Wet-bulb globe temperature (WBGT)--its history and its limitations

Uniformly elevated future heat stress in China driven by spatially heterogeneous water vapor changes

The wet bulb temperature (Tw) has gained considerable attention as a crucial indicator of heat-related health risks. Here we report south-to-north spatially heterogeneous trends of Tw in China over 1979-2018. We find that actual water vapor pressure (Ea) changes play a dominant role in determining the different trend of Tw in southern and northern China, which is attributed to the faster warming of high-latitude regions of East Asia as a response to climate change. This warming effect regulates large-scale atmospheric features and leads to extended impacts of the South Asia high (SAH) and the western Pacific subtropical high (WPSH) over southern China and to suppressed moisture transport. Attribution analysis using climate model simulations confirms these findings. We further find that the entire eastern China, that accommodates 94% of the country's population, is likely to experience widespread and uniform elevated thermal stress the end of this century. Our findings highlight the necessity for development of adaptation measures in eastern China to avoid adverse impacts of heat stress, suggesting similar implications for other regions as well.

Observed Warming Trends at U.S. Army Basic Combat Training Installations and Implications for Future Recruit Training

INTRODUCTION

Army recruits conducting BCT are among the most susceptible population of military personnel to experience exertional heat illness, a concern expected to become increasingly urgent due to steadily rising temperatures. In this study, we provide an empirical analysis of wet bulb globe temperature (WBGT) index trends at U.S. Army BCT installations and quantify the magnitude of these trends. Assuming these warming trends continue, the anticipated effects of increasing temperature trends are discussed in relation to potential impacts on recruit heat illness incidence and training disruption.

MATERIALS AND METHODS

We obtained weather data beginning in the early 1960s, including WBGT index measurements derived by the U.S. Air Force 14th Weather Squadron. We apply these datasets to two classifications for high WBGT index days, including one classification accounting for heat illness susceptibility based on prior day heat exposure, to determine when recruits are most at risk of heat illness. The daily likelihood of extreme WBGT index values is described at each installation using a 30-year climatological average. Trends in the WBGT index are evaluated quantitatively during the warm season (May 1-September 30) and full year and compared between decades and by individual BCT classes.

RESULTS

Trends in the WBGT index have increased at all four BCT installations. Between January 1960 and October 2022, the mean WBGT index value increased most quickly at Ft Jackson, SC (0.272°C decade-1, CI: 0.255-0.289) and least at Ft Moore, GA (0.190°C decade-1, CI: 0.170-0.210). Ft Moore experiences the greatest heat burden, with the daily likelihood of experiencing a "black flag" event (≥90°F WBGT index) peaking at nearly 50% in late July, while Ft Leonard Wood, MO, experiences the least heat burden. This heat burden is spread unevenly across installations and dependent on BCT class start date. Recruits beginning in mid-June will experience approximately 200 hours of hazardous heat during BCT at Ft Moore, GA; 100 hours at Ft Jackson, SC; 80 hours at Ft Sill, OK; and 61 hours at Ft Leonard Wood, MO.

CONCLUSIONS

Temperatures measured on the WBGT index have steadily increased at US Army basic training installations since at least 1960. In the future, adaptation to the BCT program will be required to maintain rigorous standards without incurring unacceptable risk of recruit heat illness. The analysis provided by this study can help inform medical, training, and policy implementations needed to ensure continued BCT in a warming world.

The influence of occupational heat stress on serum inflammatory cytokines among traditional bakery workers in Iran

Heat exposure exceeding the ISO7243:1989 standard limit can contribute to health problems among employees in a variety of workplaces. Ignoring heat standard requirements in hot working conditions such as bakeries results in physiologic and health problems, as well as an elevated risk of later illnesses. In this analytical case-control study, the serum levels of four inflammatory factors (interleukin-1 beta, interleukin-6, tumor necrosis factor-α, and C-reactive protein) were assessed using an enzyme-linked immunosorbent assay. 105 male artisan bakers (in four job classifications in bakeries and staff) were compared based on demographic characteristics and inflammatory factors. The findings of the study showed correlations between serum interleukin-1β, interleukin-6, and C-reactive protein levels and thermal exposure in the occupational environment and employment type. Moreover, some differences in serum level of interleukin-1β and job type were observed. Heat overexposure affected the increase of interleukin-1β and C-reactive protein secretion. As a result of years of working in high-temperature conditions, inflammation can lead to subsequent diseases in workers. To protect their health from this occupational hazard, additional safeguards are needed. Our recommendations could also be applied to overly hot work environments that may cause heat stress in workers.

Changes in wet bulb globe temperature and risk to heat-related hazards in Bangladesh

The rise in temperatures and changes in other meteorological variables have exposed millions of people to health risks in Bangladesh, a densely populated, hot, and humid country. To better assess the threats climate change poses to human health, the wet bulb globe temperature (WBGT) is an important indicator of human heat stress. This study utilized high-resolution reanalysis data from the fifth-generation European Centre for Medium-Range Weather Forecasts (ECMWF ERA5) to analyze the spatiotemporal changes in outdoor WBGT across Bangladesh from 1979 to 2021, employing Liljegren's model. The study revealed an increase in the annual average WBGT by 0.08-0.5 °C per decade throughout the country, with a more pronounced rise in the southeast and northeast regions. Additionally, the number of days with WBGT levels associated with high and extreme risks of heat-related illnesses has shown an upward trend. Specifically, during the monsoon period (June to September), there has been an increase of 2-4 days per decade, and during the pre-monsoon period (March to May), an increase of 1-3 days per decade from 1979 to 2021. Furthermore, the results indicated that the escalation in WBGT has led to a five-fold increase in affected areas and a three-fold increase in days of high and extreme heat stress during the monsoon season in recent years compared to the earlier period. Trend and relative importance analyses of various meteorological variables demonstrated that air temperature is the primary driver behind Bangladesh's rising WBGT and related health risks, followed by specific humidity, wind speed, and solar radiation.

Climate change and heat stress

Climate change is increasing the incidences of extreme weather. Record high temperatures are being experienced more frequently and for extended periods. Subsequently, there is an increased risk of occupational exposures resulting in heat-related illnesses, both acute and chronic. The editorial reviews the processes and tools that are available to assess heat exposure and develop effective controls to help address current and future exposures.

Post-exercise management of exertional hyperthermia in dogs participating in dog sport (canicross) events in the UK

Exercise is a common trigger of heat-related illness (HRI) events in dogs, accounting for 74% of canine HRI cases treated under primary veterinary care in the United Kingdom. However, few empirical studies have evaluated the effectiveness of differing cooling methods for dogs with exertional hyperthermia or HRI. This study aimed to prospectively evaluate effects of ambient conditions and post-exercise management practices (cooling methods and vehicular confinement) on the post-exercise temperature change of dogs participating in UK canicross events. Canine temperature was recorded at three intervals post-exercise: as close as possible to 0- (immediately post-exercise), 5-, and 15-min post-exercise. Ambient conditions and post-exercise management were recorded for 115 cooling profiles from 52 dogs. In 28/115 (24.4%) profiles, the dog's temperature increased during the first 5-min post-exercise. Overall, 68/115 (59.1%) profiles included passive cooling (stood or walked outside), 35 (30.4%) active cooling (cold-water immersion or application of a cooling coat), and 12 (10.4%) involved no cooling and were immediately housed in vehicles. No dogs developed hypothermia during the study and no adverse effects were observed from any cooling method. In hyperthermic dogs, overall post-exercise body temperature change was significantly negatively associated (i.e. the dogs cooled more) with 0-min post-exercise body temperature (β = -0.93, p < 0.001), and not being housed in a vehicle (β = -0.43, p = 0.013). This study provides evidence cold-water immersion (in water at 0.1-15.0 °C) can be used to effectively and safely cool dogs with exertional hyperthermia. Progressive temperature increases in many dogs - even after exercise has terminated - supports the message to "cool first, transport second" when managing dogs with HRI. When transporting dogs post-exercise or with HRI even after active cooling, care should be taken to cool the vehicle before entry and promote air movement around the dog during transport to facilitate ongoing cooling and prevent worsening of hyperthermia during travel.

Association Between Acute Kidney Injury Hospital Visits and Environmental Heat Stress at a Nicaraguan Sugarcane Plantation

BACKGROUND

Mesoamerican sugarcane cutters are at a high risk of chronic kidney disease of non-traditional origin, a disease likely linked to heat-related acute kidney injury (AKI). Studies in general populations have described a positive association between high environmental temperatures and clinically assessed kidney outcomes, but there are no studies in occupational settings.

METHOD

We accessed routine records of clinically diagnosed AKI (AKI-CD) and wet bulb globe temperatures (WBGT) at a large Nicaraguan sugarcane plantation and modeled the relationship between these using negative binomial regression. A rest-shade-hydration intervention was gradually enhanced during the study period, and efforts were made to increase the referral of workers with suspected AKI to healthcare.

RESULTS

Each 1°C WBGT was associated with an 18% (95% confidence interval [CI]: [4, 33%]) higher AKI-CD rate on the same day and a 14% (95% CI [-5, 37%]) higher rate over a week. AKI-CD rates and severity, and time between symptoms onset and diagnosis decreased during the study period, that is, with increasing rest-shade-hydration intervention. Symptoms and biochemical signs of systemic inflammation were common among AKI-CD cases.

DISCUSSION

Occupational heat stress, resulting from heavy work in environmental heat, was associated with a higher rate of clinically diagnosed AKI in a population at risk of CKDnt. Promoting rest-shade-hydration may have contributed to reducing AKI rates during the study period. Occupational health and safety personnel have key roles to play in enforcing rest, shade, and hydration practices, referring workers with suspected AKI to healthcare as well as collecting and analyzing the data needed to support workplace heat stress interventions.

High resolution climate change observations and projections for the evaluation of heat-related extremes

The Climate Hazards Center Coupled Model Intercomparison Project Phase 6 climate projection dataset (CHC-CMIP6) was developed to support the analysis of climate-related hazards, including extreme humid heat and drought conditions, over the recent past and in the near-future. Global daily high resolution (0.05°) grids of the Climate Hazards InfraRed Temperature with Stations temperature product, the Climate Hazards InfraRed Precipitation with Stations precipitation product, and ERA5-derived relative humidity form the basis of the 1983-2016 historical record, from which daily Vapor Pressure Deficits (VPD) and maximum Wet Bulb Globe Temperatures (WBGTmax) were derived. Large CMIP6 ensembles from the Shared Socioeconomic Pathway 2-4.5 and SSP 5-8.5 scenarios were then used to develop high resolution daily 2030 and 2050 'delta' fields. These deltas were used to perturb the historical observations, thereby generating 0.05° 2030 and 2050 projections of daily precipitation, temperature, relative humidity, and derived VPD and WBGTmax. Finally, monthly counts of frequency of extremes for each variable were derived for each time period.

Excess Mortality Risk Due to Heat Stress in Different Climatic Zones of India

India is at a high risk of heat stress-induced health impacts and economic losses owing to its tropical climate, high population density, and inadequate adaptive planning. The health impacts of heat stress across climate zones in India have not been adequately explored. Here, we examine and report the vulnerability to heat stress in India using 42 years (1979-2020) of meteorological data from ERA-5 and developed climate-zone-specific percentile-based human comfort class thresholds. We found that the heat stress is usually 1-4 °C higher on heatwave (HW) days than on nonheatwave (NHW) days. However, the stress on NHW days remains considerable and cannot be neglected. We then showed the association of a newly formulated India heat index (IHI) with daily all-cause mortality in three cities - Delhi (semiarid), Varanasi (humid subtropical), and Chennai (tropical wet and dry), using a semiparametric quasi-Poisson regression model, adjusted for nonlinear confounding effects of time and PM2.5. The all-cause mortality risk was enhanced by 8.1% (95% confidence interval, CI: 6.0-10.3), 5.9% (4.6-7.2), and 8.0% (1.7-14.2) during "sweltering" days in Varanasi, Delhi, and Chennai, respectively, relative to "comfortable" days. Across four age groups, the impact was more severe in Varanasi (ranging from a 3.2 to 7.5% increase in mortality risk for a unit rise in IHI) than in Delhi (2.6-4.2% higher risk) and Chennai (0.9-5.7% higher risk). We observed a 3-6 days lag effect of heat stress on mortality in these cities. Our results reveal heterogeneity in heat stress impact across diverse climate zones in India and call for developing an early warning system keeping in mind these regional variations.

Gut microbiota associated with appetite suppression in high-temperature and high-humidity environments

BACKGROUND

Food is crucial for maintaining vital human and animal activities. Disorders in appetite control can lead to various metabolic disturbances. Alterations in the gut microbial composition can affect appetite and energy metabolism. While alterations in the gut microbiota have been observed in high-temperature and high-humidity (HTH) environments, the relationship between the gut microbiota during HTH and appetite remains unclear.

METHODS

We utilised an artificial climate box to mimic HTH environments, and established a faecal bacteria transplantation (FMT) mouse model. Mendelian randomisation (MR) analysis was used to further confirm the causal relationship between gut microbiota and appetite or appetite-related hormones.

FINDINGS

We found that, in the eighth week of exposure to HTH environments, mice showed a decrease in food intake and body weight, and there were significant changes in the intestinal microbiota compared to the control group. After FMT, we observed similar changes in food intake, body weight, and gut bacteria. Appetite-related hormones, including ghrelin, glucagon-like peptide-1, and insulin, were reduced in DH (mice exposed to HTH conditions) and DHF (FMT from mice exposed to HTH environments for 8 weeks), while the level of peptide YY initially increased and then decreased in DH and increased after FMT. Moreover, MR analysis further confirmed that these changes in the intestinal microbiota could affect appetite or appetite-related hormones.

INTERPRETATION

Together, our data suggest that the gut microbiota is closely associated with appetite suppression in HTH. These findings provide novel insights into the effects of HTH on appetite.

FUNDING

This work was supported by the National Natural Science Foundation of China and Guangzhou University of Chinese Medicine.

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.

Evaluating long-term and high spatiotemporal resolution of wet-bulb globe temperature through land-use based machine learning model

BACKGROUND

The increase in global temperature and urban warming has led to the exacerbation of heatwaves, which negatively affect human health and cause long-term loss of work productivity. Therefore, a global assessment in temperature variation is essential.

OBJECTIVE

This paper is the first of its kind to propose land-use based spatial machine learning (LBSM) models for predicting highly spatial-temporal variations of wet-bulb globe temperature (WBGT), which is a heat stress indicator used to assess thermal comfort in indoor and outdoor environments, specifically for the main island of Taiwan.

METHODS

To develop spatiotemporal prediction models for both the working period and noon period, we calculated the WBGT of each weather station from 2001 to 2019 using temperature, humidity, and solar radiation data. These WBGT estimations were then used as the dependent variable for developing the spatiotemporal prediction models. To enhance model performance, we used innovative approaches that combined SHapley Additive exPlanations (SHAP) values for the selection of non-linear variables, along with machine learning algorithms for model development.

RESULTS

When incorporating temperature along with other land-use/land cover predictor variables, the performance of LBSM models was excellent, with an R2 value of up to 0.99. The LBSM models explained 98% and 99% of the spatial-temporal variations in WBGT for the working and noon periods, respectively, within the complete models. In the temperature-excluded models, the explained variances were 94% and 96% for the working and noon periods, respectively.

IMPACT

WBGT is a common method used by many organizations to access the impact of heat stress on human beings. However, limited studies have mentioned the association between WBGT and health impacts due to the absence of spatiotemporal databases. This study develops a new approach using land-use-based spatial machine learning (LBSM) models to better predict the fine spatial-temporal WBGT levels, with a 50-m × 50-m grid resolution for both working time and noontime. Our proposed methodology could be used in future studies aimed at evaluating the potential long-term loss of work productivity due to the effects of global warming or urban heat island.

Thermal indices for human biometeorology based on Python

Thermal indices, such as Predicted Mean Vote, Outdoor Standard Effective Temperature, Physiologically Equivalent Temperature, and Universal Thermal Climate Index, are essential for the evaluation of thermal perception, the design of climate sensitive buildings or urban area, and tourism. These thermal indices are built on complicated numeric models. RayMan was developed to calculate thermal indices based on Delphi program language on the Windows 7 operating system. RayMan is not currently under active maintenance or development. Thus, this report describes the development of an innovative Python library named biometeo that includes an innovative thermal index (modified Physiologically Equivalent Temperature) as a next generation program to calculate thermal indices and human biometeorological variables.

A review of thermal stress in cattle

Cattle control body temperature in a narrow range over varying climatic conditions. Endogenous body heat is generated by metabolism, digestion and activity. Radiation is the primary external source of heat transfer into the body of cattle. Cattle homeothermy uses behavioural and physiological controls to manage radiation, convection, conduction, and evaporative exchange of heat between the body and the environment, noting that evaporative mechanisms almost exclusively transfer body heat to the environment. Cattle control radiation by shade seeking (hot) and shelter (cold) and by huddling or standing further apart, noting there are intrinsic breed and age differences in radiative transfer potential. The temperature gradient between the skin and the external environment and wind speed (convection) determines heat transfer by these means. Cattle control these mechanisms by managing blood flow to the periphery (physiology), by shelter-seeking and standing/lying activity in the short term (behaviourally) and by modifying their coats and adjusting their metabolic rates in the longer term (acclimatisation). Evaporative heat loss in cattle is primarily from sweating, with some respiratory contribution, and is the primary mechanism for dissipating excess heat when environmental temperatures exceed skin temperature (~36°C). Cattle tend to be better adapted to cooler rather than hotter external conditions, with Bos indicus breeds more adapted to hotter conditions than Bos taurus. Management can minimise the risk of thermal stress by ensuring appropriate breeds of suitably acclimatised cattle, at appropriate stocking densities, fed appropriate diets (and water), and with access to suitable shelter and ventilation are better suited to their expected farm environment.

Distribution of upper limit of the prescriptive zone values for acclimatized and unacclimatized individuals

Heat stress has an adverse impact on worker health and well-being, and the effects will increase with more frequent and severe heat events associated with global warming. Acclimatization to heat stress is widely considered to be a critical mitigation strategy and wet bulb globe temperature- (WBGT-) based occupational standards and guidelines contain adjustments for acclimatization. The purpose here was to 1) compare the mean values for the upper limit of the prescriptive zone (ULPZ, below which the rise in core temperature is minimal) between unacclimatized and acclimatized men and women; 2) demonstrate that the change in the occupational exposure limit (ΔOEL) due to acclimatization is independent of metabolic rate; 3) examine the relation between ΔOEL and body surface area (BSA); and 4) compare the exposure-response curves between unacclimatized and acclimatized populations. Empirically derived ULPZ data for unacclimatized participants from Pennsylvania State University (PSU) and acclimatized participants from University of South Florida (USF) were used to explore the difference between unacclimatized and acclimatized heat exposure limits. The findings provide support for a constant 3°C WBGT OEL decrease to account for unacclimatized workers. Body surface area explained part of the difference in ULPZ values between men and women. In addition, the pooled PSU and USF data provide insight into the distribution of individual values for the ULPZ among young, healthy unacclimatized and acclimatized populations in support of occupational heat stress guidelines.NEW & NOTEWORTHY Occupational exposure limit guidelines using wet bulb globe temperature (WBGT) distinguish between acclimatized and unacclimatized workers with about a 3°C difference between them. For the first time, empirical data from two laboratories provide support for acclimatization state adjustments. Using a constant difference rather than increasing differences with metabolic rate better describes the limit for unacclimatized participants. Furthermore, the lower upper limit of the prescriptive zone (ULPZ) values set forth for women do not relate to fitness level but are partly explained by their smaller body surface area (BSA). An examination of individual ULPZ values suggests that many unacclimatized individuals should be able to sustain safe work at the exposure limit for acclimatized workers.

Broad Scale Spatial Modelling of Wet Bulb Globe Temperature to Investigate Impact of Shade and Airflow on Heat Injury Risk and Labour Capacity in Warm to Hot Climates

While shade and air flow are recognised factors that reduce outdoor heat exposure, the level of reduction in terms of labour capacity at varying air temperature and humidity levels is poorly understood. This study investigated cooling effects on the commonly used heat index, wet bulb globe temperature (WBGT), and subsequent impact on labour capacity, for a range of air flow and shade conditions in warm to hot climates. We modelled heat exposure using a physics-based method to map WBGT for a case study region which experiences a range of heat categories with varying levels of health risks for outdoor workers. Continent-scale modelling confirmed significant spatial variability in the effect of various shade and wind speed scenarios across a range of real-world mid-summer daytime conditions. At high WBGTs, increasing shade or air flow for outdoor workers lowered heat exposure and increases labour capacity, with shade giving the greatest benefit, but cooling varied considerably depending upon underlying air temperature and humidity. Shade had the greater cooling effect; reducing incident radiation by 90% decreased WBGT by 2-6 °C depending on location. Wind had a lower cooling effect in the hottest regions, with a decreasing exponential relationship between wind speed and WBGT observed.

Does choice of outdoor heat metric affect heat-related epidemiologic analyses in the US Medicare population?

Outdoor air temperature is associated with increased morbidity and mortality. Other thermal indices theoretically confer greater physiological relevance by incorporating additional meteorological variables. However, the optimal metric for predicting excess deaths or hospitalizations owing to extreme heat among US Medicare beneficiaries remains unknown.

Methods

We calculated daily maximum, minimum, and mean outdoor air temperature (T), heat index (HI), wet-bulb globe temperature (WBGT), and Universal Thermal Climate Index (UTCI) for populous US counties and linked estimates with daily all-cause mortality and heat-related hospitalizations among Medicare beneficiaries (2006-2016). We fit distributed-lag nonlinear models for each metric and compared relative risks (RRs) at the 99th percentile.

Results

Across all heat metrics, extreme heat was statistically significantly associated with elevated risks of morbidity and mortality. Associations were more pronounced for maximum daily values versus the corresponding minimum for the same metric. The starkest example was between HImax (RR = 1.14; 95% confidence interval [CI] = 1.12, 1.15) and HImin (RR = 1.10; 95% CI = 1.09, 1.11) for hospitalizations. When comparing RRs across heat metrics, we found no statistically significant differences within the minimum and maximum heat values (i.e., no significant differences between Tmax/HImax/WBGTmax/UTCImax or between Tmin/HImin/WBGTmin/UTCImin). We found similar relationships across the National Climate Assessment regions.

Conclusion

Among Medicare beneficiaries in populous US counties, daily maximum and mean values of outdoor heat are associated with greater RRs of heat-related morbidity and all-cause mortality versus minimum values of the same metric. The choice of heat metric (e.g., temperature versus HI) does not appear to substantively affect risk calculations in this population.

Heat stress in horses: a literature review

Healthy adult horses can balance accumulation and dissipation of body heat to maintain their body temperature between 37.5 and 38.5 °C, when they are in their thermoneutral zone (5 to 25 °C). However, under some circumstances, such as following strenuous exercise under hot, or hot and humid conditions, the accumulation of body heat exceeds dissipation and horses can suffer from heat stress. Prolonged or severe heat stress can lead to anhidrosis, heat stroke, or brain damage in the horse. To ameliorate the negative effects of high heat load in the body, early detection of heat stress and immediate human intervention is required to reduce the horse's elevated body temperature in a timely manner. Body temperature measurement and deviations from the normal range are used to detect heat stress. Rectal temperature is the most commonly used method to monitor body temperature in horses, but other body temperature monitoring technologies, percutaneous thermal sensing microchips or infrared thermometry, are currently being studied for routine monitoring of the body temperature of horses as a more practical alternative. When heat stress is detected, horses can be cooled down by cool water application, air movement over the horse (e.g., fans), or a combination of these. The early detection of heat stress and the use of the most effective cooling methods is important to improve the welfare of heat stressed horses.

Thermal responses of face-masked pedestrians during summer: An outdoor investigation under tree-shaded areas

During the SARS-CoV-2 (COVID-19) pandemic, most citizens were cooperative towards the face-masking policy; however, undeniably, face masking has increased complaints of thermal discomfort to varying degrees and resulted in potential health hazards during summer. Thus, a thermal comfort survey was conducted under tree-shaded areas generally preferred by pedestrians to explore the thermal response of face-masked pedestrians. Thirty-two subjects, with and without masks, participated in walking experiments, and their thermal parameters and physiological indicators were recorded; moreover, the subjects were asked to fill in subjective questionnaires. The results showed that although tree shades significantly reduced the average radiant temperature, dampness in the mask may cause some discomfort symptoms, among which intense sweating (54.55%) and tachycardia (42.18%) accounted for the largest proportion. Based on thermal indices, it could be concluded that face-masking does not significantly affect the thermal comfort of subjects walking in shaded areas. Notably, a 30-min walk in tree-shaded areas with face masking does not adversely affect human health or quality of life. Thus, the present assessment of the thermal safety of humans in shaded environments provides reference data for determining thermal comfort levels during outdoor walking with face masking.

Forecasting daily emergency ambulance service demand using biometeorological indexes

This study aims to study the effectiveness of using biometeorological indexes in the development of a daily emergency ambulance service demand forecast system for Taipei City, Taiwan, compared to typical weather factors. Around 370,000 emergency ambulance service patient records were aggregated into a daily emergency ambulance service demand time series as the study's dependent variable. To assess the effectiveness of biometeorological indexes in making a 1 to 7-day forecast of daily emergency ambulance service demand, five forecast models were developed to make the comparison. The model with average temperature as the only predictor performed the best consistently from 1 to 7-day forecasts. The models with net effective temperature and apparent temperature as their only predictors ranked second and third, respectively. It is surprising that the model with both average temperature and relative humidity as predictors only ranked fourth. The unexpected outperformance of average temperature over net effective temperature and apparent temperature in forecasting daily emergency ambulance service demand suggested the need to develop updated locational-specific biometeorological indexes so that the benefit of the indexes can be fully utilized. Although adopting popular biometeorological indexes that are already available would be cheap and convenient, the benefit from these general indexes may not be guaranteed.

Risk factors for, and prediction of, exertional heat illness in Thoroughbred racehorses at British racecourses

The development of exertional heat illness (EHI) is a health, welfare and performance concern for racehorses. However, there has been limited multivariable assessment of the possible risk factors for EHI in racehorses, despite such information being vital for regulators to effectively manage the condition. Consequently, this study aimed to identify the risk factors associated with the occurrence of EHI in Thoroughbred racehorses and assess the ability of the risk factor model to predict the occurrence of EHI in racehorses to assist in early identification. Runners at British racecourses recorded in the British Horseracing Authority database between 1st July 2010 and 30th April 2018 were used to model the probability that a horse would present with EHI as a function of a suite of environmental, horse level and race level factors. EHI was reported in 0.1% of runners. Race distance, wet bulb globe temperature, preceding 5-day temperature average, occurrence of a previous EHI incident, going, year and race off time were identified as risk factors for EHI. The model performed better than chance in classifying incidents with a mean area under the receiver operating characteristic curve score of 0.884 (SD = 0.02) but had a large number of false positives. The results provide vital evidence for industry on the need to provide appropriate cool down facilities, identify horses that have repeated EHI incidents for early intervention, and collect new data streams such as on course wet bulb globe temperature measurements. The results are especially relevant as the sport is operating in a changing climate and must mitigate against more extreme and longer spells of hot weather.

Effect of Work-to-Rest Cycles on Cardiovascular Strain and Maximal Oxygen Uptake during Heat Stress

Cardiovascular drift-a progressive increase in heart rate (HR) and decrease in stroke volume (SV) during prolonged exercise-is exacerbated by heat stress and thermal strain, and often accompanied by a decrease in work capacity (indexed as maximal oxygen uptake [V.O2max]). To attenuate physiological strain during work in the heat, use of work:rest ratios is recommended by the National Institute for Occupational Safety and Health. The purpose of this study was to test the hypothesis that during moderate work in hot conditions, utilizing the recommended 45:15 min work:rest ratio would result in cardiovascular drift 'accumulating' over consecutive work:rest cycles and accompanying decrements in V.O2max. Eight people (5 women; (mean ± SD) age = 25 ± 5 y; body mass = 74.8 ± 11.6 kg; V.O2max = 42.9 ± 5.6 mL·kg-1·min-1) performed 120 min of simulated moderate work (201-300 kcal·h-1) in hot conditions (indoor wet-bulb globe temperature = 29.0 ± 0.6 °C). Participants completed two 45:15 min work:rest cycles. Cardiovascular drift was evaluated at 15 and 45 min of each work bout; V.O2max was measured after 120 min. On a separate day, V.O2max was measured after 15 min under identical conditions for comparison before and after cardiovascular drift occurred. HR increased 16.7% (18 ± 9 beats·min-1, p = 0.004) and SV decreased 16.9% (-12.3 ± 5.9 mL, p = 0.003) between 15 and 105 min, but V.O2max was unaffected after 120 min (p = 0.14). Core body temperature increased 0.5 ± 0.2 °C (p = 0.006) over 2 h. Recommended work:rest ratios preserved work capacity but did not prevent the accumulation of cardiovascular and thermal strain.

Recovery with a fan-cooling jacket after exposure to high solar radiation during exercise in hot outdoor environments

The study aimed to investigate the effect of body cooling with a fan-cooling jacket on body temperature responses during recovery after exercise when exposed to high solar radiation in a hot outdoor environment. Nine males cycled using ergometer until their rectal temperature increased to 38.50 °C in hot outdoor environments, followed by body cooling recovery in warm indoor environments. Subjects repeatedly performed the cycling exercise protocol, which consisted of one set of 5 min at a load of 1.5 watt/kg body weight and 15 min at a load of 2.0 watt/kg body weight at 60 rpm. Body cooling recovery consisted of cold water ingestion (10°C: CON) or cold water ingestion + wearing a fan-cooling jacket (FAN) until the rectal temperature decreased to 37.75°C. The time for the rectal temperature to reach 38.5°C did not differ between the two trials. The rate of decrease in rectal temperature at recovery tended to be higher in FAN trial than in CON trial (P = 0.082). The rate of decrease in tympanic temperature was higher in FAN trials than in CON trials (P = 0.002). The rate of decrease in mean skin temperature at the first 20 min of recovery was higher in FAN than in CON trial (P = 0.013). Body cooling recovery with a fan-cooling jacket in addition to cold water ingestion may be effective in reducing elevated tympanic and skin temperatures after exercise in the heat under a clear sky, but may be difficult to decrease rectal temperature.

Wet Bulb Globe Temperature: Indicating Extreme Heat Risk on a Global Grid

The Wet Bulb Globe Temperature (WBGT) is an international standard heat index used by the health, industrial, sports, and climate sectors to assess thermal comfort during heat extremes. Observations of its components, the globe and the wet bulb temperature (WBT), are however sparse. Therefore WBGT is difficult to derive, making it common to rely on approximations, such as the ones developed by Liljegren et al. (2008, https://doi.org/10.1080/15459620802310770, W B G T L i l j e g r e n ) and by the American College of Sports Medicine ( W B G T A C S M 87 ). In this study, a global data set is created by implementing an updated WBGT method using ECMWF ERA5 gridded meteorological variables and is evaluated against existing WBGT methods. The new method, W B G T B r i m i c o m b e , uses globe temperature calculated using mean radiant temperature and is found to be accurate in comparison to W B G T L i l j e g r e n across three heatwave case studies. In addition, it is found that W B G T A C S M 87 is not an adequate approximation of WBGT. Our new method is a candidate for a global forecasting early warning system.

Short hydration education video and hiker fluid selection and consumption at trails, a non-randomized quasi-experimental field study

Background: Education may improve hiker safety on trails. Aim: To investigate the impact of an educational video on hiker fluid selection and fluid consumption in a hot environment. Methods: Quasi-experimental field study at hiking trails in which the intervention group (INT) viewed a three-minute hydration education video, whereas the control group (CON) did not. Before the hike, all hikers were asked if they wanted to select extra fluid, which was provided by the research team. Results: A total of n = 97 hikers participated in the study, with n = 56 in INT (32 male) and n = 41 in CON (25 male). Despite absolute differences in environmental conditions, the differences fell within the same WBGT category. The total amount of fluid brought to the trails by participants was different between INT: 904 (503-1758) mL and CON: 1509 (880-2176) mL (P = 0.006), but participants in the INT group selected extra fluid (41%; n = 23) significantly more often when compared with participants in the CON group (7%; n = 3; P < 0.001). As a result, there was no difference in the amount of fluid brought on the trail between INT: 1047 (611-1936) mL and CON: 1509 (932-2176) mL (P = 0.069), nor for fluid consumption between INT: 433 (289-615) mL/h and CON: 489 (374-719) mL/h (P = 0.18). Conclusions and Implications: A 3-min educational video may encourage hikers to select additional fluid before the start of their hike but does not appear to increase fluid intake.

Estimation of the number of heat illness patients in eight metropolitan prefectures of Japan: Correlation with ambient temperature and computed thermophysiological responses

The number of patients with heat illness transported by ambulance has been gradually increasing due to global warming. In intense heat waves, it is crucial to accurately estimate the number of cases with heat illness for management of medical resources. Ambient temperature is an essential factor with respect to the number of patients with heat illness, although thermophysiological response is a more relevant factor with respect to causing symptoms. In this study, we computed daily maximum core temperature increase and daily total amount of sweating in a test subject using a large-scale, integrated computational method considering the time course of actual ambient conditions as input. The correlation between the number of transported people and their thermophysiological temperature is evaluated in addition to conventional ambient temperature. With the exception of one prefecture, which features a different Köppen climate classification, the number of transported people in the remaining prefectures, with a Köppen climate classification of Cfa, are well estimated using either ambient temperature or computed core temperature increase and daily amount of sweating. For estimation using ambient temperature, an additional two parameters were needed to obtain comparable accuracy. Even using ambient temperature, the number of transported people can be estimated if the parameters are carefully chosen. This finding is practically useful for the management of ambulance allocation on hot days as well as public enlightenment.

Influence of the Thermal Environment on Work Rate and Physiological Strain during a UCI World Tour Multistage Cycling Race

PURPOSE

This study aimed to characterize the thermal and cardiovascular strain of professional cyclists during the 2019 Tour Down Under and determine the associations between thermal indices and power output, and physiological strain.

METHODS

Gastrointestinal temperature ( Tgi ), heart rate (HR), and power output were recorded during the six stages (129-151.5 km) of the Tour Down Under in ≤22 male participants. Thermal indices included dry-bulb, black-globe, wet-bulb, and wet-bulb-globe (WBGT) temperature; relative humidity (RH), Heat Index; Humidex; and universal thermal climate index. The heat stress index (HSI), which reflects human heat strain, was also calculated.

RESULTS

Dry-bulb temperature was 23°C-37°C, and RH was 18%-72% (WBGT: 21°C-29°C). Mean Tgi was 38.2°C-38.5°C, and mean peak Tgi was 38.9°C-39.4°C, both highest values recorded during stage 3 (WBGT: 27°C). Peak individual Tgi was ≥40.0°C in three stages and ≥39.5°C in 14%-33% of cyclists in five stages. Mean HR was 131-147 bpm (68%-77% of peak), with the highest mean recorded in stage 3 ( P ≤ 0.005). Mean power output was 180-249 W, with the highest mean recorded during stage 4 ( P < 0.001; 21°C WBGT). The thermal indices most strongly correlated with power output were black-globe temperature ( r = -0.778), RH ( r = 0.768), universal thermal climate index ( r = -0.762), and WBGT ( r = -0.745; all P < 0.001). Mean Tgi was correlated with wet-bulb temperature ( r = 0.495), HSI ( r = 0.464), and Humidex ( r = 0.314; all P < 0.05), whereas mean HR was most strongly correlated with HSI ( r = 0.720), along with Tgi ( r = 0.599) and power output ( r = 0.539; all P < 0.05).

CONCLUSIONS

Peak Tgi reached 40.0°C in some cyclists, although most remained <39.5°C with an HR of ~73% of peak. Power output was correlated with several thermal indices, primarily influenced by temperature, whereas Tgi and HR were associated with the HSI, which has potential for sport-specific heat policy development.

Occupational heat exposure and prostate cancer risk: A pooled analysis of case-control studies

BACKGROUND

Heat exposures occur in many occupations. Heat has been linked to key carcinogenic processes, however, evidence for associations with cancer risk is sparse. We examined potential associations between occupational heat exposure and prostate cancer risk in a multi-country study.

METHODS

We analysed a large, pooled dataset of 3142 histologically confirmed prostate cancer cases and 3512 frequency-matched controls from three countries: Canada, France, and Spain. Three exposure indices: ever exposure, lifetime cumulative exposure and duration of exposure, were developed using the Finnish Job-Exposure Matrix, FINJEM, applied to the lifetime occupational history of participants. We estimated odds ratios (ORs) and 95% confidence intervals (CIs), using conditional logistic regression models stratified by 5-year age groups and study, adjusting for potential confounders. Potential interactions with exposure to other occupational agents were also explored.

RESULTS

Overall, we found no association for ever occupational heat exposure (OR 0.97; 95% CI 0.87, 1.09), nor in the highest categories of lifetime cumulative exposure (OR 1.04; 95% CI 0.89, 1.23) or duration (OR 1.03; 95% CI 0.88, 1.22). When using only the Spanish case-control study and a Spanish Job Exposure Matrix (JEM), some weakly elevated ORs were observed.

CONCLUSIONS

Findings from this study provide no clear evidence for an association between occupational heat exposure and prostate cancer risk.

Using Wet Bulb Globe Temperature and Physiological Equivalent Temperature as Predicative Models of Medical Stress in a Marathon: Analysis of 30 Years of Data From the Twin Cities Marathon

OBJECTIVES

: Assess the relationships between wet bulb globe temperature (WBGT) and physiologic equivalent temperature (PET) at the start of a northern latitude marathon and their associations with medical stress and transfers to the emergency room (ER) when the race environment is unexpectedly warm, and participants are not acclimatized.

DESIGN

: Retrospective review.

SETTING

: Twin Cities Marathon from 1990 to 2019.

PARTICIPANTS

: Runners competing in the Twin Cities Marathon.

INDEPENDENT VARIABLES

: Start WBGT (prospectively collected) and PET (retrospectively calculated).

MAIN OUTCOME MEASURES

: Marathon race starters and finishers and race day medical data (eg, medical stress, number of medical encounters, and number of ER visits).

RESULTS

: The mean WBGT was 7.4°C (range -1.7°C to 22.2°C), and the meant PET was 5.2°C (range -16.7°C to 25.9°C). PET was not determined to be a significant predictor of medical stress (P = 0.71); however, a significant quadratic association between WBGT and medical stress was found (P = 0.006). WBGT (P = 0.002), but not PET (P = 0.07), was a significant predictor of the number of ER visits.

CONCLUSIONS

Start WBGT was a better predictor of medical stress and ER visits than PET at the Twin Cities Marathon over a 30-year period. The start WBGT may be a better tool to predict race day environment medical safety.

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.

Heat stress illness outcomes and annual indices of outdoor heat at U.S. Army installations

This study characterized associations between annually scaled thermal indices and annual heat stress illness (HSI) morbidity outcomes, including heat stroke and heat exhaustion, among active-duty soldiers at ten Continental U.S. (CONUS) Army installations from 1991 to 2018. We fit negative binomial models for 3 types of HSI morbidity outcomes and annual indices for temperature, heat index, and wet-bulb globe temperature (WBGT), adjusting for installation-level effects and long-term trends in the negative binomial regression models using block-bootstrap resampling. Ambulatory (out-patient) and reportable event HSI outcomes displayed predominately positive association patterns with the assessed annual indices of heat, whereas hospitalization associations were mostly null. For example, a one-degree Fahrenheit (°F) (or 0.55°C) increase in mean temperature between May and September was associated with a 1.16 (95% confidence interval [CI]: 1.11, 1.29) times greater rate of ambulatory encounters. The annual-scaled rate ratios and their uncertainties may be applied to climate projections for a wide range of thermal indices to estimate future military and civilian HSI burdens and impacts to medical resources.

Towards real-time thermal stress prediction systems for workers

Exposure to extreme temperatures in workplaces implies serious physical hazards to workers. In addition, a poorly acclimatized worker can have reduced performance and alertness. It may therefore be more vulnerable to the risk of accidents and injuries. Due to the incompatibility of standards and regulations with some work environments and a lack of thermal exchange in many personal protective equipment, heat stress remains among the most common physical risks in many industrial sectors. Furthermore, conventional methods of measuring physiological parameters in order to calculate personal thermophysiological constraints are not practical to use during work tasks. However, the emergence of wearable technologies can contribute to real-time measurement of body temperature and the biometric signals needed to assess thermophysiological constraints while actively working. Thus, the present study was carried out in order to scrutinize the current knowledge of these types of technologies by analyzing the available systems and the advances made in previous studies, as well as to discuss the efforts required to develop devices for the prevention of the occurrence of heat stress in real time.

Combining multiple human physiological signals using fuzzy logic to determine stress caused by battle dress uniforms

Abstract

This study presents a novel stress index for clothing using physiological signals to estimate stress induced by battle dress uniforms (BDU) during physical activity. The approach uses a fuzzy logic-based nonlinear mapping to compute the stress from physiological signals. Ten healthy men performed a battery of physical activities in a controlled environment. Heart rate (HR), respiration rate (RR), skin temperature (ST), and galvanic skin response (GSR) were measured continuously for the participants during activity wearing three kinds of clothing (two BDUs and a control garment). The individual physiological responses were combined using a fuzzy-logic system to derive a stress measure called Clothed Activity Stress Index (CASI). Repeated measures ANOVA showed that the garments significantly (α = .05) affected the HR (p < .001) and RR (p < .001). In addition, interactions between the activity and garment were significant for HR, RR, and ST (p < .001, p < .001, p < .036). The physiological measures differed significantly between rest and activity for the two uniforms. The stress indices (ranging between 0 and 1) during rest and activity were 0.24 and 0.35 for control, 0.27 and 0.43 for BDU-1, and 0.33 and 0.44 for BDU-2. It is shown here that clothing systems impact human stress levels to a measurable level. This computational approach is applicable to measure stress caused by protective wear under different operational conditions and can be suitable for sports and combat gears.

Article Highlights

Long-term trends of atmospheric hot-and-polluted episodes (HPE) and the public health implications in the Pearl River Delta region of China

Air pollution and extreme heat have been responsible for more than a million deaths in China every year, especially in densely urbanized regions. While previous studies intensively evaluated air pollution episodes and extreme heat events, a limited number of studies comprehensively assessed atmospheric hot-and-polluted-episodes (HPE) - an episode with simultaneously high levels of air pollution and temperature - which have potential adverse synergic impacts on human health. This study focused on the Pearl River Delta (PRD) region of China due to its high temperature in summer and poor air quality throughout a year. We employed geostatistical downscaling to model meteorology at a spatial resolution of 1 km, and applied a machine learning algorithm (XGBoost) to estimate a high-resolution (1 km) daily concentration of particulate matter with an aerodynamic diameter ≤2.5 μm (PM_2.5) and ozone (O₃) for June to October over 20 years (2000-2019). Our results indicate an increasing trend (∼50%) in the frequency of HPE occurrence in the first decade (2000-2010). Conversely, the annual frequency of HPE occurrence reduced (16.7%), but its intensity increased during the second decade (2010-2019). The northern cities in the PRD region had higher levels of PM_2.5 and O₃ than their southern counterparts. During HPEs, regional daily PM_2.5 exceeded the World Health Organization (WHO) and Chinese guideline levels by 75% and 25%, respectively, while the O₃ exceeded the WHO O₃ standard by up to 69%. Overall, 567,063 (95% confidence interval (CI): 510,357-623,770) and 52,231 (95%CI: 26,116-78,346) excessive deaths were respectively attributable to exposure to PM_2.5 and O₃ in the PRD region. Our findings imply the necessity and urgency to formulate co-benefit policies to mitigate the region's air pollution and heat problems.

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.

Extreme environmental temperatures and motorcycle crashes: a time-series analysis

Extreme temperature could affect traffic crashes by influencing road safety, vehicle performance, and drivers' behavior and abilities. Studies evaluating the impacts of extreme temperatures on the risk of traffic crashes have mainly overlooked the potential role of vehicle air conditioners. The aim of this study, therefore, was to evaluate the effect of exposure to extreme cold and hot temperatures on seeking medical attention due to motorcycle crashes. The study was conducted in Iran by using medical attendance for motorcycle crashes from March 2011 to June 2017. Data on daily minimum, mean and maximum temperature (°C), relative humidity (%), wind velocity (km/h), and precipitation (mm/day) were collected. We developed semi-parametric generalized additive models following a quasi-Poisson distribution with the distributed nonlinear lag model to estimate the immediate and lagged associations (reported as relative risk [RR], and 95% confidence interval [CI]). Between March 2011 and June 2017, 36,079 medical attendances due to motorcycle road traffic crashes were recorded (15.8 ± 5.92 victims per day). In this time period, the recorded temperature ranged from -11.2 to 45.4 °C (average: 25.5 ± 11.0 °C). We found an increased risk of medical attendance for motorcycle crashes (based on maximum daily temperature) at both extremely cold (1st percentile) and hot (99th percentile) temperatures and also hot (75th percentile) temperatures, mainly during lags 0 to 3 days (e.g., RR: 1.12 [95% CI: 1.05: 1.20]; RR: 1.08 [95% CI: 1.01: 1.16]; RR: 1.20 [95% CI: 1.09: 1.32] at lag0 for extremely cold, hot, and extremely hot conditions, respectively). The risk estimates for extremely hot temperatures were larger than hot and extremely cold temperatures. We estimated that 11.01% (95% CI: 7.77:14.06) of the medical attendance for motorcycle crashes is estimated to be attributable to non-optimal temperature (using mean temperature as exposure variable). Our findings have important public health messaging, given the considerable burden associated with road traffic injury, particularly in low- and middle-income countries.

Evaluation of Heat Stress Levels Inside Greenhouses during Summer in Korea

Farmers working inside greenhouses during summer are at risk of heat-related illness. In this study, we compared the dry-bulb temperatures (DTs) and the wet-bulb globe temperature (WBGT) index inside and outside greenhouses. We then determined the criteria for appropriate working and resting times inside greenhouses. The measurements were performed during the hottest period in 2020 and 2021 for two greenhouses, representative of those commonly found in rural areas. A direct-reading WBGT index meter was used for these measurements, and Automated Synoptic Observing System (ASOS) data were used to obtain regional DT data. DTs inside the greenhouses were significantly higher than the ASOS DTs (p < 0.001). In addition, the August WBGT index inside was significantly higher than that outside the greenhouses (p < 0.001). We found that the temperature during the period between 08:00 and 19:00 exceeded the international threshold of 28 °C for heat-acclimatized workers performing moderate-intensity work, above which heat stress becomes a concern. Our results revealed that the thermal index inside can be significantly higher than that found outside greenhouses. Therefore, when work is required inside greenhouses during the summer, stricter standards and safety measures should be considered.

Hematological parameters in a population of male bakers exposed to high heat work environment

Objectives

The aim of this study was to determine the hematological changes associated with heat exposure in a population of bakers.

Materials and methods

Personal information was collected using a questionnaire, and a venous blood sample was drawn at the end of a work shift from the bakers and from a control group. The average wet-bulb globe temperature (WBGT) index was measured in the workplaces of both the bakers and the controls.

Results

This cross-sectional study involved 137 bakers working in 20 bakeries and 107 controls who were comparable in terms of likely confounding factors. Hemoglobin and platelet values were abnormal among the bakers and statistically significantly different to the control group (P = 0.026, and P = 0.016 respectively). The average WBGT index in the bakeries was 37.4°C, while the average WBGT in the workplaces of the controls was 25.5°C, (P<0.0001).

Conclusions

The changes in the bakers’ hematological parameters were found to be associated with exposure to high environmental heat at bakeries, as measured by the WBGT index. Preventive measures should be introduced to reduce the adverse effect of heat exposure among bakers and directed toward the worker–equipment–environment triad.

Thermophysiological aspects of wearable robotics: Challenges and opportunities

Technological advancements in the last two decades have enabled development of a variety of mechanically supporting wearable robots (i.e. exoskeletons) that are transitioning to practice in medical and industrial settings. The feedback from industry and recent controlled studies is highlighting thermal discomfort as a major reason for the disuse of the devices and a substantial barrier to their long-term adoption. Furthermore, a brief overview of the devices and their intended applications reveals that many of the potential users are likely to face thermal comfort issues because of either high exertion or medically related high heat sensitivity. The aim of this review is to discuss these emerging thermal challenges and opportunities surrounding wearable robots. This review discusses mechanisms, potential solutions, and a platform for systematically measuring heat transfer inhibition caused by wearing of an exoskeleton. Lastly, the potential for substantial metabolic rate reduction provided by exoskeletons to reduce worker thermal strain in warm-to-hot conditions is also considered.

Moving in a hotter world: Maintaining adequate childhood fitness as a climate change countermeasure

Children cope with high temperatures differently than adults do, largely because of slight alterations in their body proportions and heat loss mechanisms compared to fully mature humans. Paradoxically, all current tools of assessing thermal strain have been developed on adults. As the Earth's warming continues to accelerate, children are set to bear the health risk brunt of rising global temperatures. Physical fitness has a direct impact on heat tolerance, yet children are less fit and more obese than ever before. Longitudinal research reveals that children have 30% lower aerobic fitness than their parents did at the same age; this deficit is greater than can be recovered by training alone. So, as the planet's climate and weather patterns become more extreme, children may become less capable of tolerating it. This comprehensive review provides an outline of child thermoregulation and assessment of thermal strain, before moving to summarize how aerobic fitness can modulate hyperthermia, heat tolerance, and behavioral thermoregulation in this under-researched population. The nature of child physical activity, physical fitness, and one's physical literacy journey as an interconnected paradigm for promoting climate change resilience is explored. Finally, future research foci are suggested to encourage continued exploration of this dynamic field, notable since more extreme, multifactorial environmental stressors are expected to continue challenging the physiological strain of the human population for the foreseeable future.

Utility of the Heat Index in defining the upper limits of thermal balance during light physical activity (PSU HEAT Project)

Extreme heat events and consequent detrimental heat-health outcomes have been increasing in recent decades and are expected to continue with future climate warming. While many indices have been created to quantify the combined atmospheric contributions to heat, few have been validated to determine how index-defined heat conditions impact human health. However, this subset of indices is likely not valid for all situations and populations nor easily understood and interpreted by health officials and the public. In this study, we compare the ability of thresholds determined from the National Weather Service's (NWS) Heat Index (HI), the Wet Bulb Globe Temperature (WBGT), and the Universal Thermal Climate Index (UTCI) to predict the compensability of human heat stress (upper limits of heat balance) measured as part of the Pennsylvania State University's Heat Environmental Age Thresholds (PSU HEAT) project. While the WBGT performed the best of the three indices for both minimal activities of daily living (MinAct; 83 W·m-2) and light ambulation (LightAmb; 133 W·m-2) in a cohort of young, healthy subjects, HI was likewise accurate in predicting heat stress compensability in MinAct conditions. HI was significantly correlated with subjects' perception of temperature and humidity as well as their body core temperature, linking perception of the ambient environment with physiological responses in MinAct conditions. Given the familiarity the public has with HI, it may be better utilized in the expansion of safeguard policies and the issuance of heat warnings during extreme heat events, especially when access to engineered cooling strategies is unavailable.

Baseline scenarios of heat-related ambulance transportations under climate change in Tokyo, Japan

Background

Predictive scenarios of heatstroke over the long-term future have yet to be formulated. The purpose of the present study was to generate baseline scenarios of heat-related ambulance transportations using climate change scenario datasets in Tokyo, Japan.

Methods

Data on the number of heat-related ambulance transportations in Tokyo from 2015 to 2019 were examined, and the relationship between the risk of heat-related ambulance transportations and the daily maximum wet-bulb globe temperature (WBGT) was modeled using three simple dose-response models. To quantify the risk of heatstroke, future climatological variables were then retrieved to compute the WBGT up to the year 2100 from climate change scenarios (i.e., RCP2.6, RCP4.5, and RCP8.5) using two scenario models. The predicted risk of heat-related ambulance transportations was embedded onto the future age-specific projected population.

Results

The proportion of the number of days with a WBGT above 28°C is predicted to increase every five years by 0.16% for RCP2.6, 0.31% for RCP4.5, and 0.68% for RCP8.5. In 2100, compared with 2000, the number of heat-related ambulance transportations is predicted to be more than three times greater among people aged 0-64 years and six times greater among people aged 65 years or older. The variance of the heatstroke risk becomes greater as the WBGT increases.

Conclusions

The increased risk of heatstroke for the long-term future was demonstrated using a simple statistical approach. Even with the RCP2.6 scenario, with the mildest impact of global warming, the risk of heatstroke is expected to increase. The future course of heatstroke predicted by our approach acts as a baseline for future studies.

The need for location-specific biometeorological indexes in Taiwan

Objective

As most available biometeorological indexes were developed decades ago in western countries, the benefit of using these indexes to study the effect of weather on human health in modern eastern countries is questionable. This study aimed to reconfirm the effectiveness of applying these biometeorological indexes when analyzing demand for daily emergency ambulance services (EAS) in Taipei.

Methods

More than 370,000 EAS usage records were analyzed in this study. The records were first allotted into different time-series data by age, gender, triage level, and case nature (trauma/non-trauma) in order to represent different kinds of daily EAS demand. They were then regressed on biometeorological indexes [Apparent Temperature (AT) and Net Effective Temperature (NET)]; the indexes' additional descriptive power to describe the daily EAS demand over traditional weather factors was then assessed.

Results

No significant difference was observed in the descriptive powers in terms of effect on daily EAS demand of the biometeorological indexes and traditional weather factors. The largest improvement on the regression models' adjusted-R2 using NET and AT was only 0.008.

Conclusion

It may not be a good idea to make direct use of the biometeorological indexes developed in western countries decades ago. Taiwan should have a tailor-made biometeorological index for a better representation of its unique situation.

Small changes in thermal conditions hinder marathon running performance in the tropics

We examined marathon performance of the same group of runners in relation to small changes in dry bulb temperature (T_db) and wet bulb temperature (T_wb) across 3 consecutive y, and investigated whether performance was poorer during an evening marathon compared with morning marathons. Marathon results were obtained from the 2017, 2018, and 2019 Standard Chartered Singapore Marathons. T_db, T_wb, T_d, relative humidity, and absolute humidity were gathered for each marathon. K-means clustering and linear regressions were performed on 610 runners who participated in all three marathons. Analysis of the 610 runners’ marathon performance was contrasted with T_db and T_wb. Linear regressions were also performed on 190 runners filtered by percentile, yielding similar results. For clusters with similar T_db from all runners K-means clustering, an increase in mean T_wb by 1.5°C coincided with an increase in finishing time by 559 s (9.3 min) (p < 0.033). T_wb hinders marathon performance more than T_db, with each percentage rise in T_db and T_wb resulting in an increase in net time by 7.6% and 39.1%, respectively (p < 0.025). Male and female runners’ response to T_db and T_wb changes were similar (overlap in 95% confidence intervals for the respective regression coefficients). In conclusion, small variations in environmental parameters affected marathon performance, with T_wb impairing marathon performance more than T_db. Marathon performance was likely better in the morning than evening, possibly due to time of day differences, along with unfavorable T_db that superseded training effects and the effects of lower T_wb.

Urban Heat Island and Thermal Comfort Assessment in a Medium-Sized Mediterranean City

One of the greatest issues nowadays is that of the urban heat island effect on the thermal conditions inside cities. The air temperature inside the city core is warmer than that in suburbs, thus deteriorating the quality of life for citizens and making outdoor spaces uncomfortable in terms of thermal comfort. This phenomenon is usually assessed in large scale cities worldwide and less often in medium-sized towns. The current study aimed to investigate the urban heat island effect and, therefore, to assess the outdoor thermal comfort conditions in a medium-sized city. More specifically, the methodology of the current study includes: (i) the combination of different monitoring techniques to quantify the urban heat island effect in a medium-sized Mediterranean city. Both in situ measurements and remote sensing techniques were applied to assess the urban heat island effect in terms of both the canopy layer (CUHI) and the surface (SUHI); (ii) the identification of the parameters that affect thermal comfort and the identification of the most appropriate bioclimatic indices that determine outdoor thermal comfort in the city of interest. Both questionnaire survey and in situ measurements took place on a sidewalk in the city of Xanthi, Northern Greece, during the summer. The CUHI effect was obvious, especially in the morning and afternoon. Downscaled MODIS satellite images also showed that the intensity of SUHI was higher in the morning and afternoon. Apart from air temperature, important differences in the values of most microclimatic parameters were recorded between the meteorological station placed inside the urban area and those gathered from a nearby meteorological station. The narrow roads, the thermal properties of construction materials, and the absence of greenery characterized the area of interest and may be the key factors creating these differences in climate. Concerning the thermal comfort assessment, the most significant parameters were the air temperature and solar radiation, although, both empirical and direct indices were found to describe the comfort values well. According to the results, downscaling techniques are also important for the SUHI effect to be investigating in detail in medium-sized urban environments.

Heat exposure limits for young unacclimatized males and females at low and high humidity

Little is known about the separate and combined influences of humidity conditions, sex, and aerobic fitness on heat tolerance in unacclimatized males and females. The purpose of the current study was to describe heat tolerance, in terms of critical WBGT (WBGT_crit), in unacclimatized young males and females in hot-dry (HD) and warm-humid (WH) environments. Eighteen subjects (9 M/9F; 21 ± 2 yr) were tested during exercise at 30% V̇O_2max in a controlled environmental chamber. Progressive heat stress exposures were performed with either (1) constant dry-bulb temperature (T_db) of 34 and 36 °C and increasing ambient water vapor pressure (P_a) (P_crit trials; WH); or (2) constant P_a of 12 and 16 mmHg and increasing T_db (T_crit trials; HD). Chamber T_db and P_a, and subject esophageal temperature (T_es), were continuously monitored throughout each trial. After a 30-min equilibration period, progressive heat stress continued until subject heat balance could no longer be maintained and a clear rise in T_es was observed. Absolute WBGT_crit and WBGT_crit adjusted to a metabolic rate of 300 W (WBGT₃₀₀), and the difference between WBGT_crit and occupational exposure limits (OEL; ΔOEL) was assessed. WBGT_crit, WBGT₃₀₀, and ΔOEL were higher in WH compared to HD (p < 0.0001) for females but were the same between environments for males (p ≥ 0.21). WBGT_crit was higher in females compared to males in WH (p < 0.0001) but was similar between sexes in HD (p = 0.44). When controlling for metabolic rate, WBGT₃₀₀ and ΔOEL were higher in males compared to females in WH and HD (both p < 0.0001). When controlling for sex, V̇O_2max was not associated with WBGT₃₀₀ or ΔOEL for either sex (r ≤ 0.12, p ≥ 0.49). These findings suggest that WBGT_crit is higher in females compared to males in WH, but not HD, conditions. Additionally, the WBGT_crit is lower in females, but not males, in HD compared to WH conditions.

Wet-Bulb Globe Temperature, Universal Thermal Climate Index, and Other Heat Metrics for US Counties, 2000-2020

Epidemiologic research on extreme heat consistently finds significant impacts on human morbidity and mortality. However, most of these analyses do not use spatially explicit measures of heat (typically assessing exposures at major cities using the nearest weather station), and they frequently consider only ambient temperature or heat index. The field is moving toward more expansive analyses that use spatially resolved gridded meteorological datasets and alternative assessments of heat, such as wet-bulb globe temperature (WBGT) and universal thermal climate index (UTCI), both of which require technical geoscientific skills that may be inaccessible to many public health researchers. To facilitate research in this domain, we created a database of population-weighted, spatially explicit daily heat metrics - including WBGT, UTCI, heat index, dewpoint temperature, net effective temperature, and humidex - for counties in the conterminous United States derived from the ERA5-Land gridded data set and using previously validated equations and algorithms. We also provide an R package to calculate these metrics, including gold-standard algorithms for estimating WBGT and UTCI, to facilitate replication.