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Carbon monoxide, a gas known most widely for its toxic effects at high doses, is receiving increased attention for its role as a physiological signaling molecule and potential therapeutic agent when administered in low doses. We sought to quantify any changes to oxygen consumption and energy expenditure during submaximal exercise after low-dose CO inhalation. 9 active individuals completed 4 graded submaximal exercise tests, with each test occurring during a separate visit. For their first exercise test, subjects inhaled CO or room air (1.2 mL·kg(-1) body mass) in a randomized, subject-blind fashion. A second test was repeated 24 h later when the inhaled gas should have cleared the system. Subjects repeated study procedures with the alternate dose after a washout period of at least 2 days. Low-dose CO administration did not affect oxygen consumption or energy expenditure during submaximal exercise immediately or 24 h following its administration. Increases in heart rate, blood [lactate], and perceived exertion were observed following acute CO inhalation but these effects were absent after 24 h. The results of this study suggest that low-dose CO administration does not influence the energetics of submaximal exercise, but it acutely increases the relative intensity associated with absolute workloads below the lactate threshold.

IntroductionTraditionally, post disaster response activities have focused on immediate trauma and communicable diseases. In developed countries such as Australia, the post disaster risk for communicable disease is low. However, a “disease transition” is now recognized at the population level where noncommunicable diseases (NCDs) are increasingly documented as a post disaster issue. This potentially places an extra burden on health care resources and may have implications for disaster-management systems. With increasing likelihood of major disasters for all sectors of global society, there is a need to ensure that health systems, including public health infrastructure (PHI), can respond properly.ProblemThere is limited peer-reviewed literature on the impact of disasters on NCDs. Research is required to better determine both the impact of NCDs post disaster and their impact on PHI and disaster-management systems.MethodsA literature review was used to collect and analyze data on the impact of the index case event, Australia's Severe Tropical Cyclone Yasi (STC Yasi), on PHI and the management of NCDs. The findings were compared with data from other world cyclone events. The databases searched were MEDLINE, CINAHL, Google Scholar, and Google. The date range for the STC Yasi search was January 26, 2011 through May 2, 2013. No time limits were applied to the search from other cyclone events. The variables compared were tropical cyclones and their impacts on PHI and NCDs. The outcome of interest was to identify if there were trends across similar world events and to determine if this could be extrapolated for future crises.ResultsThis research showed a tropical cyclone (including a hurricane and typhoon) can impact PHI, for instance, equipment (oxygen, syringes, and medications), services (treatment and care), and clean water availability/access that would impact both the treatment and management of NCDs. The comparison between STC Yasi and worldwide tropical cyclones found the challenges faced were linked closely. These relate to communication, equipment and services, evacuation, medication, planning, and water supplies.ConclusionThis research demonstrated that a negative trend pattern existed between the impact of STC Yasi and other similar world cyclone events on PHI and the management of NCDs. This research provides an insight for disaster planners to address concerns of people with NCDs. While further research is needed, this study provides an understanding of areas for improvement, specifically enhancing protective PHI and the development of strategies for maintaining treatment and alternative care options, such as maintaining safe water for dialysis patients.RyanBJ, FranklinRC, BurkleFMJr, WattK, AitkenP, SmithEC, LeggatP. Analyzing the impact of Severe Tropical Cyclone Yasi on public health infrastructure and the management of noncommunicable diseases. Prehosp Disaster Med. 2015;30(1):1-10.

There is an upward trend in the use of military personnel and assets to provide domestic and international humanitarian assistance and disaster relief. International humanitarian law has constrained military involvement by imposing particular obligations when it comes to providing assistance. In nonconflict situations, however, these constraints are becoming increasingly unreasonable given that the priority is to fill the gap between global humanitarian capacity and actual community need. Militaries in the Indo-Asia-Pacific region have been proactively assessing their performance in humanitarian missions, and some have made significant progress in advancing civilian-military coordination. Future efforts must focus on improving the integration of military modes of operation and assets into emerging frameworks for disaster management and humanitarian efforts. Military policy makers need to assume a more active role in expanding their focus beyond response to all phases of disasters: prevention, preparedness, response, and recovery.

This study compared the effects of cooling on the energetic and associated physiological and perceptual responses to constant power, non-steady state cycling. Twelve males cycled at their lactate threshold power for 60 min or until exhaustion under 3 conditions: wearing a cooling vest and sleeves (COOL), a synthetic shirt embedded with an active particle technology claimed to facilitate evaporative heat loss (EVAP), and a standard synthetic shirt (CON). When adjusted for time, the increase in gastrointestinal temperature from baseline was reduced during COOL and EVAP compared to CON (1.44±0.45 and 1.52±0.43 vs. 1.66±0.45°C, p0.05). Sweat rate was reduced during COOL compared to EVAP and CON (1 312±331 vs. 1 525±393 and 1 550±548 mL·h

Background: The exposure of people and infrastructure to flood and storm related disasters across the world is increasing faster than vulnerability is decreasing. For people with non-communicable diseases this presents a significant risk as traditionally the focus of disaster management systems has been on immediate trauma and communicable diseases. This focus must now be expanded to include the management of non-communicable diseases because these conditions are generating the bulk of ill health, disability and premature death around the globe. When public health service infrastructure is destroyed or damaged access to treatment and care is severely jeopardised, resulting in an increased risk of non-communicable disease exacerbation or even death. This research proposes disaster responders, coordinators and government officials are vital assets to mitigate and eventually prevent these problems from being exacerbated during a disaster. This is due to their role in supporting the public health service infrastructure required to maximise treatment and care for people with non-communicable diseases. By focusing on the disaster cycle as a template, and on mitigation and prevention phases in particular, these actions and activities performed by disaster service responders will lead to overall improved preparedness, response, recovery and rehabilitation phases. Methods: Data were collected via 32 interviews and one focus group (eight participants) between March 2014 and August 2015 (total of 40 participants). The research was conducted in the State of Queensland, Australia, with disaster service providers. The analysis included the phases of: organizing data; data description; data classification; and interpretation. Results: The research found a relationship between the impact of a disaster on public health service infrastructure, and increased health risks for people with non-communicable diseases. Mitigation strategies were described for all phases of the disaster cycle impacting public health service infrastructure. Specific measures include: increasing the use of telemedicine; preplanning with medical suppliers; effective town planning; health professionals visiting evacuation centers; evacuation centers having power for medical equipment; hubs for treatment and care after a disaster; evacuation of high risk people prior to disaster; mapping people at risk by non-communicable disease; and a mechanism for sharing information between agencies. A common theme from the participants was that having accurate and easily accessible data on people with non-communicable diseases would allow disaster service providers to adequately prepare for and respond to a disaster. Conclusions: Disaster service providers can play a vital role in reducing the risk of disaster exacerbated non-communicable diseases through public health service infrastructure resilience. They are often employed in communities where disasters occur and are therefore best-placed to lead implementation of the mitigation strategies identified in this research. To sustainably implement the mitigation strategies they will need to become integrated into effective performance and monitoring of the disaster response and health sector during non-disaster periods. For this to occur, the strategies should be integrated into business and strategic plans. Achieving this will help implement the Sendia Framework for Disaster Risk Reduction 2015-2030 and, most importantly, help protect the health of people with non-communicable diseases before, during and after a disaster.

The increasing complexity and often transboundary scope of complex emergencies are exceeding the capacity of humanitarian logistics systems. The military plays a growing role in supplementing and even leading humanitarian assistance and disaster relief logistics. However, issues relating to military involvement such as sovereignty and cost have refocused the conversation onto capabilities and capacities of commercial logistics providers, who have not been fully engaged and integrated into disaster preparedness, response, and recovery activities. The commercial sector is part of the larger supply chain management system that includes contracting, procurement, storage, and transportation of food, water, medicine, and other supplies, as well as human resources, and necessary machinery and equipment. Military and commercial logistics share many of these elements and tasks daily. The most effective and efficient response combines key elements from humanitarian, military, and commercial logistics systems. Such trilateral cooperation represents the next step in an evolving partnership paradigm that is truly synergistic. We present a Synchronized Disaster Relief Model, as well as multiple examples of how military, commercial, and humanitarian supply chains each bring unique capabilities to disaster relief operations, and how these three supply chains can complement each other in a synergistic manner, through synchronized action.

Introduction:Potentially vulnerable population groups in disasters include the elderly and frail, people who are isolated, and those with chronic diseases, including mental health conditions or mobility issues. The disasters such as the Queensland flood and Great East Japan Disaster in 2011, affected regions of Australia and Japan. This study is followed by two pilot studies in both countries after the disasters. While both countries have different evacuation center procedures for evacuees, the issues regarding the role and responsibility across governments involving planning, setup, and management of evacuation centers demonstrate similarities and differences.Aim:This paper will report the preliminary findings of a pilot study undertaken with local government officials and humanitarian agencies in Australia and Japan concerning their involvement in planning for, setting up, and managing evacuation centers for vulnerable populations in recent natural disasters. The objective is to illuminate the similarities and differences that officials and agencies faced, and to highlight the resolutions and lessons learned in the preparation of evacuation centers through this event.Methods:This is the final stage of the study. After completing an analysis of both phases, a comparative framework to highlight similarities and differences was developed.Results:Each government’s role in relation to the establishment of evacuation centers is legally defined in both countries. However, the degree of involvement and communication with non-governmental organizations from the planning cycle to the recovery cycle demonstrates different expectations across governments.Discussion:While the role of governments is clearly established in both countries based on the legal frameworks, the planning, set-up, and management of evacuation center differs.

Introduction:Disasters can damage the essential public health infrastructure and social protection systems required for vulnerable populations. This contributes to indirect mortality and morbidity as high as 70–90%, primarily due to an exacerbation of life-threatening conditions and chronic diseases. Despite this, the traditional focus of public health systems has been on communicable diseases. To address this challenge, disaster and health planners require access to repeatable and measurable methods to rank and prioritize the needs of people with life-threatening and chronic diseases before, during, and after a disaster.Aim:Propose a repeatable and measurable method for ranking and prioritizing the needs of people with life-threatening and chronic diseases before, during, and after a disaster.Methods:The research began with identifying the risk disasters pose to people with life-threatening and chronic diseases. The data gathered was then used to develop indicators and explore the use of DisasterAWARE™ (All-hazard Warnings, Analysis, and Risk Evaluation) to rank and prioritize the needs before, during, and after a disaster.Results:This research found people at greatest risk are those with underlying cardiovascular and respiratory diseases, unstable diabetes, renal diseases, and those undergoing cancer treatment. A sustainable method to help address this problem is to expand the use of DisasterAWARE™ (All-hazard Warnings, Analysis, and Risk Evaluation) to rank and prioritize needs at national and sub-national levels.Discussion:DisasterAWARE™ has been successfully applied to the assessment and prioritization of disaster risk and humanitarian assistance needs in Southeast Asia (ASEAN, Viet Nam), Central America (Guatemala, El Salvador, Honduras, Nicaragua), South America (Peru), and the Caribbean (Jamaica, Dominican Republic). Using the indicators developed through this research, this proven methodology can be seamlessly and easily translated to rank and prioritize the needs of people with life-threatening and chronic diseases before, during, and after a disaster.

Carbon monoxide (CO) rebreathing procedures are used to assess hemoglobin mass (Hbmass) but recent evidence suggests that CO is a signaling molecule that may alter physiological functions. We examined the effects of 10 days of intermittent, low-dose CO inhalation on Hbmass, aerobic performance predictors, and peak-power exercise tolerance. 18 recreationally-active men were randomized to either CO or placebo inhalation groups in a single-blind, pre-post parallel-groups trial. Primary outcomes were assessed before and after an intervention period during which subjects inhaled a bolus of 1.2 ml kg(-1) CO or placebo (room air) for 30 s, once per day on 10 days over a 12-day period. Cycling tests were performed >16 h following CO inhalation to exclude acute effects of CO exposure. CO inhalation elevated carboxyhemoglobin by 4.4±0.4% (mean±SD) following each exposure. Compared to placebo, chronic CO inhalation did not significantly alter Hbmass (p=0.99), peak oxygen uptake (p=0.59), peak power output (p=0.10), submaximal oxygen uptake (p=0.91), submaximal RER (p=0.22), lactate threshold (p=0.65), or peak-power exercise tolerance (p=0.60). In conclusion, our data support the ability to perform repeated measurements of Hbmass using CO rebreathing over a 12-day period without altering physiological responses.

Informatics systems, particularly those that provide capabilities for data storage, specimen tracking, retrieval, and order fulfillment, are critical to the success of biorepositories and other laboratories engaged in translational medical research. A crucial item-one easily overlooked-is an efficient way to receive and process investigator-initiated requests. A successful electronic ordering system should allow request processing in a maximally efficient manner, while also allowing streamlined tracking and mining of request data such as turnaround times and numerical categorizations (user groups, funding sources, protocols, and so on). Ideally, an electronic ordering system also facilitates the initial contact between the laboratory and customers, while still allowing for downstream communications and other steps toward scientific partnerships. We describe here the recently established Web-based ordering system for the biorepository at Washington University Medical Center, along with its benefits for workflow, tracking, and customer service. Because of the system's numerous value-added impacts, we think our experience can serve as a good model for other customer-focused biorepositories, especially those currently using manual or non-Web-based request systems. Our lessons learned also apply to the informatics developers who serve such biobanks.

Introduction: Over the last quarter of a century the frequency of natural disasters and the burden of non-communicable diseases (NCD) across the globe have been increasing. For individuals susceptible to, or chronically experiencing, NCDs this has become a significant risk. Disasters jeopardize access to essential treatment, care, equipment, water and food, which can result in an exacerbation of existing conditions or even preventable death. Consequently, there is a need to expand the public health focus of disaster management to include NCDs. To provide a platform for this to occur, this article presents the results from a systematic review that identifies and describes the impact of cyclone, flood and storm related disasters on those susceptible to, or experiencing, NCDs. The NCDs researched were: cardiovascular diseases; cancers; chronic respiratory diseases; and diabetes. Methods: Four electronic publication databases were searched with a date limit of 31 December 2014. The data was analyzed through an aggregation of individual papers to create an overall data description. The data was then grouped by disease to describe the impact of a disaster on treatment management, exacerbation, and health care of people with NCDs. The PRISMA checklist was used to guide presentation of the research. Results: The review identified 48 relevant articles. All studies represented developed country data. Disasters interrupt treatment management and overall care for people with NCDs, which results in an increased risk of exacerbation of their illness or even death. The interruption may be caused by a range of factors, such as damaged transport routes, reduced health services, loss of power and evacuations. The health impact varied according to the NCD. For people with chronic respiratory diseases, a disaster increases the risk of acute exacerbation. Meanwhile, for people with cancer, cardiovascular diseases and diabetes there is an increased risk of their illness exacerbating, which can result in death. Conclusion: Cyclone, flood and storm related disasters impact on treatment management and care for people with NCDs. Possible consequences include exacerbation of illness, complications or even death. There is now a need to expand traditional disaster approaches by public health to incorporate NCDs. This must be guided by the major NCDs identified by the World Health Organization and implemented in-line with the Sendai Framework for Disaster Risk Reduction: 2015-2030. This includes understanding all the factors that influence both direct and indirect (preventable) morbidity and mortality related to NCDs during and after disasters. Once achieved, disaster planners and public health professionals will be in a position to develop and implement effective mitigation strategies.

It is classically thought that increases in hemoglobin mass (Hbmass) take several weeks to develop upon ascent to high altitude and are lost gradually following descent. However, the early time course of these erythropoietic adaptations has not been thoroughly investigated and data are lacking at elevations greater than 5000 m, where the hypoxic stimulus is dramatically increased. As part of the AltitudeOmics project, we examined Hbmass in healthy men and women at sea level (SL) and 5260 m following 1, 7, and 16 days of high altitude exposure (ALT1/ALT7/ALT16). Subjects were also studied upon return to 5260 m following descent to 1525 m for either 7 or 21 days. Compared to SL, absolute Hbmass was not different at ALT1 but increased by 3.7 ± 5.8% (mean ± SD; n = 20; p

An understanding of human responses to hypoxia is important for the health of millions of people worldwide who visit, live, or work in the hypoxic environment encountered at high altitudes. In spite of dozens of studies over the last 100 years, the basic mechanisms controlling acclimatization to hypoxia remain largely unknown. The AltitudeOmics project aimed to bridge this gap. Our goals were 1) to describe a phenotype for successful acclimatization and assess its retention and 2) use these findings as a foundation for companion mechanistic studies. Our approach was to characterize acclimatization by measuring changes in arterial oxygenation and hemoglobin concentration [Hb], acute mountain sickness (AMS), cognitive function, and exercise performance in 21 subjects as they acclimatized to 5260 m over 16 days. We then focused on the retention of acclimatization by having subjects reascend to 5260 m after either 7 (n = 14) or 21 (n = 7) days at 1525 m. At 16 days at 5260 m we observed: 1) increases in arterial oxygenation and [Hb] (compared to acute hypoxia: PaO2 rose 9±4 mmHg to 45±4 while PaCO2 dropped a further 6±3 mmHg to 21±3, and [Hb] rose 1.8±0.7 g/dL to 16±2 g/dL; 2) no AMS; 3) improved cognitive function; and 4) improved exercise performance by 8±8% (all changes p

Total haemoglobin mass (Hb(mass)) can be assessed with low measurement error using carbon monoxide (CO) rebreathing. However, variability in measurement error of Hb(mass) has been reported across laboratories and it has previously been suggested that CO leaks contribute to this variability. As a result of employing a standardized leak monitoring procedure using two CO detectors, we were able to retrospectively examine the impact of CO leaks on Hb(mass) values from past test-retest studies in our laboratory using the optimized CO rebreathing method. Test-retest data were collected to determine measurement error, with subjects tested twice within 5 days. Test-retest data were placed into separate categories based on magnitude and duration of CO leak observed during one of the two tests. The No Leak category contained test-retest data in which no leak occurred during either test. The Minor Leak category contained test-retest data in which one of the tests had a CO leak of magnitude less than 30 ppm and less than 5 seconds duration, whereas the Major Leak category included test-retest data in which a leak greater than this magnitude or duration occurred. Measurement error was lowest in the No Leak category (1.9%; 95%CI: 1.6-2.3%; n = 56), approximately doubled in the Minor Leaks category (3.6%; 95%CI: 2.6-6.1%; n = 13), and dramatically increased in the Major Leaks category (9.3%; 95%CI: 6.3-17.6%; n = 10). We recommend careful monitoring of potential CO leaks using multiple detectors. To minimize measurement error, tests in which any CO leak is detected should be excluded.