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  Subjects -> ENVIRONMENTAL STUDIES (Total: 786 journals)
    - ENVIRONMENTAL STUDIES (722 journals)
    - POLLUTION (21 journals)
    - TOXICOLOGY AND ENVIRONMENTAL SAFETY (35 journals)
    - WASTE MANAGEMENT (8 journals)

ENVIRONMENTAL STUDIES (722 journals)            First | 1 2 3 4 5 6 7 8     

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: 7)
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: 5)
Management of Environmental Quality: An International Journal     Hybrid Journal   (Followers: 4)
Management of Sustainable Development     Open Access   (Followers: 2)
Marine Ecology     Hybrid Journal   (Followers: 13)
Marine Environmental Research     Hybrid Journal   (Followers: 12)
Marine Pollution Bulletin     Hybrid Journal   (Followers: 12)
Materials for Renewable and Sustainable Energy     Open Access   (Followers: 8)
Mathematical and Computational Forestry & Natural-Resource Sciences     Free  
Mathematical Population Studies: An International Journal of Mathematical Demography     Hybrid Journal   (Followers: 2)
Medio Ambiente y Urbanizacion     Full-text available via subscription  
Membranes     Open Access   (Followers: 4)
Michigan Journal of Sustainability     Open Access  
Midwest Studies In Philosophy     Hybrid Journal   (Followers: 10)
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: 7)
Modern Cartography Series     Full-text available via subscription   (Followers: 6)
Mountain Research and Development     Open Access   (Followers: 3)
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: 7)
Natural Hazards     Hybrid Journal   (Followers: 302)
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  
Neurotoxicology and Teratology     Hybrid Journal   (Followers: 1)
NEW SOLUTIONS: A Journal of Environmental and Occupational Health Policy     Full-text available via subscription   (Followers: 6)
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 Notes     Full-text available via subscription   (Followers: 3)
Novos Cadernos NAEA     Open Access  
Observatorio Medioambiental     Open Access  
Occupational and Environmental Medicine     Full-text available via subscription   (Followers: 7)
Ocean Acidification     Open Access  
Ochrona Srodowiska i Zasobów Naturalnych     Open Access  
Oecologia     Hybrid Journal   (Followers: 29)
Oikos     Hybrid Journal   (Followers: 33)
Open Journal of Ecology     Open Access   (Followers: 11)
Open Journal of Marine Science     Open Access   (Followers: 6)
Open Journal of Modern Hydrology     Open Access   (Followers: 3)
Our Nature     Open Access   (Followers: 2)
Oxford Journal of Legal Studies     Hybrid Journal   (Followers: 18)
Pace Environmental Law Review     Open Access   (Followers: 4)
Palaeobiodiversity and Palaeoenvironments     Hybrid Journal   (Followers: 3)
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: 9)
Physio-Géo     Open Access   (Followers: 2)
Pittsburgh Journal of Environmental and Public Health Law     Open Access   (Followers: 1)
Planet     Open Access   (Followers: 1)
Planning & Environmental Law: Issues and decisions that impact the built and natural environments     Hybrid Journal   (Followers: 7)
Plant Ecology & Diversity     Partially Free   (Followers: 11)
Plant Knowledge Journal     Open Access   (Followers: 2)
Plant, Cell & Environment     Hybrid Journal   (Followers: 4)
Polar Journal     Hybrid Journal   (Followers: 1)
Policy Studies     Hybrid Journal   (Followers: 8)
Policy Studies Journal     Hybrid Journal   (Followers: 5)
Polish Polar Research     Open Access   (Followers: 4)
Political Studies     Hybrid Journal   (Followers: 24)
Political Studies Review     Hybrid Journal   (Followers: 14)
Population and Environment     Hybrid Journal   (Followers: 6)
Population Ecology     Hybrid Journal   (Followers: 9)
Population Studies: A Journal of Demography     Hybrid Journal   (Followers: 8)
Postcolonial Studies     Hybrid Journal   (Followers: 9)
Practice Periodical of Hazardous, Toxic, and Radioactive Waste Management     Full-text available via subscription   (Followers: 2)
Presence Teleoperators & Virtual Environments     Hybrid Journal   (Followers: 1)
Presidential Studies Quarterly     Hybrid Journal   (Followers: 4)
Procedia Environmental Sciences     Open Access   (Followers: 2)
Proceedings of ICE, Waste and Resource Management     Hybrid Journal   (Followers: 2)
Proceedings of the Institution of Mechanical Engineers Part M: Journal of Engineering for the Maritime Environment     Hybrid Journal   (Followers: 1)
Proceedings of the International Academy of Ecology and Environmental Sciences     Open Access   (Followers: 4)
Process Safety and Environmental Protection     Hybrid Journal   (Followers: 5)
Progress in Industrial Ecology, An International Journal     Hybrid Journal   (Followers: 4)
Psychological Assessment     Full-text available via subscription   (Followers: 5)
Public Money & Management     Hybrid Journal   (Followers: 5)
Public Works Management & Policy     Hybrid Journal   (Followers: 6)
Qatar Foundation Annual Research Forum Proceedings     Open Access   (Followers: 3)
Radioactivity in the Environment     Full-text available via subscription   (Followers: 3)
Regional Environmental Change     Hybrid Journal   (Followers: 4)
Regional Studies     Hybrid Journal   (Followers: 6)
Religious Studies     Hybrid Journal   (Followers: 10)
RELP - Renewable Energy Law and Policy     Full-text available via subscription   (Followers: 4)
Remediation Journal     Hybrid Journal   (Followers: 5)
Remote Sensing Letters     Hybrid Journal   (Followers: 9)
Renaissance Studies     Hybrid Journal   (Followers: 15)

  First | 1 2 3 4 5 6 7 8     

Journal Cover   Wilderness & Environmental Medicine
  [5 followers]  Follow
    
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 1080-6032
   Published by Elsevier Homepage  [2589 journals]
  • Genome-wide analyses of Tibetan Athletes
    • Abstract: Publication date: March 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 1
      Author(s): Basangzhuoma , Xiujuan Shao , Changqing Zeng



      PubDate: 2015-02-25T23:56:08Z
       
  • Cardiorespiratory Coupling in Health and Disease: From Bench and
           Wilderness to the Bedside
    • Abstract: Publication date: March 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 1
      Author(s): Jan Marino-Ramirez



      PubDate: 2015-02-25T23:56:08Z
       
  • Hypoxia and Cancer
    • Abstract: Publication date: March 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 1
      Author(s): Govind Babu



      PubDate: 2015-02-25T23:56:08Z
       
  • Polyerythrocythemia and Adaptation to High Altitude
    • Abstract: Publication date: March 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 1
      Author(s): Gustavo Zubieta-Castillo Sr , Gustavo Zubieta-Calleja Jr



      PubDate: 2015-02-25T23:56:08Z
       
  • Use of Intermittent Hypoxia Training (IHT) in Cardiology: Principles and
           Practices
    • Abstract: Publication date: March 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 1
      Author(s): Tatiana Serebrovska , Valery B. Shatilo



      PubDate: 2015-02-25T23:56:08Z
       
  • Surviving Birth at Any Altitude
    • Abstract: Publication date: March 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 1
      Author(s): Alexandra Heath



      PubDate: 2015-02-25T23:56:08Z
       
  • How the Central Nervous System Copes With Hypoxic Challenges
    • Abstract: Publication date: March 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 1
      Author(s): Jan Marino-Ramirez



      PubDate: 2015-02-25T23:56:08Z
       
  • Tolerance to Hypoxia: A High Altitude Paradox
    • Abstract: Publication date: March 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 1
      Author(s): Gustavo Zubieta-Calleja Jr , Gustavo Zubieta-Castillo Sr



      PubDate: 2015-02-25T23:56:08Z
       
  • Measurable and Quantifiable Uncertainties at High Altitude Condition
    • Abstract: Publication date: March 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 1
      Author(s): Thuppil Venkatesh



      PubDate: 2015-02-25T23:56:08Z
       
  • Endogenous Antioxidants and Three Paradoxes of Hypoxic Preconditioning
    • Abstract: Publication date: March 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 1
      Author(s): Sergei A. Stroev , Mikhail O. Samoilov , Ekaterina I. Tyulkova , Tatiana S. Glushchenko



      PubDate: 2015-02-25T23:56:08Z
       
  • Overlooking. Monte Solaro on the island of Capri in Campania, Italy.
           Photograph by Jon Conard, DO.
    • Abstract: Publication date: March 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 1
      Author(s): Jon Conard



      PubDate: 2015-02-25T23:56:08Z
       
  • Wilderness Image
    • Abstract: Publication date: March 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 1
      Author(s): Tom Edward Mallinson



      PubDate: 2015-02-25T23:56:08Z
       
  • Flying for CME—A Big Carbon Footprint
    • Abstract: Publication date: March 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 1
      Author(s): Nathan M. Hemmer



      PubDate: 2015-02-25T23:56:08Z
       
  • Concussions: A Succinct Clinical Picture
    • Abstract: Publication date: March 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 1
      Author(s): Kenneth V. Iseerson



      PubDate: 2015-02-25T23:56:08Z
       
  • Kenneth V.IsersonMDThe Global Healthcare Volunteer’s Handbook: What
           You Need to Know Before You Go2014Galen PressTucson, AZUS $28.95, 340
           pages, paperback
    • Abstract: Publication date: March 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 1
      Author(s): Aaron D. Campbell



      PubDate: 2015-02-25T23:56:08Z
       
  • The Economic Impact of a Medical Adventure Race
    • Abstract: Publication date: March 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 1
      Author(s): David Ledrick , Michael Omori , Michael Caudell



      PubDate: 2015-02-25T23:56:08Z
       
  • Waterfall Mortality and Morbidity in North Carolina, 2001–2013
    • Abstract: Publication date: March 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 1
      Author(s): Aram Attarian



      PubDate: 2015-02-25T23:56:08Z
       
  • Plos One
    • Abstract: Publication date: March 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 1




      PubDate: 2015-02-25T23:56:08Z
       
  • Intentional Ingestion of Strychnos Nux-vomica Seeds Causing Severe Muscle
           Spasms and Cardiac Arrest: A Postmortem Report
    • Abstract: Publication date: March 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 1
      Author(s): Kasun Fernando , Krishantha Jayasekara , Janaki Warushahennadi , Iranthi Kumarasinghe , Kosala Weerakoon , Senanayake A.M. Kularatne



      PubDate: 2015-02-25T23:56:08Z
       
  • Krait Envenomation Disguised as Heat Exhaustion in a Wilderness Setting
    • Abstract: Publication date: March 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 1
      Author(s): Rajesh Deshwal , Vaibhav Gupta



      PubDate: 2015-02-25T23:56:08Z
       
  • Ieee Transactions On Cybernetics
    • Abstract: Publication date: March 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 1
      Author(s): Matthew Stewart



      PubDate: 2015-02-25T23:56:08Z
       
  • International Journal Of Environmental Research And Public Health
    • Abstract: Publication date: March 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 1
      Author(s): August Longino



      PubDate: 2015-02-25T23:56:08Z
       
  • Development and Implementation of a Standardized Wilderness Medicine
           Curriculum (AWLS) for Fourth Year Medical Students
    • Abstract: Publication date: March 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 1
      Author(s): Simon C. Watson , Sarah E. Sterner , Jeffrey S. Bush , Christina L. Bourne



      PubDate: 2015-02-25T23:56:08Z
       
  • Annals Of Emergency Medicine
    • Abstract: Publication date: March 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 1
      Author(s): Matthew Stewart



      PubDate: 2015-02-25T23:56:08Z
       
  • British Journal Of Sports Medicine
    • Abstract: Publication date: March 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 1
      Author(s): Justine MacNeil



      PubDate: 2015-02-25T23:56:08Z
       
  • Epidemiology of Whitewater Fatalities in the Arkansas Headwaters
           Recreation Area
    • Abstract: Publication date: March 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 1
      Author(s): Leah E. Jacoby , John D. Anderson , Tracy A. Cushing



      PubDate: 2015-02-25T23:56:08Z
       
  • Study Looking at End Expiratory Pressure for Altitude Illness Decrease
           (SLEEP AID): A Randomized Controlled Trial
    • Abstract: Publication date: March 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 1
      Author(s): Grant S. Lipman , Kristin Fontes , Becky Higbee , Michael Shaheen , Nicholas C. Kanaan , Caleb Phillips , Dave Pomeranz , Patrick Cain , Carolyn Meyer , Sean Wentworth



      PubDate: 2015-02-25T23:56:08Z
       
  • Mount Everest Base Camp Medical Clinic “Everest ER”:
           Epidemiology of Medical Events During the First 10 Years of Operation
    • Abstract: Publication date: March 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 1
      Author(s): Andrew B. Pressman , Mária Némethy , Scott E. McIntosh , Luanne Freer



      PubDate: 2015-02-25T23:56:08Z
       
  • Healthcare Utilization Following Acute and Overuse Injuries Among Outdoor
           Rock Climbers
    • Abstract: Publication date: March 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 1
      Author(s): Nathan Furst-Nichols , Courtney Jones , Erik Rueckmann , Mark Mirabelli



      PubDate: 2015-02-25T23:56:08Z
       
  • Irukandji-Like Syndrome in the Caribbean Sea, Puerto Rico: Case Report
    • Abstract: Publication date: March 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 1
      Author(s): Isabel Algaze , Joanna Mercado , Pedro Arroyo



      PubDate: 2015-02-25T23:56:08Z
       
  • Utilization of Wrist Protection by Snowboarders
    • Abstract: Publication date: March 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 1
      Author(s): R. Alissa Mussell , Hollynn L. Larrabee , Danielle M. Davidov , Virginia K. Horne , Henderson D. McGinnis



      PubDate: 2015-02-25T23:56:08Z
       
  • Nonsurgical Treatment of Two Cases of Infantile Facial Growths in a
           Resource-Poor Setting
    • Abstract: Publication date: March 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 1
      Author(s): Ronald Natawidjaja , N. Ewen Wang



      PubDate: 2015-02-25T23:56:08Z
       
  • The Impact of Freeze-Thaw Cycles on Epinephrine
    • Abstract: Publication date: March 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 1
      Author(s): Heather Beasley , Pearlly Ng , Scott E. McIntosh , Albert Wheeler , William R Smith



      PubDate: 2015-02-25T23:56:08Z
       
  • Polar Predators
    • Abstract: Publication date: March 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 1
      Author(s): Christina L. Bourne , Simon C. Watson



      PubDate: 2015-02-25T23:56:08Z
       
  • An Itchy Situation
    • Abstract: Publication date: March 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 1
      Author(s): Pratibha Phuyal , Pranawa Koirala , Buddha Basnyat , Ken Zafren



      PubDate: 2015-02-25T23:56:08Z
       
  • Injury Patterns at Isle Royale National Park: An Epidemiologic Review of
           Injuries and Illnesses Sustained in a Remote Environment
    • Abstract: Publication date: March 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 1
      Author(s): Kathleen D. Saxon , Jenna M.B. White , Mary M. Eddy , Daniel L. Albertus , Benjamin S. Bassin
      Objective Isle Royale National Park is a remote island in northern Lake Superior that attracts 16,000 visitors annually. The epidemiology of injuries and illnesses sustained by Isle Royale׳s visitors has not been previously studied. The purpose of this study is to examine these data and evaluate them for injury patterns. Methods This is a retrospective observational study examining the epidemiology of injuries and illnesses sustained during the period from 2008 to 2012. Incident reports completed by park rangers were reviewed and the data sorted according to time of year, time of day, type of medical encounter, and whether the patient was stable, unstable, or required transport. Results Two hundred and seventy patient care reports were obtained from the National Park Service. Sixty-four percent of encounters occurred in July and August, and most patients sought care in the afternoon. Care was provided by park rangers, the majority of whom were trained to the level of emergency medical technician. Fifty-eight percent of cases were trauma related, and 20% of all cases were evacuated. Conclusions The majority of incidents were trauma related. The majority of the rangers on the island are trained to the level of emergency medical technician-B and appear to offer appropriate care to the island’s many visitors, utilizing the National Park Service treatment protocols and comprehensive medical kits. In addition, access to advanced medical care is readily available by air and water evacuation.


      PubDate: 2015-02-25T23:56:08Z
       
  • The Effect of Acetazolamide on Saccadic Latency at 3459 Meters
    • Abstract: Publication date: March 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 1
      Author(s): Olivia K. Faull , Josephine Robertson , Owen Thomas , Arthur R. Bradwell , Chrystalina A. Antoniades , Kyle T.S. Pattinson
      Objective The effect of altitude on brain function is not yet well understood, nor is the influence of height and speed of ascent. Additionally, the relationship between acute mountain sickness (AMS) symptoms and brain function at altitude is unclear. We hypothesized that a deterioration from baseline measures of brain function occurs after rapid, mechanical ascent to 3459 m and would be less pronounced in persons taking acetazolamide. Methods In this double blind, randomized, placebo-controlled study, 20 healthy volunteers (14 men, 6 women; mean age [±SD] 43 ± 16 years) were alternately allocated to acetazolamide 250 mg or to placebo, taken every 12 hours commencing 3 days before ascent. Prosaccadic and antisaccadic eye movements, heart rate, arterial saturation, and Lake Louise AMS scores were assessed at sea level and 15 to 22 hours after ascent to 3459 m. Results Arterial oxygen saturation was significantly lower in the placebo group compared to the acetazolamide group at altitude (Wilcoxon signed-rank test, median [interquartile range]: acetazolamide vs placebo: 92% [5] vs 85% [5]; P = .007), with no differences in prosaccadic latency, heart rate, or Lake Louise score. No differences in saccadic latencies from baseline to altitude were observed in the placebo group, whereas prosaccadic latencies were significantly longer at altitude with acetazolamide (altitude vs baseline: 153 ms [41] vs 176 ms [52], P = .008). Conclusions Brain function, measured by saccadic eye movements, appears to be unimpaired after rapid ascent to 3459 m. Although acetazolamide improves oxygen saturations, it may worsen prosaccades, possibly indicating adverse effects of acetazolamide on brain function at moderate altitude.


      PubDate: 2015-02-25T23:56:08Z
       
  • Search and Rescue Response to a Large-Scale Rockfall Disaster
    • Abstract: Publication date: March 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 1
      Author(s): Emily Procter , Giacomo Strapazzon , Karla Balkenhol , Ernst Fop , Alessandro Faggionato , Karl Mayr , Markus Falk , Hermann Brugger
      Objective To describe the prehospital management and safety of search and rescue (SAR) teams involved in a large-scale rockfall disaster and monitor the acute and chronic health effects on personnel with severe dolomitic dust exposure. Methods SAR personnel underwent on-site medical screening and lung function testing 3 months and 3 years after the event. Results The emergency dispatch center was responsible for central coordination of resources. One hundred fifty SAR members from multidisciplinary air- and ground-based teams as well as geotechnical experts were dispatched to a provisionary operation center. Acute exposure to dolomite dust with detectable silicon and magnesium concentrations was not associated with (sub)acute or chronic sequelae or a clinically significant impairment in lung function in exposed personnel. Conclusions The risk for personnel involved in mountain SAR operations is rarely reported and not easily investigated or quantified. This case exemplifies the importance of a multiskilled team and additional considerations for prehospital management during natural hazard events. Safety plans should include compulsory protective measures and medical monitoring of personnel.


      PubDate: 2015-02-25T23:56:08Z
       
  • Injury Trends in Rock Climbers: Evaluation of a Case Series of 911
           Injuries Between 2009 and 2012
    • Abstract: Publication date: March 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 1
      Author(s): Volker Schöffl , Dominik Popp , Thomas Küpper , Isabelle Schöffl
      Objective Rock climbing is a widely performed sport. This prospective single-institution study evaluated the demographics of climbing-related injuries to improve our comprehension of current injury characteristics. Methods During a 4-year period, 836 patients with a total of 911 independent climbing injuries were prospectively evaluated using a standard questionnaire and examination protocol. Results Of all injuries, 833 were on the upper extremities, 58 on the lower. Seventeen injuries were Union International des Associations d’Alpinisme (UIAA) grade 1 injuries, 881 were grade 2, and 13 were grade 3. No higher UIAA graded injuries occurred. Overall, 380 were acute injuries (359 were seen in clinic, 21 were seen through the emergency department), and 531 were overstrain injuries (all seen in clinic). Finger injuries accounted for 52% of all injuries, the shoulder being the second most frequent location. Pulley injuries were the most frequent finger injuries. Of 20 injured young climbers under the age of 15 years, 14 had an epiphyseal fracture (all epiphyseal fractures: mean age 14 years, range 12 to 15 years). Male climbers were significantly older (P < .05), had more climbing years (P < .05), and were climbing at a higher climbing level (P < .01). Older, more experienced climbers had significantly more overstrain injuries than acute injuries (P < .05). Conclusions When comparing this study with our previous study from 1998 to 2001, there are some notable differences. Although pulley injuries are still the most common climbing injury, there are now more A4 pulley injuries than A2. Shoulder injuries are becoming more common, as are epiphyseal fractures among young climbers. It is important to understand current patterns of climbing injuries so that health providers can target interventions appropriately.


      PubDate: 2015-02-25T23:56:08Z
       
  • Exercise-Associated Hyponatremic Encephalopathy in an Endurance Open Water
           Swimmer
    • Abstract: Publication date: March 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 1
      Author(s): Ian R. Rogers , Stephen Grainger , Yusuf Nagree
      Exercise-associated hyponatremia and its more serious form, known as exercise-associated hyponatremic encephalopathy, are recognized as some of the most important medical problems seen in a variety of different forms of endurance exercise. We describe a case of exercise-associated hyponatremic encephalopathy presenting as altered conscious state and seizures in a woman who had completed a 20-km open ocean swim. Her serum sodium measured approximately 1 hour after her seizure was 119 mmol/L on point-of-care testing. With ongoing critical care support and the use of hypertonic saline, she was able to be extubated the next day, neurologically intact, and ultimately was discharged from hospital without neurological sequelae. This case emphasizes both the importance of considering exercise-associated hyponatremic encephalopathy as a cause of neurological impairment in all athletes and the pivotal role of hypertonic saline in the treatment of this condition.


      PubDate: 2015-02-25T23:56:08Z
       
  • A 51-Year-Old Woman Crushed by an Elephant Trunk
    • Abstract: Publication date: March 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 1
      Author(s): Ann H. Tsung , Brandon R. Allen
      Wild and exotic animal attacks are not common in the United States. Animal-related injuries in the United States are usually caused by dog bites, followed by cattle and horse injuries. Exotic animal attacks can occur when the animals are provoked, depressed, or housed improperly by owners. We report the case of a 51-year-old woman who sustained multiple systemic traumatic injuries after she was pinned to a fence by an elephant’s trunk. Upon arrival in the emergency department, she was hypothermic with a temperature of 35.1ºC (95.1ºF), hypotensive to 94/60 mm Hg after 5 L crystalloid, tachycardic at 108 beats/min, and intubated with oxygen saturation of 100%. Tranexamic acid was administered in addition to starting a massive transfusion protocol. Injuries included bilateral multiple rib fractures, left abdominal wall degloving injury, right pneumothorax, right hemothorax, left chest wall puncture wound, grade IV splenic laceration, 3 grade III liver lacerations, retroperitoneal hematoma, and degloving injuries to bilateral posterior thighs requiring more than 30 operations. Why should an emergency physician be aware of this? Several factors need to be considered when evaluating animal-related injuries, including type, age, and sex of the animal. Multisystem traumatic injuries should be assumed when a large animal is involved. Prehospital care and transport time are vital to a patient’s survival in both urban and rural settings. During the initial resuscitation, administering antibiotics tailored to the specific animal can greatly decrease risk of infection and morbidity. Additionally, tetanus immunoglobulin, tetanus toxoid, and rabies immunoglobulin and vaccine may be needed, unless the victim has been previously vaccinated.


      PubDate: 2015-02-25T23:56:08Z
       
  • A Lightning Multiple Casualty Incident in Sequoia and Kings Canyon
           National Parks
    • Abstract: Publication date: March 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 1
      Author(s): Susanne J. Spano , Danielle Campagne , Geoff Stroh , Marc Shalit
      Multiple casualty incidents (MCIs) are uncommon in remote wilderness settings. This is a case report of a lightning strike on a Boy Scout troop hiking through Sequoia and Kings Canyon National Parks (SEKI), in which the lightning storm hindered rescue efforts. The purpose of this study was to review the response to a lightning-caused MCI in a wilderness setting, address lightning injury as it relates to field management, and discuss evacuation options in inclement weather incidents occurring in remote locations. An analysis of SEKI search and rescue data and a review of current literature were performed. A lightning strike at 10,600 feet elevation in the Sierra Nevada Mountains affected a party of 5 adults and 7 Boy Scouts (age range 12 to 17 years old). Resources mobilized for the rescue included 5 helicopters, 2 ambulances, 2 hospitals, and 15 field and 14 logistical support personnel. The incident was managed from strike to scene clearance in 4 hours and 20 minutes. There were 2 fatalities, 1 on scene and 1 in the hospital. Storm conditions complicated on-scene communication and evacuation efforts. Exposure to ongoing lightning and a remote wilderness location affected both victims and rescuers in a lightning MCI. Helicopters, the main vehicles of wilderness rescue in SEKI, can be limited by weather, daylight, and terrain. Redundancies in communication systems are vital for episodes of radio failure. Reverse triage should be implemented in lightning injury MCIs. Education of both wilderness travelers and rescuers regarding these issues should be pursued.


      PubDate: 2015-02-25T23:56:08Z
       
  • Presence of L-Canavanine in Hedysarum alpinum Seeds and Its Potential Role
           in the Death of Chris McCandless
    • Abstract: Publication date: March 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 1
      Author(s): Jon Krakauer , Ying Long , Andrew Kolbert , Shri Thanedar , Jonathan Southard
      Objective For the past 2 decades there has been vigorous disagreement over the purported toxicity of Hedysarum alpinum seeds, and whether the consumption of such seeds was a factor in the 1992 death of Chris McCandless, the subject of the book Into the Wild. Our objective was to confirm or disprove the presence of L-canavanine (a nonprotein amino acid known to induce systemic lupuslike symptoms in humans) in H alpinum seeds. Methods Liquid chromatography–tandem mass spectrometry analysis of H alpinum seeds was performed. Results Our analysis confirmed the presence of L-canavanine in H alpinum seeds and demonstrated that it is a significant component of the seeds, with a concentration of 1.2% (weight/weight), roughly half of that found in Canavalia ensiformis. Conclusions The data led us to conclude it is highly likely that the consumption of H alpinum seeds contributed to the death of Chris McCandless.


      PubDate: 2015-02-25T23:56:08Z
       
  • Characterization of Medical Care at the 161-km Western States Endurance
           Run
    • Abstract: Publication date: March 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 1
      Author(s): Vanessa McGowan , Martin D. Hoffman
      Objective To examine the medical care at a highly competitive 161-km mountain ultramarathon. Methods Encounter forms from the 2010 through 2013 Western States Endurance Run were analyzed for trends in consultation and use of intravenous fluids. Results A total of 63 consultations (8.2% of starters) were documented in 2012 and 2013, of which 10% involved noncompetitors. Most (77%) of the consultations with competitors occurred on the course rather than at the finish line, and were generally during the middle third of the race. Of the on-course consultations, the runner was able to continue the race 55% of the time, and 75% of those who continued after consultation ultimately finished the race. Relative number of consultations did not differ among competitors within 10-year age groups (P = .7) or between men and women (P = .2). Overall, consultations for medical issues were predominant, and nausea and vomiting accounted for the single highest reason for consultation (24%). Although there was an overall decrease in finish line consultations and intravenous fluid use from 2010 through 2013 (P < .0001 for both) that was independent of maximum ambient temperature (P = .3 and P = .4), the proportion of those being treated with intravenous fluids relative to those receiving consultation at the finish line was directly related to maximum ambient temperature (r = .93, P = .037). Both 2012 and 2013 had a single medical emergency that required emergency evacuation. Conclusions This work demonstrates that the medical needs in a 161-km ultramarathon are mostly for minor issues. However, occasional serious issues arise that warrant a well-organized medical system.


      PubDate: 2015-02-25T23:56:08Z
       
  • Effect of Head and Face Insulation on Cooling Rate During Snow Burial
    • Abstract: Publication date: March 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 1
      Author(s): Scott E. McIntosh , Andre K. Crouch , Andrew Dorais , Marion McDevitt , Courtney Wilson , Chris H. Harmston , Marty I. Radwin , Colin K. Grissom
      Objectives Avalanche victims are subjected to a number of physiological stressors during burial. We simulated avalanche burial to monitor physiological data and determine whether wearing head and face insulation slows cooling rate during snow burial. In addition, we sought to compare 3 different types of temperature measurement methods. Methods Nine subjects underwent 2 burials each, 1 with head and face insulation and 1 without. Burials consisted of a 60-minute burial phase followed by a 60-minute rewarming phase. Temperature was measured via 3 methods: esophageal probe, ingestible capsule, and rectal probe. Results Cooling and rewarming rates were not statistically different between the 2 testing conditions when measured by the 3 measurement methods. All temperature measurement methods correlated significantly. Conclusions Head and face insulation did not protect the simulated avalanche victim from faster cooling or rewarming. Because the 3 temperature measurement methods correlated, the ingestible capsule may provide an advantageous noninvasive method for snow burial and future hypothermia studies if interruptions in data transmission can be minimized.


      PubDate: 2015-02-25T23:56:08Z
       
  • Protection Against Cold in Prehospital Care: Wet Clothing Removal or
           Addition of a Vapor Barrier
    • Abstract: Publication date: March 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 1
      Author(s): Otto Henriksson , Peter J. Lundgren , Kalev Kuklane , Ingvar Holmér , Gordon G. Giesbrecht , Peter Naredi , Ulf Bjornstig
      Objective The purpose of this study was to evaluate the effect of wet clothing removal or the addition of a vapor barrier in shivering subjects exposed to a cold environment with only limited insulation available. Methods Volunteer subjects (n = 8) wearing wet clothing were positioned on a spineboard in a climatic chamber (–18.5°C) and subjected to an initial 20 minutes of cooling followed by 30 minutes of 4 different insulation interventions in a crossover design: 1) 1 woolen blanket; 2) vapor barrier plus 1 woolen blanket; 3) wet clothing removal plus 1 woolen blanket; or 4) 2 woolen blankets. Metabolic rate, core body temperature, skin temperature, and heart rate were continuously monitored, and cold discomfort was evaluated at 5-minute intervals. Results Wet clothing removal or the addition of a vapor barrier significantly reduced metabolic rate (mean difference ± SE; 14 ± 4.7 W/m2) and increased skin temperature rewarming (1.0° ± 0.2°C). Increasing the insulation rendered a similar effect. There were, however, no significant differences in core body temperature or heart rate among any of the conditions. Cold discomfort (median; interquartile range) was significantly lower with the addition of a vapor barrier (4; 2–4.75) and with 2 woolen blankets (3.5; 1.5–4) compared with 1 woolen blanket alone (5; 3.25–6). Conclusions In protracted rescue scenarios in cold environments with only limited insulation available, wet clothing removal or the use of a vapor barrier is advocated to limit the need for shivering thermogenesis and improve the patient’s condition on admission to the emergency department.


      PubDate: 2015-02-25T23:56:08Z
       
  • Mt Everest Base Camp Medical Clinic “Everest ER”: Epidemiology
           of Medical Events During the First 10 Years of Operation
    • Abstract: Publication date: March 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 1
      Author(s): Mária Némethy , Andrew B. Pressman , Luanne Freer , Scott E. McIntosh
      Objectives As the highest peak on the planet, Mt Everest provides a truly austere environment in which to practice medicine. We examined records of all visits to the Everest Base Camp Medical Clinic (Everest ER) to characterize the medical problems that occur in these patients. Methods A retrospective analysis of medical records from the first 10 years of operation (2003 to 2012) was performed. Results Medical reasons accounted for 85.3% (3045) of diagnoses, whereas 14.0% (500) were for trauma. The most common medical diagnoses were pulmonary causes such as high altitude cough and upper respiratory infection, comprising more than 38% of medical diagnoses. For traumatic diagnoses, 56% were for dermatologic causes, most commonly for frostbite and lacerations. Pulmonary and dermatologic diagnoses were also the most frequent causes for evacuation from Everest Base Camp, most commonly for high altitude pulmonary edema and frostbite, respectively. Conclusions Medical professionals treating patients at extreme altitude should have a broad scope of practice and be well prepared to deal with serious trauma from falls, cold exposure injuries, and altitude illness.


      PubDate: 2015-02-25T23:56:08Z
       
  • What is Wilderness Medicine?
    • Abstract: Publication date: March 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 1
      Author(s): Scott E. McIntosh , Tracy A. Cushing , Linda E. Keyes , Neal W. Pollock



      PubDate: 2015-02-25T23:56:08Z
       
  • 2014 Wilderness &amp; Environmental Medicine Peer Reviewers
    • Abstract: Publication date: March 2015
      Source:Wilderness & Environmental Medicine, Volume 26, Issue 1




      PubDate: 2015-02-25T23:56:08Z
       
  • Differing Levels of Acute Hypoxia Do Not Influence Maximal Anaerobic Power
           Capacity
    • Abstract: Publication date: Available online 23 December 2014
      Source:Wilderness & Environmental Medicine
      Author(s): Jesús Álvarez-Herms , Sonia Julià-Sánchez , Hannes Gatterer , Ginés Viscor , Martin Burtscher
      Objective The purpose of this study was to determine the effects of different inspired oxygen fractions (Fio 2) on average and peak power capacity during consecutive jumps to assess the effectiveness of a hypoxic explosive-strength program. Methods Eight physically active subjects (aged 33.62 ± 4.07 years; height, 1.77 ± 0.05 m; weight, 74.38 ± 6.86 kg) completed a Bosco jump test, consisting of a series of 15-second “all-out” jumps with 3 minutes of recovery, performed in a normoxia condition (N [Fio 2 = 21%]) and in two hypoxic conditions: moderate hypoxia (MH [Fio 2 16.5% o 2]) and high hypoxia (HH [13.5% o 2]). A force platform provided the average and the maximal power output (W) generated during consecutive jumps. Measurements were also taken of lactate, creatine kinase, arterial oxygen saturation, and perceived exertion using the Borg fatigue scale. Results The average power outputs throughout the entire sets were similar between N (3187 ± 46) and MH (3184 ± 15; P > .05), but slightly greater with HH (3285 ± 43) compared with N (P < .05). Values for lactate during N (7.5 ± 3.0), MH (7.7 ± 4.0), and HH (7.9 ± 3.0; P > .05), and for creatine kinase (values before, 69.8 ± 15; and 24 hours after in N [79.4 ± 15.60], MH [85.2 ± 26.7], and HH [84.3 ± 47.2]; P > .05) were similar for all conditions. Only during exercise in hypoxia were moderate and severe hypoxemia induced as the sets increased and Fio 2 was lower (P < .05). At the same time, the perceived exertion reported by subjects was substantially higher at HH (8.9 ± 1.1) than at N (7.1 ± 1.9; P < .05). Conclusions Jumping power output was not negatively affected by mild or high hypoxia in comparison with normoxia during an anaerobic workout despite having higher hypoxemia and a greater perception of exertion.


      PubDate: 2014-12-24T15:12:41Z
       
 
 
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