highlights Heat exposure (35-40°C) did not affect mechanical performance during a typical RSH session. This indicates hot ambient temperature can be implemented during RSH, without negative consequence to training output.Hotter ambient conditions (35-40°C) likely result in greater muscle oxygenation changes during both exercise and recovery compared to temperate conditions.Although hotter sessions were perceived as more difficult and more thermally challenging, they did not further elevate Tc beyond that of temperate conditions. Accordingly, if intended to be used for heat acclimation purposes, alterations to the session may be required to increase heat load.

Taking the plunge: When is best for hot water immersion to complement exercise in heat and hypoxia.

This investigation assessed the psycho-physiological and performance effects of hot water immersion (HWI) implemented either before or after a repeated-sprint training in hypoxia (RSH) session conducted in the heat. Ten participants completed three RSH trials (3 × 10 × 5-s sprints), conducted at 40°C and simulated altitude of 3000 m. A 30-min monitoring period preceded and followed all exercise sessions. In PRE, the pre-exercise period was HWI, and the post-exercise period was seated rest in temperate conditions. This combination was reversed in POST. In CON, participants were seated in temperate conditions for both periods. Compared to CON, PRE elicited a reduction in power output during each repeated-sprint set (14.8-16.2%, all p < 0.001), and a significantly higher core temperature (Tc) during the pre-exercise period and throughout the exercise session (p < 0.001 and p = 0.025, respectively). In POST, power output and Tc until the end of exercise were similar to CON, with Tc higher at the conclusion of the post-exercise period (p < 0.001). Time across the entire protocol spent ≥38.5°C Tc was significantly longer in PRE (48.1 ± 22.5 min) than POST (31.0 ± 11.3 min, p = 0.05) and CON (15.8 ± 16.3 min, p < 0.001). Employing HWI following RSH conducted in the heat provides effective outcomes regarding physiological strain and cycling performance when compared to pre-exercise or no HWI.

Ice Ingestion Maintains Cognitive Performance during a Repeated Sprint Performance in The Heat.

This study investigated the effects of precooling via crushed ice ingestion on cognitive performance during repeated-sprint cycling in the heat. Nine males, non-heat acclimatised to heat (mean age: 28.2 ± 2.7 y; height: 175.7 ± 9.7 cm; body-mass: 76.9 ± 10.6 kg) completed a 30 min bout of repeated-sprint (36 × 4 s sprints, interspersed with 56 s rest-breaks) on a cycle ergometer in a climate chamber (35°C, 70% relative humidity). Crushed ice ingestion (7g·kg-1, -0.4°C, ICE) or no cooling (CON) interventions were completed at rest, in the climate chamber, 30 min prior to exercise. Working memory was assessed via the serial seven test (S7) and the automated operation span task (OSPAN) at various time points before, during, and post-exercise. Core body temperature (Tc), forehead temperature (Th), and thermal sensation (TS) were assessed throughout the protocol. Working memory significantly declined during exercise in CON as measured by S7 (p = 0.01) and OSPAN (p = 0.03); however, it was preserved in ICE with no change at the end of exercise in either S7 or OSPAN scores compared to baseline (p = 0.50, p = 0.09, respectively). Following precooling, Th (-0.59°C, p < 0.001) and Tc (-0.67°C, p = 0.005) were significantly decreased in ICE compared to CON. At the end of the exercise, ICE significantly reduced Tc compared to CON (p = 0.03), but no significant differences were recorded for Th. Further, TS was lower following precooling in ICE (p = 0.008) but not during exercise. In conclusion, ice ingestion significantly reduced Th and Tc and facilitated maintenance of cognitive performance during repeated-sprint exercise in the heat, which may lead to better decision making.

The influence of rest break frequency and duration on physical performance and psychophysiological responses: a mining simulation study.

PURPOSE: To investigate the influence of shorter, more frequent rest breaks during simulated work (outdoor mining) in the heat on physical performance and psychophysiological responses. METHODS: On separate days, thirteen males undertook two 225 min simulation trials in the afternoon (12.00-3.45 pm) including 180 min of treadmill walking at a constant rate of perceived exertion of 11 (or 'light') on the 6-20 Borg scale in a heat chamber (37 °C, 40% RH), interspersed with 45 min of rest breaks in an air-conditioned room (22 °C, 35% RH). Rest breaks in the current practice (CP) trial occurred at 1.00 and 2.30 pm (30 min and 15 min, respectively), while in the experimental (EXP) trial were at 1.00 (15 min), 1.45, 2.25 and 3.05 pm (10 min each). RESULTS: Total distance covered was not different (p = 0.086) between CP (12,858 ± 2207 m) and EXP (12,094 ± 2174 m). Heart rate, thermal sensation and thermal comfort were significantly higher at 120-180 min (all p < 0.05) in CP compared to EXP. Moderate- to large-effect sizes (Hedge's g) between trials were also found at 120-180 min for core temperature (g = 0.50 and 0.99, respectively). No differences were found between trials for cognitive performance, perceived fatigue, urine specific gravity, or total water intake (p > 0.05). CONCLUSION: Shorter, more frequent rest breaks have little impact on physical performance, thermal strain and exercise-related sensations. Current practices should remain in place until further studies can be conducted on an actual mine site during summer where outdoor workers perform their work duties.

A Combination of Ice Ingestion and Head Cooling Enhances Cognitive Performance during Endurance Exercise in the Heat.

This study assessed the effectiveness of head cooling during exercise in the heat on cognitive performance, either alone or with ice ingestion. Ten healthy males, non-acclimatized to heat, ran (70% V̇O2peak) for 2×30 min in heat (35 ± 0.9°C, 68.2 ± 6.9% RH). Participants completed 3 trials: 10 min of head cooling during exercise (HC); precooling with crushed ice (7gikg-1) and head cooling during exercise (MIX); or no-cooling/control (CON). Working memory was assessed using the automated operation span task (OSPAN) and serial seven test (S7). Following MIX, S7 scores were improved compared to CON (12 ± 9.5, p = 0.004, d = 1.42, 0.34-2.28) and HC (4 ± 5.5, p = 0.048, d = 0.45, -0.47 to 1.3) during exercise. Moderate to large effect sizes were recorded for S7 and OSPAN following MIX and HC compared to CON, suggesting a tendency for improved cognitive performance during exercise in heat. Following precooling (MIX), core body temperature (Tc) and forehead temperature (Th) were lower compared to baseline (-0.75 ± 0.37°C, p < 0.001; -0.31 ± 0.29°C, p = 0.008, respectively) but not in HC or CON (p > 0.05). Thermal sensation (TS) was lower in MIX and HC compared to CON during exercise (p < 0.05). The reduction in Tc, Th and TS with MIX may have attenuated the effect of heat and subsequently improved working memory during exercise in heat.

Heat Added to Repeated-Sprint Training in Hypoxia Does Not Affect Cycling Performance.

PURPOSE: This study aimed to assess the influence of graded air temperatures during repeated-sprint training in hypoxia (RSH) on performance and physiological responses. METHODS: Ten well-trained athletes completed one familiarization and 4 experimental sessions at a simulated altitude of 3000 m (0.144 FIO2) above sea level. Air temperatures utilized across the 4 experimental sessions were 20°C, 25°C, 30°C, and 35°C (all 50% relative humidity). The participants performed 3 sets of 5 × 10 seconds "all-out" cycle sprints, with 20 seconds of active recovery between sprints and 5 minutes of active recovery between sets (recovery intensity = 120 W). Core temperature, skin temperature, pulse oxygen saturation, heart rate, rating of perceived exertion, and thermal sensation were collected. RESULTS: There were no differences between conditions for peak power, mean power, and total work in each set (P > .05). There were no condition × time interaction effects for any variables tested. The peak core temperature was highest at 30°C (38.06°C [0.31°C]). Overall, the pulse oxygen saturation was higher at 35°C than at 20°C (P < .001; d < 0.8), 25°C (P < .001; d = 1.12 ± 0.54, large), and 30°C (P < .001; d = 0.84 ± 0.53, large). CONCLUSION: Manipulating air temperature between 20°C and 35°C had no effect on performance or core temperature during a typical RSH session. However, the pulse oxygen saturation was preserved at 35°C, which may not be a desirable outcome for RSH interventions. The application of increased levels of ambient heat may require a different approach if augmenting the RSH stimulus is the desired outcome.

Head Cooling Prior to Exercise in the Heat Does Not Improve Cognitive Performance.

This study investigated the effectiveness of head cooling on cognitive performance after 30 min and 60 min of running in the heat. Ten moderately-trained, non-heat-acclimated, male endurance athletes (mean age: 22 ± 6.6 y; height: 1.78 ± 0.10 m; body-mass: 75.7 ± 15.6 kg; VO2peak: 51.6 ± 4.31 mL-1>kg-1>min) volunteered for this study. Participants performed two experimental trials: head cooling versus no-cooling (within-subjects factor with trial order randomized). For each trial, participants wore a head-cooling cap for 15 min with the cap either cooled to 0°C (HC) or not cooled (22°C; CON). Participants then completed 2 × 30 min running efforts on a treadmill at 70% VO2peak in hot conditions (35°C, 70% relative humidity), with a 10 min rest between efforts. Working memory was assessed using an operation span (OSPAN) task immediately prior to the 15 min cooling/no-cooling period (22°C, 35% RH) and again after 30 min and 60 min of running in the heat. Numerous physiological variables, including gastrointestinal core temperature (Tc) were assessed over the protocol. Scores for OSPAN were similar between trials, with no interaction effect or main effects for time and trial found (p = 0.58, p = 0.67, p = 0.54, respectively). Forehead temperature following precooling was lower in HC (32.4 ± 1.6°C) compared with CON (34.5 ± 1.1°C) (p = 0.01), however, no differences were seen in Tc, skin temperature, heart rate and ratings of perceived exertion between HC and CON trials at any time point assessed (p > 0.05). In conclusion, despite HC reducing forehead temperature prior to exercise, it did not significantly improve cognitive performance during (half-time break) or after subsequent exercise in hot environmental conditions, compared to a no cooling control.

An Experimental Simulation of Heat Effects on Cognition and Workload of Surgical Team Members.

OBJECTIVE: To isolate heat exposure as a cause of cognitive impairment and increased subjective workload in burns surgical teams. SUMMARY OF BACKGROUND DATA: Raising ambient temperature of the operating room can improve burns patient outcomes, but risks increased cognitive impairment and workload of surgical team members. Prior research indicates ambient heat exposure depletes physiological and cognitive resources, but these findings have not been studied in the context of burns surgical teams. METHODS: Seventeen surgical team members completed 2 surgery simulations of similar complexities in a hot and in a normothermic operating room. During each simulation, participants completed multiple cognitive tests to assess cognitive functioning and the SURG-TLX to self-assess workload. Order effects, core body temperature changes due to menstruation, and circadian rhythms were controlled for in the experimental design. Descriptive statistics, correlations, and mixed ANOVAs were performed to assess relationships between ambient heat exposure with cognitive functioning and perceived workload. RESULTS: Heat had a main effect on executive functioning and verbal reasoning. Duration of heat exposure (heat ∗ time) increased response times and negatively impacted executive functioning, spatial planning, and mental rotation. Perceived workload was higher in the hot condition. CONCLUSIONS: We provide causal evidence that over time, heat exposure impairs cognitive speed and accuracy, and increases subjective workload. We recommend building on this study to drive best-practices for acute burns surgery and design work to enable burns teams to maintain their cognitive stamina, lower their workload, and improve outcomes for patients and surgeons.

Cardiovascular Testing Detects Underlying Dysfunction in Childhood Leukemia Survivors.

PURPOSE: Childhood leukemia survivors commonly develop late-onset cardiovascular disease after treatment with anthracyclines. Resting echocardiogram is the standard procedure for monitoring cardiac health but this method may not be sensitive enough to detect subclinical injury. Exercise echocardiography may provide a viable alternative. METHODS: Nineteen (9 males; age, 19 ± 3 yr) anthracycline-treated survivors of childhood leukemia and 17 (8 males) healthy individuals of similar age (22 ± 2 yr) were recruited. All survivors had normal resting echocardiography upon recruitment. Exercise echocardiography was performed using contemporary imaging techniques. Flow-mediated dilation (FMD), body composition, and cardiorespiratory fitness (V˙O2peak) were assessed to determine predisposition to additional disease. RESULTS: Mitral valve peak flow velocity in late diastole (interaction, P = 0.007) increased from rest in survivors (P = 0.023) and controls (P = 0.020) immediately postexercise but did not recover again in the survivors (exercise-recovery, P = 0.784) after recuperation. Consequently, E/A ratio (interaction, P < 0.001) was lower in the survivors at recovery (P < 0.001). Survivors had reduced FMD (7.88 ± 1.70 vs 9.65 ± 2.83; P = 0.030), maximal and recovery HR (P = 0.001; P < 0.001), minute ventilation (P < 0.001), and V˙O2peak (absolute, 2.64 ± 0.62 vs 3.14 ± 0.74 L·min, P = 0.034; relative, 36.78 ± 11.49 vs 45.14 ± 6.80 mL·kg·min; P = 0.013) compared with controls. They also had higher total body fat (percentage, P = 0.034; mass, P = 0.024) and fat mass in the central (P = 0.050), peripheral (P = 0.039) and visceral (P < 0.001) regions. Survivors matched controls with regard to height (173.0 ± 7.8 cm vs 173.8 ± 9.1 cm; P = 0.796), body mass (76.16 ± 19.05 kg vs 70.07 ± 13.96 kg; P = 0.287) and body mass index (25.2 ± 5.1 vs 22.9 ± 2.7; P = 0.109). CONCLUSIONS: Exercise echocardiography unmasked subclinical diastolic dysfunction that may indicate late anthracycline toxicity in apparently healthy survivors of childhood leukemia. Presence of secondary risk factors indicates increased predisposition to comorbidities and highlights the importance of assessing cardiovascular health during follow-up.

Effects of a hot ambient operating theatre on manual dexterity, psychological and physiological parameters in staff during a simulated burn surgery.

OBJECTIVES: Hot environmental conditions can result in a high core-temperature and dehydration which can impair physical and cognitive performance. This study aimed to assess the effects of a hot operating theatre on various performance, physiological and psychological parameters in staff during a simulated burn surgery. METHODS: Due to varying activity levels, surgery staff were allocated to either an Active (n = 9) or Less-Active (n = 8) subgroup, with both subgroups performing two simulated burn surgery trials (CONTROL: ambient conditions; 23±0.2°C, 35.8±1.2% RH and HOT: 34±0°C, 28.3±1.9% RH; 150 min duration for each trial), using a crossover design with four weeks between trials. Manual dexterity, core-temperature, heart-rate, sweat-loss, thermal sensation and alertness were assessed at various time points during surgery. RESULTS: Pre-trials, 13/17 participants were mildly-significantly dehydrated (HOT) while 12/17 participants were mildly-significantly dehydrated (CONTROL). There were no significant differences in manual dexterity scores between trials, however there was a tendency for scores to be lower/impaired during HOT (both subgroups) compared to CONTROL, at various time-points (Cohen's d = -0.74 to -0.50). Furthermore, alertness scores tended to be higher/better in HOT (Active subgroup only) for most time-points (p = 0.06) compared to CONTROL, while core-temperature and heart-rate were higher in HOT either overall (Active; p<0.05) or at numerous time points (Less-Active; p<0.05). Finally, sweat-loss and thermal sensation were greater/higher in HOT for both subgroups (p<0.05). CONCLUSIONS: A hot operating theatre resulted in significantly higher core-temperature, heart-rate, thermal sensation and sweat-loss in staff. There was also a tendency for slight impairment in manual dexterity, while alertness improved. A longer, real-life surgery is likely to further increase physiological variables assessed here and in turn affect optimal performance/outcomes.

Hand and torso pre-cooling does not enhance subsequent high-intensity cycling or cognitive performance in heat.

The purpose of this study was to compare the separate and combined effects of two practical cooling methods (hand and torso) used prior to exercise on subsequent high-intensity cycling performance in heat. Ten trained male cyclists (V̇O2peak: 65.7 ± 10.7 ml.kg-1.min-1) performed four experimental trials (randomised within-subjects design) involving 30-min of pre-cooling (20-min seated; PRE-COOL, 10 min warm-up; PRE-COOL+WUP), while using a: (1) hand-cooling glove (CG); (2) cooling jacket (CJ); (3) both CG and CJ (CG+J); or (4) no-cooling (NC) control, followed by a cycling race simulation protocol (all performed in 35.0 ± 0.6°C and 56.6 ± 4.5% RH). During the 30-min of pre-cooling, no reductions in core (Tc) or mean skin temperature (Tsk) occurred; however, Tsk remained lower in the CJ and CG+J trials compared to NC and CG (p = 0.002-0.040, d= 0.55-1.01). Thermal sensation ratings also indicated that participants felt "hotter" during NC compared to all other trials during both PRE-COOL and PRE-COOL+WUP (p = 0.001-0.015, d= 1.0-2.19), plus the early stages of exercise (sets 1-2; p = 0.005-0.050, d= 0.56-1.22). Following cooling, no differences were found for absolute Tc and Tsk responses between trials over the entire exercise protocol (p > 0.05). Exercise and cognitive (working memory) performance also did not differ between trials (p = 0.843); however, cognitive performance improved over time in all trials (p < 0.001). In summary, pre-cooling (20-min seated and 10-min warm-up) in heat did not improve subsequent high-intensity cycling performance, cognitive responses and associated thermoregulatory strain (Tc and Tsk) compared to control.