Thermal Indices and Thermophysiological Modeling for Heat Stress

Occupational heat stress and its health impacts- an overview of research status and need for further research in Southeast Asia with special emphasis on mitigation strategies in North East India

The Intergovernmental Panel on Climate Change, IPCC predicts that hot seasons will get even hotter due to global climate change. There exists a critical dependence of human metabolic processes on temperature. Changes in thermal balance therefore, have an adverse effect on health because they raise body temperature, cause excessive sweating, and accelerate the rate of dehydration. Different nations and professional groups use different techniques to measure heat strain. This paper aims to review previous research conducted in the area of heat strain due to heat exposure among workers in Southeast Asia and also to profile mitigation strategies in North East India. Studies conducted between the years 2011 to 2023 in the evaluation of the health impacts of occupational heat stress were searched systematically using several sources of databases like PubMed, Google Scholar, Science Direct, Web of Science, Scopus, etc. It was noted that a greater proportion of previous research on evaluating physiological effects was carried out in controlled environments as opposed to real-world field settings. While such studies give us valuable insights into the relationship, applying the same methodology in the workplace may not be feasible. In India, very few research has been carried out on workplace heat stress, and even fewer have been done in North East India using physiological indicators. North East India is also affected by global climate change leading top more hotter days than before. The region of Northeast India, particularly Guwahati (Assam), has recently seen extreme heat waves during the sweltering summer months. With less literature available in this geographical location, studies with actual field-based settings are much needed to understand the occupational health impacts in this region. This review can formulate a suitable methodology for assessing the health impacts in working environment. This can also help the local health professionals to recognize the heat strain parameters that are acceptable worldwide, and use as pertinent indicators to scrutinize worker's health and develop preventive agendas as climate change advances.

Identifying physiological indicators of the cognitive, thermal, and combined (cognitive-thermal) stress conditions

Physiologically based stress detection systems have proven to be effective in identifying different stress conditions in the body to determine the source of stress and be able to counteract it. However, some stress conditions have not been widely studied, including thermal stress, cognitive stress, and combined (thermal-cognitive) stress conditions, which are frequently encountered in work or school environments. In order to develop systems to detect and differentiate these conditions, it is necessary to identify the physiological indicators that characterize each of them. The present research aims to identify which physiological indicators (heart rate, respiratory rate, galvanic skin response, and local temperature) could differentiate different stress conditions (no-stress, cognitive stress, thermal stress, and combined (thermal-cognitive) stress conditions). Thirty participants were exposed to cognitive, thermal, and combined stress sources while recording their physiological signals. The findings indicate that both mean heart rate and mean galvanic skin response identify moderate thermal and cognitive stress conditions as distinct from a no-stress condition, yet they do not differentiate between the two stress conditions. Additionally, heart rate uniquely identifies the cognitive-thermal stress condition, effectively distinguishing this combined stress condition from the singular stress conditions and the no-stress condition. Mean local temperature specifically signals thermal stress conditions, whereas mean respiratory rate accurately identifies cognitive stress conditions, with both indicators effectively separating these conditions from each other and from the no-stress condition. This is the first basis for differentiating thermal and cognitive stress conditions through physiological indicators.

Light rain exacerbates extreme humid heat

Humid heat waves pose significant risks to human health and the ecosystem. Intuitively, rainfall often alleviates extreme humid heat. However, here we show that light rain often accompanies extreme humid heat, exacerbating its frequency and intensity, especially over arid and semi-arid regions compared to no rain and moderate-to-heavy rain cases. This is because light rain does not dramatically reduce solar radiation but increases near-surface humidity through enhanced surface evaporation. The water replenishment from light rain as well as a shallower planetary boundary layer is crucial for consecutive extremes where there are commonly sporadic drizzle days amidst several rain-free days. These extremes last longer than rain-free extremes. Current global climate models (GCMs) overestimate light rain. After reducing this bias in a GCM, underestimations of humid heat waves in energy-limited regions and overestimations in water-limited regions are largely alleviated. These findings underscore the underappreciated impact of light rain on extreme humid heat.

Comparing the efficacy of different climate indices for prediction of labor loss, body temperatures, and thermal perception in a wide variety of warm and hot climates

The purpose of this study was to investigate which climate/heat indices perform best in predicting heat-induced loss of physical work capacity (PWCloss). Integrating data from earlier studies, data from 982 exposures (75 conditions) exercising at a fixed cardiovascular load of 130 beats·min-1, in varying temperatures (15-50°C), humidities (20-80%), solar radiation (0-800 W·m-2), wind (0.2-3.5 m·s-1), and two clothing levels, were used to model the predictive power of ambient temperature, universal thermal climate index (UTCI), wet bulb globe temperature (WBGT), modified physiologically equivalent temperature (mPET), heat index, apparent temperature (AT), and wet bulb temperature (Twb) for the calculation of PWCloss, skin temperature (Tskin) and core-to-skin temperature gradient, and thermal perception (thermal sensation vote, TSV) in the heat. R2, RMSE, and Akaike information criterion were used indicating model performance. Indices not including wind/radiation in their calculation (Ta, heat index, AT, and Twb) struggled to provide consistent predictions across variables. For PWCloss and TSV, UTCI and WBGT had the highest predictive power. For Tskin, and core-to-skin temperature gradient, the physiological models UTCI and mPET worked best in seminude conditions, but clothed, AT, WBGT, and UTCI worked best. For all index predictions, Ta, vapor pressure, and Twb were shown to be the worst heat strain predictors. Although UTCI and WBGT had similar model performance using the full dataset, WBGT did not work appropriately in windy, hot-dry, conditions where WBGT predicted lower strain due to wind, whereas the empirical data, UTCI and mPET indicated that wind in fact increased the overall level of thermal strain. The findings of the current study highlight the advantages of using a physiological model-based index like UTCI when evaluating heat stress in dynamic thermal environments.NEW & NOTEWORTHY There is an urgent need to determine the optimal heat stress metric when forecasting the impact of heat stress on human performance, physiological stress, and perception. We analyzed a wealth of laboratory data, simulating heart rate (HR)-paced work with wide variations in air temperature, humidity, wind speed, solar radiation, and clothing. We conclude that the universal thermal climate index (UTCI) [followed by wet-bulb globe temperature (WBGT)] is the optimal heat index to reliably predict reductions in performance, and elevations in physiological and perceptual stress.

Identification of anther thermotolerance genes by the integration of linkage and association analysis in maize

Maize is one of the world's most important staple crops, yet its production is increasingly threatened by the rising frequency of high-temperature stress (HTS). To investigate the genetic basis of anther thermotolerance under field conditions, we performed linkage and association analysis to identify HTS response quantitative trait loci (QTL) using three recombinant inbred line (RIL) populations and an association panel containing 375 diverse maize inbred lines. These analyses resulted in the identification of 16 co-located large QTL intervals. Among the 37 candidate genes identified in these QTL intervals, five have rice or Arabidopsis homologs known to influence pollen and filament development. Notably, one of the candidate genes, ZmDUP707, has been subject to selection pressure during breeding. Its expression is suppressed by HTS, leading to pollen abortion and barren seeds. We also identified several additional candidate genes potentially underly QTL previously reported by other researchers. Taken together, our results provide a pool of valuable candidate genes that could be employed by future breeding programs aiming at enhancing maize HTS tolerance.

Heat-related risk at Paris 2024: a proposal for classification and review of International Federations policies

Several International Federations (IFs) employ specific policies to protect athletes' health from the danger of heat. Most policies rely on the measurement of thermal indices such as the Wet Bulb Globe Temperature (WBGT) to estimate the risk of heat-related illness. This review summarises the policies implemented by the 32 IFs of the 45 sports included in the Paris 2024 Olympic Games. It provides details into the venue type, measured parameters, used thermal indices, measurement procedures, mitigation strategies and specifies whether the policy is a recommendation or a requirement. Additionally, a categorisation of sports' heat stress risk is proposed. Among the 15 sports identified as high, very high or extreme risk, one did not have a heat policy, three did not specify any parameter measurement, one relied on water temperature, two on air temperature and relative humidity, seven on WBGT (six measured on-site and one estimated) and one on the Heat Stress Index. However, indices currently used in sports have been developed for soldiers or workers and may not adequately reflect the thermal strain endured by athletes. Notably, they do not account for the athletes' high metabolic heat production and their level of acclimation. It is, therefore, worthwhile listing the relevance of the thermal indices used by IFs to quantify the risk of heat stress, and in the near future, develop an index adapted to the specific needs of athletes.

Effects of Wearing Personal Protective Equipment on Serum Cortisol Levels and Physiological Variables in Healthcare Workers: A Randomised Controlled Trial in a Simulated Pandemic Environment

INTRODUCTION

The COVID-19 pandemic has necessitated the widespread use of personal protective equipment (PPE), particularly in high-risk environments. Full-body PPE is favoured for its comprehensive protection against the virus but poses challenges to the body's thermoregulatory system as it inhibits air exchange. This randomised trial was undertaken to investigate the effects of wearing a commonly used gown-type full-body PPE kit in a simulated environment.

METHODS

Initially, 65 healthy males were recruited and randomly divided into two groups: a study group wearing a full-body PPE kit (gown-type, full-body PPE kit with trousers, a gown-type shirt with a hood, a shoe cover, an N95 face mask, and an optional face shield) and a control group without PPE. They remained seated for three hours while wearing the PPE kit. Room conditions mimicked non-air-conditioned hospital scenarios, with temperature and humidity recorded and ventilation provided through open doors and windows, along with ceiling fan cooling. Activities with minimal physical exertion were allowed, and access to the toilet was kept to a minimum. Subjects underwent assessments of heart rate, respiratory rate, temperature, blood pressure, heart rate variability (HRV), and blood samples for serum cortisol before donning the PPE kit and entering a simulated ICU/WARD environment and after doffing.

RESULTS

A total of 60 participants completed the study (30 in each group). Compared to the controls, serum cortisol levels significantly increased in the PPE groups, and HRV data indicated increased sympathetic activity in the PPE group.

CONCLUSION

 Wearing a full-body PPE kit (gown-type upper garment with trousers) was found to have a significant impact on cortisol levels and physiological variables in a simulated environment. This suggests that in situations like the COVID-19 pandemic that warrant the use of such PPE kits, appropriate measures should be taken to provide better thermal stability for maintaining the well-being of healthcare workers.

A case report on the physiological responses to extreme heat during Sicily's July 2023 heatwave

July 2023 has been confirmed as Earth's hottest month on record, and it was characterized by extraordinary heatwaves across southern Europe. Field data collected under real heatwave periods could add important evidence to understand human adaptability to extreme heat. However, field studies on human physiological responses to heatwave periods remain limited. We performed field thermo-physiological measurements in a healthy 37-years male undergoing resting and physical activity in an outdoor environment in the capital of Sicily, Palermo, during (July 21; highest level of local heat-health alert) and following (August 10; lowest level of local heat-health alert) the peak of Sicily's July 2023 heatwave. Results indicated that ~40 min of outdoor walking and light running in 33.8°C Wet Bulb Globe Temperature (WBGT) conditions (July 21) resulted in significant physiological stress (i.e., peak heart rate: 209 bpm; core temperature: 39.13°C; mean skin temperature: 37.2°C; whole-body sweat losses: 1.7 kg). Importantly, significant physiological stress was also observed during less severe heat conditions (August 10; WBGT: 29.1°C; peak heart rate: 190 bpm; core temperature: 38.48°C; whole-body sweat losses: 2 kg). These observations highlight the physiological strain that current heatwave conditions pose on healthy young individuals. This ecologically-valid empirical evidence could inform more accurate heat-health planning.

Whole body sweat rate prediction: outdoor running and cycling exercise

Our aim was to develop and validate separate whole body sweat rate prediction equations for moderate to high-intensity outdoor cycling and running, using simple measured or estimated activity and environmental inputs. Across two collection sites in Australia, 182 outdoor running trials and 158 outdoor cycling trials were completed at a wet-bulb globe temperature ranging from ∼15°C to ∼29°C, with ∼60-min whole body sweat rates measured in each trial. Data were randomly separated into model development (running: 120; cycling: 100 trials) and validation groups (running: 62; cycling: 58 trials), enabling proprietary prediction models to be developed and then validated. Running and cycling models were also developed and tested when locally measured environmental conditions were substituted with participants' subjective ratings for black globe temperature, wind speed, and humidity. The mean absolute error for predicted sweating rate was 0.03 and 0.02 L·h-1 for running and cycling models, respectively. The 95% confidence intervals for running (+0.44 and -0.38 L·h-1) and cycling (+0.45 and -0.42 L·h-1) were within acceptable limits for an equivalent change in total body mass over 3 h of ±2%. The individual variance in observed sweating described by the predictive models was 77% and 60% for running and cycling, respectively. Substituting measured environmental variables with subjective assessments of climatic characteristics reduced the variation in observed sweating described by the running model by up to ∼25%, but only by ∼2% for the cycling model. These prediction models are publicly accessible (https://sweatratecalculator.com) and can guide individualized hydration management in advance of outdoor running and cycling.NEW & NOTEWORTHY We report the development and validation of new proprietary whole body sweat rate prediction models for outdoor running and outdoor cycling using simple activity and environmental inputs. Separate sweat rate models were also developed and tested for situations where all four environmental parameters are not available, and some must be subsequently estimated by the user via a simple rating scale. All models are freely accessible through an online calculator: https://sweatratecalculator.com. These models, via the online calculator, will enable individualized hydration management for training or recreational cycling or running in an outdoor environment.

An assessment of WRF-urban schemes in simulating local meteorology for heat stress analysis in a tropical sub-Saharan African city, Lagos, Nigeria

Megacities, such as Lagos, Nigeria, face significant challenges due to rapid urbanization and climate change, resulting in a higher intensity of the urban heat island effect, coupled with high population density, making the city fall under the category of moderate to high heat stress/risk. Despite this, very few studies have analyzed the urban impact on heat stress over the coastal city, albeit with poor resolution data. In this study, we assessed the performance of an integrated high-resolution WRF-urban scheme driven by the readily available urban canopy information of the local climate zone (LCZ) to simulate local meteorological data for analyzing the spatiotemporal pattern of heat stress over the megacity. Our results show that the WRF-BEP scheme outperformed the other evaluated urban schemes, reducing the normalized root mean squared error by 25%. Furthermore, using humidex, we found a generally high incidence of intense discomfort in highly urbanized areas and noted the significant influence of urban morphology on the pattern of heat stress, particularly at night due to the combined effect of urban warming and higher relative humidity. The most socioeconomically disadvantaged urban areas, LCZ7, were most affected, with "hot" heat stress conditions observed over 90% of the time. However, during the afternoon, we found reduced heat stress in the core urban areas which might be due to the shading effect and/or cold air advection. Our findings would be relevant in the development of the urgently needed climate/heat adaptation plans for the city and other sub-Saharan African cities.

Modeling thermoregulatory responses during high-intensity exercise in warm environments

The six cylinder thermoregulatory model (SCTM) has been validated thoroughly for resting humans. This type of modeling is helpful to predict and develop guidance for safe performance of work and recreational activities. In the context of a warming global climate, updating the accuracy of the model for intense exercise in warm environments will help a wide range of individuals in athletic, recreational, and military settings. Three sets of previously collected data were used to determine SCTM accuracy. Dataset 1: two groups [large (LG) 91.5 kg and small (SM) 67.7 kg] of individuals performed 60 min of semirecumbent cycling in temperate conditions (25.1°C) at metabolic rates of 570-700 W. Dataset 2: two LG (100 kg) and SM (65.8 kg) groups performed 60 min of semirecumbent cycling in warm/hot environmental conditions (36.2°C) at metabolic rates of 590-680 W. Dataset 3: seven volunteers completed 8-km track trials (∼30 min) in cool (17°C) and warm (30°C) environments. The volunteers' metabolic rates were estimated to be 1,268 W and 1,166 W, respectively. For all datasets, SCTM-predicted core temperatures were found to be similar to the observed core temperatures. The root mean square deviations (RMSDs) ranged from 0.06 to 0.46°C with an average of 0.2°C deviation, which is less than the acceptance threshold of 0.5°C. Thus, the present validation shows that SCTM predicts core temperatures with acceptable accuracy during intense exercise in warm environments and successfully captures core temperature differences between large and small individuals.NEW & NOTEWORTHY The SCTM has been validated thoroughly for resting humans in warm and cold environments and during water immersion. The present study further demonstrated that SCTM predicts core temperatures with acceptable accuracy during intense exercise up to 1,300 W in temperate and warm environments and captures core temperature differences between large and small individuals. SCTM is potentially useful to develop guidance for safe operation in athletic, military, and occupational settings during exposure to warm or hot environments.

A century of exercise physiology: concepts that ignited the study of human thermoregulation. Part 3: Heat and cold tolerance during exercise

In this third installment of our four-part historical series, we evaluate contributions that shaped our understanding of heat and cold stress during occupational and athletic pursuits. Our first topic concerns how we tolerate, and sometimes fail to tolerate, exercise-heat stress. By 1900, physical activity with clothing- and climate-induced evaporative impediments led to an extraordinarily high incidence of heat stroke within the military. Fortunately, deep-body temperatures > 40 °C were not always fatal. Thirty years later, water immersion and patient treatments mimicking sweat evaporation were found to be effective, with the adage of cool first, transport later being adopted. We gradually acquired an understanding of thermoeffector function during heat storage, and learned about challenges to other regulatory mechanisms. In our second topic, we explore cold tolerance and intolerance. By the 1930s, hypothermia was known to reduce cutaneous circulation, particularly at the extremities, conserving body heat. Cold-induced vasodilatation hindered heat conservation, but it was protective. Increased metabolic heat production followed, driven by shivering and non-shivering thermogenesis, even during exercise and work. Physical endurance and shivering could both be compromised by hypoglycaemia. Later, treatments for hypothermia and cold injuries were refined, and the thermal after-drop was explained. In our final topic, we critique the numerous indices developed in attempts to numerically rate hot and cold stresses. The criteria for an effective thermal stress index were established by the 1930s. However, few indices satisfied those requirements, either then or now, and the surviving indices, including the unvalidated Wet-Bulb Globe-Thermometer index, do not fully predict thermal strain.

A century of exercise physiology: concepts that ignited the study of human thermoregulation. Part 1: Foundational principles and theories of regulation

This contribution is the first of a four-part, historical series encompassing foundational principles, mechanistic hypotheses and supported facts concerning human thermoregulation during athletic and occupational pursuits, as understood 100 years ago and now. Herein, the emphasis is upon the physical and physiological principles underlying thermoregulation, the goal of which is thermal homeostasis (homeothermy). As one of many homeostatic processes affected by exercise, thermoregulation shares, and competes for, physiological resources. The impact of that sharing is revealed through the physiological measurements that we take (Part 2), in the physiological responses to the thermal stresses to which we are exposed (Part 3) and in the adaptations that increase our tolerance to those stresses (Part 4). Exercising muscles impose our most-powerful heat stress, and the physiological avenues for redistributing heat, and for balancing heat exchange with the environment, must adhere to the laws of physics. The first principles of internal and external heat exchange were established before 1900, yet their full significance is not always recognised. Those physiological processes are governed by a thermoregulatory centre, which employs feedback and feedforward control, and which functions as far more than a thermostat with a set-point, as once was thought. The hypothalamus, today established firmly as the neural seat of thermoregulation, does not regulate deep-body temperature alone, but an integrated temperature to which thermoreceptors from all over the body contribute, including the skin and probably the muscles. No work factor needs to be invoked to explain how body temperature is stabilised during exercise.

CMIP6 models informed summer human thermal discomfort conditions in Indian regional hotspot

The frequency and intensity of extreme thermal stress conditions during summer are expected to increase due to climate change. This study examines sixteen models from the Coupled Model Intercomparison Project Phase 6 (CMIP6) that have been bias-adjusted using the quantile delta mapping method. These models provide Universal Thermal Climate Index (UTCI) for summer seasons between 1979 and 2010, which are regridded to a similar spatial grid as ERA5-HEAT (available at 0.25° × 0.25° spatial resolution) using bilinear interpolation. The evaluation compares the summertime climatology and trends of the CMIP6 multi-model ensemble (MME) mean UTCI with ERA5 data, focusing on a regional hotspot in northwest India (NWI). The Pattern Correlation Coefficient (between CMIP6 models and ERA5) values exceeding 0.9 were employed to derive the MME mean of UTCI, which was subsequently used to analyze the climatology and trends of UTCI in the CMIP6 models.The spatial climatological mean of CMIP6 MME UTCI demonstrates significant thermal stress over the NWI region, similar to ERA5. Both ERA5 and CMIP6 MME UTCI show a rising trend in thermal stress conditions over NWI. The temporal variation analysis reveals that NWI experiences higher thermal stress during the summer compared to the rest of India. The number of thermal stress days is also increasing in NWI and major Indian cities according to ERA5 and CMIP6 MME. Future climate projections under different scenarios (SSP1-2.6, SSP2-4.5, and SSP5-8.5) indicate an increasing trend in thermal discomfort conditions throughout the twenty-first century. The projected rates of increase are approximately 0.09 °C per decade, 0.26 °C per decade, and 0.56 °C per decade, respectively. Assessing the near (2022-2059) and far (2060-2100) future, all three scenarios suggest a rise in intense heat stress days (UTCI > 38 °C) in NWI. Notably, the CMIP6 models predict that NWI could reach deadly levels of heat stress under the high-emission (SSP5-8.5) scenario. The findings underscore the urgency of addressing climate change and its potential impacts on human well-being and socio-economic sectors.

Beating the heat: military training and operations in the era of global warming

Global climate change has resulted in an increase in the number and intensity of environmental heat waves, both in areas traditionally associated with hot temperatures and in areas where heat waves did not previously occur. For military communities around the world, these changes pose progressively increasing risks of heat-related illnesses and interference with training sessions. This is a significant and persistent "noncombat threat" to both training and operational activities of military personnel. In addition to these important health and safety concerns, there are broader implications in terms of the ability of worldwide security forces to effectively do their job (particularly in areas that historically already have high ambient temperatures). In the present review, we attempt to quantify the impact of climate change on various aspects of military training and performance. We also summarize ongoing research efforts designed to minimize and/or prevent heat injuries and illness. In terms of future approaches, we propose the need to "think outside the box" for a more effective training/schedule paradigm. One approach may be to investigate potential impacts of a reversal of sleep-wake cycles during basic training during the hot months of the year, to minimize the usual increase in heat-related injuries, and to enhance the capacity for physical training and combat performance. Regardless of which approaches are taken, a central feature of successful present and future interventions will be that they are rigorously tested using integrative physiological approaches.

Comparative Analysis of Elastic Polyester Sportswear Fabrics with Printed Graphene Patterns

In this study two elastic polyester fabrics differentiated by a graphene-printed pattern, called honeycomb (HC) and spider web (SW), were analyzed with a focus on their thermal, mechanical, moisture management and sensorial properties, aiming to identify the fabric with the most elevated heat dissipation and comfort for sportswear. The shape of the graphene-printed circuit did not lead to significant difference between the mechanical properties of the fabrics SW and HC assessed by the Fabric Touch Tester (FTT). Fabric SW outperformed fabric HC with respect of drying time, air permeability, moisture, and liquid management properties. On the other hand, both the Infrared (IR) thermography and FTT-predicted warmness clearly showed that fabric HC dissipates heat faster on its surface along the graphene circuit. This fabric was also predicted by the FTT as smoother and softer than fabric SW and had a better overall fabric hand. The results revealed that both graphene patterns resulted in comfortable fabrics with great potential applications in sportswear fields, in specific use scenario's.

Three dimensional models of human thermoregulation: A review

Numerous human thermoregulatory models have been developed and widely used in various applications such as aerospace, medicine, public health, and physiology research. This paper is a review of three dimensional (3D) models for human thermoregulation. This review begins with a short introduction of thermoregulatory model development followed by key principles for mathematical description of human thermoregulation systems. Different representations of 3D human bodies are discussed with respect to their detail and prediction capability. The human body was divided into fifteen layered cylinders in early 3D models (cylinder model). Recent 3D models have utilized medical image datasets to develop geometrically correct human models (realistic geometry model). The finite element method is mostly used to solve the governing equations and get numerical solutions. The realistic geometry models provide a high degree of anatomical realism and predict whole-body thermoregulatory responses at high resolution and at organ and tissue levels. Thus, 3D models extend to a wide range of applications where temperature distribution is critical, such as hypothermia/hyperthermia therapy and physiology research. The development of thermoregulatory models will continue with the growth in computational power, advancement in numerical methods and simulation software, advances in modern imaging techniques, and progress in the basic science of thermal physiology.

Finite element model of female thermoregulation with geometry based on medical images

INTRODUCTION

this study describes the development of a female finite element thermoregulatory model (FETM) METHOD: the female body model was developed from medical image datasets of a median U.S. female and was constructed to be anatomically correct. The body model preserves the geometric shapes of 13 organs and tissues, including skin, muscles, fat, bones, heart, lungs, brain, bladder, intestines, stomach, kidneys, liver, and eyes. Heat balance within the body is described by the bio-heat transfer equation. Heat exchange at the skin surface includes conduction, convection, radiation, and sweat evaporation. Vasodilation, vasoconstriction, sweating, and shivering are controlled by afferent and efferent signals to and from the skin and hypothalamus.

RESULTS

the model was validated with measured physiological data during exercise and rest in thermoneutral, hot, and cold conditions. Validations show the model predicted the core temperature (rectal and tympanic temperatures) and mean skin temperatures with acceptable accuracy (within 0.5 °C and 1.6 °C, respectively) CONCLUSION: this female FETM predicted high spatial resolution temperature distribution across the female body, which provides quantitative insights into human thermoregulatory responses in females to non-uniform and transient environmental exposure.

Heat stress in the Caribbean: Climatology, drivers, and trends of human biometeorology indices

Forty years (1980-2019) of reanalysis data were used to investigate climatology and trends of heat stress in the Caribbean region. Represented via the Universal Thermal Climate Index (UTCI), a multivariate thermophysiological-relevant parameter, the highest heat stress is found to be most frequent and geographically widespread during the rainy season (August, September, and October). UTCI trends indicate an increase of more than 0.2°C·decade-1, with southern Florida and the Lesser Antilles witnessing the greatest upward rates (0.45°C·decade-1). Correlations with climate variables known to induce heat stress reveal that the increase in heat stress is driven by increases in air temperature and radiation, and decreases in wind speed. Conditions of heat danger, as depicted by the heat index (HI), have intensified since 1980 (+1.2°C) and are found to occur simultaneously to conditions of heat stress suggesting a synergy between heat illnesses and physiological responses to heat. This work also includes the analysis of the record-breaking 2020 heat season during which the UTCI and HI achieved above average values, indicating that local populations most likely experienced heat stress and danger higher than the ones they are used to. These findings confirm the gradual intensification of heat stress in the Caribbean and aim to provide a guidance for heat-related policies in the region.

IOC consensus statement on recommendations and regulations for sport events in the heat

This document presents the recommendations developed by the IOC Medical and Scientific Commission and several international federations (IF) on the protection of athletes competing in the heat. It is based on a working group, meetings, field experience and a Delphi process. The first section presents recommendations for event organisers to monitor environmental conditions before and during an event; to provide sufficient ice, shading and cooling; and to work with the IF to remove regulatory and logistical limitations. The second section summarises recommendations that are directly associated with athletes' behaviours, which include the role and methods for heat acclimation; the management of hydration; and adaptation to the warm-up and clothing. The third section explains the specific medical management of exertional heat stroke (EHS) from the field of play triage to the prehospital management in a dedicated heat deck, complementing the usual medical services. The fourth section provides an example for developing an environmental heat risk analysis for sport competitions across all IFs. In summary, while EHS is one of the leading life-threatening conditions for athletes, it is preventable and treatable with the proper risk mitigation and medical response. The protection of athletes competing in the heat involves the close cooperation of the local organising committee, the national and international federations, the athletes and their entourages and the medical team.

Biomarkers for warfighter safety and performance in hot and cold environments

Exposure to extreme environmental heat or cold during military activities can impose severe thermal strain, leading to impairments in task performance and increasing the risk of exertional heat (including heat stroke) and cold injuries that can be life-threatening. Substantial individual variability in physiological tolerance to thermal stress necessitates an individualized approach to mitigate the deleterious effects of thermal stress, such as physiological monitoring of individual thermal strain. During heat exposure, measurements of deep-body (T_c) and skin temperatures and heart rate can provide some indication of thermal strain. Combining these physiological variables with biomechanical markers of gait (in)stability may provide further insight on central nervous system dysfunction - the key criterion of exertional heat stroke (EHS). Thermal strain in cold environments can be monitored with skin temperature (peripheral and proximal), shivering thermogenesis and T_c. Non-invasive methods for real-time estimation of T_c have been developed and some appear to be promising but require further validation. Decision-support tools provide useful information for planning activities and biomarkers can be used to improve their predictions, thus maximizing safety and performance during hot- and cold-weather operations. With better understanding on the etiology and pathophysiology of EHS, the microbiome and markers of the inflammatory responses have been identified as novel biomarkers of heat intolerance. This review aims to (i) discuss selected physiological and biomechanical markers of heat or cold strain, (ii) how biomarkers may be used to ensure operational readiness in hot and cold environments, and (iii) present novel molecular biomarkers (e.g., microbiome, inflammatory cytokines) for preventing EHS.

Beyond heat exposure - new methods to quantify and link personal heat exposure, stress, and strain in diverse populations and climates: The journal Temperature toolbox

Fine-scale personal heat exposure (PHE) information can help prevent or minimize weather-related deaths, illnesses, and reduced work productivity. Common methods to estimate heat risk do not simultaneously account for the intensity, frequency, and duration of thermal exposures, nor do they include inter-individual factors that modify physiological response. This study demonstrates new whole-body net thermal load estimations to link PHE to heat stress and strain over time. We apply a human-environment heat exchange model to examine how time-varying net thermal loads differ across climate contexts, personal attributes, and spatiotemporal scales. First, we investigate summertime climatic PHE impacts for three US cities: Phoenix, Miami, and New York. Second, we model body morphology and acclimatization for three profiles (middle-aged male/female; female >65 years). Finally, we quantify model sensitivity using representative data at synoptic and micro-scales. For all cases, we compare required and potential evaporative heat losses that can lead to dangerous thermal exposures based on (un)compensable heat stress. Results reveal misclassifications in heat stress or strain due to incomplete environmental data and assumed equivalent physiology and activities between people. Heat strain is most poorly represented by PHE alone for the elderly, non-acclimatized, those engaged in strenuous activities, and when negating solar radiation. Moreover, humid versus dry heat across climates elicits distinct thermal responses from the body. We outline criteria for inclusive PHE evaluations connecting heat exposure, stress, and strain while using physiological-based methods to avoid misclassifications. This work underlines the value of moving from "one-size-fits-all" thermal indices to "fit-for-purpose" approaches using personalized information.

Environmental heat stress on maternal physiology and fetal blood flow in pregnant subsistence farmers in The Gambia, west Africa: an observational cohort study

BACKGROUND

Anthropogenic climate change has caused extreme temperatures worldwide, with data showing that sub-Saharan Africa is especially vulnerable to these changes. In sub-Saharan Africa, women comprise 50% of the agricultural workforce, often working throughout pregnancy despite heat exposure increasing the risk of adverse birth outcomes. In this study, we aimed to improve understanding of the pathophysiological mechanisms responsible for the adverse health outcomes resulting from environmental heat stress in pregnant subsistence farmers. We also aimed to provide data to establish whether environmental heat stress also has physiological effects on the fetus.

METHODS

We conducted an observational cohort study in West Kiang, The Gambia, at the field station for the Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine (named the MRC Keneba field station). Pregnant women who were aged 16 years or older and who were at <36 weeks' gestation of any gravida or parity were invited to participate in the study. Participants were eligible if they were involved in agricultural or related manual daily tasks of living. Participants were ineligible if they refused to provide consent, had multiple pregnancies (eg, if they had twins), were acutely unwell, or were diagnosed with pre-eclampsia or eclampsia. Heat stress was measured by wet bulb globe temperature (WBGT) and by using the universal thermal climate index (UTCI), and maternal heat strain was directly measured by modified physiological strain index calculated from heart rate and skin temperature. Outcome measures of fetal heart rate (FHR) and fetal strain (defined as a FHR >160 beats per min [bpm] or <115 bpm, or increase in umbilical artery resistance index) were measured at rest and during the working period. Multivariable repeated measure models (linear regression for FHR, and logistic regression for fetal strain) were used to evaluate the association of heat stress and heat strain with acute fetal strain.

FINDINGS

Between Aug 26, 2019, and March 27, 2020, 92 eligible participants were recruited to the study. Extreme heat exposure was frequent, with average exposures of WBGT of 27·2°C (SD 3·6°C) and UTCI equivalent temperature of 34·0°C (SD 3·7°C). The total effect of UTCI on fetal strain resulted in an odds ratio (OR) of 1·17 (95% CI 1·09-1·29; p<0·0001), with an adjusted direct effect of OR of 1·12 (1·03-1·21; p=0·010) with each 1°C increase in UTCI. The adjusted OR of maternal heat strain on fetal strain was 1·20 (1·01-1·43; p=0·038), using the UTCI model, with each unit increase.

INTERPRETATION

Data from our study show that decreasing maternal exposure to heat stress and heat strain is likely to reduce fetal strain, with the potential to reduce adverse birth outcomes. Further work that explores the association between heat stress and pregnancy outcomes in a variety of settings and populations is urgently needed to develop effective interventions.

FUNDING

The Wellcome Trust.

Climate change and the prevention of cardiovascular disease

Climate change is a worsening global crisis that will continue negatively impacting population health and well-being unless adaptation and mitigation interventions are rapidly implemented. Climate change-related cardiovascular disease is mediated by air pollution, increased ambient temperatures, vector-borne disease and mental health disorders. Climate change-related cardiovascular disease can be modulated by climate change adaptation; however, this process could result in significant health inequity because persons and populations of lower socioeconomic status have fewer adaptation options. Clear scientific evidence for climate change and its impact on human health have not yet resulted in the national and international impetus and policies necessary to slow climate change. As respected members of society who regularly communicate scientific evidence to patients, clinicians are well-positioned to advocate on the importance of addressing climate change. This narrative review summarizes the links between climate change and cardiovascular health, proposes actionable items clinicians and other healthcare providers can execute both in their personal life and as an advocate of climate policies, and encourages communication of the health impacts of climate change when counseling patients. Our aim is to inspire the reader to invest more time in communicating the most crucial public health issue of the 21st century to their patients.

Characterizing the Thermal Demands and Mobility Performance During International Wheelchair Rugby Competition

Objective

To determine the thermoregulatory responses and mobility performance of wheelchair rugby (WCR) players during international competition.

Methods

Eleven male National Team WCR players volunteered for the study. Testing occurred during a four game series against international competition (temp 24.7 ± 0.7°C, relative humidity 50.1 ± 3.6%), with movement time (MT) and gastrointestinal temperature (T_gi) recorded continuously.

Results

The mean maximal T_gi was 38.6 ± 0.6°C (37.9-39.7) and did not significantly differ among Low-Class, Mid-Class, and High-Class athletes (p > 0.05). Moreover, there was a strong and significant relationship between minutes (min) played per quarter of the game and change in T_gi (r = 0.36, p = 0.01). Athletes moved a total of 27:43 ± 9:40 min:seconds (s), spent a total of 15:02 ± 8.23 min:s in Zone 1 (53.5%), 8:19 ± 3:20 min:s in Zone 2 (31.7%), and 5:59 ± 1:51 min:s in Zone 3 (21.3%). There were no differences among classification in total movement time (p = 0.169) or for speed in Zone 1, Zone 2, or Zone 3 (p > 0.05). The relationship between peak forward speed and total movement time was strong (p = 0.021, r = 0.68).

Conclusion

This study demonstrated that the time spent in absolute movement zones is not classification dependent, the change in core temperature is related to movement time per quarter. Furthermore, peak speeds obtained on-court were linked to overall movement time which suggests athletes should warm-up before going on court.

Exertional heat stroke in sport and the military: epidemiology and mitigation

NEW FINDINGS

What is the topic of this review? Exertional heat stroke epidemiology in sport and military settings, along with common risk factors and strategies and policies designed to mitigate its occurrence. What advances does it highlight? Individual susceptibility to exertional heat stroke risk is dependent on the interaction of intrinsic and extrinsic factors. Heat policies in sport should assess environmental conditions, as well as the characteristics of the athlete, clothing/equipment worn and activity level of the sport. Exertional heat stroke risk reduction in the military should account for factors specific to training and personnel.

ABSTRACT

Exertional heat illness occurs along a continuum, developing from the relatively mild condition of muscle cramps, to heat exhaustion, and in some cases to the life-threatening condition of heat stroke. The development of exertional heat stroke (EHS) is associated with an increase in core temperature stemming from inadequate heat dissipation to offset the rate of metabolically generated heat. Susceptibility to EHS is linked to the interaction of several factors including environmental conditions, individual characteristics, health conditions, medication and drug use, behavioural responses, and sport/organisational requirements. Two settings in which EHS is commonly observed are competitive sport and the military. In sport, the exact prevalence of EHS is unclear due to inconsistent exertional heat illness terminology, diagnostic criteria and data reporting. In contrast, exertional heat illness surveillance in the military is facilitated by standardised case definitions, a requirement to report all heat illness cases and a centralised medical record repository. To mitigate EHS risk, several strategies can be implemented by athletes and military personnel, including heat acclimation, ensuring adequate hydration, cold-water immersion and mandated work-to-rest ratios. Organisations may also consider developing sport or military task-specific heat stress policies that account for the evaporative heat loss requirement of participants, relative to the evaporative capacity of the environment. This review examines the epidemiology of EHS along with the strategies and policies designed to reduce its occurrence in sport and military settings. We highlight the nuances of identifying individuals at risk of EHS and summarise the benefits and shortcomings of various mitigation strategies.

A mathematical model for predicting cardiovascular responses at rest and during exercise in demanding environmental conditions

The present research describes the development and validation of a cardiovascular model (CVR Model) for use in conjunction with advanced thermophysiological models, where usually only a total cardiac output is estimated. The CVR Model detailed herein estimates cardio-dynamic parameters (changes in cardiac output, stroke volume, and heart rate), regional blood flow, and muscle oxygen extraction, in response to rest and physical workloads, across a range of ages and aerobic fitness levels, as well as during exposure to heat, dehydration, and altitude. The model development strategy was to first establish basic resting and exercise predictions for cardio-dynamic parameters in an "ideal" environment (cool, sea level, and hydrated person). This basic model was then advanced for increasing levels of altitude, heat strain, and dehydration, using meta-analysis and reaggregation of published data. Using the estimated altitude- and heat-induced changes in maximum oxygen extraction and maximum cardiac output, the decline in maximum oxygen consumption at high altitude and in the heat was also modeled. A validation of predicted cardiovascular strain using heart rate was conducted using a dataset of 101 heterogeneous individuals (1,371 data points) during rest and exercise in the heat and at altitude, demonstrating that the CVR Model performs well (R² = 0.82-0.84) in predicting cardiovascular strain, particularly at a group mean level (R² = 0.97). The development of the CVR Model is aimed at providing the Fiala thermal Physiology & Comfort (FPC) Model and other complex thermophysiological models with improved estimations of cardiac strain and exercise tolerance, across a range of individuals during acute exposure to environmental stressors.NEW & NOTEWORTHY The present research promotes the adaption of thermophysiological modeling to the estimation of cardiovascular strain in individuals exercising under acute environmental stress. Integration with advanced models of human thermoregulation opens doors for detailed numerical analysis of athletes' performance and physiology during exercise, occupational safety, and individual work tolerability. The research provides a simple-to-validate metric of cardiovascular function (heart rate), as well as a method to evaluate key principles influencing exercise- and thermoregulation in humans.

Indicators to assess physiological heat strain - Part 1: Systematic review

In a series of three companion papers published in this Journal, we identify and validate the available thermal stress indicators (TSIs). In this first paper of the series, we conducted a systematic review (registration: INPLASY202090088) to identify all TSIs and provide reliable information regarding their use (funded by EU Horizon 2020; HEAT-SHIELD). Eight databases (PubMed, Agricultural and Environmental Science Collection, Web of Science, Scopus, Embase, Russian Science Citation Index, MEDLINE, and Google Scholar) were searched from database inception to 15 April 2020. No restrictions on language or study design were applied. Of the 879 publications identified, 232 records were considered for further analysis. This search identified 340 instruments and indicators developed between 200 BC and 2019 AD. Of these, 153 are nomograms, instruments, and/or require detailed non-meteorological information, while 187 can be mathematically calculated utilizing only meteorological data. Of these meteorology-based TSIs, 127 were developed for people who are physically active, and 61 of those are eligible for use in occupational settings. Information regarding the equation, operating range, interpretation categories, required input data, as well as a free software to calculate all 187 meteorology-based TSIs is provided. The information presented in this systematic review should be adopted by those interested in performing on-site monitoring and/or big data analytics for climate services to ensure appropriate use of the meteorology-based TSIs. Studies two and three in this series of companion papers present guidance on the application and validation of these TSIs, to guide end users of these indicators for more effective use.

Effect of meteorological conditions on leisure walking: a time series analysis and the application of outdoor thermal comfort indexes

Leisure walking is affected by meteorological conditions. However, it is still not clear what scales of meteorological conditions and thermal status affect the number of people who choose to leisure walk. Using a time series regression, this study examines the heat-leisure walking relationship by analyzing the effect of the seasons, weather, microclimate, and outdoor thermal comfort on walking count. Eight thermal indexes were selected to estimate the pedestrians' thermal comfort, and their predictive capacities in walking count were evaluated. Particular consideration was given to identifying heat thresholds of walking that determined the tolerance range of pedestrian heat stress. Four years of hourly daytime walking counts and publicly available ASOS meteorological data at Seoul-lo 7017, a pedestrian bridge in Seoul, were used for the analysis. Our findings indicate that walking count is correlated with seasonal climatic variations, with the highest number of pedestrians observed in fall and the lowest in summer. Moreover, air temperature played a vital role, showing that a 5.0 °C rise in temperature was associated with a 1.34% rise in the square root of the walking count. Its impact becomes greater when combined with intense solar radiation and higher absolute humidity. The heat threshold for walking was between 23.8 °C and 26.2 °C. Empirical model indexes showed the highest predictive capacity in walking count at approximately 30.0%, which was followed by rational model indexes at 28.0%.

The use of sun-shade on safe heat exposure limit on a sunny summer day: a modelling study in Japan

Sustainable methods are required to reduce the risks of thermal strain and heat-related illness without exacerbating greenhouse gas emissions. We investigated the effects of sun-shade use on safe heat exposure limit on a sunny summer day using historical climate data in Japan. We simulated a heat-acclimatised person standing at rest (metabolic heat production, 70 W·m^-2) and during light work (100 W·m^-2) on an asphalt pavement in the sun and sun-shade. Japan has three Köppen climate regions: tropical, temperate and cold. We analysed one city in the tropical region (24°N), three cities in the temperate region (31°N, 35°N and 39°N) and one city in the cold region (40°N). Hourly data were collected from 7 AM to 6 PM, June to September, from 2010 to 2019. The day with the longest daylight hours and the greatest solar radiation intensity was used for analysis. With sun-shade (a white polyester tarpaulin/awning), ambient temperature, global solar radiation and ground surface temperature were assumed to be 0.5°C, 45% and 6°C lower than in the sun, respectively. Sun-shade use eliminated the days with at least 1 hour exceeding safe heat exposure limit at rest in all cities. The same was observed for light work in the temperate and cold cities, although the tropical city had 2 days exceeding safe heat exposure limit during the decade. Sun-shade use on a sunny summer day can be an effective and sustainable method to reduce heat exposure hazard at rest and during light work in tropical, temperate and cold climate regions.

Quantifying the impact of heat on human physical work capacity; part II: the observed interaction of air velocity with temperature, humidity, sweat rate, and clothing is not captured by most heat stress indices

Increasing air movement can alleviate or exacerbate occupational heat strain, but the impact is not well defined across a wide range of hot environments, with different clothing levels. Therefore, we combined a large empirical study with a physical model of human heat transfer to determine the climates where increased air movement (with electric fans) provides effective body cooling. The model allowed us to generate practical advice using a high-resolution matrix of temperature and humidity. The empirical study involved a total of 300 1-h work trials in a variety of environments (35, 40, 45, and 50 °C, with 20 up to 80% relative humidity) with and without simulated wind (3.5 vs 0.2 m∙s^-1), and wearing either minimal clothing or a full body work coverall. Our data provides compelling evidence that the impact of fans is strongly determined by air temperature and humidity. When air temperature is ≥ 35 °C, fans are ineffective and potentially harmful when relative humidity is below 50%. Our simulated data also show the climates where high wind/fans are beneficial or harmful, considering heat acclimation, age, and wind speed. Using unified weather indices, the impact of air movement is well captured by the universal thermal climate index, but not by wet-bulb globe temperature and aspirated wet-bulb temperature. Overall, the data from this study can inform new guidance for major public and occupational health agencies, potentially maintaining health and productivity in a warming climate.

Analyzing occupational heat stress using sensor-based monitoring: a wearable approach with environmental ergonomics perspective

Occupational heat stress could impose a greater risk of heat-related morbidities among the exposed users, declining their work productivity and contributing to a financial burden. This necessitate the implementation of adequate preventive measures and control policies to improve the users' well-being and productive capacity. The emergence of modernistic sensors gives rise to workplace heat stress monitoring at a substantially lower cost than expensive conventional equipment. Present work unveils the productive role of sensor-based safety helmet, which could monitor the environmental variables, heat stress indices, and users' physiological variables as an indicator of heat strain. The proposed safety helmet was tested under three different work environments with users' engaged in specific work activities. Notable variations were perceived among the measured data under respective work conditions and physical activity performed. Higher heat risk exposures were attributable to the outdoor condition compared to indoor work conditions. For wet bulb globe temperature index, strong association (p-value < 0.01) was observed with fighter index of thermal stress (R ²-value = 0.959) followed by discomfort index (R ²-value = 0.899) and heat index (R ²-value = 0.867). Results revealed a rise in measured physiological parameters under the heavy workload activity (shoveling task; outdoor location) followed by hacksaw cutting task (indoor location), while least values were associated with light workload activity (drilling task; indoor location). The proposed design intervention could be considered an effective site-specific solution for monitoring heat stress exposures and keeping exposed users well aware of the prevalent thermal work conditions at the individual level.

Quantifying the impact of heat on human physical work capacity; part III: the impact of solar radiation varies with air temperature, humidity, and clothing coverage

Heat stress decreases human physical work capacity (PWC), but the extent to which solar radiation (SOLAR) compounds this response is not well understood. This study empirically quantified how SOLAR impacts PWC in the heat, considering wide, but controlled, variations in air temperature, humidity, and clothing coverage. We also provide correction equations so PWC can be quantified outdoors using heat stress indices that do not ordinarily account for SOLAR (including the Heat Stress Index, Humidex, and Wet-Bulb Temperature). Fourteen young adult males (7 donning a work coverall, 7 with shorts and trainers) walked for 1 h at a fixed heart rate of 130 beats∙min^-1, in seven combinations of air temperature (25 to 45°C) and relative humidity (20 or 80%), with and without SOLAR (800 W/m² from solar lamps). Cumulative energy expenditure in the heat, relative to the work achieved in a cool reference condition, was used to determine PWC%. Skin temperature was the primary determinant of PWC in the heat. In dry climates with exposed skin (0.3 Clo), SOLAR caused PWC to decrease exponentially with rising air temperature, whereas work coveralls (0.9 Clo) negated this effect. In humid conditions, the SOLAR-induced reduction in PWC was consistent and linear across all levels of air temperature and clothing conditions. Wet-Bulb Globe Temperature and the Universal Thermal Climate Index represented SOLAR correctly and did not require a correction factor. For the Heat Stress Index, Humidex, and Wet-Bulb Temperature, correction factors are provided enabling forecasting of heat effects on work productivity.

ClimApp-Integrating Personal Factors with Weather Forecasts for Individualised Warning and Guidance on Thermal Stress

This paper describes the functional development of the ClimApp tool (available for free on iOS and Android devices), which combines current and 24 h weather forecasting with individual information to offer personalised guidance related to thermal exposure. Heat and cold stress assessments are based on ISO standards and thermal models where environmental settings and personal factors are integrated into the ClimApp index ranging from -4 (extremely cold) to +4 (extremely hot), while a range of -1 and +1 signifies low thermal stress. Advice for individuals or for groups is available, and the user can customise the model input according to their personal situation, including activity level, clothing, body characteristics, heat acclimatisation, indoor or outdoor situation, and geographical location. ClimApp output consists of a weather summary, a brief assessment of the thermal situation, and a thermal stress warning. Advice is provided via infographics and text depending on the user profile. ClimApp is available in 10 languages: English, Danish, Dutch, Swedish, Norwegian, Hellenic (Greek), Italian, German, Spanish and French. The tool also includes a research functionality providing a platform for worker and citizen science projects to collect individual data on physical thermal strain and the experienced thermal strain. The application may therefore improve the translation of heat and cold risk assessments and guidance for subpopulations. ClimApp provides the framework for personalising and downscaling weather reports, alerts and advice at the personal level, based on GPS location and adjustable input of individual factors.

Automated Monitoring of Cattle Heat Stress and Its Mitigation

Climate change related global warming is likely to continue, despite all mitigation measures taken by humans, due to the lag effect of long-term anthropogenic activities. Warming of the atmosphere can impact worldwide cattle production directly by compromising health, welfare and productivity, and indirectly by reducing the quality and quantity of animal feed. Under warm thermal conditions, cattle adjust their physiological and behavioural responses as an integral part of thermoregulation to maintain internal body temperature within a safe range. However, a greater intensity and duration of heat exposure can exceed thermoregulatory capacity leading to an increase in internal body temperature beyond the normal limit that ultimately evokes different animal responses to heat. In cattle, response to heat stress can be visually observed as elevated respiration rate or panting, but continuous visual monitoring is labour intensive, time consuming and subjective. Therefore, different weather-based indices have been developed such as the temperature humidity index (THI) and heat load index (HLI) which are commonly used weather-based indices for monitoring cattle heat stress at commercial level. However, the thermal comfort level of cattle based on weather-based indices has limited use at a microclimatic and individual animal level. Varying sensor-based approaches have shown promise to shift the focus of heat stress management to the individual level. Monitoring individual animal response and mitigation strategies for isolated heat-susceptible cattle could save on heat management costs whilst improving animal welfare and productivity. Here we review the technologies that enable automatic, continuous, and real-time cattle heat stress monitoring and mitigation under commercial conditions. Future platforms for autonomous monitoring and mitigation of heat stress in cattle are likely to be based on minimally-invasive smart technologies either singly, or in an integrated system, enabling real-time solutions to animal responses under various production systems and environmental conditions.

A geometrically accurate 3 dimensional model of human thermoregulation for transient cold and hot environments

This paper outlines the development of a finite element human thermoregulatory model using an anatomically and geometrically correct human body model. The finite element body model was constructed from digital Phantoms and is anatomically realistic, including 13 organs and tissues: skin, muscles, fat, bones, heart, lungs, brain, bladder, intestines, stomach, kidneys, liver, and eyes. The model simulates thermal responses through a passive and active system. The passive system describes heat balance within the body and between the skin surface and environment. The active system describes thermoregulatory mechanisms, i.e., vasodilation, vasoconstriction, sweating, and shivering heat production. This model predicts temperature distribution across the body at high spatial resolution, and provides insight into human thermoregulatory responses to non-uniform and transient environments. Predicted temperatures (i.e., core, skin, muscle and fat) at 29 sites were compared with measured values in comfort, hot, and cold conditions. The comprehensive validation shows predictions are accurate and acceptable.

Performance and thermoregulation of Dutch Olympic and Paralympic athletes exercising in the heat: Rationale and design of the Thermo Tokyo study: The journal Temperature toolbox

The environmental conditions during the Tokyo Olympic and Paralympic Games are expected to be challenging, which increases the risk for participating athletes to develop heat-related illnesses and experience performance loss. To allow safe and optimal exercise performance of Dutch elite athletes, the Thermo Tokyo study aimed to determine thermoregulatory responses and performance loss among elite athletes during exercise in the heat, and to identify personal, sports-related, and environmental factors that contribute to the magnitude of these outcomes. For this purpose, Dutch Olympic and Paralympic athletes performed two personalized incremental exercise tests in simulated control (15°C, relative humidity (RH) 50%) and Tokyo (32°C, RH 75%) conditions, during which exercise performance and (thermo)physiological parameters were obtained. Thereafter, athletes were invited for an additional visit to conduct anthropometric, dual-energy X-ray absorptiometry (DXA), and 3D scan measurements. Collected data also served as input for a thermophysiological computer simulation model to estimate the impact of a wider range of environmental conditions on thermoregulatory responses. Findings of this study can be used to inform elite athletes and their coaches on how heat impacts their individual (thermo)physiological responses and, based on these data, advise which personalized countermeasures (i.e. heat acclimation, cooling interventions, rehydration plan) can be taken to allow safe and maximal performance in the challenging environmental conditions of the Tokyo 2020 Olympic and Paralympic Games.

Homeostatic model of human thermoregulation with bi-stability

All homoiothermic organisms are capable of maintaining a stable body temperature using various negative feedback mechanisms. However, current models cannot satisfactorily describe the thermal adaptation of homoiothermic living systems in a physiologically meaningful way. Previously, we introduced stress entropic load, a novel variable designed to quantify adaptation costs, i.e. the stress of the organism, using a thermodynamic approach. In this study, we use stress entropic load as a starting point for the construction of a novel dynamical model of human thermoregulation. This model exhibits bi-stable mechanisms, a physiologically plausible features which has thus far not been demonstrated using a mathematical model. This finding allows us to predict critical points at which a living system, in this case a human body, may proceed towards two stabilities, only one of which is compatible with being alive. In the future, this may allow us to quantify not only the direction but rather the extent of therapeutic intervention in critical care patients.

Effects of climate change on combined labour productivity and supply: an empirical, multi-model study

BACKGROUND

Although effects on labour is one of the most tangible and attributable climate impact, our quantification of these effects is insufficient and based on weak methodologies. Partly, this gap is due to the inability to resolve different impact channels, such as changes in time allocation (labour supply) and slowdown of work (labour productivity). Explicitly resolving those in a multi-model inter-comparison framework can help to improve estimates of the effects of climate change on labour effectiveness.

METHODS

In this empirical, multi-model study, we used a large collection of micro-survey data aggregated to subnational regions across the world to estimate new, robust global and regional temperature and wet-bulb globe temperature exposure-response functions (ERFs) for labour supply. We then assessed the uncertainty in existing labour productivity response functions and derived an augmented mean function. Finally, we combined these two dimensions of labour into a single compound metric (effective labour effects). This combined measure allowed us to estimate the effect of future climate change on both the number of hours worked and on the productivity of workers during their working hours under 1·5°C, 2·0°C, and 3·0°C of global warming. We separately analysed low-exposure (indoors or outdoors in the shade) and high-exposure (outdoor in the sun) sectors.

FINDINGS

We found differentiated empirical regional and sectoral ERF's for labour supply. Current climate conditions already negatively affect labour effectiveness, particularly in tropical countries. Future climate change will reduce global total labour in the low-exposure sectors by 18 percentage points (range -48·8 to 5·3) under a scenario of 3·0°C warming (24·8 percentage points in the high-exposure sectors). The reductions will be 25·9 percentage points (-48·8 to 2·7) in Africa, 18·6 percentage points (-33·6 to 5·3) in Asia, and 10·4 percentage points (-35·0 to 2·6) in the Americas in the low-exposure sectors. These regional effects are projected to be substantially higher for labour outdoors in full sunlight compared with indoors (or outdoors in the shade) with the average reductions in total labour projected to be 32·8 percentage points (-66·3 to 1·6) in Africa, 25·0 percentage points (-66·3 to 7·0) in Asia, and 16·7 percentage points (-45·5 to 4·4) in the Americas.

INTERPRETATION

Both labour supply and productivity are projected to decrease under future climate change in most parts of the world, and particularly in tropical regions. Parts of sub-Saharan Africa, south Asia, and southeast Asia are at highest risk under future warming scenarios. The heterogeneous regional response functions suggest that it is necessary to move away from one-size-fits-all response functions to investigate the climate effect on labour. Our findings imply income and distributional consequences in terms of increased inequality and poverty, especially in low-income countries, where the labour effects are projected to be high.

FUNDING

COST (European Cooperation in Science and Technology).

An advanced empirical model for quantifying the impact of heat and climate change on human physical work capacity

Occupational heat stress directly hampers physical work capacity (PWC), with large economic consequences for industries and regions vulnerable to global warming. Accurately quantifying PWC is essential for forecasting impacts of different climate change scenarios, but the current state of knowledge is limited, leading to potential underestimations in mild heat, and overestimations in extreme heat. We therefore developed advanced empirical equations for PWC based on 338 work sessions in climatic chambers (low air movement, no solar radiation) spanning mild to extreme heat stress. Equations for PWC are available based on air temperature and humidity, for a suite of heat stress assessment metrics, and mean skin temperature. Our models are highly sensitive to mild heat and to our knowledge are the first to include empirical data across the full range of warm and hot environments possible with future climate change across the world. Using wet bulb globe temperature (WBGT) as an example, we noted 10% reductions in PWC at mild heat stress (WBGT = 18°C) and reductions of 78% in the most extreme conditions (WBGT = 40°C). Of the different heat stress indices available, the heat index was the best predictor of group level PWC (R2 = 0.96) but can only be applied in shaded conditions. The skin temperature, but not internal/core temperature, was a strong predictor of PWC (R2 = 0.88), thermal sensation (R2 = 0.84), and thermal comfort (R2 = 0.73). The models presented apply to occupational workloads and can be used in climate projection models to predict economic and social consequences of climate change.

The upper temperature thresholds of life

Temperature affects many life processes, but its effect might be expected to differ among eukaryotic organisms inhabiting similar environments. We reviewed literature on temperature thresholds of humans, livestock, poultry, agricultural crops, and sparse examples of fisheries. We found that preferable and harmful temperatures are similar for humans, cattle, pigs, poultry, fish, and agricultural crops. Preferable temperatures range from 17°C to 24°C. Stress temperature thresholds are lower when humidity is higher. However, extended exposure to temperatures above 25°C with high humidity can cause heat stress in many organisms. Short exposures to temperatures above 35°C with high humidity, or above 40°C with low humidity, can be lethal. Increases in exposure, frequency, and duration of stressful and lethal temperatures increase the physiological stress and bodily damage suffered by humans, livestock, poultry, fish, and agricultural crops.

Mean Radiant Temperature Measurements through Small Black Globes under Forced Convection Conditions

One of the most critical variables in the field of thermal comfort measurements is the mean radiant temperature which is typically measured with a standard 150 mm black globe thermometer. This is also the reference instrument required for the assessment of heat stress conditions by means of the well-known Wet Bulb Globe Temperature index (WBGT). However, one of the limitations of this method is represented by the relatively long response time. This is why in recent years there has been a more and more pressing need of smart sensors for controlling Heating Ventilation and Air Conditioning (HVAC) systems, and for pocket heat stress meters (e.g., WBGT meters provided with table tennis balls). Although it is widely agreed that there is a clear advantage of small probes in terms of response times, their accuracy is a still a debated matter and no systematic studies aimed at metrologically characterizing their performances are actually available, due to the difficulty of reproducing measuring conditions such as a black enclosure at uniform temperature. In this paper the results of a metrological analysis of two small globes (38 and 50 mm diameter) carried out by means of an experimental apparatus specifically designed to reproduce a black uniform enclosure are presented and discussed. Experimental results revealed a systematic underestimation of the mean radiant temperature predicted by small globes of more than 10 °C in forced convection and at high radiative loads.

Adapting to Changing Labor Productivity as a Result of Intensified Heat Stress in a Changing Climate

The intensification of heat stress reduces the labor capacity and hence poses a threat to socio-economic development. The reliable projection of the changing climate and the development of sound adaptation strategies are thus desired for adapting to the decreasing labor productivity under climate change. In this study, an optimization modeling approach coupled with dynamical downscaling is proposed to design the optimal adaptation strategies for improving labor productivity under heat stress in China. The future changes in heat stress represented by the wet-bulb globe temperature (WBGT) are projected with a spatial resolution of 25 × 25 km by a regional climate model (RCM) through the dynamical downscaling of its driving global climate model (GCM). Uncertain information such as system costs, environmental costs, and subsidies are also incorporated into the optimization process to provide reliable decision alternatives for improving labor productivity. Results indicate that the intensification of WBGT is overestimated by the GCM compared to the RCM. Such an overestimation can lead to more losses in working hours derived from the GCM than those from the RCM regardless of climate scenarios. Nevertheless, the overestimated heat stress does not alter the regional measures taken to adapt to decreasing labor productivity. Compared to inland regions, the monsoon-affected regions tend to improve labor productivity by applying air conditioning rather than working overtime due to the cost differences. Consequently, decision-makers need to optimally make a balance between working overtime and air conditioning measures to meet sustainable development goals.

The physiological strain index does not reliably identify individuals at risk of reaching a thermal tolerance limit

PURPOSE

The physiological strain index (PSI) was developed to assess individuals' heat strain, yet evidence supporting its use to identify individuals at potential risk of reaching a thermal tolerance limit (TTL) is limited. The aim of this study was to assess whether PSI can identify individuals at risk of reaching a TTL.

METHODS

Fifteen females and 21 males undertook a total of 136 trials, each consisting of two 40-60 minute periods of treadmill walking separated by ~ 15 minutes rest, wearing permeable or impermeable clothing, in a range of climatic conditions. Heart rate (HR), skin temperature (T_sk), rectal temperature (T_re), temperature sensation (TS) and thermal comfort (TC) were measured throughout. Various forms of the PSI-index were assessed including the original PSI, PSI_fixed, adaptive-PSI (aPSI) and a version comprised of a measure of heat storage (PSI_HS). Final physiological and PSI values and their rate of change (ROC) over a trial and in the last 10 minutes of a trial were compared between trials completed (C, 101 trials) and those terminated prematurely (TTL, 35 trials).

RESULTS

Final PSI_original, PSI_fixed, aPSI, PSI_HS did not differ between TTL and C (p > 0.05). However, differences between TTL and C occurred in final T_sk, T_re-T_sk, TS, TC and ROC in PSI_fixed, T_re, T_sk and HR (p < 0.05).

CONCLUSION

These results suggest the PSI, in the various forms, does not reliably identify individuals at imminent risk of reaching their TTL and its validity as a physiological safety index is therefore questionable. However, a physiological-perceptual strain index may provide a more valid measure.

A Mixed-Method Approach of Pre-Cooling Enhances High-Intensity Running Performance in the Heat

We investigated whether single or combined methods of pre-cooling could affect high-intensity exercise performance in a hot environment. Seven male athletes were subjected to four experimental conditions for 30 min in a randomised order. The four experimental conditions were: 1) wearing a vest cooled to a temperature of 4 ℃ (Vest), 2) consuming a beverage cooled to a temperature of 4 ℃ (Beverage), 3) simultaneous usage of vest and consumption of beverage (Mix), and 4) the control trial without pre-cooling (CON). Following those experimental conditions, they exercised at a speed of 80% VO₂max until exhaustion in the heat (38.1 ± 0.6 ℃, 55.3 ± 0.3% RH). Heart rate (HR), rectal temperature (T_core), skin temperature (T_skin), sweat loss (SL), urine specific gravity (USG), levels of sodium (Na⁺) and potassium (K⁺), rating of perceived exertion (RPE), thermal sensation (TS), and levels of blood lactic acid ([Bla]) were monitored. Performance was improved using the mixed pre-cooling strategy (648.43 ± 77.53 s, p = 0.016) compared to CON (509.14 ± 54.57 s). T_core after pre-cooling was not different (Mix: 37.01 ± 0.27 ℃, Vest: 37.19 ± 0.33 ℃, Beverage: 37.03 ± 0.35 ℃) in all cooling conditions compared to those of CON (37.31 ±0.29 ℃). A similar T_core values was achieved at exhaustion in all trials (from 38.10 ℃ to 39.00 ℃). No difference in the level of USG was observed between the conditions. Our findings suggest that pre-cooling with a combination of cold vest usage and cold fluid intake can improve performance in the heat.

Validation of ISO 9920 clothing item insulation summation method based on an ambulance personnel clothing system

This study aimed to validate the summation methods suggested by ISO 9920. Twenty seven items from an ambulance personnel clothing system were selected for testing. The basic insulation of each garment item (I_clu) was calculated based on the thermal manikin tests. More than 100 realistic clothing combinations were compiled and basic insulation (I_cl) of these ensembles was calculated according to ISO 9920. These were ranked after the calculated insulation, and 14 sets covering insulation from 0.63 to 3.33 clo were measured on the thermal manikin for acquiring the basic clothing insulation (I_cl). Regression analysis was used to compare the summed and measured I_cl values. The difference between values varied from -18 to 12%. The highest percentual difference was for the lightest clothing sets, while the absolute differences were similar over the whole insulation range ranging between -0.17 to 0.18 clo with an average difference of 0.02 clo (-0.16%). All basic insulation values stayed very close to the line of identity (R²=0.98). The summation equation gave, in the case of this ambulance clothing system, very close results to the measured values. This encourages evaluating and selecting protective clothing combinations for thermal comfort based on individual item measurements.

A Field Evaluation of Construction Workers' Activity, Hydration Status, and Heat Strain in the Extreme Summer Heat of Saudi Arabia

OBJECTIVES

Assess the impact of summer heat exposure (June-September) on residential construction workers in Al-Ahsa, Saudi Arabia by evaluating (i) heart rate (HR) responses, hydration status, and physical workload among workers in indoor and outdoor construction settings, (ii) factors related to physiological responses to work in hot conditions, and (iii) how well wet-bulb globe temperature-based occupational exposure limits (WBGTOELs) predict measures of heat strain.

METHODS

Twenty-three construction workers (plasterers, tilers, and laborers) contributed 260 person-days of monitoring. Workload energy expenditure, HR, fluid intake, and pre- and postshift urine specific gravity (USG) were measured. Indoor and outdoor heat exposures (WBGT) were measured continuously and a WBGTOEL was calculated. The effects of heat exposure and workload on heart rate reserve (HRR), a measure of cardiovascular strain, were examined with linear mixed models. A metric called 'heat stress exceedance' (HSE) was constructed to summarize whether the environmental heat exposure (WBGT) exceeded the heat stress exposure limit (WBGTOEL). The sensitivity and specificity of the HSE as a predictor of cardiovascular strain (HRR ≥30%) were determined.

RESULTS

The WBGTOEL was exceeded frequently, on 63 person-days indoors (44%) and 91(78%) outdoors. High-risk HRR occurred on 26 and 36 person-days indoors and outdoors, respectively. The HSE metric showed higher sensitivity for HRR ≥30% outdoors (89%) than indoors (58%) and greater specificity indoors (59%) than outdoors (27%). Workload intensity was generally moderate, with light intensity work more common outdoors. The ability to self-pace work was associated with a lower frequency of HRR ≥30%. USG concentrations indicated that workers began and ended their shifts dehydrated (USG ≥1.020).

CONCLUSIONS

Construction work where WBGTOEL is commonly exceeded poses health risks. The ability of workers to self-pace may help reduce risks.