Wilderness & Environmental Medicine最新文献

Introduction: Augmented reality is a promising technology for enhancing remote medical assistance. It assists users by directly projecting the relevant virtual assistance in the real world at the right moment and at the right location. This modality is called colocalization but has not been validated in parabolic flights. Our hypothesis was that this modality is technically feasible in weightlessness and is superior to a paper checklist in assisting a caregiver during a simulated medical emergency.

Methods: During parabolic flight campaigns, we conducted an abdominal pain simulation scenario and sought to compare procedural assistances. Participants performed a basic medical examination using either classic cognitive aids (such as a paper checklist) or an augmented-reality device projecting visual co-localized (situated or embedded) assistance.

Results: Gravity variations induced technical difficulties in the nominal functioning of augmented-reality headsets due to the native accelerometers in these devices. Clinical data were not interpretable due to small sample size secondary to the technical difficulties encountered. Finally, an efficient and stable spatial tracking configuration was found during the last flight, offering future research perspectives.

Conclusions: Our study validated the first achievement of a stable co-localized assistance under gravity variation. The augmented-reality headset required an external tracking system based on surrounding infrared cameras and an in-flight calibration to recreate the virtual environment (spatial mapping) independently of gravity conditions. Further studies are needed to clinically validate the potential benefits of co-localized augmented reality for space medicine.

Commercially available insulin pumps for treatment of diabetes mellitus are currently not qualified to operate in the space environment. This work rigorously tested the fluid delivery performance of a Tandem t:slim X2 insulin pump in both micro- and hypergravity during a parabolic microgravity research flight. The parabolic research flight environment serves as an analogue to the types of transient gravitational loadings experienced during human-led missions, which provides a foundation to expand testing to suborbital and orbital flights in addition to other extreme environmental tests for wilderness dependency. The results of the flight data showed no significant difference between fluid delivery performance at 0, 1, and 2g acceleration regimes, nor at the transitions between gravity environments. Recommendations are made for further experimentation and qualification tests before use in future spaceflight missions.

Introduction: Fishhook injuries are a common occurrence among anglers. There are no guidelines for prophylactic antibiotic use after fishhook removal. This study analyzed the management of embedded fishhooks, prophylactic antibiotic use, and complication rate at a Michigan county emergency department to observe whether antibiotic use changes patient outcome. Commentary on a freshwater pathogen (Aeromonas hydrophila) is also included.

Methods: Cases were obtained through a retrospective chart review of patients seen for fishhook injury between 2016 and 2022. We analyzed age, sex, relevant medical history, type of fishhook, site preparation, removal technique, antibiotic use, return visit within 30 days, and complications.

Results: Fifty-one patients with fishhooks injuries were identified. Mean age was 48±17 y. Forty-three patients were male (84%), and 8 were female (16%). Hook site varied, with most occurring in the finger/thumb (78.4%) and scalp (5.9%). One case involved the ear cartilage. The most common removal technique was the advance and cut method (52.9%). Four patients had an immunocompromising condition (eg, diabetes). Oral antibiotics were prescribed to 26 patients (51%) on discharge. Prophylactic antibiotic choice varied-cephalexin predominated (61.5%). There were no wound infections or complications in cases where the fishhook was removed during the emergency department encounter (50 of 51). One case involved a delayed presentation, abscess formation, and outpatient hand surgery referral.

Conclusions: In this small observational study, antibiotic prophylaxis for freshwater-associated fishhook injury did not change outcome regardless of fishhook location or presence of an immunocompromising condition. Further controlled studies are needed to determine the validity of these findings.

Introduction: During the confinement in the COVID-19 pandemic, there was an increase in the production of urban waste, increasing the risk of accidents caused by scorpions. We sought to determine the clinical and epidemiologic aspects of scorpionism records in the 7 mesoregions of the State of Bahia, Brazil, examining differences in periods before and during the pandemic.

Methods: Data were obtained from SINAN, Brazil's Notifiable Diseases Information System (January 2010-December 2021). Measures of morbidity (incidence and lethality) and mortality were evaluated, comparing the averages before (2018 and 2019) and during the pandemic (2020 and 2021). Sociodemographic data (ie, gender, age group, and race) and conditions of care (ie, time, classification, and evolution) were compared by mesoregion.

Results: A total of 159,982 cases of scorpionism were registered, with a higher proportion in the prepandemic period (P<0.05) and a higher average incidence in the Center South of Bahia (267.32; n=82,059; 51.29%). Most cases occurred in mixed-race individuals (61.73%), females (n=81,292; 51.22%), and individuals between 20 and 39 y of age (n=48,876; 30.55%) and most cases were classified as mild (n=136,816; 85.52%), were attended in <1 h (n=81,941; 51.22%), and progresses to cure (n=142,082; 88.81%). There were 263 deaths (0.16%), with a mortality rate of 1.77/100,000 inhabitants and a lethality of 0.16%.

Conclusion: It is suggested that during the COVID-19 pandemic, despite the upward curve of accidents, social isolation measures and collective fear may have decreased the search for medical care after a scorpion sting, reducing notifications of the condition in the State of Bahia.

Introduction: As humanity progresses further into space, astronauts must be increasingly independent from mission control, especially in high-consequence medical scenarios. The high-utility and low-mass nature of point-of-care ultrasound (POCUS) makes this imaging modality ideal for spaceflight mission deployment. However, POCUS operator skill degrades over time, presenting an operational barrier to continuous, effective use. Further, formal medical education and POCUS-specific training are not requirements for astronaut candidates, potentially exacerbating skill degradation. Artificial intelligence (AI) assistance may mitigate skill decay, enabling long-term POCUS skill retention. To characterize the utility of this paradigm in space, we evaluated AI assistance effects on POCUS skill retention in subject pools with astronaut-mimicking educational demographics.

Methods: This prospective cohort study included 30 participants, evenly split into unassisted and AI-assisted cohorts. After undergoing 1 training session, participants collected 5 renal images, bladder images, and bladder volume estimations and completed usability and self-confidence surveys immediately, 2 wk, and 8 wk after initial training. Primary outcomes included target organ capture rates, image quality, bladder volume variability, perceived self-confidence, and perceived system usability.

Results: AI assistance minimized bladder volume variability aggregated over time (P=0.004) and 2 wk after training (P=0.009) and mitigated perceived system usability degradation with time (P=0.04). No trends were found in organ-capture abilities, image quality, or self-confidence.

Conclusion: POCUS AI decreased bladder volume variability and mitigated system usability decrement. We recommend increasing study duration or reducing the number of data collections in future study designs and the fieldwide adoption of objective ultrasound image-quality metrics.

The Solanaceae plant family (Solanum), such as capsicum, eggplant, potato, and tomato, is made up of common plants consumed by humans. Despite having medicinal benefits, these plants can produce toxic alkaloid compounds. We report 2 cases of uncommon Solanum erianthum poisoning after consuming the berries as a meal. Both patients presented with slurring of speech, which is easily mistaken for a stroke. Symptoms developed 19 h after consuming the wild berries and resolved spontaneously 12 h after onset. Both patients recovered with no neurologic deficit. No antidote was given in either case. The Solanaceae plant family is a common group of plants consumed by humans and is considered one of the largest genera. The phytochemical profile showed that the leaves and berries contain toxic glycoalkaloid levels, which can cause gastrointestinal and neurologic symptoms in poisoning cases. Reports have shown that the toxic glycoalkaloids can inhibit the cholinesterase enzyme, thus producing cholinergic effects. Theoretically, atropine is the choice of antidote, but no case report of atropine use has been documented. Treatment of S erianthum poisoning remains supportive care. These cases highlight the rare occurrence of poisoning from S erianthum and emphasize the necessity for considering toxicologic causes in nonlocalizing neurologic symptoms.

Introduction: Lightweight shelters made of water- and windproof polyester are frequently used by mountain rescue, but information on physical and psychological stress during their use is scarce.

Methods: A prospective observational study was conducted with 48 experienced rescuers who performed cardiopulmonary resuscitation training on a manikin in a shelter in alpine terrain. The objective parameters of air temperature, moisture, and concentrations of carbon dioxide and oxygen were measured inside the shelter. The subjective experience of the rescuers regarding stress, moisture, noise, air draft, convenience, spatial confinement, brightness, room temperature, and air quality was assessed using a questionnaire.

Results: During 15 min of cardiopulmonary resuscitation, the median temperature in the shelter rose by >15°C (Δt, 15.9°C; interquartile range, 14.3-16.5°C; P=0.018). Carbon dioxide concentrations increased to 0.97 vol% maximum. Bag valve mask ventilation was established with and without the use of supplemental oxygen, which showed significantly different oxygen shelter concentrations (21.1 vol% with oxygen, 20.6 vol% without oxygen; P<0.001). Most participants rated the physical comfort and spatial conditions inside the shelter as convenient.

Conclusions: In this study, the use of shelters in alpine terrain improved physical comfort while carrying out a rescue. Most participants gave high ratings for the working conditions in the shelter.

Introduction: The black widow spider, Latrodectus mactans, stands out as one of the most medically significant arachnids due to its extensive geographic distribution in the United States and its ability to produce a potent neurotoxin, α-latrotoxin. This study aimed to describe the epidemiology of black widow spider exposures by month of exposure, geographic distribution, demographics, symptoms, treatment, and health system resource utilization between 2012 and 2022.

Methods: This was a retrospective observational study using the US National Poison Data System, the data warehouse of the 55 US poison centers. A descriptive analysis of patient demographic data, month of exposure, clinical effects, level of healthcare received, and medical outcome was performed.

Results: During the studied period, a total of 15,299 cases of Latrodectus spp exposures were reported to US poison centers. Exposures occurred with higher frequency in warm-weather states and during summer months. Almost half the cases were managed outside a healthcare facility (48.6%). Hospital admission was required for 10.0% of exposures. The most common therapies received were wound care (43.7%) and benzodiazepines (18.6%). Antivenom was administered in 3.4% (n=521) of exposures.

Conclusions: Poison center data indicate that most black widow spider exposures result in minor consequences. Supportive care is the primary approach for black widow spider bites. Although antivenom use is infrequent, providers may seek administration guidance from toxicologists through local poison centers. This study underscores the pivotal role of poison centers in mitigating unnecessary healthcare visits and subsequent hospitalizations.

Introduction: Predictive analytics may be a useful adjunct to identify training needs for exploration class medical officers onboard deep space vehicles.

Methods: This study used a preliminary version of NASA's newest medical predictive analytics tool, the Medical Extensible Database Probabilistic Risk Assessment Tool (MEDPRAT), to test the application of predictive analytics to exploration crew medical officer curriculum design for 5 distinct design reference mission (DRM) profiles. Partial and fully treated paradigms were explored. Curriculum elements were identified using a leave-one-out analysis and a threshold of 5% risk increase over the fully treated baseline.

Results: For the partial treatment scenario, among the 5 DRM profiles 4-32 curriculum elements met the 5% RRI increase. For the absolute treatment scenario, among the 5 DRM profiles, 13-126 curriculum elements met the 5% RRI increase. For the partial treatment paradigm, 13 capabilities are present in at least 3 of the 5 DRM profiles, and these elements may constitute a common baseline curriculum. This covers 41% of the skillsets needed for an ISS-like profile, 100% of a late Artemis-like profile, 41% of a Mars mission-like profile, 100% of a Starship orbital-like profile, and 68% of a Starship lunar flyby-like profile.

Conclusions: This proof-of-concept study demonstrated that predictive analytics can rapidly generate generic and mission profile-specific exploration CMO curricula using an evidence-based process driven by optimizing mission risk reduction. This technique may serve as part of a human-machine team approach to medical curriculum planning for future space missions. It has significant potential to improve astronaut health and save time and effort for planners, trainers, and trainees.

Introduction: We studied field rewarming using a typical winter sleeping bag versus two heated hypothermia wrap systems in a semi-realistic lab simulation.

Methods: 10 participants (8 M, 2 F) were cooled to 36.1°C core temperature through 10.5-11.5°C water immersion, then performed 60 min of passive rewarming in 0°C air. The rewarming methods tested were: 1) a -9°C rated mummy-style Sleeping Bag; 2) Doctor Down Rescue Wrap; and 3) Thermal Yielding Vascular Airway Capsule (TYVAC) system; the latter two methods included vapor barriers and two heating pads. Rectal and skin temperatures, along with metabolic heat production calculated via indirect calorimetry, were measured throughout rewarming.

Results: One male participant was removed from analysis due to lack of sufficient cooling. Rectal temperature decreased in the remaining participants by ∼1.1-1.2°C to 36.1°C during the initial immersion phase. Over the 60 min of rewarming, rectal temperature changes were Δ0.0 ± 0.6°C in a sleeping bag, Δ+0.2 ± 0.3°C in Doctor Down, and Δ+0.2 ± 0.3°C in TYVAC, with no significant differences across methods. Mean skin temperatures, metabolic heat production, and perceptual measures were also similar across methods with no method×time interactions.

Conclusions: After 60 min of passive rewarming in cold conditions, all three rewarming methods were able to stall continued core cooling to levels at or slightly above post-immersion temperatures. With no differences in any physiological measures, it appears that all three rewarming methods are equally viable options for wilderness responders, and the choice should come down to environmetal conditions, availability, convenience, and ergonomics rather than rewarming efficacy.