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  Subjects -> ENVIRONMENTAL STUDIES (Total: 817 journals)
    - ENVIRONMENTAL STUDIES (744 journals)
    - POLLUTION (23 journals)
    - WASTE MANAGEMENT (10 journals)

ENVIRONMENTAL STUDIES (744 journals)            First | 1 2 3 4 5 6 7 8     

Journal of Tropical Ecology     Hybrid Journal   (Followers: 11)
Journal of Urban and Environmental Engineering     Open Access   (Followers: 1)
Journal of Vietnamese Environment     Open Access   (Followers: 2)
Journal of Water Security     Open Access  
Journal of Wetlands Environmental Management     Open Access  
Julius-Kühn-Archiv     Open Access  
Kleio     Full-text available via subscription   (Followers: 2)
Knowledge Management Research & Practice     Hybrid Journal   (Followers: 20)
Koedoe : African Protected Area Conservation and Science     Open Access   (Followers: 7)
L1-Educational Studies in Language and Literature     Open Access   (Followers: 2)
Lake and Reservoir Management     Hybrid Journal   (Followers: 4)
Landscape Ecology     Hybrid Journal   (Followers: 30)
Landscapes     Hybrid Journal   (Followers: 21)
Large Marine Ecosystems     Full-text available via subscription  
Latin American and Caribbean Ethnic Studies     Hybrid Journal   (Followers: 4)
Latin American Journal of Management for Sustainable Development     Hybrid Journal   (Followers: 1)
Legal Studies     Hybrid Journal   (Followers: 4)
Letras Verdes. Revista Latinoamericana de Estudios Socioambientales     Open Access  
Leviathan : A Journal of Melville Studies     Full-text available via subscription   (Followers: 2)
Limnological Review     Open Access   (Followers: 6)
Living Reviews in Landscape Research     Open Access   (Followers: 2)
Local Environment: The International Journal of Justice and Sustainability     Hybrid Journal   (Followers: 8)
Low Carbon Economy     Open Access   (Followers: 4)
Luna Azul     Open Access  
M+A. Revista Electrónica de Medioambiente     Open Access  
Macquarie Journal of International and Comparative Environmental Law     Full-text available via subscription   (Followers: 8)
Madagascar Conservation & Development     Open Access  
Management International Review     Hybrid Journal   (Followers: 7)
Management of Environmental Quality: An International Journal     Hybrid Journal   (Followers: 6)
Management of Sustainable Development     Open Access   (Followers: 2)
Marine Ecology     Hybrid Journal   (Followers: 13)
Marine Environmental Research     Hybrid Journal   (Followers: 13)
Marine Pollution Bulletin     Hybrid Journal   (Followers: 12)
Materials for Renewable and Sustainable Energy     Open Access   (Followers: 10)
Mathematical and Computational Forestry & Natural-Resource Sciences     Free  
Mathematical Population Studies: An International Journal of Mathematical Demography     Hybrid Journal   (Followers: 2)
Medieval Sermon Studies     Hybrid Journal   (Followers: 3)
Medio Ambiente y Urbanizacion     Full-text available via subscription  
Membranes     Open Access   (Followers: 6)
Michigan Journal of Sustainability     Open Access  
Midwest Studies In Philosophy     Hybrid Journal   (Followers: 12)
Mine Water and the Environment     Hybrid Journal   (Followers: 6)
Mitigation and Adaptation Strategies for Global Change     Hybrid Journal   (Followers: 12)
Modern Asian Studies     Hybrid Journal   (Followers: 8)
Modern Cartography Series     Full-text available via subscription   (Followers: 6)
Mountain Research and Development     Open Access   (Followers: 4)
Multequina     Open Access  
Mutation Research/Fundamental and Molecular Mechanisms of Mutagenesis     Hybrid Journal   (Followers: 2)
Mutation Research/Genetic Toxicology and Environmental Mutagenesis     Hybrid Journal   (Followers: 7)
Nativa     Open Access  
Natur und Recht     Hybrid Journal   (Followers: 7)
Natural Areas Journal     Full-text available via subscription   (Followers: 8)
Natural Hazards     Hybrid Journal   (Followers: 162)
Natural Resources     Open Access  
Natural Resources and Environmental Issues     Open Access   (Followers: 5)
Nature and Culture     Full-text available via subscription   (Followers: 10)
NeuroToxicology     Hybrid Journal   (Followers: 1)
Neurotoxicology and Teratology     Hybrid Journal   (Followers: 1)
NEW SOLUTIONS: A Journal of Environmental and Occupational Health Policy     Full-text available via subscription   (Followers: 5)
New Zealand Journal of Environmental Law     Full-text available via subscription   (Followers: 3)
NJAS - Wageningen Journal of Life Sciences     Full-text available via subscription   (Followers: 1)
Noise Mapping     Open Access  
Noise Notes     Full-text available via subscription   (Followers: 3)
Novos Cadernos NAEA     Open Access   (Followers: 2)
Observatorio Medioambiental     Open Access  
Occupational and Environmental Medicine     Full-text available via subscription   (Followers: 10)
Ocean Acidification     Open Access   (Followers: 1)
Ochrona Srodowiska i Zasobów Naturalnych : Environmental Protection and Natural Resources     Open Access  
Oecologia     Hybrid Journal   (Followers: 34)
Oikos     Hybrid Journal   (Followers: 34)
Open Journal of Ecology     Open Access   (Followers: 10)
Open Journal of Marine Science     Open Access   (Followers: 7)
Open Journal of Modern Hydrology     Open Access   (Followers: 4)
Our Nature     Open Access   (Followers: 3)
Oxford Journal of Legal Studies     Hybrid Journal   (Followers: 20)
Pace Environmental Law Review     Open Access   (Followers: 6)
Pace Environmental Law Review Online Companion     Open Access   (Followers: 1)
Packaging, Transport, Storage & Security of Radioactive Material     Hybrid Journal   (Followers: 1)
Palaeobiodiversity and Palaeoenvironments     Hybrid Journal   (Followers: 4)
Particle and Fibre Toxicology     Open Access   (Followers: 2)
Pastos y Forrajes     Open Access  
Pesquisa em Educação Ambiental     Open Access  
Pharmacology & Therapeutics     Hybrid Journal   (Followers: 5)
Pharmacology Biochemistry and Behavior     Hybrid Journal   (Followers: 1)
Philosophical Studies     Hybrid Journal   (Followers: 8)
Physio-Géo     Open Access   (Followers: 2)
Pittsburgh Journal of Environmental and Public Health Law     Open Access   (Followers: 1)
Planet     Open Access   (Followers: 2)
Planning & Environmental Law: Issues and decisions that impact the built and natural environments     Hybrid Journal   (Followers: 7)
Plant Ecology & Diversity     Partially Free   (Followers: 13)
Plant Knowledge Journal     Open Access   (Followers: 3)
Plant, Cell & Environment     Hybrid Journal   (Followers: 5)
Polar Journal     Hybrid Journal   (Followers: 4)
Policy Studies     Hybrid Journal   (Followers: 8)
Policy Studies Journal     Hybrid Journal   (Followers: 4)
Polish Polar Research     Open Access   (Followers: 4)
Political Studies     Hybrid Journal   (Followers: 25)
Political Studies Review     Hybrid Journal   (Followers: 15)
Population and Environment     Hybrid Journal   (Followers: 6)
Population Ecology     Hybrid Journal   (Followers: 11)

  First | 1 2 3 4 5 6 7 8     

Journal Cover   Wilderness & Environmental Medicine
  [3 followers]  Follow
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 1080-6032
   Published by Elsevier Homepage  [2801 journals]
  • The Great Earthquake in Nepal—A Personal View
    • Abstract: Publication date: Available online 17 November 2015
      Source:Wilderness & Environmental Medicine
      Author(s): Ken Zafren

      PubDate: 2015-11-20T23:28:12Z
  • Subungual Hematoma in the Mountains
    • Abstract: Publication date: Available online 16 November 2015
      Source:Wilderness & Environmental Medicine
      Author(s): Harvey V. Lankford

      PubDate: 2015-11-20T23:28:12Z
  • Orbital Compartment Syndrome: Alternative Tools to Perform a Lateral
           Canthotomy and Cantholysis
    • Abstract: Publication date: Available online 12 November 2015
      Source:Wilderness & Environmental Medicine
      Author(s): Kenneth V. Iserson, Zelda Luke-Blyden, Scott Clemans
      Orbital compartment syndrome acutely threatens vision. Lateral canthotomy and cantholysis ameliorate the compartment syndrome and, to save a patient’s vision, must be performed in a timely manner. This requires appropriate tools. In resource-poor settings, the straight hemostat and iris scissors that are generally used for this procedure may be unavailable. In such situations, safe alternatives include using a multitool in place of a hemostat and a #11 scalpel blade instead of the iris scissors. As when using hemostats of varying sizes, the pressure applied to the multitool must be carefully modulated. When using a scalpel blade for the lateral canthotomy, the hemostat arm remains beneath the lateral canthus as a “backstop” to protect deeper tissues. For the cantholysis, use the back of the blade to “strum” for the ligaments, reversing its direction only to cut the ligament when it is identified.

      PubDate: 2015-11-16T18:23:32Z
  • In Response to Management of a Pediatric Snake Envenomation After
           Presentation With a Tight Tourniquet by Bush and Kinlaw
    • Abstract: Publication date: Available online 3 November 2015
      Source:Wilderness & Environmental Medicine
      Author(s): Michael J. Matteucci

      PubDate: 2015-11-06T17:07:48Z
  • Acetazolamide Use in an Ultra-Runner: A Complicated Treatment
           Consideration for AMS
    • Abstract: Publication date: Available online 29 October 2015
      Source:Wilderness & Environmental Medicine
      Author(s): Amy Sue Biondich, Jeremy D. Joslin

      PubDate: 2015-11-01T07:55:01Z
  • The West Coast Trail Rescue, and 6 Lessons to Pack With You
    • Abstract: Publication date: Available online 26 October 2015
      Source:Wilderness & Environmental Medicine
      Author(s): Marissa Tsoi
      The transition from medical student to physician is a unique time in life. This author’s conversion was accelerated by unexpectedly becoming a trauma team leader while hiking Canada’s remote West Coast Trail. Six key lessons resulted from this rescue regarding emergency preparedness.

      PubDate: 2015-10-27T07:33:24Z
  • Coca: High Altitude Remedy of the Ancient Incas
    • Abstract: Publication date: Available online 23 October 2015
      Source:Wilderness & Environmental Medicine
      Author(s): Amy Sue Biondich, Jeremy D. Joslin
      The use of coca leaf for medicinal purposes is a centuries-old tradition of the native peoples of South America. Coca products are thought by many laypersons to provide risk-free benefits to users participating in strenuous activities at high altitude. Physiologic studies of coca have increased understanding of its possible mechanism of action as well as its potential impact on high altitude activities. This present work explores the role of coca throughout the history of the Andean peoples and explores whether this ancient remedy has a place in modern medicine. A focused summary of research articles with particular relevance to the field of wilderness medicine is also included to better provide the reader with lessons not only from history but also from another culture.

      PubDate: 2015-10-23T07:12:07Z
  • Epidemiology of Search and Rescue in Baxter State Park: Dangers of Descent
           and Fatigue
    • Abstract: Publication date: Available online 21 October 2015
      Source:Wilderness & Environmental Medicine
      Author(s): Chris R. Welter, J. Matthew Sholl, Tania D. Strout, Ben Woodard
      Objective The purpose of this study was to determine the epidemiology of injury in Baxter State Park, Maine, and to better tailor search and rescue (SAR) resources, personnel, and training to acute needs in the park. Methods We conducted a retrospective review of all SAR incident reports in Baxter State Park from July 1992 through June 2014. For each event, demographics, location, time, activity before the incident, incident details, and evacuation means were recorded and analyzed. Results In all, 754 incidents of SAR or medical need were identified. Mean age was 38.9 years; mean age for subjects with fatigue as the primary complaint was 48.7 years. A majority (60.5%) of victims were male. Nineteen fatalities occurred during the study. Traumatic injuries precipitated 51% of SAR incidents, and an additional 30% were initiated for late or lost parties. Slips or falls while hiking were the most common causes of injury (67%), with the lower extremity being the most common injury site (31%). When applicable, 84.4% of acute need occurred while descending, as opposed to ascending, a mountain. Fatigue was the most commonly reported medical emergency, causative in 66% of medical SAR events. Conclusions Fatigue is a major factor in SAR events, both as a discreet cause and as a contributor to other injuries. Search and rescue need is more likely to occur during mountain descent, and lower extremity injuries are the most common etiology. Efforts should be focused on training rescuers in lower extremity and fatigue treatment, and more rescuers should be available when many are descending.

      PubDate: 2015-10-23T07:12:07Z
  • In Reply to Drs Mullins and Ali
    • Abstract: Publication date: Available online 23 October 2015
      Source:Wilderness & Environmental Medicine
      Author(s): William R. Witham

      PubDate: 2015-10-23T07:12:07Z
  • California Sea Lion (Zalophus californianus) and Harbor Seal (Phoca
           vitulina richardii) Bites and Contact Abrasions in Open-Water Swimmers: A
           Series of 11 Cases
    • Abstract: Publication date: Available online 23 October 2015
      Source:Wilderness & Environmental Medicine
      Author(s): Thomas J. Nuckton, Claire A. Simeone, Roger T. Phelps
      Objective To review cases of bites and contact abrasions in open-water swimmers from California sea lions (Zalophus californianus) and harbor seals (Phoca vitulina richardii). Methods Open-water swimmers from a San Francisco swimming club were questioned about encounters with pinnipeds (seals and sea lions) that resulted in bites or contact abrasions. When possible, wounds were documented with photographs. Medical follow-up and treatment complications were also reviewed. Results From October 2011 to December 2014, 11 swimmers reported bites by a sea lion (n = 1), harbor seal (n = 7), or unidentified pinniped (n = 3). Ten of the encounters occurred in San Francisco Bay; 1 occurred in the Eld Inlet, in Puget Sound, near Olympia, WA. None of the swimmers were wearing wetsuits. All bites involved the lower extremities; skin was broken in 4 of 11 bites and antibiotics were prescribed in 3 cases. One swimmer, who was bitten by a harbor seal, also had claw scratches. A treatment failure occurred with amoxicillin/clavulanate in another swimmer who was bitten by an unidentified pinniped; the wound healed subsequently with doxycycline, suggesting an infection with Mycoplasma spp. There were no long-lasting consequences from any of the bites. The majority of cases occurred at low tide, and bumping of the swimmer by the animal before or after a bite was common, but no clear tide or attack pattern was identified. Conclusions Bites and contact abrasions from sea lions and harbor seals are reported infrequently in open-water swimmers and typically involve the lower extremities. Because of the risk of Mycoplasma infection, treatment with a tetracycline is recommended in pinniped bites with signs of infection or serious trauma. Attempting to touch or pet sea lions or seals is inadvisable and prohibited by the Marine Mammal Protection Act. Swimmers should leave the water as soon as possible after a bite or encounter.

      PubDate: 2015-10-23T07:12:07Z
  • Civilian Helicopter Search and Rescue Accidents in the United States: 1980
           Through 2013
    • Abstract: Publication date: Available online 9 October 2015
      Source:Wilderness & Environmental Medicine
      Author(s): Gordon H. Worley
      Objective Helicopters are commonly used in search and rescue operations, and accidents have occurred during helicopter search and rescue (HSAR) missions. The purposes of this study were to investigate whether the HSAR accident rate in the United States could be determined and whether any common contributing factors or trends could be identified. Methods Searches were conducted of the National Transportation Safety Board aviation accident database, the records of the major search and rescue and air medical organizations, and the medical and professional literature for reports of HSAR accidents. Results A total of 47 civilian HSAR accidents were identified during the study. Of these, 43% involved fatal injuries, compared with a 19% fatality rate for US helicopter general aviation accidents during the same time period and a 40% rate for helicopter emergency medical services. The HSAR accidents carried a significantly higher risk of fatal outcomes when compared with helicopter general aviation accidents (2-tailed Fisher’s exact test, P < .0005). Accidents that occurred at night and under instrument meteorological conditions did not have a statistically significant increase in percentage of fatal outcomes (P > .05). The number of HSAR missions conducted annually could not be established, so an overall accident rate could not be calculated. Conclusions Although the overall number of HSAR accidents is small, the percentage of fatal outcomes from HSAR accidents is significantly higher than that from general helicopter aviation accidents and is comparable to that seen for helicopter emergency medical services operations. Further study could help to improve the safety of HSAR flights.

      PubDate: 2015-10-11T01:58:07Z
  • A Case Study: What Doses of Amanita phalloides and Amatoxins Are Lethal to
    • Abstract: Publication date: Available online 9 October 2015
      Source:Wilderness & Environmental Medicine
      Author(s): Ismail Yilmaz, Fatih Ermis, Ilgaz Akata, Ertugrul Kaya
      There are few data estimating the human lethal dose of amatoxins or of the toxin level present in ingested raw poisonous mushrooms. Here, we present a patient who intentionally ingested several wild collected mushrooms to assess whether they were poisonous. Nearly 1 day after ingestion, during which the patient had nausea and vomiting, he presented at the emergency department. His transaminase levels started to increase starting from hour 48 and peaking at hour 72 (alanine aminotransferase 2496 IU/L; aspartate aminotransferase 1777 IU/L). A toxin analysis was carried out on the mushrooms that the patient said he had ingested. With reversed-phase high-performance liquid chromatography analysis, an uptake of approximately 21.3 mg amatoxin from nearly 50 g mushroom was calculated; it consisted of 11.9 mg alpha amanitin, 8.4 mg beta amanitin, and 1 mg gamma amanitin. In the urine sample taken on day 4, 2.7 ng/mL alpha amanitin and 1.25 ng/mL beta amanitin were found, and there was no gamma amanitin. Our findings suggest that the patient ingested approximately 0.32 mg/kg amatoxin, and fortunately recovered after serious hepatotoxicity developed.

      PubDate: 2015-10-11T01:58:07Z
  • Thevetia peruviana
    • Abstract: Publication date: Available online 9 October 2015
      Source:Wilderness & Environmental Medicine
      Author(s): GN Pramod Kumar, Alok Atreya, Tanuj Kanchan

      PubDate: 2015-10-11T01:58:07Z
  • In Response to Snakebite Rebound Coagulopathy by Witham et al.
    • Abstract: Publication date: Available online 1 October 2015
      Source:Wilderness & Environmental Medicine
      Author(s): Michael E. Mullins, Anah J. Ali

      PubDate: 2015-10-03T00:21:12Z
  • Predictive Factors for Determining the Clinical Severity of Pediatric
           Scorpion Envenomation Cases in Southeastern Turkey
    • Abstract: Publication date: Available online 1 October 2015
      Source:Wilderness & Environmental Medicine
      Author(s): Aykut Çağlar, Halil Köse, Aslan Babayiğit, Taliha Öner, Murat Duman
      Objective The aim of this study was to define the epidemiological, clinical, and laboratory manifestations of scorpion envenomation and to identify factors that are predictive of severe cases. Methods The medical files of 41 scorpion envenomation cases were reviewed retrospectively. The cases were classified as mild-moderate or severe. The epidemiological, clinical, and laboratory findings of patients were recorded. Results There were 27 patients (65.9%) in the mild-moderate group and 14 patients (34.1%) in the severe group. The median age of all patients was 48 months. The most common systemic finding was cold extremities (41.5%). In all patients, the most commonly observed dysrhythmia was sinus tachycardia (34.1%). Two patients (4.9%) had pulseless ventricular tachycardia and died. Pulmonary edema and myocarditis were observed in 9 patients (22%). Median values of leukocyte and glucose levels were markedly increased in the severe group. Additionally, the mean thrombocyte level (540,857 ± 115,261 cells/mm3) in the severe group was significantly increased compared with the mild-moderate group (391,365 ± 150,017 cells/mm3). Thrombocyte levels exhibited a positive correlation with leukocyte and glucose values and a negative correlation with patient left ventricular ejection fraction. Multivariate analysis of laboratory parameters indicated that the most predictive factor for clinical severity is thrombocytosis (odds ratio 23.9; 95% CI: 1.6–353.5, P = .021). Conclusions Although our results share some similarities with those of other reports, thrombocytosis was markedly increased in the severe group and served as the most predictive laboratory factor of clinical severity.

      PubDate: 2015-10-03T00:21:12Z
  • An Elderly Man from Solukhumbu, Nepal, with a Rash
    • Abstract: Publication date: Available online 1 October 2015
      Source:Wilderness & Environmental Medicine
      Author(s): Nishant Raj Pandey, Abhijit Adhikary, Sanjaya Karki

      PubDate: 2015-10-03T00:21:12Z
  • Brown Bear Attacks in a Nepalese Scenario: A Brief Review
    • Abstract: Publication date: Available online 1 October 2015
      Source:Wilderness & Environmental Medicine
      Author(s): Alok Atreya, Tanuj Kanchan, Samata Nepal, Jenash Acharya

      PubDate: 2015-10-03T00:21:12Z
  • In Reply to Dr Lankford
    • Abstract: Publication date: Available online 1 October 2015
      Source:Wilderness & Environmental Medicine
      Author(s): Morteza Khodaee, Mark Riederer, Karin VanBaak, John C. Hill

      PubDate: 2015-10-03T00:21:12Z
  • Marked Hypofibrinogenemia and Gastrointestinal Bleeding After Copperhead
           (Agkistrodon contortrix) Envenomation
    • Abstract: Publication date: Available online 1 October 2015
      Source:Wilderness & Environmental Medicine
      Author(s): Kathryn T. Kopec, May Yen, Matthew Bitner, C. Scott Evans, Charles J. Gerardo
      Compared with other crotaline envenomations, copperhead envenomations have historically been reported as having less severe hematologic venom effects and rarely hemorrhage. We report a case of clinically significant gastrointestinal bleeding after a copperhead (Agkistrodon contortrix) envenomation. A 52-year-old woman with a history of systemic lupus erythematosus was bitten on her right medial ankle after which hypofibrinogenemia and hematochezia developed. The symptoms resolved after repeated administration of Crotalidae polyvalent immune Fab (ovine) antivenom. She was discharged without further complications 2 days later. Although copperhead envenomations are classically considered less severe than other crotaline envenomations, this case demonstrates the potential of the venom to produce clinically significant hematologic effects.

      PubDate: 2015-10-03T00:21:12Z
  • In Response to Ultraendurance Athletes With Type 1 Diabetes: Leadville 100
           Experience, by Khodaee et al
    • Abstract: Publication date: Available online 26 September 2015
      Source:Wilderness & Environmental Medicine
      Author(s): Harvey V. Lankford

      PubDate: 2015-09-28T19:32:24Z
  • Emergency Medical Service in the US National Park Service: A
           Characterization and Two-Year Review, 2012–2013
    • Abstract: Publication date: Available online 16 September 2015
      Source:Wilderness & Environmental Medicine
      Author(s): Jeffrey P. Lane, Bonnaleigh Taylor, William R. Smith, Albert R. Wheeler
      Objective Visitors to US National Park Service (NPS) units have a unique set of needs in terms of emergency medical care. The purpose of this review is to quantify and characterize emergency medical services (EMS) activities in the NPS to elaborate on its unique aspects, establish trends, and benchmark these data against a sample of national EMS data. Methods The EMS data for calendar years 2012 and 2013 were queried from national NPS reports. Results The EMS responses totaled 40 calls per million visitors in 2012 and 34 calls per million visitors in 2013. Of those, 75% required a basic life support level of care. There were comparable incidences of transported EMS trauma calls (49%) and medical calls (51%). Of a total of 137 sudden cardiac arrest events, 65% of patients received defibrillation and 26% survived to hospital release. There were 262 total fatalities in 2012 and 238 in 2013, with traumatic fatalities occurring approximately twice as often as nontraumatic fatalities. Conclusions Across the country, the NPS responded to a large number of EMS calls each year, but with a relatively low frequency, considering the large number of visitors. This is a challenging setting in which to provide consistent EMS care throughout various NPS administered areas. The typical NPS EMS response provided basic life support level care to visitors with traumatic injuries. The NPS caregivers must be prepared, however, to respond to a varied and diverse range of EMS calls.

      PubDate: 2015-09-19T19:19:22Z
  • Finger and Toe Temperature Responses to Cold After Freezing Cold Injury in
           Elite Alpinists
    • Abstract: Publication date: September 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 3
      Author(s): Shawnda A. Morrison, Jurij Gorjanc, Ola Eiken, Igor B. Mekjavic
      Objective To assess whether previous freezing cold injuries (FCI) would affect digit skin temperatures and rewarming rates during a follow-up cold stress test protocol. Design Nonrandomized control trial. Methods Twenty elite alpinists participated; alpinists with previous FCI requiring digit amputations (injured, INJ: n = 10 total, n = 8 male) were compared with ability-matched, uninjured alpinists (control, CON: n = 10, all male). Digit skin temperature was measured using infrared thermography as an index of peripheral digit perfusion after a cold stress test, which consisted of 30 minutes of immersion in 8°C water. Results The INJ alpinists’ injured toes were warmer (approximately 6%) than their uninjured toes immediately after cold immersion (95% CI, 0.01°C to 1.00°C; P = .05); there were no differences between the rates of rewarming of injured and uninjured toes (INJ, 0.5° ± 0.1°C/min; CON, 0.7° ± 0.3°C/min; P = .16). Although the INJ alpinists had colder injured fingers immediately after the 35°C warm bath compared with their own uninjured fingers (32.2° ± 2.0°C vs 34.5° ± 0.5°C; P = .02), there were no differences observed between the rates of rewarming of injured and uninjured fingers after cold exposure (INJ, 1.1° ± 0.2°C/min; CON, 1.3° ± 0.5°C/min; P = .22). Conclusions Even after FCI that requires digit amputation, there is no evidence of different tissue rates of rewarming between the injured and uninjured fingers or toes of elite alpinists.

      PubDate: 2015-08-30T16:16:03Z
  • Indian Pediatrics
    • Abstract: Publication date: September 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 3

      PubDate: 2015-08-30T16:16:03Z
  • Emerging Infectious Diseases
    • Abstract: Publication date: September 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 3

      PubDate: 2015-08-30T16:16:03Z
  • The American Journal of Medicine
    • Abstract: Publication date: September 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 3

      PubDate: 2015-08-30T16:16:03Z
  • A Pain in the Neck
    • Abstract: Publication date: September 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 3
      Author(s): Pranawa Koirala, Seth Wolpin, Pratibha Phuyal, Buddha Basnyat, Ken Zafren

      PubDate: 2015-08-30T16:16:03Z
  • Resuscitation
    • Abstract: Publication date: September 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 3

      PubDate: 2015-08-30T16:16:03Z
  • Jellyfish Stings: A Practical Approach
    • Abstract: Publication date: September 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 3
      Author(s): Najla A. Lakkis, Grace J. Maalouf, Dina M. Mahmassani
      Jellyfish have a worldwide distribution. Their stings can cause different reactions, ranging from cutaneous, localized, and self-limited to serious systemic or fatal ones, depending on the envenoming species. Several first aid treatments are used to manage such stings but few have evidence behind their use. This review of the literature describes and discusses the different related first aid and treatment recommendations, ending with a summarized practical approach. Further randomized controlled trials in this field are needed.

      PubDate: 2015-08-30T16:16:03Z
  • Advanced Avalanche Safety Equipment of Backcountry Users: Current Trends
           and Perceptions
    • Abstract: Publication date: September 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 3
      Author(s): Pearlly Ng, William R. Smith, Albert Wheeler, Scott E. McIntosh
      Objective Backcountry travelers should carry a standard set of safety gear (transceiver, shovel, and probe) to improve rescue chances and reduce mortality risk. Many backcountry enthusiasts are using other advanced equipment such as an artificial air pocket (eg, the AvaLung) or an avalanche air bag. Our goal was to determine the numbers of backcountry users carrying advanced equipment and their perceptions of mortality and morbidity benefit while carrying this gear. Methods A convenience sample of backcountry skiers, snowboarders, snowshoers, and snowmobilers was surveyed between February and April 2014. Participants of this study were backcountry mountain users recruited at trailheads in the Wasatch and Teton mountain ranges of Utah and Wyoming, respectively. Questions included prior avalanche education, equipment carried, and perceived safety benefit derived from advanced equipment. Results In all, 193 surveys were collected. Skiers and snowboarders were likely to have taken an avalanche safety course, whereas snowshoers and snowmobilers were less likely to have taken a course. Most backcountry users (149, 77.2%), predominantly skiers and snowboarders, carried standard safety equipment. The AvaLung was carried more often (47 users) than an avalanche air bag (10 users). The avalanche air bag had a more favorable perceived safety benefit. A majority of participants reported cost as the barrier to obtaining advanced equipment. Conclusions Standard avalanche safety practices, including taking an avalanche safety course and carrying standard equipment, remain the most common safety practices among backcountry users in the Wasatch and Tetons. Snowshoers remain an ideal target for outreach to increase avalanche awareness and safety.

      PubDate: 2015-08-30T16:16:03Z
  • Which Improvised Tourniquet Windlasses Work Well and Which Ones
    • Abstract: Publication date: September 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 3
      Author(s): John F. Kragh, Timothy E. Wallum, James K. Aden, Michael A. Dubick, David G. Baer
      Objective Improvised tourniquets in first aid are recommended when no scientifically designed tourniquet is available. Windlasses for mechanical advantage can be a stick or pencil and can be used singly or multiply in tightening a tourniquet band, but currently there is an absence of empiric knowledge of how well such windlasses work. The purpose of the present study was to determine the performance of improvised tourniquets in their use by the type and number of windlasses to improve tourniquet practice. Methods A simulated Leg Tourniquet Trainer was used as a manikin thigh to test the effectiveness of improvised tourniquets of a band-and-windlass design. Two users made 20 tests each with 3 types of windlasses. Tests started with 1 representative of a given type (eg, 1 pencil), then continued with increasing numbers of each windlass type until the user reached 100% effectiveness as determined by cessation of simulated blood flow. Windlass types included chopsticks, pencils, and craft sticks. Results Effectiveness percentages in stopping bleeding were associated inversely with breakage percentages. Pulse stoppage percentages were associated inversely with breakage. The windlass turn numbers, time to stop bleeding, the number of windlasses, and the under-tourniquet pressure were associated inversely with breakage. The windlass type was associated with breakage; at 2 windlasses, only chopsticks were without breakage. Of those windlass types that broke, 20.7% were chopsticks, 26.1% were pencils, and 53.2% were craft sticks. Conclusions A pair of chopsticks as an improvised tourniquet windlass worked better than pencils or craft sticks.

      PubDate: 2015-08-30T16:16:03Z
  • Reduction of Acute Shoulder Dislocations in a Remote Environment: A
           Prospective Multicenter Observational Study
    • Abstract: Publication date: September 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 3
      Author(s): Therezia Bokor-Billmann, Hryhoryi Lapshyn, Erhard Kiffner, Matthias F. Goos, Ulrich T. Hopt, Franck G. Billmann
      Objective Acute dislocations of the glenohumeral joint are common in wilderness activities. Emergent reduction should take place at the site of trauma to reduce the patient’s pain and the risk of vascular and neurological complications. A limited number of reduction methods are applicable in remote areas. The aim of this study is to present our method of reduction of anterior shoulder luxation that is easily applicable in remote areas without medication, adjuncts, and assistants and is well tolerated by patients. Methods A prospective observational study was conducted during a 5-year period. The patients included underwent closed manual reduction with our technique. After each reduction, the physician who performed the reduction completed a standardized detailed history, and reexamined the patient (for acute complications). The patients were contacted 6 months after the trauma to investigate long-term postreduction complications. Results Reduction was achieved with our method in 39 (100.0%) of 39 patients. The mean pain felt during our reduction procedure was rated 1.7 ± 1.4 (on a scale of 10) using the visual analog scale scoring system. No complications were noted before or after the reduction attempts. We did not find any long-term complications. Conclusions The reduction method presented in the present study is an effective method for the reduction of acute shoulder luxations in remote places. Our data suggest that this method could be applied for safe and effective reduction of shoulder dislocation.

      PubDate: 2015-08-30T16:16:03Z
  • Epidemiology of Hunting Stand Injuries Presenting to US Emergency
           Departments, 2008–2013
    • Abstract: Publication date: September 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 3
      Author(s): Randall T. Loder
      Objective To determine the epidemiology of injuries from hunting stands presenting to US emergency departments (EDs). Methods The National Electronic Injury Surveillance System (NEISS) database was queried for ED visits for the period 2008 through 2013 for hunting stand injuries and analyzed for age, diagnosis, sex, race, anatomic location of the injury, the use of alcohol, and association with a gunshot wound. Results There were an estimated 38,308 visits with an average age of 40.0 years (range, 1–83 years). The patients were predominantly male (93.3%), white (99.1%), and seen at small- or medium-size hospitals (80.6%). Disposition from the ED was admission in 20.1% and released in 79.9%. A fall occurred in 80.3%, a gunshot wound in 0.4%, and alcohol was involved in 0.6%. The most common diagnoses were a fracture (34.7%), contusion or abrasion (24.0%), strain or sprain (16.8%), laceration (7.7%), and internal organ injury (5.4%). Those injured in a fall were more frequently admitted (23.0% vs. 8.7%) and more likely to have a fracture (37.9% vs. 9.1%). Those with a fracture were older (44.6% vs. 37.9%). Those with internal organ injuries were more frequently admitted (44.8% vs 18.6%). Conclusions This study has characterized the epidemiology of hunting stand injuries with most occurring from falls. A fracture was the most common injury with a very low alcohol intoxication rate. These baseline data can now be used to compare other studies of hunting stand injuries and guide prevention strategies, such as education regarding the need for safety measures to prevent falls.

      PubDate: 2015-08-30T16:16:03Z
  • Retained Stingray Barb and the Importance of Imaging
    • Abstract: Publication date: September 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 3
      Author(s): Gerald F. O’Malley, Rika N. O’Malley, Oahn Pham, Frederick Randolph
      Stingray envenomation is a common occurrence. X-ray evaluation of stingray wounds is an unnecessarily misunderstood diagnostic concept. We present the case of a patient stung by a stingray with a prolonged and complicated course and permanent disability due to a retained barb. The patient had undergone multiple medical evaluations before an X-ray was obtained.

      PubDate: 2015-08-30T16:16:03Z
  • Complete Spinal Accessory Nerve Palsy From Carrying Climbing Gear
    • Abstract: Publication date: September 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 3
      Author(s): Jess M. Coulter, Winston J. Warme
      We report an unusual case of spinal accessory nerve palsy sustained while transporting climbing gear. Spinal accessory nerve injury is commonly a result of iatrogenic surgical trauma during lymph node excision. This particular nerve is less frequently injured by blunt trauma. The case reported here results from compression of the spinal accessory nerve for a sustained period—that is, carrying a load over the shoulder using a single nylon rope for 2.5 hours. This highlights the importance of using proper load-carrying equipment to distribute weight over a greater surface area to avoid nerve compression in the posterior triangle of the neck. The signs and symptoms of spinal accessory nerve palsy and its etiology are discussed. This report is particularly relevant to individuals involved in mountaineering and rock climbing but can be extended to anyone carrying a load with a strap over one shoulder and across the body.

      PubDate: 2015-08-30T16:16:03Z
  • Hiker Fatality From Severe Hyponatremia in Grand Canyon National Park
    • Abstract: Publication date: September 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 3
      Author(s): Thomas M. Myers, Martin D. Hoffman
      We present the case of a hiker who died of severe hyponatremia at Grand Canyon National Park. The woman collapsed on the rim shortly after finishing a 5-hour hike into the Canyon during which she was reported to have consumed large quantities of water. First responders transported her to the nearest hospital. En route, she became unresponsive, and subsequent treatment included intravenous normal saline. Imaging and laboratory data at the hospital confirmed hypervolemic hyponatremia with encephalopathy. She never regained consciousness and died of severe cerebral edema less than 24 hours later. We believe this is the first report of a fatality due to acute hyponatremia associated with hiking in a wilderness setting. This case demonstrates the typical pathophysiology, which includes overconsumption of fluids, and demonstrates the challenges of diagnosis and the importance of appropriate acute management. Current treatment guidelines indicate that symptomatic exercise-associated hyponatremia should be acutely managed with hypertonic saline and can be done so without concern over central pontine myelinolysis, whereas treatment with high volumes of isotonic fluids may delay recovery and has even resulted in deaths.

      PubDate: 2015-08-30T16:16:03Z
  • Neurological Involvement and Hepatocellular Injury Caused by a Snake With
           Hematotoxin Envenomation
    • Abstract: Publication date: September 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 3
      Author(s): Watchareewan Sontichai, Sanit Reungrongrat, Paitoon Narongchai, Rungrote Natesirinilkul
      Venomous snakes with hematotoxin—Russell’s viper (Daboia spp), Malayan pit viper (Calloselasma rhodostoma), and green pit viper (Cryptelytrops albolabris and C macrops, previously named Trimeresurus spp) are commonly found in Thailand. Coagulation factor activation, thrombocytopenia, hyperfibrinolysis, and disseminated intravascular coagulation are the main mechanisms of hemorrhaging from these snake bites. The neurological involvement and hepatocellular injury after Russell’s viper bites were reported in Sri Lanka, but there is no report from Southeast Asia. This case was a 12-year-old hill tribe boy who had ptosis and exotropia of the left eye, respiratory distress, and prolonged venous clotting time, prothrombin time, and activated partial thromboplastin time; low fibrinogen and platelet count; and transaminitis after being bitten by a darkish-colored snake. He did not respond to antivenom for cobra, Malayan pit viper, or Russell’s viper. However, his neurological abnormalities, respiratory failure, and hepatocellular injury improved, and coagulopathy was finally corrected after receiving antivenom for green pit viper. The unidentified snake with hematotoxin was alleged for all manifestations in this patient.

      PubDate: 2015-08-30T16:16:03Z
  • Cardiovascular and Perceptual Responses to an Ultraendurance Channel Swim:
           A Case Study
    • Abstract: Publication date: September 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 3
      Author(s): Daniel A. Judelson, James R. Bagley, Jennifer M. Schumacher, Lenny D. Wiersma
      Ultraendurance open water swimming presents unique physiological challenges. This case study aimed to describe cardiovascular and perceptual responses during a successful solo channel swim. Investigators followed a female swimmer’s Catalina Channel (32.2 km) crossing, monitoring water temperature (Twater) and air temperature (Tair), distance remaining (DR), average velocity, and heart rate (HRswim) at regular intervals. Every 24 minutes, the swimmer reported perceived pain (on a scale of 0–10), rating of perceived exertion (RPE [scale of 6–20]), perceived thermal sensation (scale 0–8), and thirst (scale 1–9). Data are presented as mean ± SD where applicable. The participant finished in 9 hours, 2 minutes, and 48 seconds; Twater averaged 19.1 ± 0.4ºC, and Tair averaged 18.6 ± 0.9ºC. Her HRswim ranged from 148 to 155 beats/min, and thermal sensation ranged from 3 to 4. Pain inconsistently varied from 0 to 5 during the swim. The RPE remained between 12 and 14 for the first 8 hours, but increased dramatically near the end (reaching 18). Thirst sensation steadily increased throughout the swim, again reaching maximal values on completion. Physiologically and statistically significant correlations existed between thirst and DR (r = −0.905), RPE and HRswim (r = 0.741), RPE and DR (r = −0.694), and pain and DR (r = −0.671). The primary findings were that, despite fluctuations in perceptual stressors, the swimmer maintained a consistent exercise intensity as indicated by HRswim; and during ultraendurance swimming, pain, RPE, and thirst positively correlated with distance swum. We hope these findings aid in the preparation and performance of future athletes by providing information on what swimmers may expect during an ultraendurance attempt and by increasing the understanding of physiological and perceptual responses during open water swimming.

      PubDate: 2015-08-30T16:16:03Z
  • Management of a Pediatric Snake Envenomation After Presentation With a
           Tight Tourniquet
    • Abstract: Publication date: September 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 3
      Author(s): Sean P. Bush, Shannon B. Kinlaw
      We describe an illustrative case of pediatric snake envenomation presenting with a tightly wound tourniquet. A 10-year-old boy presented after a snake bite to the right calf. A tourniquet was in place just below the right knee. The species of snake was unknown. The patient was hemodynamically stable, but the entirety of the right leg distal to the tourniquet was discolored. Over concern for a potential venom bolus effect upon tourniquet removal, the decision was made to start a crotaline Fab antivenom infusion and gradually loosen the tourniquet. The patient tolerated the infusion and removal of the tourniquet without signs of anaphylaxis or decompensation. Dynamic improvements were observed in the right leg and wound site that appeared to be the result of vascular congestion. Tourniquets are generally not recommended for snakebites; however, if a tourniquet is already placed, we avoid removal until prepared to manage acute toxicity or immediate hypersensitivity.

      PubDate: 2015-08-30T16:16:03Z
  • A Case Study: Rare Lepiota brunneoincarnata Poisoning
    • Abstract: Publication date: September 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 3
      Author(s): Murat Kose, Ismail Yilmaz, Ilgaz Akata, Ertugrul Kaya, Kerim Guler
      Amatoxin poisoning from the genus Lepiota may have a deadly outcome, although this is not seen as often as it is from the genus Amanita. In this report, we present a patient who was poisoned by a sublethal dose of Lepiota brunneoincarnata mushrooms. The patient was hospitalized 12 hours after eating the mushrooms. The patient’s transaminase levels increased dramatically starting on day 4. Aspartate transaminase peaked at 78 hours. Starting at 1265 IU/L, alanine transaminase peaked at 90 hours at 5124 IU/L. The patient was discharged on day 8 to outpatient care, and his transaminase levels returned to normal ranges in the subsequent days. A toxin analysis was carried out on the mushrooms that the patient claimed to have eaten. Using reversed-phase high-performance liquid chromatography analysis, an uptake of approximately 19.9 mg of amatoxin from nearly 30 g of mushrooms was calculated. This consisted of 10.59 mg of α-amanitin, 9.18 mg of β-amanitin, and 0.16 mg of γ-amanitin. In conclusion, we present a patient from Turkey who was poisoned by L. brunneoincarnata mushrooms.

      PubDate: 2015-08-30T16:16:03Z
  • The Effect of Environmental Temperature on Glucose and Insulin After an
           Oral Glucose Tolerance Test in Healthy Young Men
    • Abstract: Publication date: September 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 3
      Author(s): Charles L. Dumke, Dustin R. Slivka, John S. Cuddy, Walter S. Hailes, Shawn M. Rose, Brent C. Ruby
      Objective The purpose of this study was to compare glucose and insulin responses during an oral glucose tolerance test (OGTT) in cold (C), neutral (N), and hot (H) environments. Methods Eleven males completed three 4-hour climate-controlled OGTT trials (C, 7.2°C; N, 22°C; and H, 43°C). Participants remained semireclined for 60 minutes before ingesting a 1.8 g/kg glucose beverage. Skin and rectal core temperatures were continuously monitored. Blood was collected just before glucose ingestion (time 0) and at 15, 30, 60, 90, 120, and 180 minutes, and analyzed for serum glucose, insulin, hematocrit, and hemoglobin. Expired gases were collected upon entering the chamber (−60 minutes), before glucose ingestion (0 minutes), and at 60, 120, and 180 minutes to determine Vo 2 and respiratory exchange ratio. Results Rectal core temperature was greater in the H condition compared with both C and N (P < .001). Rectal core temperature was not different between C and N, whereas skin temperature was different across all trials (H greater than N greater than C). The Vo 2 was greater in C than in both H and N during all time points. Carbohydrate oxidation was greater in C compared with H and N (P < 0.001). Glucose was higher during H compared with C and N (P ≤ 0.002). Glucose was elevated in C compared with N. Insulin was higher in H compared with C (P = 0.009). Area under the curve for serum glucose was greater in H compared with C and N (P ≤ 0.001); however, there was no significant difference in area under the curve for insulin. Conclusions These data indicate that after an OGTT, glucose and insulin are elevated in a hot environment.

      PubDate: 2015-08-30T16:16:03Z
  • Quantifying Search Dog Effectiveness in a Terrestrial Search and Rescue
    • Abstract: Publication date: September 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 3
      Author(s): Ian Greatbatch, Rebecca J. Gosling, Sophie Allen
      Objective There is widespread and longstanding use of dogs in land search and rescue (SAR) operations, and their effectiveness is well accepted within the SAR community. However, very little published research exists that quantifies that effectiveness within a realistic SAR environment. Methods This study included 25 experiments, conducted between October 2013 and February 2014 with 10 dog/handler pairs, using randomized target placement to calculate the ratio of hits, misses, and false positives per dog. Each dog was fitted with a GPS receiver to record their paths and ambient temperature. Wind strength and humidity were recorded throughout each run. Results There was no identifiable correlation between humidity, temperature, or wind speed and effectiveness, but the age of the dog has a small positive correlation. Using a standard effectiveness formula, basic descriptive statistics were generated, which showed that the dogs tested were 76.4% successful overall, with an effectiveness of 62.9%. Dogs covered a mean distance 2.4 times greater than their human handlers but travelled at roughly average human walking speed. Conclusions This work represents a first attempt to quantify and understand levels of performance in lowland search dogs, and these results need to be understood within that context. A repeatable experimental framework has been demonstrated and provides a foundation for further work in this area.

      PubDate: 2015-08-30T16:16:03Z
  • Field Ultrasound Evaluation of Central Volume Status and Acute Mountain
    • Abstract: Publication date: September 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 3
      Author(s): Justin T. Pitman, Ghan B. Thapa, N. Stuart Harris
      Objective To investigate whether ultrasonography can be used for field volume status assessment and to determine whether a detectable difference in intravascular volume exists in individuals with acute mountain sickness (AMS) compared with those without. Methods Study was performed at the Himalayan Rescue Association Clinic in Manang, Nepal, located on the Annapurna trekking circuit at an altitude of 3519 m (11545 feet). A convenience sample was taken from individuals trekking over 5 to 8 days from 760 m (2490 feet) to 3519 m (11,545 feet), comparing asymptomatic trekkers vs those who experienced AMS. Subjects were evaluated for AMS based on the Lake Louise AMS Questionnaire (LLS ≥ 3 indicates AMS). After medical screening examination, both groups (control, n = 51; AMS, n = 18) underwent ultrasonography to obtain measurements of inferior vena cava collapsibility index (IVC CI) and left ventricular outflow tract velocity–time integral (LVOT VTI) before and after a passive leg raise (PLR) maneuver. Results There was no statistically significant difference between groups regarding change in heart rate before and after PLR, or IVC CI; however, there was a statistically significant greater increase in LVOT VTI after PLR maneuver in control group subjects compared with those with AMS (18.96% control vs 11.71% AMS; P < .01). Conclusions Ultrasonography is a useful tool in the assessment of intravascular volume at altitude. In this sample, we found ultrasonographic evidence that subjects with AMS have a higher intravascular volume than asymptomatic individuals. These data support the hypothesis that individuals with AMS have decreased altitude-related diuresis compared with asymptomatic individuals.

      PubDate: 2015-08-30T16:16:03Z
  • Norovirus Outbreaks Among Colorado River Rafters in the Grand Canyon,
           Summer 2012
    • Abstract: Publication date: September 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 3
      Author(s): Anne Magill-Collins, Marlene Gaither, Charles P. Gerba, Masaaki Kitajima, Brandon C. Iker, James D. Stoehr
      Objective To investigate the incidence and causative agent of the recurrent outbreaks of acute gastrointestinal illness (AGI) among different rafting groups on the Colorado River in the Grand Canyon National Park during the 2012 summer season. Methods Confidential illness reports were completed by all individuals with symptoms of AGI, and samples of fecal matter and vomitus, surface swabs of rafting equipment, and environmental swabs at stops along the hiking corridor were collected and tested for the presence of norovirus using reverse transcription–quantitative polymerase chain reaction (RT-qPCR). Results During the active outbreak period between May 9 and July 9, 2012, 97 rafters (1.4%) from 10 trips (2.9% of all trips) declared AGI symptoms. AGI incidence within the 10 infected trips varied from 6% to 88%. Outbreaks occurred in 3 distinct temporal clusters that involved 2 different genogroups of norovirus. All available toilet fecal samples (5 samples) were positive for norovirus RNA: 1 with genogroup I (GI) and 4 with GII. The vomitus sample tested positive for GI. None of the fomite samples from rafting equipment or from the hiking corridors were confirmed for norovirus. Conclusions The results suggest that norovirus may have been introduced by ill or asymptomatic individuals actively shedding the virus in their vomitus or feces, and spread within, or between, river trips by different modes of transmission. This study reinforces the importance of appropriate guidance and practice regarding norovirus prevention and the necessity of postoutbreak containment in relatively isolated groups of individuals.

      PubDate: 2015-08-30T16:16:03Z
  • Femoral Traction Splints in Mountain Rescue Prehospital Care: To Use or
           Not to Use? That Is the Question
    • Abstract: Publication date: September 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 3
      Author(s): Harriet Runcie, Mike Greene
      Objectives To determine the incidence of femur fractures in mountain rescue in England and Wales. To investigate the attitudes of rescuers toward the use of femoral traction splints. To review the literature for evidence on the use of traction splints in prehospital medicine and test the hypothesis that femoral traction splints reduce morbidity and mortality in patients with a fractured femur. Methods The Mountain Rescue England and Wales database was searched for cases of suspected fractured femur occurring between 2002 and 2012, a questionnaire was sent to all mountain rescue teams in England and Wales, and a literature review was performed. Relevant articles were critically reviewed to identify the evidence base for the use of femoral traction splints. Results Femur fractures are uncommon in mountain rescue, with an incidence of suspected femur fractures on scene at 9.3 a year. Traction splints are used infrequently; 13% of the suspected femur fractures were treated with traction. However, rescuers have a positive attitude toward traction splints and perceive few disadvantages to their use. No trials demonstrate that traction splints reduce morbidity or mortality, but a number describe complications resulting from their use. Conclusions Femur fractures are rare within mountain rescue. Traction splints may be no more effective than other methods of splinting in prehospital care. We failed to identify evidence that supports the hypothesis that traction splints reduce morbidity or mortality. We advocate the use of a femoral traction splints but recognize that other splints may also be appropriate in this environment.

      PubDate: 2015-08-30T16:16:03Z
  • EPAS1 Gene Polymorphisms Are Associated With High Altitude Polycythemia in
           Tibetans at the Qinghai-Tibetan Plateau
    • Abstract: Publication date: September 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 3
      Author(s): Jin Xu, Ying-Zhong Yang, Feng Tang, Qin Ga, Wuren Tana, Ri-Li Ge
      Objective To test the hypothesis that the polymorphisms in the EPAS1 gene are associated with the susceptibility to high altitude polycythemia (HAPC) in Tibetans at the Qinghai-Tibetan Plateau. Methods We enrolled 63 Tibetan HAPC patients and 131 matched healthy Tibetans as a control group, from the Yushu area in Qinghai where the altitude is greater than 3500 m. Eight single-nucleotide polymorphisms (SNPs) of the EPAS1 gene, including rs12619696, rs13420857, rs2881504, rs4953388, rs13419896, rs4953354, rs10187368, and rs7587138, were genotyped by the Sequenom MassARRAY SNP assay. Results The frequencies of the G allele of EPAS1 SNP rs13419896 were significantly higher in the HAPC group than in the control group (P < .05). Moreover, the A alleles of rs12619696 and rs4953354 were prevalent in the HAPC group, and their counterpart homozygotes were prevalent in the normal Tibetan group (P < .05). Conclusions Compared with normal Tibetans, Tibetans with HAPC are maladapted and have a different haplotype in EPAS1 SNPs rs12619696, rs13419896, and rs4953354.

      PubDate: 2015-08-30T16:16:03Z
  • Climbing On: Editorial Evolution
    • Abstract: Publication date: Available online 31 July 2015
      Source:Wilderness & Environmental Medicine
      Author(s): Scott E. McIntosh, Tracy A. Cushing, Linda E. Keyes, Neal W. Pollock

      PubDate: 2015-07-31T22:01:06Z
  • Russula subnigricans Poisoning: From Gastrointestinal Symptoms to
    • Abstract: Publication date: Available online 27 July 2015
      Source:Wilderness & Environmental Medicine
      Author(s): Shide Lin, Maoyuan Mu, Fangwan Yang, Chunfei Yang
      Wild mushroom poisoning is often reported to cause acute liver or renal failure. However, acute rhabdomyolysis caused by wild mushroom poisoning has rarely been reported. We describe 7 patients of 1 family with Russula subnigricans Hongo poisoning. Their clinical manifestations varied from gastrointestinal symptoms to rhabdomyolysis, with 1 fatality. Our report provides supporting evidence that rhabdomyolysis may result from ingestion of R subnigricans mushrooms. A key to survival for patients with rhabdomyolysis caused by R subnigricans poisoning may be early recognition and intensive supportive care.

      PubDate: 2015-07-31T22:01:06Z
  • Oxidized Low Density Lipoprotein Among the Elderly in Qinghai-Tibet
    • Abstract: Publication date: Available online 26 July 2015
      Source:Wilderness & Environmental Medicine
      Author(s): Ryota Sakamoto, Kiyohito Okumiya, Hongxin Wang, Qingxiang Dai, Michiko Fujisawa, Taizo Wada, Hissei Imai, Yumi Kimura, Yasuko Ishimoto, Eriko Fukutomi, Wingling Chen, Kwanchit Sasiwongsaroj, Emiko Kato, Ri-Li Ge, Kozo Matsubayashi
      Objective Several environmental factors including hypoxia have been reported to contribute to oxidative stress in individuals living in the highlands. However, little is known about the role of oxidized low-density lipoprotein (ox-LDL) among community-dwelling elderly in the Qinghai-Tibet plateau. Methods The study population comprised 168 community-dwelling elderly subjects aged 60 years or older (male to female ratio, 70:98; mean age, 65.8 years) living in Haiyan County, located 3000 to 3200 m above sea level, 30 km northwest of Xining, Qinghai. The subjects were volunteers who joined a Comprehensive Geriatric Assessment. Plasma ox-LDL was measured in 168 community-dwelling elderly subjects aged 60 years or older (23 Tibetans and 145 Hans) with a monoclonal antibody-based enzyme-linked immunosorbent assay. Results Mean ox-LDL level was higher among Tibetan elderly than Han elderly (Tibetan, 79.0 ± 29.6 U/L; Han, 62.8 ± 23.5 U/L; P = .003). Tibetan ethnicity was significantly associated with ox-LDL levels after adjusting for LDL cholesterol levels. In addition, high ox-LDL levels (≥70 U/L) were significantly associated with a homeostasis model assessment insulin resistance index of at least 1.6 (odds ratio [OR], 2.82; 95% confidence interval [95% CI], 1.11 to 7.15; P = .029) and ankle brachial pressure index of less than 1.0 (OR, 4.85; 95% CI, 1.14 to 10.00; P = .028), after adjusting for age, sex, and ethnicity. Conclusions Our findings support the hypothesis that ox-LDL levels are higher among Tibetan elderly highlanders compared with those among Han elderly. As ox-LDL levels can affect insulin resistance and arteriosclerosis, further research is needed to determine how oxidative stress influences the health situation among elderly individuals at high altitudes.

      PubDate: 2015-07-27T03:56:47Z
  • Comparison of Distal Limb Warming With Fluidotherapy and Warm Water
           Immersion for Mild Hypothermia Rewarming
    • Abstract: Publication date: Available online 24 June 2015
      Source:Wilderness & Environmental Medicine
      Author(s): Parveen Kumar , Gerren K. McDonald , Radhika Chitkara , Alan M. Steinman , Phillip F. Gardiner , Gordon G. Giesbrecht
      Objective The purpose of the study was to determine the effectiveness of Fluidotherapy rewarming through the distal extremities for mildly hypothermic, vigorously shivering subjects. Fluidotherapy is a dry heat modality in which cellulose particles are suspended by warm air circulation. Methods Seven subjects (2 female) were cooled on 3 occasions in 8˚C water for 60 minutes, or to a core temperature of 35°C. They were then dried and rewarmed in a seated position by 1) shivering only; 2) Fluidotherapy applied to the distal extremities (46 ± 1°C, mean ± SD); or 3) water immersion of the distal extremities (44 ± 1°C). The order of rewarming followed a balanced design. Esophageal temperature, skin temperature, heart rate, oxygen consumption, and heat flux were measured. Results The warm water produced the highest rewarming rate, 6.1°C·h−1, 95% CI: 5.3–6.9, compared with Fluidotherapy, 2.2°C·h−1, 95% CI: 1.4–3.0, and shivering only, 2.0°C·h−1, 95% CI: 1.2–2.8. The Fluidotherapy and warm water conditions increased skin temperature and inhibited shivering heat production, thus reducing metabolic heat production (166 ± 42 W and 181 ± 45 W, respectively), compared with shivering only (322 ± 142 W). Warm water provided a significantly higher net heat gain (398.0 ± 52 W) than shivering only (288.4 ± 115 W). Conclusions Fluidotherapy was not as effective as warm water for rewarming mildly hypothermic subjects. Although Fluidotherapy is more portable and technically simpler, it provides a lower rate of rewarming that is similar to shivering only. It does help decrease shivering heat production, lowering energy expenditure and cardiac work, and could be considered in a hospital setting, if convenient.

      PubDate: 2015-06-29T06:15:49Z
  • A Chemical Heat Pack–Based Method For Consistent Heating of
           Intravenous Fluids
    • Abstract: Publication date: Available online 19 June 2015
      Source:Wilderness & Environmental Medicine
      Author(s): Matthieu P. DeClerck , Grant S. Lipman , Dennis A. Grahn , Vinh Cao , Mark Wieland , Tom Troxel , H. Craig Heller
      Background Transfusion of cold intravenous fluids (IVF) can exacerbate hypothermia. Civilian and military guidelines recommend heated IVF for hypothermic patients; however, there is currently no ideal IVF heating system for use in resource-limited settings. Objective Development of a system that uses flameless ration heaters (FRH) and an insulated sleeve for the consistent delivery of IVF at physiologically appropriate temperatures (40°–42°C) over the range of ambient conditions typical of the prehospital and wilderness environments. Methods The temperatures of 0.9% normal saline (NS) 1-L bags were measured under 3 ambient conditions: 3°C, 10°C, and 20°C. The IVF was placed in an insulated pouch along with a predetermined number of activated FRH (5 FRH for 3°C, 4 FRH for 10°C, and 3 FRH for 20°C) for 10 minutes before removing the FRHs. The insulated IVF bag was drained through 280 cm of intravenous tubing at a flow rate of 77 mL/min. Raw temperature data for internal and delivery temperatures were collected and analyzed. Results The temperature of the IVF throughout the delivery of 1 L of NS under the 3 ambient conditions was as follows (mean ± SD): at 3°C ambient, 47° ± 2.1°C internal and 42.6°C ± 1.4°C at delivery; at 10°C ambient, 52.3° ± 2.7°C and 45.2° ± 1.6°C; and at 20°C ambient, 45.5° ± 1°C and 39.7° ± 0.7°C. Conclusions The IVF heating system described here reliably delivered physiologically appropriate temperature intravenous fluids in 2 of the 3 ambient treatment conditions. With the appropriate number of FRH for the ambient conditions, this system enables the delivery of warmed IVF to provide active warming, which may be clinically beneficial in the prevention and treatment of hypothermia.

      PubDate: 2015-06-23T06:08:58Z
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