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  Subjects -> ENVIRONMENTAL STUDIES (Total: 812 journals)
    - ENVIRONMENTAL STUDIES (739 journals)
    - POLLUTION (22 journals)
    - TOXICOLOGY AND ENVIRONMENTAL SAFETY (41 journals)
    - WASTE MANAGEMENT (10 journals)

ENVIRONMENTAL STUDIES (739 journals)            First | 1 2 3 4 5 6 7 8     

Julius-Kühn-Archiv     Open Access  
Kleio     Full-text available via subscription   (Followers: 2)
Knowledge Management Research & Practice     Hybrid Journal   (Followers: 17)
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: 20)
Large Marine Ecosystems     Full-text available via subscription   (Followers: 1)
Latin American and Caribbean Ethnic Studies     Hybrid Journal   (Followers: 4)
Latin American Journal of Management for Sustainable Development     Hybrid Journal  
Legal Studies     Hybrid Journal   (Followers: 3)
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: 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: 6)
Management of Environmental Quality: An International Journal     Hybrid Journal   (Followers: 5)
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: 9)
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: 4)
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: 101)
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: 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: 1)
Observatorio Medioambiental     Open Access  
Occupational and Environmental Medicine     Full-text available via subscription   (Followers: 8)
Ocean Acidification     Open Access  
Ochrona Srodowiska i Zasobów Naturalnych     Open Access  
Oecologia     Hybrid Journal   (Followers: 31)
Oikos     Hybrid Journal   (Followers: 34)
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)
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: 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: 5)
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: 15)
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: 10)
Practice Periodical of Hazardous, Toxic, and Radioactive Waste Management     Full-text available via subscription   (Followers: 2)
Presence Teleoperators & Virtual Environments     Hybrid Journal   (Followers: 1)
Present Environment and Sustainable Development     Open Access  
Presidential Studies Quarterly     Hybrid Journal   (Followers: 4)

  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  [2812 journals]
  • The Impact of Freeze-Thaw Cycles on Epinephrine
    • Abstract: Publication date: Available online 19 May 2015
      Source:Wilderness & Environmental Medicine
      Author(s): Heather Beasley , Pearlly Ng , Albert Wheeler , William R. Smith , Scott E. McIntosh
      Objectives Epinephrine is the first-line medical treatment for anaphylaxis, a life-threatening allergic syndrome. To treat anaphylaxis, backcountry recreationalists and guides commonly carry epinephrine autoinjectors. Epinephrine may be exposed to cold temperatures and freezing during expeditions. An epinephrine solution must contain 90% to 115% of the labeled epinephrine amount to meet United States Pharmacopeia standards. The purpose of this study was to determine whether freeze-thaw cycles alter epinephrine concentrations in autoinjectors labeled to contain 1.0 mg/mL epinephrine. A further objective was to determine whether samples continued to meet United States Pharmacopeia concentration standards after freeze-thaw cycles. Methods Epinephrine from 6 autoinjectors was extracted and divided into experimental and control samples. The experimental samples underwent 7 consecutive 12-hour freeze cycles followed by 7 12-hour thaw cycles. The control samples remained at an average temperature of 23.1°C for the duration of the study. After the seventh thaw cycle, epinephrine concentrations were measured using a high-performance liquid chromatography assay with mass spectrometry detection. Results The mean epinephrine concentration of the freeze-thaw samples demonstrated a statistically significant increase compared with the control samples: 1.07 mg/mL (SD ± 8.78; 95% CI, 1.04 to 1.11) versus 0.96 mg/mL (SD ± 6.81; 95% CI, 0.94 to 0.99), respectively. The maximal mean epinephrine concentration in the experimental freeze-thaw group was 1.12 mg/mL, which still fell within the range of United States Pharmacopeia standards for injectables (0.90 to 1.15 mg/mL). Conclusions Although every attempt should be made to prevent freezing of autoinjectors, this preliminary study demonstrates that epinephrine concentrations remain within 90% to 115% of 1.0 mg/mL after multiple freeze-thaw cycles.


      PubDate: 2015-05-24T11:16:24Z
       
  • In Response to How Not To Train Your Dragon: A Case of Komodo Dragon Bite,
           by Borek and Charlton
    • Abstract: Publication date: Available online 18 May 2015
      Source:Wilderness & Environmental Medicine
      Author(s): Scott A. Weinstein , Julian White



      PubDate: 2015-05-24T11:16:24Z
       
  • Quantifying Search Dog Effectiveness in a Terrestrial Search and Rescue
           Environment
    • Abstract: Publication date: Available online 18 May 2015
      Source:Wilderness & Environmental Medicine
      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: 2015-05-24T11:16:24Z
       
  • In Reply to Drs Weinstein and White
    • Abstract: Publication date: Available online 19 May 2015
      Source:Wilderness & Environmental Medicine
      Author(s): Heather A. Borek , Nathan P. Charlton



      PubDate: 2015-05-24T11:16:24Z
       
  • An Attack by a Teiidae Lizard (Tegu) on a Human: Is There a Pattern of the
           Injuries?
    • Abstract: Publication date: Available online 30 April 2015
      Source:Wilderness & Environmental Medicine
      Author(s): Ricardo Augusto Monteiro de Barros Almeida , Danilo Galvão Teixeira , Vidal Haddad Junior



      PubDate: 2015-05-08T11:03:54Z
       
  • The Effect of Environmental Temperature on Glucose and Insulin After an
           Oral Glucose Tolerance Test in Healthy Young Men
    • Abstract: Publication date: Available online 30 April 2015
      Source:Wilderness & Environmental Medicine
      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: 2015-05-08T11:03:54Z
       
  • Advanced Avalanche Safety Equipment of Backcountry Users: Current Trends
           and Perceptions
    • Abstract: Publication date: Available online 30 April 2015
      Source:Wilderness & Environmental Medicine
      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: 2015-05-08T11:03:54Z
       
  • Complete Spinal Accessory Nerve Palsy From Carrying Climbing Gear
    • Abstract: Publication date: Available online 30 April 2015
      Source:Wilderness & Environmental Medicine
      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: 2015-05-08T11:03:54Z
       
  • Retained Stingray Barb and the Importance of Imaging
    • Abstract: Publication date: Available online 30 April 2015
      Source:Wilderness & Environmental Medicine
      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: 2015-05-08T11:03:54Z
       
  • The Hand-Powered Ring Cutter: A Useful Tool in Your Wilderness Medical Bag
    • Abstract: Publication date: Available online 30 April 2015
      Source:Wilderness & Environmental Medicine
      Author(s): Morteza Khodaee , Jill Tirabassi



      PubDate: 2015-05-08T11:03:54Z
       
  • Jellyfish Stings: A Practical Approach
    • Abstract: Publication date: Available online 29 April 2015
      Source:Wilderness & Environmental Medicine
      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: 2015-05-08T11:03:54Z
       
  • Hiker Fatality From Severe Hyponatremia in Grand Canyon National Park
    • Abstract: Publication date: Available online 29 April 2015
      Source:Wilderness & Environmental Medicine
      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: 2015-05-08T11:03:54Z
       
  • GrahamRatcliffeA Day To Die For: 1996: Everest’s Worst
           Disaster2011Mainstream PublishingLondon, UKUS $14.95 (paperback); $9.99
           (Kindle), 334 pages
    • Abstract: Publication date: Available online 29 April 2015
      Source:Wilderness & Environmental Medicine
      Author(s): Harvey Lankford



      PubDate: 2015-05-08T11:03:54Z
       
  • Bites, Bugs, and Blood
    • Abstract: Publication date: Available online 18 April 2015
      Source:Wilderness & Environmental Medicine
      Author(s): Scott E. McIntosh , Tracy A. Cushing , Linda E. Keyes , Neal W. Pollock



      PubDate: 2015-05-08T11:03:54Z
       
  • Diabetic Ketoacidosis and Acute Mountain Sickness: Case Report and Review
           of Treatment Options in Type 1 Diabetes Mellitus
    • Abstract: Publication date: Available online 18 April 2015
      Source:Wilderness & Environmental Medicine
      Author(s): Steven C.M. Miller
      A 30-year-old man with a 20-year history of well-controlled type 1 diabetes mellitus and no microvascular complications traveled from near sea level to an altitude of 3000 m within 6 hours. At altitude, his blood glucose levels began to rise, necessitating increased insulin delivery. Typical symptoms of acute mountain sickness (AMS) developed, and he became increasingly hyperglycemic and unwell. Upon presentation to an emergency clinic, diabetic ketoacidosis (DKA) was diagnosed and was managed with insulin, intravenous fluids with potassium, and acetazolamide orally. No other potential causes for diabetic ketoacidosis were identified. Hyperglycemia, ketosis, and acidosis resolved with treatment as expected, but an increased insulin requirement was noted for the next 48 hours, until returning to expected levels when acetazolamide was discontinued. This case describes an episode of mild diabetic ketoacidosis potentially precipitated by moderate to severe acute mountain sickness, and an apparent hyperglycemic effect of acetazolamide. Individuals with type 1 diabetes traveling to altitude and their physicians should be vigilant for this complication and should be aware of the effects of conventional first-line therapies for acute mountain sickness on insulin requirement, glycemic control, and preexisting microvascular diabetes complications.


      PubDate: 2015-05-08T11:03:54Z
       
  • Acute Stress Symptoms Among US Ocean Lifeguards
    • Abstract: Publication date: Available online 15 April 2015
      Source:Wilderness & Environmental Medicine
      Author(s): Chris L. O’Halloran , Mary W. Silver , John M. Colford Jr



      PubDate: 2015-05-08T11:03:54Z
       
  • Neurological Involvement and Hepatocellular Injury Caused by a Snake With
           Hematotoxin Envenomation
    • Abstract: Publication date: Available online 15 April 2015
      Source:Wilderness & Environmental Medicine
      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: 2015-05-08T11:03:54Z
       
  • Norovirus Outbreaks Among Colorado River Rafters in the Grand Canyon,
           Summer 2012
    • Abstract: Publication date: Available online 15 April 2015
      Source:Wilderness & Environmental Medicine
      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: 2015-05-08T11:03:54Z
       
  • A Pain in the Neck
    • Abstract: Publication date: Available online 7 April 2015
      Source:Wilderness & Environmental Medicine
      Author(s): Pranawa Koirala , Seth Wolpin , Pratibha Phuyal , Buddha Basnyat , Ken Zafren



      PubDate: 2015-04-11T01:24:01Z
       
  • Field Ultrasound Evaluation of Central Volume Status and Acute Mountain
           Sickness
    • Abstract: Publication date: Available online 8 April 2015
      Source:Wilderness & Environmental Medicine
      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 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: 2015-04-11T01:24:01Z
       
  • Cardiovascular and Perceptual Responses to an Ultraendurance Channel Swim:
           A Case Study
    • Abstract: Publication date: Available online 24 March 2015
      Source:Wilderness & Environmental Medicine
      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: 2015-04-02T01:16:10Z
       
  • Reduction of Acute Shoulder Dislocations in a Remote Environment: A
           Prospective Multicenter Observational Study
    • Abstract: Publication date: Available online 29 March 2015
      Source:Wilderness & Environmental Medicine
      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: 2015-04-02T01:16:10Z
       
  • In Reply to Hypothermia Evidence, Afterdrop, and Guidelines
    • Abstract: Publication date: Available online 1 April 2015
      Source:Wilderness & Environmental Medicine
      Author(s): Ken Zafren , Gordon G. Giesbrecht , Daniel F. Danzl , Hermann Brugger , Emily B. Sagalyn , Beat Walpoth , Eric A. Weiss , Paul S. Auerbach , Scott E. McIntosh , Mária Némethy , Marion McDevitt , Jennifer Dow , Robert B. Schoene , George W. Rodway , Peter H. Hackett , Brad L. Bennett , Colin K. Grissom



      PubDate: 2015-04-02T01:16:10Z
       
  • Hypothermia Evidence, Afterdrop, and Practical Experience
    • Abstract: Publication date: Available online 29 March 2015
      Source:Wilderness & Environmental Medicine
      Author(s): Douglas Brown , John Ellerton , Peter Paal , Jeff Boyd



      PubDate: 2015-04-02T01:16:10Z
       
  • Cerebral Hemodynamics at Altitude: Effects of Hyperventilation and
           Acclimatization on Cerebral Blood Flow and Oxygenation
    • Abstract: Publication date: Available online 18 March 2015
      Source:Wilderness & Environmental Medicine
      Author(s): Matthew R. Sanborn , Mark E. Edsell , Meeri N. Kim , Rickson Mesquita , Mary E. Putt , Chris Imray , Heng Yow , Mark H. Wilson , Arjun G. Yodh , Mike Grocott , Daniel S. Martin
      Objective Alterations in cerebral blood flow (CBF) and cerebral oxygenation are implicated in altitude-associated diseases. We assessed the dynamic changes in CBF and peripheral and cerebral oxygenation engendered by ascent to altitude with partial acclimatization and hyperventilation using a combination of near-infrared spectroscopy, transcranial Doppler ultrasound, and diffuse correlation spectroscopy. Methods Peripheral (Spo 2) and cerebral (Scto 2) oxygenation, end-tidal carbon dioxide (ETCO 2), and cerebral hemodynamics were studied in 12 subjects using transcranial Doppler and diffuse correlation spectroscopy (DCS) at 75 m and then 2 days and 7 days after ascending to 4559 m above sea level. After obtaining baseline measurements, subjects hyperventilated to reduce baseline ETCO2 by 50%, and a further set of measurements were obtained. Results Cerebral oxygenation and peripheral oxygenation showed a divergent response, with cerebral oxygenation decreasing at day 2 and decreasing further at day 7 at altitude, whereas peripheral oxygenation decreased on day 2 before partially rebounding on day 7. Cerebral oxygenation decreased after hyperventilation at sea level (Scto 2 from 68.8% to 63.5%; P < .001), increased after hyperventilation after 2 days at altitude (Scto 2 from 65.6% to 69.9%; P = .001), and did not change after hyperventilation after 7 days at altitude (Scto 2 from 62.2% to 63.3%; P = .35). Conclusions An intensification of the normal cerebral hypocapnic vasoconstrictive response occurred after partial acclimatization in the setting of divergent peripheral and cerebral oxygenation. This may help explain why hyperventilation fails to improve cerebral oxygenation after partial acclimatization as it does after initial ascent. The use of DCS is feasible at altitude and provides a direct measure of CBF indices with high temporal resolution.


      PubDate: 2015-04-02T01:16:10Z
       
  • Adirondack Park Incidents: A Retrospective Review of Search and Rescue
           Reports From 2008 and 2009
    • Abstract: Publication date: Available online 19 March 2015
      Source:Wilderness & Environmental Medicine
      Author(s): Rokhsanna Sadeghi , Joseph C. Konwinski , Rita K. Cydulka
      Background The Adirondack Park is a 6 million acre recreational area in northeastern New York used for activities such as hiking, camping, canoeing, hunting, fishing, snowmobiling, skiing, and rock climbing. Given the large number of people who use the Adirondacks for recreation, there exists the potential for many accidents, injuries, and illnesses to occur in areas ranging from state-operated campgrounds to remote backcountry. Objective The aim of this study was to gain insight into the demographics of search and rescue (SAR) operations in the Adirondack Park. Methods This study is a retrospective review of the Adirondack Park Forest Ranger SAR reports from January 1, 2008, through December 31, 2009. Epidemiologic data were gathered from the NY State Department of Environmental Conservation for each report, including victim demographics, incident, reason for injury, medical care needed, preparation of victim, and prior medical conditions. Results In all, 239 SAR missions were carried out involving at least 349 victims. Of all cases, 28% (66) involved an injured victim, and 9% (21) involved illness; 56% (10) of the victims had a known prior illness or medical condition; and 21% (27) of cases were due to victims exceeding their abilities. Of the search missions, 54% of victims (93) had little experience with the activity, and 9% (15) had no experience. Only 43% (62) of victims had any form of orientation equipment. Conclusions This study portrays the initial demographics of SAR efforts in Adirondack Park. It will aid in educating people on preparing for wilderness activities, as well as tailoring SAR resources to the demographics of injury and illness within the park.


      PubDate: 2015-04-02T01:16:10Z
       
  • Femoral Traction Splints in Mountain Rescue Prehospital Care: To Use or
           Not to Use? That Is the Question
    • Abstract: Publication date: Available online 24 March 2015
      Source:Wilderness & Environmental Medicine
      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: 2015-04-02T01:16:10Z
       
  • The Epidemiology of Caving Fatalities in the United States
    • Abstract: Publication date: Available online 12 March 2015
      Source:Wilderness & Environmental Medicine
      Author(s): Alejandro C. Stella , J. Priyanka Vakkalanka , Christopher P. Holstege , Nathan P. Charlton



      PubDate: 2015-03-17T01:03:08Z
       
  • A Case Study: Rare Lepiota brunneoincarnata Poisoning
    • Abstract: Publication date: Available online 12 March 2015
      Source:Wilderness & Environmental Medicine
      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: 2015-03-17T01:03:08Z
       
  • How Not to Train Your Dragon: A Case of a Komodo Dragon Bite
    • Abstract: Publication date: Available online 12 March 2015
      Source:Wilderness & Environmental Medicine
      Author(s): Heather A. Borek , Nathan P. Charlton
      Komodo dragons (Varanus komodoensis) are the world’s largest lizards, known for killing prey that exceed their body mass. Reports of bites to humans in the popular press suggest high degrees of morbidity and mortality. Reports in the medical literature are lacking. We describe the case of a zookeeper who was bitten by a Komodo dragon, with a resultant mallet finger. We further discuss the various potential mechanisms of Komodo dragon lethality, including sepsis and venom deposition theories that are useful in guiding management.


      PubDate: 2015-03-17T01:03:08Z
       
  • High Altitude Cerebral Edema—Serial MRI Findings
    • Abstract: Publication date: Available online 12 March 2015
      Source:Wilderness & Environmental Medicine
      Author(s): Ivaturi Venkata Nagesh , Gopinath Manoj , Madan Gurdarshdeep



      PubDate: 2015-03-17T01:03:08Z
       
  • Prediction of Physiological Responses and Performance at Altitude Using
           the 6-Minute Walk Test in Normoxia and Hypoxia
    • Abstract: Publication date: Available online 12 March 2015
      Source:Wilderness & Environmental Medicine
      Author(s): Oliver R. Gibson , Alan J. Richardson , Mark Hayes , Ben Duncan , Neil S. Maxwell
      Objective The 6-minute walk test (6MWT) is a reliable and valid tool for determining an individual’s functional capacity, and has been used to predict summit success. The primary aim of the study was to evaluate whether a 6MWT in normobaric hypoxia could predict physiological responses and exercise performance at altitude. The secondary aim was to determine construct validity of the 6MWT for monitoring acclimatization to 3400 m (Cuzco, Peru). Methods Twenty-nine participants performed six 6MWTs in four conditions: normoxic outdoor (NO), normoxic treadmill (NT), and hypoxic treadmill (HT) were each performed once; and hypoxic outdoor (HO) was performed three times, at 42 hours (HO1), 138 hours (HO2), and 210 hours (HO3) after arrival at Cuzco. Results One-way analysis of variance revealed no difference (P > .05) between NO and HO1 for 6MWT distance. HT and HO protocols were comparable for the measurement of delta heart rate (HR) and post-test peripheral oxygen saturation (%Spo 2; P > .05). Acclimatization was evidenced by reductions (P < .05) in resting HR and respiratory rate (RR) between HO1, HO2, and HO3, and preservation of Spo 2 between HO1 and HO2. Postexercise HR and RR were not different (P > .05) with acclimatization. The duration to ascend to 4215 m on a trek was moderately correlated (P < .05) to HR during the trek and the 6MWT distance during HT; no other physiological markers predicted performance. Conclusions The 6MWT is a simple, time-efficient tool for predicting physiological responses to simulated and actual altitude, which are comparable. The 6MWT is effective at monitoring elements of acclimatization to moderate altitude.


      PubDate: 2015-03-17T01:03:08Z
       
  • Electronic Tablet Augmented Simulation: A Pilot Study
    • Abstract: Publication date: Available online 12 March 2015
      Source:Wilderness & Environmental Medicine
      Author(s): Shane Peterson , Martin Musi , Jonathan L. Bar , Christopher Tedeschi



      PubDate: 2015-03-17T01:03:08Z
       
  • Novel Application of Chemical Cold Packs for Treatment of Exercise-Induced
           Hyperthermia: A Randomized Controlled Trial
    • Abstract: Publication date: Available online 12 March 2015
      Source:Wilderness & Environmental Medicine
      Author(s): John B. Lissoway , Grant S. Lipman , Dennis A. Grahn , Vinh H. Cao , Michael Shaheen , Samson Phan , Eric A. Weiss , H. Craig Heller
      Objective Heat-related illness is a common disease with significant morbidity and mortality. Despite no proven efficacy, application of chemical cold packs (CCP) to the skin overlying the large vessels of the neck, groin, and axillae is a traditional recommended cooling modality. The study objective was to compare the cooling rates of CCP applied to these traditional areas vs the glabrous skin surfaces of the cheeks, palms, and soles in exercise-induced hyperthermia. Methods Ten healthy adult male volunteers walked on a treadmill in a heated room (40° ± 0.5°C) while wearing insulated military overgarments until their esophageal temperatures (Tes) reached 39.2°C. Each participant had three heat stress trials on separate days: no treatment followed by randomly ordered traditional (neck, groin, and axillae) cooling and glabrous skin cooling. Results With no treatment, Tes remained stable after the first 5 minutes of the heat trial (ΔTes = 0.12° ± 0.07°C/10 min). Traditional cooling followed a linear decline (ΔTes = 0.17° ± 0.04°C/10 min; P < .001). Glabrous cooling enhanced the treatment effect by a steeper decline (ΔTes = 0.30° ± 0.06°C/10 min; P < .001), significantly different from traditional cooling by 2-way analysis of variance (P < .001). Conclusions Application of CCP to glabrous skin surfaces was more effective for treating exercise-induced heat stress than the traditional CCP cooling intervention. This novel cooling technique may be beneficial as an adjunctive treatment for heat-related illness in the prehospital environment.


      PubDate: 2015-03-17T01:03:08Z
       
  • Electromagnetic Interference From Electronic Devices Used in the
           Management of Type 1 Diabetes Can Impair the Performance of an Avalanche
           Transceiver in Search Mode
    • Abstract: Publication date: Available online 12 March 2015
      Source:Wilderness & Environmental Medicine
      Author(s): Steven C.M. Miller
      Objective Portable electronic devices play an important role in the management of type 1 diabetes mellitus. Electromagnetic interference from electronic devices has been shown to impair the function of an avalanche transceiver in search mode (but not in transmitting mode). This study investigates the influence of electromagnetic interference from diabetes devices on a searching avalanche beacon. Methods The greatest distance at which an avalanche transceiver (in search mode) could accurately indicate the location of a transmitting transceiver was assessed when portable electronic devices (including an insulin pump and commonly used real-time continuous subcutaneous glucose monitoring system [rtCGMS]) were held in close proximity to each transceiver. Results The searching transceiver could accurately locate a transmitted signal at a distance of 30 m when used alone. This distance was unchanged by the Dexcom G4 rtCGMS, but was reduced to 10 m when the Medtronic Guardian rtCGMS was held close (within 30 cm) to the receiving beacon. Interference from the Animas Vibe insulin pump reduced this distance to 5 m, impairing the searching transceiver in a manner identical to the effect of a cell phone. Conclusions Electromagnetic interference produced by some diabetes devices when held within 30 cm of a searching avalanche transceiver can impair the ability to locate a signal. Such interference could significantly compromise the outcome of a companion rescue scenario. Further investigation using other pumps and rtCGMS devices is required to evaluate all available diabetes electronics. Meantime, all electronic diabetes devices including rtCGMS and insulin pumps should not be used within 30 cm of an avalanche transceiver.


      PubDate: 2015-03-17T01:03:08Z
       
  • Which Improvised Tourniquet Windlasses Work Well and Which Ones
           Won’t?
    • Abstract: Publication date: Available online 12 March 2015
      Source:Wilderness & Environmental Medicine
      Author(s): John F. Kragh Jr , Timothy E. Wallum , James K. Aden III , 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: 2015-03-17T01:03:08Z
       
  • Improvised Method for Increasing the Temperature of an i-STAT Analyzer and
           Cartridge in Cold Environments
    • Abstract: Publication date: Available online 13 March 2015
      Source:Wilderness & Environmental Medicine
      Author(s): David Radler , Matthew Wetschler , Mark Christensen , Grant S. Lipman



      PubDate: 2015-03-17T01:03:08Z
       
  • Work Patterns Dictate Energy Demands and Thermal Strain During Wildland
           Firefighting
    • Abstract: Publication date: Available online 12 March 2015
      Source:Wilderness & Environmental Medicine
      Author(s): John S. Cuddy , Joseph A. Sol , Walter S. Hailes , Brent C. Ruby
      Objective The purpose of this investigation was to characterize the effects of self-selected work activity on energy expenditure, water turnover, and thermal strain during wildland fire suppression. A secondary aim was to contrast current data with data collected 15 years ago using similar methods to determine whether job demands have changed. Methods Participants (n = 15, 26 ± 3 years, 179 ± 6 cm, 78.3 ± 8.6 kg) were monitored for 3 days for total energy expenditure, water turnover, core and chest skin temperature, physical activity, and heart rate. Participants arrived to the mobile laboratory each morning, submitted a nude weight, ingested a temperature transmitter, provided a urine sample, and were equipped with a physiological and activity monitor. Participants completed live wildland fire suppression during their work shifts. Results Mean core temperature was 37.6° ± 0.2°C, mean chest skin temperature was 34.1° ± 1.0°C, mean heart rate was 112 ± 13 beats/min, and the mean physiological strain index score was 3.3 ± 1.0. Wildland firefighters spent 49 ± 8%, 39 ± 6%, and 12 ± 2% in the sedentary, light, and moderate-vigorous intensity categories, respectively. The mean total energy expenditure was 19.1 ± 3.9 MJ/d, similar to 1997 (17.5 ± 6.9 MJ/d). The mean water turnover in 2012 was 9.5 ± 1.7 L/d, which was higher (P < .05) compared with 1997–98 (7.0 ± 1.7 L/d). Conclusions Wildland firefighters do not induce consistently high cardiovascular and thermal strain while completing arduous work in a hot environment despite fairly high chest skin temperatures. The total energy expenditure in the current study suggests job demands are similar to those of 15 years ago, while the increased water turnover may reflect a change in drinking habits.


      PubDate: 2015-03-17T01:03:08Z
       
  • In Response to Wilderness Search Strategy and Tactics, by Phillips et al
    • Abstract: Publication date: Available online 16 March 2015
      Source:Wilderness & Environmental Medicine
      Author(s): Donald C. Cooper , John R. Frost



      PubDate: 2015-03-17T01:03:08Z
       
  • EPAS1 Gene Polymorphisms Are Associated With High Altitude Polycythemia in
           Tibetans at the Qinghai-Tibetan Plateau
    • Abstract: Publication date: Available online 16 March 2015
      Source:Wilderness & Environmental Medicine
      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: 2015-03-17T01:03:08Z
       
  • Management of a Pediatric Snake Envenomation After Presentation With a
           Tight Tourniquet
    • Abstract: Publication date: Available online 16 March 2015
      Source:Wilderness & Environmental Medicine
      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: 2015-03-17T01:03:08Z
       
  • Cardiovascular Demands of Deer Retrieval Methods
    • Abstract: Publication date: Available online 11 March 2015
      Source:Wilderness & Environmental Medicine
      Author(s): Charles J. Fountaine , Mitchell J. Evenson
      Objective The purpose of this study was to compare the cardiovascular (CV) demands of 2 deer retrieval methods. Methods Twelve male participants (weight 86 ± 24 kg, age 21 ± 1 years) performed a maximum treadmill test on day 1 to determine baseline fitness levels. On day 2, all participants first towed, then dragged a 45-kg simulated deer carcass for 457 m at a self-selected pace. The tow condition utilized a shoulder harness system with a 2-m strap connecting the harness to the carcass, allowing the participant to walk upright as he towed the load. The dragging condition required the participants to flex their trunk, grasp the legs of the deer with both hands, and drag the carcass the length of the course. Heart rate and oxygen consumption (Vo 2) from each trial were measured by indirect calorimetry. Results The CV responses of towing were significantly less compared with those of dragging for Vo 2 peak (P = .001), peak heart rate (P = .003), average heart rate (P = .028), and rating of perceived exertion (P < .001). No significant differences were observed for average Vo 2 (P = .91) or time to completion (P = .27). Conclusions The results of this study suggest towing a deer with a shoulder harness results in significant reductions in CV demand and lower perceived exertion compared with traditional deer dragging techniques. Deer hunters who are deconditioned or have CV risk factors are strongly encouraged to consider deer retrieval methods utilizing a shoulder harness and tow rope to mitigate the increased demands commonly found with traditional retrieval methods.


      PubDate: 2015-03-12T00:58:12Z
       
  • Wilderness Image
    • Abstract: Publication date: Available online 11 March 2015
      Source:Wilderness & Environmental Medicine
      Author(s): Frank Karle III



      PubDate: 2015-03-12T00:58:12Z
       
  • Tough Beginnings on Galapagos, Baby Blue Footed Booby
    • Abstract: Publication date: Available online 7 March 2015
      Source:Wilderness & Environmental Medicine
      Author(s): Jon Conard



      PubDate: 2015-03-12T00:58:12Z
       
  • An Introduction to Wilderness Emergency Medical Services Medical Director
           Course
    • Abstract: Publication date: Available online 7 March 2015
      Source:Wilderness & Environmental Medicine
      Author(s): Steve Donelan



      PubDate: 2015-03-12T00:58:12Z
       
  • Rebound Coagulopathy in Patients With Snakebite Presenting With Marked
           Initial Coagulopathy
    • Abstract: Publication date: Available online 7 March 2015
      Source:Wilderness & Environmental Medicine
      Author(s): Willam R. Witham , Cathy McNeill , Sunny Patel
      Objective An estimated 70% of patients with pit viper snakebites require antivenom to treat serious complications such as coagulopathy. Evidence-based guidance is limited for the appropriate administration of Crotalinae Polyvalent Immune Fab (FabAV) and the duration of laboratory follow-up. The objective of our study was to assess the incidence of marked and recurrent envenomation coagulopathy at our trauma center and identify practice patterns that may prevent serious complications. Methods A retrospective case review was conducted over a 3-year period on patients treated for symptomatic snakebite injury. Case records were reviewed for the inclusion criteria of international normalized ratio (INR) greater than 2.0. The exclusion criterion was limited to patients receiving anticoagulant therapy. Results In all, 61 patients were identified on retrospective chart review and 3 patients (4.9%) met inclusion criteria. Two of the 3 patients had marked rebound coagulopathy requiring readmission and additional treatment. In our small series, 2 patients presenting after crotaline envenomation with increased INR (>6.0), decreased fibrinogen (<60 mg/dL), and decreased platelet count (<100,000/mL) had recurrent coagulopathy and were asymptomatic, and recurrence was noted only with follow-up laboratory testing. All patients responded positively within a matter of hours to repeat FabAV administration, with resolution of rebound coagulopathy. Conclusions We recommend periodic monitoring of patients with increased INR, decreased fibrinogen, and decreased platelet count. Patients should be monitored for 10 to 14 days after envenomation to identify asymptomatic rebound coagulopathy. Prompt readministration of FabAV appears to correct the coagulopathy.


      PubDate: 2015-03-12T00:58:12Z
       
  • Negative Predictive Value of Excluding an Embedded Snake Foreign Body by
           Ultrasonography
    • Abstract: Publication date: Available online 11 March 2015
      Source:Wilderness & Environmental Medicine
      Author(s): William F. Rushton , J. Priyanka Vakkalanka , James H. Moak , Nathan P. Charlton
      Objective Numerous reputable sources for healthcare providers advocate routine imaging to rule out an embedded tooth or fang after a snake bite. The objective of this study was to determine whether these foreign bodies can be reliably excluded by bedside ultrasonography. Methods All emergency medicine (EM) residents and faculty at a single institution were invited to participate. Two sets of 5 ultrasound gel phantoms were prepared using a method previously validated to have the same density as human tissue. In the first set of 5 phantoms, 1 snake fang was embedded to simulate a retained foreign body. Similarly, in the second set of 5 phantoms, 1 snake tooth was also embedded. Participants were asked to identify the presence or absence of a foreign body in each phantom using bedside ultrasonography. Year of training and confidence in excluding a snake foreign body were also recorded. Results Each participant (n = 27) performed ultrasound imaging on 10 phantoms for a total of 270 samples. Range of experience included postgraduate year 1 (25.9%), postgraduate year 2 (29.6%), postgraduate year 3 (33.3%), and graduates of EM residency (11.1%). The sensitivity and negative predictive value for ruling out an embedded fang was 92.6% and 98.1%, respectively. The sensitivity and negative predictive value for ruling out an embedded tooth was 77.8% and 93.7%, respectively. Among all the phantoms, there was a sensitivity of 85.2% and a negative predictive value of 96%. Conclusion Bedside ultrasonography performed by an EM physician is a feasible option to rule out embedded foreign bodies after a snake bite if imaging is warranted.


      PubDate: 2015-03-12T00:58:12Z
       
  • Deriving Effective Sweep Width for Air-scent Dog Teams
    • Abstract: Publication date: Available online 5 March 2015
      Source:Wilderness & Environmental Medicine
      Author(s): Kenneth B. Chiacchia , Heather E. Houlahan , Rebecca S. Hostetter
      Objective We sought to obtain the first effective sweep widths (ESWs) ever measured for an air-scent search dog unit to compare their performance to historical data from human searchers and to initially test the validity of atmospheric convection as a limiting factor in air-scent search. Methods We used GPS tracks and waypoints to measure lateral hit and miss distances for the dog teams during blinded, randomized training tasks during a 6-year period, calculating ESW using the crossover method. During the tasks we collected weather data for determining convection. We used nonparametric statistics and least-square regression to compare the dog ESW data with historical human data and weather conditions. Results The mean value of ESW for the 4 teams under all conditions was 95 m (95% CI, 44 to 145). The dog teams’ performance was statistically superior to human visual searchers in detecting search subjects in low-visibility colors, but not subjects in high-visibility colors. A nonparametric correlation test of ESW vs convection gave P < .05, suggesting that convection may be an operationally significant factor in air-scent dog performance. Conclusions The ESW methodology is applicable to air-scent dog teams, potentially allowing search managers to make decisions in applying resources operationally, as well as improving accuracy of planning calculations. In addition, the methods described appear to be capable, given more widely representative data, of making valid statistical comparisons between different search modalities and weather and other factors.


      PubDate: 2015-03-07T00:52:28Z
       
  • Near-Fatal Outcome From Absence of Information About Exercise-Associated
           Hyponatremia in a Wilderness Medicine Field Guidebook
    • Abstract: Publication date: Available online 6 March 2015
      Source:Wilderness & Environmental Medicine
      Author(s): Martin D. Hoffman , Thomas M. Myers



      PubDate: 2015-03-07T00:52:28Z
       
  • Finger and Toe Temperature Responses to Cold After Freezing Cold Injury in
           Elite Alpinists
    • Abstract: Publication date: Available online 5 March 2015
      Source:Wilderness & Environmental Medicine
      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: 2015-03-07T00:52:28Z
       
 
 
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