Impacts of heatwaves on type 2 diabetes mortality in China: a comparative analysis between coastal and inland cities

The impacts of extreme temperatures on diabetes have been explored in previous studies. However, it is unknown whether the impacts of heatwaves appear variations between inland and coastal regions. This study aims to quantify the associations between heat exposure and type 2 diabetes mellitus (T2DM) deaths in two cities with different climate features in Shandong Province, China. We used a case-crossover design by quasi-Poisson generalized additive regression with a distributed lag model with lag 2 weeks, controlling for relative humidity, the concentration of air pollution particles with a diameter of 2.5 µm or less (PM2.5), and seasonality. The wet- bulb temperature (Tw) was used to measure the heat stress of the heatwaves. A significant association between heatwaves and T2DM deaths was only found in the coastal city (Qingdao) at the lag of 2 weeks at the lowest Tw = 14℃ (relative risk (RR) = 1.49, 95% confidence interval (CI): 1.11-2.02; women: RR = 1.51, 95% CI: 1.02-2.24; elderly: RR = 1.50, 95% CI: 1.08-2.09). The lag-specific effects were significant associated with Tw at lag of 1 week at the lowest Tw = 14℃ (RR = 1.14, 95% CI: 1.03-1.26; women: RR = 1.15, 95% CI: 1.01-1.31; elderly: RR = 1.15, 95% CI: 1.03-1.28). However, no significant association was found in Jian city. The research suggested that Tw was significantly associated with T2DM mortality in the coastal city during heatwaves on T2DM mortality. Future strategies should be implemented with considering socio-environmental contexts in regions.

How climate change degrades child health: A systematic review and meta-analysis

BACKGROUND

Children are more vulnerable than adults to climate-related health threats, but reviews examining how climate change affects human health have been mainly descriptive and lack an assessment of the magnitude of health effects children face. This is the first systematic review and meta-analysis that identifies which climate-health relationships pose the greatest threats to children.

OBJECTIVES

We reviewed epidemiologic studies to analyse various child health outcomes due to climate change and identify the relationships with the largest effect size. We identify population-specific risks and provide recommendations for future research.

METHODS

We searched four large online databases for observational studies published up to 5 January 2023 following PRISMA (systematic review) guidelines. We evaluated each included study individually and aggregated relevant quantitative data. We used quantitative data in our meta-analysis, where we standardised effect sizes and compared them among different groupings of climate variables and health outcomes.

RESULTS

Of 1301 articles we identified, 163 studies were eligible for analysis. We identified many relationships between climate change and child health, the strongest of which was increasing risk (60 % on average) of preterm birth from exposure to temperature extremes. Respiratory disease, mortality, and morbidity, among others, were also influenced by climate changes. The effects of different air pollutants on health outcomes were considerably smaller compared to temperature effects, but with most (16/20 = 80 %) pollutant studies indicating at least a weak effect. Most studies occurred in high-income regions, but we found no geographical clustering according to health outcome, climate variable, or magnitude of risk. The following factors were protective of climate-related child-health threats: (i) economic stability and strength, (ii) access to quality healthcare, (iii) adequate infrastructure, and (iv) food security. Threats to these services vary by local geographical, climate, and socio-economic conditions. Children will have increased prevalence of disease due to anthropogenic climate change, and our quantification of the impact of various aspects of climate change on child health can contribute to the planning of mitigation that will improve the health of current and future generations.

Heatwave-like events affect drone production and brood-care behaviour in bumblebees

Climate change is currently considered one of the major threats to biodiversity and is associated with an increase in the frequency and intensity of extreme weather events, such as heatwaves. Heatwaves create acutely stressful conditions that may lead to disruption in the performance and survival of ecologically and economically important organisms, such as insect pollinators. In this study, we investigated the impact of simulated heatwaves on the performance of queenless microcolonies of Bombus terrestris audax under laboratory conditions. Our results indicate that heatwaves can have significant impacts on bumblebee performance. However, contrary to our expectations, exposure to heatwaves did not affect survival. Exposure to a mild 5-day heatwave (30-32 °C) resulted in increased offspring production compared to those exposed to an extreme heatwave (34-36 °C) and to the control group (24 °C). We also found that brood-care behaviours were impacted by the magnitude of the heatwave. Wing fanning occurred occasionally at temperatures of 30-32 °C, whereas at 34-36 °C the proportion of workers engaged in this thermoregulatory behaviour increased significantly. Our results provide insights into the effects of heatwaves on bumblebee colony performance and underscore the use of microcolonies as a valuable tool for studying the effects of extreme weather events. Future research, especially field-based studies replicating natural foraging conditions, is crucial to complement laboratory-based studies to comprehend how heatwaves compromise the performance of pollinators. Such studies may potentially help to identify those species more resilient to climate change, as well as those that are most vulnerable.

The association of extreme environmental heat with incidence and outcomes of out-of-hospital cardiac arrest in British Columbia: A time series analysis

Background

The impact of extreme heat on out-of-hospital cardiac arrest (OHCA) incidence and outcomes is under-studied. We investigated OHCA incidence and outcomes over increasing temperatures.

Methods

We included non-traumatic EMS (Emergency Medical Services)-assessed OHCAs in British Columbia during the warm seasons of 2020-2021. We fit a time-series quasi-Poisson generalized linear model to estimate the association between temperature and incidence of both EMS-assessed, EMS-treated, and EMS-untreated OHCAs. Second, we employed a logistic regression model to estimate the association between "heatwave" periods (defined as a daily mean temperature > 99th percentile for ≥ 2 consecutive days, plus 3 lag days) with survival and favourable neurological outcomes (cerebral performance category ≤ 2) at hospital discharge.

Results

Of 5478 EMS-assessed OHCAs, 2833 were EMS-treated. OHCA incidence increased with increasing temperatures, especially exceeding a daily mean temperature of 25 °C Compared to the median daily mean temperature (16.9 °C), the risk of EMS-assessed (relative risk [RR] 3.7; 95%CI 3.0-4.6), EMS-treated (RR 2.9; 95%CI 2.2-3.9), and EMS-untreated (RR 4.3; 95%CI 3.2-5.7) OHCA incidence were higher during days with a temperature over the 99th percentile. Of EMS-treated OHCAs, during the heatwave (n = 179) and non-heatwave (n = 2654) periods, 4 (2.2%) and 270 (10%) survived and 4 (2.2%) and 241 (9.2%) had favourable neurological outcomes, respectively. Heatwave period OHCAs had decreased odds of survival (adjusted OR 0.28; 95%CI 0.10-0.79) and favourable neurological outcome (adjusted OR 0.31; 95%CI 0.11-0.89) at hospital discharge, compared to other periods.

Conclusion

Extreme heat was associated with a higher incidence of OHCA, and lower odds of survival and favourable neurological status at hospital discharge.

Uptake and cellular responses of Microcystis aeruginosa to PFOS in various environmental conditions

Although PFOS has been banned as a persistent organic pollutant, it still exists in large quantities within the environment, thus impacting the health of aquatic ecosystems. Previous studies focused solely on high PFOS concentrations, disregarding the connection with environmental factors. To gain a more comprehensive understanding of the PFOS effects on aquatic ecosystems amidst changing environmental conditions, this study investigated the cellular responses of Microcystis aeruginosa to varying PFOS concentrations under heatwave and nutrient stress conditions. The results showed that PFOS concentrations exceeding 5.0 µg/L had obvious effects on multiple physiological responses of M. aeruginosa, resulting in the suppression of algal cell growth and the induction of oxidative damage. However, PFOS concentration at levels below 20.0 µg/L has been found to enhance the growth of algal cells and trigger significant oxidative damage under heatwave conditions. Heatwave conditions could enhance the uptake of PFOS in algal cells, potentially leading to heightened algal growth when PFOS concentration was equal to or less than 5.0 µg/L. Conversely, deficiency or limitation of nitrogen and phosphorus significantly decreased algal abundance and chlorophyll content, inducing severe oxidative stress that could be mitigated by exposure to PFOS. This study holds significance in managing the impact of PFOS on algal growth across diverse environmental conditions.

Heatstroke presentations to urban hospitals during BC's extreme heat event: lessons for the future

BACKGROUND

Climate change is leading to more extreme heat events in temperate climates that typically have low levels of preparedness. Our objective was to describe the characteristics, treatments, and outcomes of adults presenting to hospitals with heatstroke during BC's 2021 heat dome.

METHODS

We conducted a review of consecutive adults presenting to 7 hospitals in BC's Lower Mainland. We screened the triage records of all patients presenting between June 25th and 30th, 2021 for complaints related to heat, and reviewed the full records of those who met heatstroke criteria. Our primary outcome was in-hospital mortality. We used Mann-Whitney U tests and logistic regression to investigate associations between patient and treatment factors and mortality.

RESULTS

Among 10,247 consecutive presentations to urban hospitals during the extreme heat event, 1.3% (139; 95% confidence intervals [CI] 1.1-1.6%) met criteria for heatstroke. Of heatstroke patients, 129 (90.6%) were triaged into the two highest acuity levels. Patients with heatstroke had a median age of 84.4 years, with 122 (87.8%) living alone, and 101 (84.2%) unable to activate 911 themselves. A minority (< 5, < 3.6%) of patients presented within 48 h of the onset of extreme heat. Most patients (107, 77.0%) required admission, and 11.5% (16) died in hospital. Hypotension on presentation was associated with mortality (odds ratio [OR] 5.3).

INTERPRETATION

Heatstroke patients were unable to activate 911 themselves, and most presented with a 48-h delay. This delay may represent a critical window of opportunity for pre-hospital and hospital systems to prepare for the influx of high-acuity resource-intensive patients.

Dynamic changes in bacterial communities in three species of corals during the 2017 bleaching event in subtropical Hong Kong waters

Bacteria play important roles in coral health, yet little is known about the dynamics of coral-associated bacterial communities during coral bleaching. Here, we reported the dynamic changes of bacterial communities in three scleractinian corals (Montipora peltiformis, Pavona decussata and Platygyra carnosa) during and after bleaching through amplicon sequencing. Our results revealed that the bacterial composition and dominant bacteria varied among the three coral species. The higher susceptibility of M. peltiformis to bleaching corresponded to a lower bacterial community diversity, and the dominant Synechococcus shifted in abundance during the bleaching and coral recovery phases. The resilient P. decussata and P. carnosa had higher bacterial diversity and a more similar bacterial composition between the healthy and bleached conditions. Overall, our study reveals the dynamic changes in coral-associated microbial diversity under different conditions, contributing to explaining the differential susceptibility of corals to extreme climate conditions.

Heatwave characteristics complicate the association between PM2.5 components and schizophrenia hospitalizations in a changing climate: Leveraging of the individual residential environment

BACKGROUND

In the era characterized by global environmental and climatic changes, understanding the effects of PM2.5 components and heatwaves on schizophrenia (SCZ) is essential for implementing environmental interventions at the population level. However, research in this area remains limited, which highlights the need for further research and effort. We aim to assess the association between exposure to PM2.5 components and hospitalizations for SCZ under different heatwave characteristics.

METHODS

We conducted a 16 municipalities-wide, individual exposure-based, time-stratified, case-crossover study from January 1, 2017, to December 31, 2020, encompassing 160736 hospitalizations in Anhui Province, China. Daily concentrations of PM2.5 components were obtained from the Tracking Air Pollution in China dataset. Conditional logistic regression models were used to investigate the association between PM2.5 components and hospitalizations. Additionally, restricted cubic spline models were used to identify protective thresholds of residential environment in response to environmental and climate change.

RESULTS

Our findings indicate a positive correlation between PM2.5 and its components and hospitalizations. Significantly, a 1 μg/m3 increase in black carbon (BC) was associated with the highest risk, at 1.58% (95%CI: 0.95-2.25). Exposure to heatwaves synergistically enhanced the impact of PM2.5 components on hospitalization risks, and the interaction varied with the intensity and duration of heatwaves. Under the 99th percentile heatwave events, the impact of PM2.5 and its components on hospitalizations was most pronounced, which were PM2.5 (2-4d: 4.59%, 5.09%, and 5.09%), sulfate (2-4d: 21.73%, 23.23%, and 25.25%), nitrate (2-4d: 17.51%, 16.93%, and 20.31%), ammonium (2-4d: 27.49%, 31.03%, and 32.41%), organic matter (2-4d: 32.07%, 25.42%, and 24.48%), and BC (2-4d: 259.36%, 288.21%, and 152.52%), respectively. Encouragingly, a protective effect was observed when green and blue spaces comprised more than 17.6% of the residential environment.

DISCUSSION

PM2.5 components and heatwave exposure were positively associated with an increased risk of hospitalizations, although green and blue spaces provided a mitigating effect.

Tissue-specific transcriptional response of post-larval clownfish to ocean warming

Anthropogenically driven climate change is predicted to increase average sea surface temperatures, as well as the frequency and intensity of marine heatwaves in the future. This increasing temperature is predicted to have a range of negative physiological impacts on multiple life-stages of coral reef fish. Nevertheless, studies of early-life stages remain limited, and tissue-specific transcriptomic studies of post-larval coral reef fish are yet to be conducted. Here, in an aquaria-based study we investigate the tissue-specific (brain, liver, muscle, and digestive tract) transcriptomic response of post-larval (20 dph) Amphiprion ocellaris to temperatures associated with future climate change (+3 °C). Additionally, we utilized metatranscriptomic sequencing to investigate how the microbiome of the digestive tract changes at +3 °C. Our results show that the transcriptional response to elevated temperatures is highly tissue-specific, as the number of differentially expressed genes (DEGs) and gene functions varied amongst the brain (102), liver (1785), digestive tract (380), and muscle (447). All tissues displayed DEGs associated with thermal stress, as 23 heat-shock protein genes were upregulated in all tissues. Our results indicate that post-larval clownfish may experience liver fibrosis-like symptoms at +3 °C as genes associated with extracellular matrix structure, oxidative stress, inflammation, glucose transport, and metabolism were all upregulated. We also observe a shift in the digestive tract microbiome community structure, as Vibrio sp. replace Escherichia coli as the dominant bacteria. This shift is coupled with the dysregulation of various genes involved in immune response in the digestive tract. Overall, this study highlights post-larval clownfish will display tissue-specific transcriptomic responses to future increases in temperature, with many potentially harmful pathways activated at +3 °C.

Impacts of compounding drought and heatwave events on child mental health: insights from a spatial clustering analysis

BACKGROUND

Concurrent heatwave and drought events may have larger health impacts than each event separately; however, no US-based studies have examined differential mental health impacts of compound drought and heatwave events in pediatric populations.

OBJECTIVE

To examine the spatial patterns of mood disorders and suicide-related emergency department (ED) visits in children during heatwave, drought, and compound heatwave and drought events. We tested whether the occurrence of compound heatwave and drought events have a synergistic (multiplicative) effect on the risk of mental health related outcomes in children as compared to the additive effect of each individual climate hazard. Lastly, we identified household and community-level determinants of geographic variability of high psychiatric burden.

METHODS

Daily counts of psychiatric ED visits in North Carolina from 2016 to 2019 (May to Sept) for pediatric populations were aggregated at the county scale. Bernoulli cluster analyses identified high-risk spatial clusters of psychiatric morbidity during heatwave, drought, or compound heatwave and drought periods. Multivariate adaptive regression models examined the individual importance of household and community-level determinants in predicting high-risk clustering of mood disorders or suicidality across the three climate threats.

RESULTS

Results showed significant spatial clustering of suicide and mood disorder risks in children during heatwave, drought, and compound event periods. Periods of drought were associated with the highest likelihood of spatial clustering for suicide and mood disorders, where the risk of an ED visit was 4.48 and 6.32 times higher, respectively, compared to non-drought periods. Compounding events were associated with a threefold increase in both suicide and mood disorder-related ED visits. Community and household vulnerability factors that most contributed to spatial clustering varied across climate hazards, but consistent determinants included residential segregation, green space availability, low English proficiency, overcrowding, no broadband access, no vehicle access, housing vacancy, and availability of housing units.

CONCLUSION

Findings advance understanding on the locations of vulnerable pediatric populations who are disproportionately exposed to compounding climate stressors and identify community resilience factors to target in public health adaptation strategies.

Heatwave exposure in relation to decreased sleep duration in older adults

Few studies have delved into the effects of heatwaves on sleep duration loss among older adults. Our study examined correlations between heatwave exposure and sleep duration reductions in this demographic. Utilizing data of 7,240 older adults drawn from the China Health and Retirement Longitudinal Study (CHARLS) from 2015 to 2018, we assessed sleep duration differences between the baseline year (2015) and follow-up year (2018). Absolute reductions in sleep duration were defined as differences of ≥ 1, 1.5, or 2 h. Changes in sleep duration were categorized based on cut-offs of 5 and 8 h, including excessive decrease, moderate to short and persistent short sleep duration types. 12 heatwave definitions combining four thresholds (90th, 92.5th, 95th, and 97.5th percentiles of daily minimum temperature) and three durations (≥2, ≥3 and ≥ 4 days) were used. Heatwave exposure was determined by the difference in the number of 12 preceding months' heatwave days or events in 2015 and the number of 12 preceding months' heatwave days or events in 2018. The results showed that increased heatwave events (defined as ≥ P90th percentile & lasting three days) were associated with a higher likelihood of ≥ 1-hour sleep reduction and persistent short sleep duration. An increase in heatwave event (defined as ≥ P95th percentile & lasting three days) was linked to shifts from moderate to short sleep duration. For the association between an absolute reduction in sleep duration and heatwave exposure, while higher thresholds signified greater sleep reduction risks, the effect estimates of longer durations were not uniformly consistent. We observed that air pollution and green space modified the relationship between heatwaves and sleep duration. Females, urban residents, and individuals with chronic diseases were identified as vulnerable populations. This study found that increased heatwave exposure was associated with a higher risk of sleep duration loss in older adults.

Increase in summertime ambient temperature is associated with decreased sick leave risk in Helsinki, Finland

OBJECTIVES

Climate change has increased attention to the health effects of high ambient temperatures and heatwaves worldwide. Both cause-specific mortality and hospital admissions are studied widely, mainly concentrating on warmer climates, but studies focusing on more subtle health effects and cold climates lack. This study investigated the effect of summertime daily ambient temperatures and heatwaves on sick leaves in the employed population in Helsinki, Finland, a Nordic country with a relatively cold climate.

METHODS

We obtained from the City of Helsinki personnel register data on sick leaves for the summer months (June-August) of 2002-2017. We estimated the overall cumulative association of all and short (maximum 3-day) sick leaves with daily mean temperature over a 21-day lag period using a negative binomial regression model coupled with a penalized distributed lag non-linear model (penalized DLNM). The association of sick leaves with heatwaves (cut-off temperature 20.8 °C), and prolonged heatwaves, was estimated using a negative binomial regression model coupled with DLNM. We adjusted the time series model for potential confounders, such as air pollution, relative humidity, time trends, and holidays.

RESULTS

Increasing daily temperature tended to be associated with decreased overall cumulative risk of sick leaves and short sick leaves over a 21-day lag period. In addition, heatwaves and prolonged heatwaves were associated with decreased overall cumulative risk of sick leaves compared to all other summer days: RR 0.87 (95 % CI 0.78 to 0.97) and RR 0.83 (95 % CI 0.70 to 0.98), respectively.

CONCLUSIONS

This research suggests that summertime daily temperatures that are high for this northern location have protective effects on the health of the working population.

A novel optimized model based on NARX networks for predicting thermal anomalies in Polish lakes during heatwaves, with special reference to the 2018 heatwave

In 2018, Europe experienced one of the most severe heatwaves ever recorded. This extreme event's impact on lake surface water temperature (LSWT) in Polish lakes has largely remained unknown. In this study, the impact of the 2018 European heatwave on LSWT in 24 Polish lakes was investigated based on a long-term observed dataset (1987-2020). To capture the LSWT dynamics during the heatwave period and reproduce lake heatwaves, a novel BO-NARX-BR model was developed and evaluated. This model combines the capabilities of the Nonlinear Autoregressive network with Exogenous Inputs (NARX) neural network, the Bayesian Optimization (BO) algorithm for optimizing the number of NARX hidden nodes and lagged input/target values, and the Bayesian Regularization (BR) backpropagation algorithm for the NARX training. The results showed that from April to October 2018, the mean and maximum LSWTs were 2.35 and 3.38 °C warmer than the base-period average (1987-2010) due to the impact of the extreme heatwave. The NARX-based model outperformed another widely used model called air2water in calibration and validation periods. The results also revealed that the BO-NARX-BR model produced significantly better results in capturing lake heatwaves, with computed duration and intensity of lake heatwaves close to the in-situ data. Additionally, LSWT anomaly significantly impacted the duration and intensity of heatwaves that occurred in lakes. Extreme climatic events are gaining increasing importance for the functioning of various elements of the hydrosphere. Such a situation encourages the search for more accurate methods and tools for their prediction. The model applied in the paper corresponds with these assumptions, and its good performance allows for its adaptation to lakes in other regions.

The effects of heatwave on cognitive impairment among older adults: Exploring the combined effects of air pollution and green space

The association between heatwaves and cognitive impairment in older adults, especially the joint effect of air pollution and green space on this association, remains unknown. The present cohort study used data from waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS) from 2008 to 2018. Heatwaves were defined as having daily maximum temperature ≥ 92.5th, 95th and 97.5th percentile that continued at least two, three and four days, measured as the one-year heatwave days prior to the participants' incident cognitive impairment. Data on the annual average air pollutant concentrations of fine particulate matter (PM2.5) and ozone (O3) as well as green space exposure (according to the Normalized Difference Vegetation Index (NDVI)) were collected. Time-varying Cox proportional hazards models were constructed to examine the independent effect of heatwaves on cognitive impairment and the combined effect of heatwaves, air pollution, and green space on cognitive impairment. Potential multiplicative interactions were examined by adding a product term of air pollutants and NDVI with heatwaves in the models. The relative excess risk due to interaction (RERI) was calculated to reflect additive interactions. We found that heatwave exposure was associated with higher risks of cognitive impairment, with hazard ratios (HRs) and 95 % confidence intervals (CIs) ranging from 1.035 (95 % CI: 1.016-1.055) to 1.058 (95 % CI: 1.040-1.075). We observed a positive interaction of PM2.5 concentrations, O3 concentrations, lack of green space, and heatwave exposure on a multiplicative scale (HRs for product terms >1). Furthermore, we found a synergistic interaction of PM2.5 concentrations, O3, lack of green space, and heatwave exposure on an additive scale, with RERIs >0. These results suggest that extreme heat exposure may be a potential risk factor for cognitive impairment in older adults. Additionally, coexposure to air pollution and lack of green space exacerbated the adverse effects of heatwaves on cognitive function.

The association of heatwave with drowning mortality in five provinces of China

Drowning is a serious public health problem in the world. Several studies have found that ambient temperature is associated with drowning, but few have investigated the effect of heatwave on drowning. This study aimed to explore the associations between heatwave and drowning mortality, and further estimate the mortality burden of drowning attributed to heatwave in China. Drowning mortality data were collected in 71 prefectures in China during 2013-2018 from provincial vital register system. Meteorological data at the same period were collected from European Centre for Medium-Range Weather Forecasts (ECMWF). A distributed lag non-linear model (DLNM) was first to explore the association between heatwave and drowning mortality in each prefecture. Secondly, the prefecture-specific associations were pooled using meta-analysis. Finally, attributable fractions (AFs) of drowning deaths caused by heatwave were estimated. Compared to normal day, the mortality risk of drowning significantly increased during heatwave (RR = 1.20, 95%CI: 1.18-1.23). Higher risks were observed in males (RR = 1.23, 95%CI: 1.20-1.27) than females (RR = 1.18, 95%CI: 1.13-1.23), in children aged 5-14 years old (RR = 1.24, 95%CI: 1.15-1.33) than other age groups, in urban city (RR = 1.32, 95%CI: 1.28-1.36) than rural area (RR = 1.09, 95%CI: 1.07-1.12) and in Jilin province (RR = 2.85, 95%CI: 1.61-5.06) than other provinces. The AF of drowning deaths due to heatwave was 11.4 % (95%CI: 10.0 %-12.9 %) during heatwave and 1.0 % (95%CI: 0.9 %-1.1 %) during study period, respectively. Moreover, the AFs during study period were higher for male (1.2 %, 95%CI: 1.0 %-1.3 %), children 5-14 years (1.1 %, 95%CI: 0.7 %-1.6 %), urban city (1.6 %, 95%CI: 1.4 %-1.8 %) than their correspondents. These differences were also observed in AFs during heatwave. We found that heatwave may significantly increase the mortality risk of drowning mortality, and its mortality burden attributable to heatwave was noteworthy. Targeted intervention should be carried out to decrease drowning mortality during heatwave.

Global warming and heat wave risks for cardiovascular diseases: A position paper from the Portuguese Society of Cardiology

Global warming is a result of the increased emission of greenhouse gases. The consequences of this climate change threaten society, biodiversity, food and resource availability. The consequences include an increased risk of cardiovascular (CV) disease and cardiovascular mortality. In this position paper, we summarize the data from the main studies that assess the risks of a temperature increase or heat waves in CV events (CV mortality, myocardial infarction, heart failure, stroke, and CV hospitalizations), as well as the data concerning air pollution as an enhancer of temperature-related CV risks. The data currently support global warming/heat waves (extreme temperatures) as cardiovascular threats. Achieving neutrality in emissions to prevent global warming is essential and it is likely to have an effect in the global health, including the cardiovascular health. Simultaneously, urgent steps are required to adapt the society and individuals to this new climatic context that is potentially harmful for cardiovascular health. Multidisciplinary teams should plan and intervene healthcare related to temperature changes and heat waves and advocate for a change in environmental health policy.

Analysis of heatwaves based on the universal thermal climate index and apparent temperature over mainland Southeast Asia

Heatwaves have caused significant damage to human health, infrastructure, and economies in recent decades, and the occurrences of heatwaves are becoming more frequent and severe across the globe under climate change. The previous studies on heatwaves have primarily focused on air temperature, neglecting other variables like wind speed, relative humidity, and radiation, which could lead to a serious underestimation of the adverse effects of heatwaves. To address this issue, this study proposed to the use of more sophisticated thermal indices, such as universal thermal climate index (UTCI) and apparent temperature (AT), to define heatwaves and carry out a comprehensive heatwave assessment over mainland southeast Asia (MSEA) from 1961 to 2020. The traditional temperature-based method was also compared. The results of the study demonstrate that the annual maximum temperature in heatwave days (HWA) and the annual average temperature in heatwave days (HWM) are significantly underestimated if only air temperature is considered. However, UTCI and AT tend to predict a lower frequency of yearly heatwave occurrences and shorter durations. Trend analysis indicates a general increase in heatwave occurrences across MSEA under all thermal indices in the past six decades, particularly in the last 30 years. This study's approach and findings provide a holistic view of heatwave characteristics based on thermal indices and highlight the risk of intensified heat stress during heatwaves in MSEA.

Evolution of surface ozone pollution pattern in eastern China and its relationship with different intensity heatwaves

With climate warming, eastern China has experienced a significant increase in temperature accompanied by intensified ozone pollution. We aimed to investigate the spatiotemporal patterns and relationships between ozone levels and temperature in eastern China using observation-based ozone data from 418 air quality monitoring stations and temperature data from ERA5. The summer maximum temperature and annual ozone concentration in eastern China increased significantly between 2015 and 2022, with increases rate of 10% and 2.84 μg/m3 yr-1, respectively. The baseline ozone concentration was increasing over time. The average difference in MDA8 O3 concentration in spring, summer, and autumn decreased, with more ozone pollution spreading into spring and autumn, indicating a trend of prolonging the ozone season. During the June-July-August (JJA) period of 2015-2022, heatwaves increased significantly in eastern China. The frequency of heatwave events >10 days played a vital role in exacerbating ozone pollution. During the JJA period, the increase rate in MDA8 O3 concentration was 9.31 μg/m3 yr-1 during heatwave periods, significantly higher than that during non-heatwave periods (4.01 μg/m3 yr-1). The correlation between MDA8 O3 concentration and temperature was as high as 0.99, indicating that temperature was vital in ozone formation during the JJA period in eastern China. This study suggests that more stringent actions are needed to control ozone-precursor compounds during frequent summertime heatwaves in eastern China.

Evaluation of species thermal sensitivity with individual-based physiological performance

Ignoring intraspecific variations can prevent us from accurately assessing species' thermal sensitivity to global warming. Individual-based physiological performance provides a feasible solution to depict species' thermal sensitivity using a bottom-up approach. We measured the cardiac performance of intertidal bivalves (1159 individuals from multiple populations of six bivalves), determined the upper thermal limit of each individual, calculated the proportions of individuals suffering sublethal/lethal heat stress, and mapped sensitive regions to high temperatures. Results showed that high inter-individual variations of physiological performance existed in levels of populations and species, and species' thermal sensitivity was positively related to the intraspecific variations of heat tolerance. This bottom-up approach scaled up from individual, population to species emphasizes the importance of individual-based physiology performance in assessing thermal sensitivity across different hierarchical levels and enables better evaluating and forecasting of species responses to global warming.

Descriptive analysis of occupational accidents in Spain and their relationship with heatwaves

OBJECTIVE

The purpose of this work is to carry out a descriptive analysis of occupational accidents and to evaluate the relationship between heatwaves and work accidents in Spain's three most populated provinces: Madrid, Barcelona and Valencia.

METHODS

Daily data of work accidents (including for each case: gender, age, date, length of time in the position, type of work, place of accident and duration of medical leave) was collected. A heatwave was defined when daily mean temperatures above the threshold (95th percentile) of the climatological period (1990-2021) were recorded for at least three consecutive days. To estimate the association between daily workplace accidents and heatwave events, we applied a Generalized Additive Model combined with a Distributed Lag Non-linear Model with a quasi-Poisson distribution.

RESULTS

The average annual accident rate was 33.2 work accidents/100,000 employees in Madrid, 35.8 work accidents/100,000 employees in Barcelona and 31.8 work accidents/100,000 employees in Valencia. The total accident rates followed a downward trend between 2005 and 2021. The difference in work accident rates between sex decreased over the studied period (p < 0.005). In the first month of work, the highest casualty rate occurs among construction workers in Madrid and Barcelona, and in primary sector workers in Valencia. Work accidents tend to increase during heatwaves. The highest risk was recorded when considering a cumulative lagged effect of 3 days in Madrid and Barcelona and 5 days in Valencia.

CONCLUSIONS

Since work accidents increase during heatwaves, risk prevention services and public administrations must take special measures to prevent them.

Immediate and delayed effects of a heatwave and Prorocentrum lima ((Ehrenberg) Stein 1878) bloom on the toxin accumulation, physiology, and survival of the oyster Magallana gigas (Thunberg, 1793)

Warming could facilitate the intensification of toxic algal blooms, two important stressors for marine organisms that are predicted to co-occur more frequently in the future. We investigated the immediate and delayed effects of a heatwave and a simulated bloom (3 × 106 cells L-1) of the diarrhetic shellfish toxin (DST)-producing benthic dinoflagellate Prorocentrum lima on the survival, physiology (oxygen consumption rate, condition index, immune parameters), and toxin accumulation in the Pacific rock oyster Magallana (Crassostrea) gigas. Oysters exposed to both stressors contained higher mean DST concentrations (mean ± 1 SE: 173.3 ± 19.78 μg kg-1 soft tissue) than those exposed to P. lima bloom alone (120.4 ± 20.90 μg kg-1) and exceeded the maximum permitted levels for human consumption. Exposure to individual stressors and their combination modified the physiology of M. gigas. Oysters exposed to heatwave alone had significantly higher oxygen consumption rates (0.7 ± 0.06 mg O2 h-1 g-1) than the control (0.3 ± 0.06 mg O2 h-1 g-1). However, this was not observed in oysters exposed to both heatwave and P. lima (0.5 ± 0.06 mg O2 h-1 g-1). This alteration of the metabolic response to warming in the presence of P. lima may affect the ability of rock oysters to adapt to environmental stressors (i.e., a heatwave) to ensure survival. Immunomodulation, through changes in total hemocyte count, was observed in oysters exposed to P. lima alone and in combination with warming. Individual stressors and their combination did not influence the condition index, but one mortality was recorded in oysters exposed to both stressors. The findings of this study highlight the vulnerability of rock oysters to the predicted increased frequency of heatwaves and toxic algal blooms, and the increased likelihood of shellfish containing higher than regulatory levels of DST in warming coasts.

Analysis of heatwave characteristics under climate change over three highly populated cities of South India: a CMIP6-based assessment

Climate change is arguably the most alarming global concern of the twenty-first century, particularly due to the increased frequency of meteorological extremes, e.g., heatwaves, droughts, and floods. Heatwaves are considered a potential health risk and urge further study, robust preparedness, and policy framing. This study presents an analysis of heatwave characteristics for historical (1980-2014), near-future (2021-2055), and far-future (2056-2090) scenarios over three highly populated cities of South India, i.e., Bangalore, Chennai, and Hyderabad. Two different approaches, i.e., the India Meteorological Department (IMD) criterion and the percentile-based criterion, are considered for defining the threshold of a heatwave day. Nine general circulation models (GCMs) from the Coupled Model Inter-comparison Project phase 6 (CMIP6) experiment are selected, evaluated after bias correction, and the best performer was utilized to obtain the temperature projections corresponding to two shared socioeconomic pathways (SSP 2-4.5 and 5-8.5) for the future periods. The results reveal a high frequency of heatwave days over the cities in recent years from both approaches, which may further exacerbate in the future, thereby putting a large population at risk. The number of heatwave days is much higher for SSP5-8.5 than that for SSP2-4.5, depicting the direct effects of anthropogenic activities on the frequency of heatwaves. The detailed analysis of heatwave projections will help develop equitable heat resilient mitigation and adaptation strategies for the future, thereby alleviating their pernicious impacts.

Evaluating the Applicability and Health Benefits of the Graded Heat Health Risk Early Warning Model - Jinan City, Shandong Province, China, 2022

What is already known about this topic?

The heat health early warning model serves as an effective strategy for reducing health risks related to heatwaves and improving population adaptability. Several high-income countries have taken the lead in conducting research and implementing measures aimed at safeguarding their populations.

What is added by this report?

The graded heat health risk early warning model (GHREWM) in Jinan City has demonstrated efficacy in safeguarding males, females, individuals aged above 75 years, and those with cardiopulmonary diseases. During the summer of 2022, the warning stage of GHREWM contributed to the prevention of 10.9 deaths per million individuals, concurrently averting health-related economic losses estimated at approximately 227 million Chinese Yuan (CNY).

What are the implications for public health practice?

The GHREWM has the potential to enhance cities' adaptability to climate change. It is crucial to incorporate additional adverse health endpoint data in the development of early warning models, as this will improve their applicability and protective efficacy.

Surviving high temperatures: a case study of the spotted munia (Lonchura punctulata)

Every year, a combination of summer with extreme weather events such as "heatwaves" affects the life of organisms on earth. Previous studies on humans, rodents, and some birds signify the impact of heat stress on their survival and existence. Over the past four decades, the frequency of heatwaves has increased because of global warming. Therefore, we performed a longitudinal study on a resident bird species, the spotted munia (Lonchura punctulata) by simulating a heatwave-like condition. We were interested in understanding how a Passeriformes native to a sub-tropical country deals with heatwave-like conditions. Initially, the birds were subjected to room temperature (25 ± 2 °C; T1) for 10 days, followed by a simulated heatwave-like condition (42 ± 1 °C; T2) for 7 days and again back to room temperature (25 ± 2 °C; RT1) for the next 7 days. To elucidate how birds cope with simulated heatwave conditions, we examined different behavioral and physiological parameters. We found that although heat stress significantly reduced total activity counts and food intake but, the body mass, blood glucose, and hemoglobin levels remained unaffected by any of the temperature conditions. Furthermore, HSP70 and biochemical markers of liver injuries such as ALP, AST, ALT, bilirubin direct, and bilirubin total were found elevated in response to the simulated heatwave-like condition, whereas uric acid and triglyceride were reduced. Creatinine and total protein levels were unaffected by the heatwave. The post heatwave treatment resulted in a rebound of the behavioral and physiological responses, but the recovered responses were not equivalent to the pre-heatwave levels (T1 conditions). Thus, the present study demonstrates heatwave-associated behavioral and physiological changes in a resident passerine finch which has tremendous physiological flexibility.

Evolution of the local climate in Montreal and Ottawa before, during and after a heatwave and the effects on urban heat islands

The heatwave event to which the Ontario-Quebec area was subjected in 2018 resulted in significant morbidity and mortality. In this study, an investigation was conducted on how this heatwave affected the respective urban heat islands (UHIs) in Montreal and Ottawa. The modelled urban climates were compared before, during and after the heatwave using a Weather Research and Forecast (WRF) model having a 1 km spatial resolution. The UHI was calculated using two methods. As a first method, the "rural-ring" method was used to calculate the UHI in regard to temperature differences between urban and surrounding rural areas. The second method used the "urban-increment" approach where simulation results were compared to another simulation in which urban cells are replaced by croplands. Results show that urban land can raise temperatures by up to 12 °C at surfaces and 6 °C in the near-surface air. A synoptic anticyclone in the lower atmosphere was responsible for the heatwave, although both cities were located in areas peripheral to the anticyclone. During the heatwave, precipitation at the initial stage of the event and low wind conditions largely varied the pattern of the UHI effect within each urban center. The UHI was generally unchanged or even reduced during this heatwave, but there was substantial diurnal variation. Around noon and in the afternoon, the UHI was amplified by up to 3 °C, whereas it was suppressed or even negative at sunrise.

Effect of the historic Spanish heatwave over glycemic control in adult patients with type 1 diabetes

AIM

To evaluate the effect of the historic Spanish heatwave (9th-26th July 2022) over glycemic control in adults with type 1 diabetes (T1D).

METHODS

Cross-sectional retrospective analysis of adult patients with T1D in Castilla-La Mancha (south-central Spanish region) using intermittently scanned continuous glucose monitoring (isCGM) during and after the heatwave. Primary outcome was change in time in range (TIR) 3.0-10 mmol/L (70-180 mg/dL) of interstitial glucose in the two weeks following the heatwave.

RESULTS

A total of 2701 T1D patients were analyzed. We detected a TIR reduction of 4.0 % (95 % CI -3.4, -4.6; P < 0.001) in the two weeks following the heatwave. Patients in the highest daily scan frequency quartile (>13 scans/day) during the heatwave showed the greatest deterioration in TIR after it concluded (-5.4 % [95 % CI -6.5, -4.3; P < 0.001]). The percentage of patients meeting all the recommendations of the International Consensus of Time in Range was greater during the heatwave than after it ended (10.6 % vs. 8.4 %, P < 0.001).

CONCLUSIONS

Adults with T1D had better glycemic control during the historic Spanish heatwave compared to the following period.

Mortality, metabolic rate, and oviposition of Gryllus (Gryllus) assimilis (Fabricius, 1775) (Orthoptera: Gryllidae) females under constant and fluctuating warm temperatures

The global average temperature will increase by up to 5.7 °C, under high greenhouse gas emissions, consequently increasing the frequency of heatwaves, according to recent IPCC forecasts. These especially impacts ectotherms, such as insects, which are the most susceptible animals to changes in environmental temperature, affecting their physiology and reproduction. Thus, we investigated the effects of a 96-h exposure to constant temperatures (CT: 27, 30.5, 34, 39, 41, or 43 °C) and fluctuating temperatures (FT: 27/34 °C, 12/12 h) on the survival, metabolic rate, and oviposition of the female cricket Gryllus (Gryllus) assimilis (Orthoptera: Gryllidae). Mortality, body mass and water content of females and males were quantified and compared. It was found that CT₂₇, CT₃₄ and FT_27/34 do not cause mortality in females of G. (G.) assimilis. CT_30.5 (average temperature between 27 and 34), despite causing mortality of 5.0 ± 3.5%, do not differ from CT₂₇, CT₃₄ or FT_27/34. CT₃₉ causes a mortality of 8.3 ± 5.5%. Estimated lethal temperature for 50% of the population of females (LT_50Temp) is 40 °C, and 43 °C promotes 100% mortality in 96 h. Comparing mortality between sexes, females present higher LT_50Temp and thermotolerance than males. In addition, FT_27/34 and CT₃₄ do not differ in the metabolic rate, but both have higher values than CT₂₇. CT₃₄ strongly reduces oviposition in females, however FT_27/34 does not. We suggest that CT₃₄ reduces oviposition in females in two ways: by affecting the endocrine system related to egg production, or by causing behavioral egg retention, as a strategy to survive thermal stress. Moreover, females had a higher wet body mass and present a lower average weight loss than males. In conclusion, despite females present a higher mortality at temperatures above 39 °C, they are more thermotolerant than males. Furthermore, CT₃₄ is detrimental to the oviposition of G. (G.) assimilis.

Effects of high temperatures and heatwaves on dengue fever: a systematic review and meta-analysis

BACKGROUND

Studies have shown that dengue virus transmission increases in association with ambient temperature. We performed a systematic review and meta-analysis to assess the effect of both high temperatures and heatwave events on dengue transmission in different climate zones globally.

METHODS

A systematic literature search was conducted in PubMed, Scopus, Embase, and Web of Science from January 1990 to September 20, 2022. We included peer reviewed original observational studies using ecological time series, case crossover, or case series study designs reporting the association of high temperatures and heatwave with dengue and comparing risks over different exposures or time periods. Studies classified as case reports, clinical trials, non-human studies, conference abstracts, editorials, reviews, books, posters, commentaries; and studies that examined only seasonal effects were excluded. Effect estimates were extracted from published literature. A random effects meta-analysis was performed to pool the relative risks (RRs) of dengue infection per 1 °C increase in temperature, and further subgroup analyses were also conducted. The quality and strength of evidence were evaluated following the Navigation Guide systematic review methodology framework. The review protocol has been registered in the International Prospective Register of Systematic Reviews (PROSPERO).

FINDINGS

The study selection process yielded 6367 studies. A total of 106 studies covering more than four million dengue cases fulfilled the inclusion criteria; of these, 54 studies were eligible for meta-analysis. The overall pooled estimate showed a 13% increase in risk of dengue infection (RR = 1.13; 95% confidence interval (CI): 1.11-1.16, I² = 98.0%) for each 1 °C increase in high temperatures. Subgroup analyses by climate zones suggested greater effects of temperature in tropical monsoon climate zone (RR = 1.29, 95% CI: 1.11-1.51) and humid subtropical climate zone (RR = 1.20, 95% CI: 1.15-1.25). Heatwave events showed association with an increased risk of dengue infection (RR = 1.08; 95% CI: 0.95-1.23, I² = 88.9%), despite a wide confidence interval. The overall strength of evidence was found to be "sufficient" for high temperatures but "limited" for heatwaves. Our results showed that high temperatures increased the risk of dengue infection, albeit with varying risks across climate zones and different levels of national income.

INTERPRETATION

High temperatures increased the relative risk of dengue infection. Future studies on the association between temperature and dengue infection should consider local and regional climate, socio-demographic and environmental characteristics to explore vulnerability at local and regional levels for tailored prevention.

FUNDING

Australian Research Council Discovery Program.

Heatwave and mental health

Physical health has been associated with ambient temperature and heatwave. With the frequent occurrence of heatwave, the adaptive effects and mechanisms on mental health remain uncertain. On the basis of the China Health and Nutrition Survey, we estimated the relationship between heatwaves and self-assessed mental health scores in the Chinese population aged 50 and above. This study has identified that with each additional heatwave event, mental health scores decreased by an average of 0.027 points, which is equivalent to 0.3% of the average level. Heat is more likely to affect groups with low education, no medical insurance, and living in rural areas. In mechanistic exploration, we found that stress emotion is a fully mediating effect. Heat led to reduced health activities and more frequent drinking, which may lead to lower psychological well-being. Moreover, good dietary preference is a regulator that can help mitigate the adverse effects of heat on mental health. This study corroborates the impact of heat on spiritual welfare, and demonstrates the mechanisms and channels of impact, which can help reduce global economic losses due to mental health problems.

Impacts of rising temperatures and water acidification on the oxidative status and immune system of aquatic ectothermic vertebrates: A meta-analysis

Species persistence in the Anthropocene is dramatically threatened by global climate change. Large emissions of carbon dioxide (CO₂) from human activities are driving increases in mean temperature, intensity of heatwaves, and acidification of oceans and freshwater bodies. Ectotherms are particularly sensitive to CO₂-induced stressors, because the rate of their metabolic reactions, as well as their immunological performance, are affected by environmental temperatures and water pH. We reviewed and performed a meta-analysis of 56 studies, involving 1259 effect sizes, that compared oxidative status or immune function metrics between 42 species of ectothermic vertebrates exposed to long-term increased temperatures or water acidification (≥48 h), and those exposed to control parameters resembling natural conditions. We found that CO₂-induced stressors enhance levels of molecular oxidative damages in ectotherms, while the activity of antioxidant enzymes was upregulated only at higher temperatures, possibly due to an increased rate of biochemical reactions dependent on the higher ambient temperature. Differently, both temperature and water acidification showed weak impacts on immune function, indicating different direction (increase or decrease) of responses among immune traits. Further, we found that the intensity of temperature treatments (Δ°C) and their duration, enhance the physiological response of ectotherms, pointing to stronger effects of prolonged extreme warming events (i.e., heatwaves) on the oxidative status. Finally, adult individuals showed weaker antioxidant enzymatic responses to an increase in water temperature compared to early life stages, suggesting lower acclimation capacity. Antarctic species showed weaker antioxidant response compared to temperate and tropical species, but level of uncertainty in the antioxidant enzymatic response of Antarctic species was high, thus pairwise comparisons were statistically non-significant. Overall, the results of this meta-analysis indicate that the regulation of oxidative status might be one key mechanism underlying thermal plasticity in aquatic ectothermic vertebrates.

Combined effects of heatwaves and air pollution, green space and blue space on the incidence of hypertension: A national cohort study

Extreme heat exposure has been associated with hypertension. However, its interactive influences with air pollution, green and blue spaces are unclear. This study aimed to explore the interaction between heatwaves, air pollution, green and blue spaces on hypertension. Cohort data enrolled 6448 Chinese older adults aged 65 years and over were derived from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) between 2008 and 2018. Nine heatwave definitions, combining three heat thresholds (92.5th, 95th, and 97.5th percentiles of daily maximum temperature) and three durations (≥2, 3 and 4 days) were used as time-varying variables in the analysis and were the one-year exposure before survival events. Fine particulate matter (PM ≤2.5 μm in aerodynamic diameter (PM_2.5)), the Normalized Difference Vegetation Index (NDVI) and the average proportion of open water bodies were used to reflect the air pollution, green and blue space exposures, respectively. PM_2.5, green and blue space exposures were time-varying indicators and contemporaneous with heatwaves. Mixed Cox models with time-varying variables were fitted to assess the multiplicative and additive interaction of heatwaves, PM_2.5, and green and blue spaces on hypertension, measured by a traditional product term with the ratio of hazard ratio (HR) and relative risk due to interaction (RERI), respectively. A positive multiplicative (HRs >1) and additive interaction (RERIs >0) between heatwaves and higher PM_2.5 levels was observed. There was a synergistic effect between heatwaves and decreasing greenness levels on hypertension incidence on additive and multiplicative scales. No significant interaction between heatwaves and blue space was observed in the analysis. The combined effects of heatwaves, air pollution, green and blue space exposures on the risk of hypertension varied with age, gender, and educational attainment. This study's findings complemented the existing evidence and revealed synergistic harmful impacts for heatwaves with air pollution and lack of green space on hypertension incidence.

Outdoor heat stress assessment using an integrated multi-scale numerical weather prediction system: A case study of a heatwave in Montreal

More frequent and severe extreme weather events such as heatwaves are among the most serious challenges to society in coping with the changing climate. To evaluate the impacts of the heatwave on large-scale urban areas, a multi-scale weather forecasting system is designed by integrating different resolutions of the Canadian urbanized version of the Global Environmental Multiscale (GEM) Numerical Weather Prediction (NWP) model, cascading from 10 km to 2.5 km, and 250 m. The multi-scale model is implemented in Montreal, Canada, for modeling the 2018 heatwave. Simulation results are well-validated against measurement data, including Moderate Resolution Imaging Spectroradiometer (MODIS) satellite imagery and ten weather stations in the city. The Universal Thermal Climate Index (UTCI) map was calculated to identify vulnerable regions in the city against the heatwave. Land-use types in hotspots and coldspots are analyzed to find dominant factors in the formation of hot and cold areas. It is found that natural landscapes such as vegetation, trees, and water bodies are the dominant features of most coldspots. On the other hand, roads, parking lots, less tree covers, and industrial activities are the common land use features in the hotspots. A weak correlation is found between heat-related death locations and the outdoor UTCI map, implying that the assessment of an outdoor heatwave may not address overheated buildings and communities. This paper shows the importance of built environments - their properties and occupants' socio-demographic factors in the study of heat-related mortalities in cities.

Identifying research progress, focuses, and prospects of local climate zone (LCZ) using bibliometrics and critical reviews

The local climate zone (LCZ) has been an important land surface classification used to differentiate urban climate between localities. The general knowledge maps of LCZ studies are needed when LCZ-related research has attracted great attention. This study integrated bibliometrics and critical review to understand the status quo and suggest future research directions. Bibliometrics provided a statistical technique to explore large volumes of article data from the Web of Science, ScienceDirect, and Scopus databases, based on the Co-Occurrence 13.4 (COOC) software. The bibliometric results indicated a rapid increase in LCZ publications and identified the high-frequency keywords which can be clustered into two groups, including a human thermal comfort-related group and the other urban climatology-related one. From 2011 to 2020, the effects of land use and urban morphology on urban climate and heat island effects predominated the LCZ-related research. Since 2021, the research focuses had shifted to the fields of thermal environment and heatwave, due to the growing demand for human thermal comfort and heat risk reduction. Moreover, this study identified 'Land Surface Temperature' and 'Heatwave' as two focuses of LCZ-related research during the last decade. Their critical reviews demonstrated the need for additional in-depth LCZ-heatwave studies that consider the risk of human exposure. This study also recommended incorporating hydrological concerns and social issues into the LCZ plan for a more integrated LCZ research outlook. Overall, this study provides not only a comprehensive understanding of LCZ knowledge networks, but also critical details on research focuses and potential research prospects.

Heatwaves and mortality in Queensland 2010-2019: implications for a homogenous state-wide approach

Heatwaves are a significant cause of adverse health outcomes and mortality in Australia, worsening with climate change. In Queensland, the northeastern-most state, little is known about the impact of heatwaves outside of the capital city of Brisbane. This study aims to explore the impact of heatwaves on mortality across various demographic and environmental conditions within Queensland from 2010 to 2019. The Excess Heat Factor was used to indicate heatwave periods at the Statistical Area 2 (SA2) level. Registered deaths data from the Australian Bureau of Statistics and heatwave data from the Bureau of Meteorology were matched using a case-crossover approach. Relative risk and 95% confidence intervals were calculated across years, regions, age, sex, rurality, socioeconomic status, and cause of death. Heatwaves were associated with a 5% increase in all-cause mortality compared to deaths on non-heatwave days, with variability across the state. The risk of death on a heatwave day versus a non-heatwave day varied by heatwave severity. Individuals living in urban centers, the elderly, and those living in regions of lower socioeconomic status were most impacted by heatwave mortality. The relative risk of dying from neoplasms, nervous system conditions, respiratory conditions, and mental and behavioral conditions increased during heatwaves. As heatwaves increase in Queensland due to climate change, understanding the impact of heatwaves on mortality across Queensland is important to tailor public health messages. There is considerable variability across communities, demographic groups, and medical conditions, and as such messages need to be tailored to risk.

The role of extreme heat exposure on premature rupture of membranes in Southern California: A study from a large pregnancy cohort

BACKGROUND

Significant mortality and morbidity in pregnant women and their offspring are linked to premature rupture of membranes (PROM). Epidemiological evidence for heat-related PROM risk is extremely limited. We investigated associations between acute heatwave exposure and spontaneous PROM.

METHODS

We conducted this retrospective cohort study among mothers in Kaiser Permanente Southern California who experienced membrane ruptures during the warm season (May-September) from 2008 to 2018. Twelve definitions of heatwaves with different cut-off percentiles (75th, 90th, 95th, and 98th) and durations (≥ 2, 3, and 4 consecutive days) were developed using the daily maximum heat index, which incorporates both daily maximum temperature and minimum relative humidity in the last gestational week. Cox proportional hazards models were fitted separately for spontaneous PROM, term PROM (TPROM), and preterm PROM (PPROM) with zip codes as the random effect and gestational week as the temporal unit. Effect modification by air pollution (i.e., PM2.5 and NO2), climate adaptation measures (i.e., green space and air conditioning [AC] penetration), sociodemographic factors, and smoking behavior was examined.

RESULTS

In total, we included 190,767 subjects with 16,490 (8.6%) spontaneous PROMs. We identified a 9-14% increase in PROM risks associated with less intense heatwaves. Similar patterns as PROM were found for TPROM and PPROM. The heat-related PROM risks were greater among mothers exposed to a higher level of PM2.5 during pregnancy, under 25 years old, with lower education and household income level, and who smoked. Even though climate adaptation factors were not statistically significant effect modifiers, mothers living with lower green space or lower AC penetration were at consistently higher heat-related PROM risks compared to their counterparts.

CONCLUSION

Using a rich and high-quality clinical database, we detected harmful heat exposure for spontaneous PROM in preterm and term deliveries. Some subgroups with specific characteristics were more susceptible to heat-related PROM risk.

Short- and long-term consequences of heat exposure on mitochondrial metabolism in zebra finches (Taeniopygia castanotis)

Understanding the consequences of heat exposure on mitochondrial function is crucial as mitochondria lie at the core of metabolic processes, also affecting population dynamics. In adults, mitochondrial metabolism varies with temperature but can also depend on thermal conditions experienced during development. We exposed zebra finches to two alternative heat treatments during early development: "constant", maintained birds at ambient 35 °C from parental pair formation to fledglings' independence, while "periodic" heated broods at 40 °C, 6 h daily at nestling stage. Two years later, we acclimated birds from both experiments at 25 °C for 21 days, before exposing them to artificial heat (40 °C, 5 h daily for 10 days). After both conditions, we measured red blood cells' mitochondrial metabolism using a high-resolution respirometer. We found significantly decreased mitochondrial metabolism for Routine, Oxidative Phosphorylation (OxPhos) and Electron Transport System maximum capacity (ETS) after the heat treatments. In addition, the birds exposed to "constant" heat in early life showed lower oxygen consumption at the Proton Leak (Leak) stage after the heat treatment as adults. Females showed higher mitochondrial respiration for Routine, ETS and Leak independent of the treatments, while this pattern was reversed for OxPhos coupling efficiency (OxCE). Our results show that short-term acclimation involved reduced mitochondrial respiration, and that the reaction of adult birds to heat depends on the intensity, pattern and duration of temperature conditions experienced at early-life stages. Our study provides insight into the complexity underlying variation in mitochondrial metabolism and raises questions on the adaptive value of long-lasting physiological adjustments triggered by the early-life thermal environment.

Impact of different roofing mitigation strategies on near-surface temperature and energy consumption over the Chicago metropolitan area during a heatwave event

This study examined the impact of cool roofs, green roofs, and solar panel roofs on near-surface temperature and cooling energy demand through regional modeling in the Chicago metropolitan area (CMA). The new parameterization of green roofs and solar panel roofs based on model physics has recently been developed, updated, and coupled to a multilayer building energy model that is fully integrated with the Weather Research and Forecasting model. We evaluate the model performance against with observation measurements to show that our model is capable of being a suited tool to simulate the heatwave event. Next, we examine the impact by characterizing the near-surface air temperature and its diurnal cycle from experiments with and without the different rooftops. We also estimate the impact of the rooftop on the urban island intensity (UHII), surface heat flux, and the boundary layer. Finally, we measure the impact of the different rooftops on citywide air-conditioning consumption. Results show that the deployment of the cool roof can reduce the near-surface temperature most over urban areas, followed by green roof and solar panel roof. The cool roof experiment was the only one where the near-surface temperature trended down as the urban fraction increased, indicating the cool roof is the most effective mitigation strategy among these three rooftop options. For cooling energy consumption, it can be reduced by 16.6 %, 14.0 %, and 7.6 %, when cool roofs, green roofs, and solar panel roofs are deployed, respectively. Although solar panel roofs show the smallest reduction in energy consumption, if we assume that all electricity production can be applied to cooling demand, we can expect almost a savings of almost half (46.7 %) on cooling energy demand.

Urban heat island effect-related mortality under extreme heat and non-extreme heat scenarios: A 2010-2019 case study in Hong Kong

The urban heat island (UHI) effect exacerbates the adverse impact of heat on human health. However, while the UHI effect is further intensified during extreme heat events, prior studies have rarely mapped the UHI effect during extreme heat events to assess its direct temperature impact on mortality. This study examined the UHI effect during extreme heat and non-extreme heat scenarios and compared their temperature-mortality associations in Hong Kong from 2010 to 2019. Four urban heat island degree hour (UHIdh) scenarios were mapped onto Hong Kong's tertiary planning units and classified into three levels (Low, Moderate, and High). We assessed the association between temperature and non-external mortality of populations living in each UHIdh level for the extreme heat/non-extreme heat scenarios during the 2010-2019 hot seasons. Our results showed substantial differences between the temperature-mortality associations in the three levels under the UHIdh extreme heat scenario (UHIdh_EH). While there was no evidence of increased mortality in Low UHIdh_EH areas, the mortality risk in Moderate and High UHIdh_EH areas were significantly increased during periods of hot temperature, with the High UHIdh_EH areas displaying almost double the risk (RR: 1.08, 95%CI: 1.03, 1.14 vs. RR: 1.05, 95 % CI: 1.01, 1.09). However, other non-extreme heat UHI scenarios did not demonstrate as prominent of a difference. When stratified by age, the heat effects were found in Moderate and High UHIdh_EH among the elderly aged 75 and above. Our study found a difference in the temperature-mortality associations based on UHI intensity and potential heat vulnerability of populations during extreme heat events. Preventive measures should be taken to mitigate heat especially in urban areas with high UHI intensity during extreme heat events, with particular attention and support for those prone to heat vulnerability, such as the elderly and poorer populations.

Urban-rural disparity in heatwave effects on diabetes mortality in eastern China: A case-crossover analysis in 2016-2019

Diabetics are sensitive to high ambient temperature due to impaired thermoregulation. However, available evidence on the impact of prolonged high temperature (i.e., heatwave) on diabetes deaths is limited and whether urban and rural areas differ in heatwave vulnerability remains unknown so far. A time-stratified case-crossover analysis was employed to estimate the association between heatwaves and diabetes deaths in 1486 districts (509 urban and 977 rural areas) of eastern China (Jiangsu Province), 2016-2019. For each decedent, residential heatwave exposure was measured by matching daily mean temperatures to the geocoded residential address. We adopted nine-tiered heatwave definitions incorporating intensity and duration. Stratified analyses by decedents' characteristics (gender, age, and education) were also conducted. During the study period, there were 18,685 deaths from diabetes (urban proportion: 36.95 %, p-value for urban-rural difference < 0.05). Heatwaves were associated with an increased risk of diabetes deaths, with greater and longer-lasting effects in rural areas than urban areas [e.g., rural odds ratio (OR): 1.19 (95 % confidence interval (CI): 1.14, 1.25) vs. urban OR: 1.09 (95 % CI: 1.05, 1.12)]. Risk of diabetes deaths increased with the intensity of heatwaves in rural areas (p-value for trend <0.01), but not in urban areas. Stratified analyses in rural areas suggested that females and less-educated people were more vulnerable to heatwave-related diabetes deaths. Our findings revealed the urban-rural disparity in the risk of diabetes deaths associated with heatwaves. Rural diabetics should be made aware of the increased death risk posed by heatwaves in the context of warming climate.

Heatwave and urinary hospital admissions in China: Disease burden and associated economic loss, 2014 to 2019

BACKGROUND

Many studies have shown that heatwaves are associated with an increased prevalence of urinary diseases. However, few national studies have been undertaken in China, and none have considered the associated economic losses. Such information would be useful for health authorities and medical service providers to improve their policy-making and medical resource allocation decisions.

OBJECTIVES

To explore the association between heatwaves and hospital admissions for urinary diseases and assess the related medical costs and indirect economic losses in China from 2014 to 2019.

METHODS

Daily meteorological and hospital admission data from 2014 to 2019 were collected from 23 study sites with different climatic characteristics in China. We assessed the heatwave-hospitalization associations and evaluated the location-specific attributable fractions (AFs) of urinary-related hospital admissions due to heatwaves by using a time-stratified case-crossover method with a distributed lag nonlinear model. We then pooled the AFs in a meta-analysis and estimated the national excess disease burden and associated economic losses. We also performed stratified analyses by sex, age, climate zone, and urinary disease subtype.

RESULTS

A significant association between heatwaves and urinary-related hospital admissions was found with a relative risk of 1.090 (95 % confidence interval (CI): 1.050, 1.132). The pooled AF was 8.27 % (95%CI: 4.77 %, 11.63 %), indicating that heatwaves during the warm season (May to September) caused 248,364 urinary-related hospital admissions per year, with 2.42 (95%CI: 1.35, 3.45) billion CNY in economic losses, including 2.23 (95%CI: 1.29, 3.14) billion in direct losses and 0.19 (95%CI, 0.06, 0.31) billion in indirect losses, males, people aged 15-64 years, residents of temperate continental climate zones, and patients with urolithiasis were at higher risk.

CONCLUSION

Tailored community health campaigns should be developed and implemented to reduce the adverse health effects and economic losses of heatwave-related urinary diseases, especially in the context of climate change.

The synergistic effect of hydraulic and thermal impairments accounts for the severe crown damage in Fraxinus mandshurica seedlings following the combined drought-heatwave stress

Drought combined with extreme heatwaves has been increasingly identified as the important trigger of worldwide tree mortality in the context of climate change; nonetheless, our understanding of the potential hydraulic and thermal impairments of hot droughts to trees and the subsequent post-recovery process remains limited. To investigate the response of tree water and carbon relations to drought, heatwave, and combined drought-heatwave stresses, three-year-old potted seedlings of Fraxinus mandshurica Rupr., a dominant tree species in temperate forests of northeast China, were grown under well-watered and drought-stressed conditions and exposed to a rapid, acute heatwave treatment. During the heatwave treatment with a maximum temperature exceeding 40 °C for two days, the leaf temperature of drought-stressed seedlings was, on average, 5 °C higher than that of well-watered counterparts due to less effective evaporative cooling, indicating that soil water availability influenced leaf thermoregulatory capacity during hot extremes. Consistently, more pronounced crown damage, as shown by 13 % irreversible leaf scorch, was found in seedlings under the drought-heatwave treatment relative to sole heatwave treatment, alongside the more severe stem xylem embolism and leaf electrolyte leakage. While the heatwave treatment accelerated the depletion of non-structural carbohydrates in drought-stressed seedlings, the increase of branch soluble sugar concentration in response to heatwave might be related to the requirement for maintaining hydraulic functioning via osmoregulation under high dehydration risk. The coordination between leaf stomatal conductance and total non-structural carbohydrate content during the post-heatwave recovery phase implied that plant-water relations and carbon physiology were closely coupled in coping with hot droughts. This study highlights that, under scenarios of aggravating drought co-occurring with heatwaves, tree seedlings could face a high risk of crown decline in relation to the synergistically increased hydraulic and thermal impairments.

Analysis and intervention of heatwave related economic loss: Comprehensive insights from supply, demand, and public expenditure into the relationship between the influencing factors

Increasing extreme temperatures are producing a serious impact on the economies of cities. However, the importance of social factors is typically neglected by the existing research. In this work, we first establish a supply-demand-public expenditure (SDP) framework for assessing and forecasting heat-related economic loss. Compared with the previous framework, SDP possesses a more comprehensive index system and functions that apply to all types of cities. We selected different economic development and geographical locations (Nanjing, Suzhou, and Yancheng) as case studies to verify the wide applicability of the SDP framework. A qualitative analysis and quantitative prediction of heatwaves and socioeconomic factors on losses were conducted for different cities. The results showed that different loss types displayed obvious regional heterogeneity among the cities. The labor value loss was the most significant type, and health loss was the most vulnerable type. In addition, public expenditure played a neglected critical regulatory role. Apart from these, the current level of public expenditure for heat prevention and control remains insufficient. Based on an assessment of the effects of interventions, policymakers need to make more efforts to increase the proportion of heat-related public spending and ensure stable socio-economic development by utilizing pathways with positive intervention potentials.

Acute exposure to high temperature affects expression of heat shock proteins in altricial avian embryos

As the world warms, understanding the fundamental mechanisms available to organisms to protect themselves from thermal stress is becoming ever more important. Heat shock proteins are highly conserved molecular chaperones which serve to maintain cellular processes during stress, including thermal extremes. Developing animals may be particularly vulnerable to elevated temperatures, but the relevance of heat shock proteins for developing altricial birds exposed to a thermal stressor has never been investigated. Here, we sought to test whether three stress-induced genes - HSPD1, HSPA2, HSP90AA1 - and two constitutively expressed genes - HSPA8, HSP90B1 - are upregulated in response to acute thermal shock in zebra finch (Taeniopygia guttata) embryos half-way through incubation. Tested on a gradient from 37.5 °C (control) to 45 °C, we found that all genes, except HSPD1, were upregulated. However, not all genes initiated upregulation at the same temperature. For all genes, the best fitting model included a correlate of developmental stage that, although it was never significant after multiple-test correction, hints that heat shock protein upregulation might increase through embryonic development. Together, these results show that altricial avian embryos are capable of upregulating a known protective mechanism against thermal stress, and suggest that these highly conserved cellular mechanisms may be a vital component of early developmental protection under climate change.

Quantifying the impact of heat on human physical work capacity; part IV: interactions between work duration and heat stress severity

High workplace temperatures negatively impact physical work capacity (PWC). Although PWC loss models with heat based on 1-h exposures are available, it is unclear if further adjustments are required to accommodate repeated work/rest cycles over the course of a full work shift. Therefore, we examined the impact of heat stress exposure on human PWC during a simulated work shift consisting of six 1-h work-rest cycles. Nine healthy males completed six 50-min work bouts, separated by 10-min rest intervals and an extended lunch break, on four separate occasions: once in a cool environment (15 °C/50% RH) and in three different air temperature and relative humidity combinations (moderate, 35 °C/50% RH; hot, 40 °C/50% RH; and very hot, 40 °C/70%). To mimic moderate to heavy workload, work was performed on a treadmill at a fixed heart rate of 130 beats·min^-1. During each work bout, PWC was quantified as the kilojoules expended above resting levels. Over the shift, work output per cycle decreased, even in the cool climate, with the biggest decrement after the lunch break and meal consumption. Expressing PWC relative to that achieved in the cool environment for the same work duration, there was an additional 5(± 4)%, 7(± 6)%, and 16(± 7)% decrease in PWC when work was performed across a full work shift for the moderate, hot, and very hot condition respectively, compared with 1-h projections. Empirical models to predict PWC based on the level of heat stress (Wet-Bulb Globe Temperature, Universal Thermal Climate Index, Psychrometric Wet-Bulb Temperature, Humidex, and Heat Index) and the number of work cycles performed are presented.

An analysis of past and future heatwaves based on a heat-associated mortality threshold: towards a heat health warning system

Heatwaves can have severe impacts on human health extending from illness to mortality. These health effects are related to not only the physical phenomenon of heat itself but other characteristics such as frequency, intensity, and duration of heatwaves. Therefore, understanding heatwave characteristics is a crucial step in the development of heat-health warning systems (HHWS) that could prevent or reduce negative heat-related health outcomes. However, there are no South African studies that have quantified heatwaves with a threshold that incorporated a temperature metric based on a health outcome. To fill this gap, this study aimed to assess the spatial and temporal distribution and frequency of past (2014 - 2019) and future (period 2020 - 2039) heatwaves across South Africa. Heatwaves were defined using a threshold for diurnal temperature range (DTR) that was found to have measurable impacts on mortality. In the current climate, inland provinces experienced fewer heatwaves of longer duration and greater intensity compared to coastal provinces that experienced heatwaves of lower intensity. The highest frequency of heatwaves occurred during the austral summer accounting for a total of 150 events out of 270 from 2014 to 2019. The heatwave definition applied in this study also identified severe heatwaves across the country during late 2015 to early 2016 which was during the strongest El Niño event ever recorded to date. Record-breaking global temperatures were reported during this period; the North West province in South Africa was the worst affected experiencing heatwaves ranging from 12 to 77 days. Future climate analysis showed increasing trends in heatwave events with the greatest increases (80%-87%) expected to occur during summer months. The number of heatwaves occurring in cooler seasons is expected to increase with more events projected from the winter months of July and August, onwards. The findings of this study show that the identification of provinces and towns that experience intense, long-lasting heatwaves is crucial to inform development and implementation of targeted heat-health adaptation strategies. These findings could also guide authorities to prioritise vulnerable population groups such as the elderly and children living in high-risk areas likely to be affected by heatwaves.

Projections of heatwave-attributable mortality under climate change and future population scenarios in China

BACKGROUND

In China, most previous projections of heat-related mortality have been based on modeling studies using global climate models (GCMs), which can help to elucidate the risks of extreme heat events in a changing climate. However, spatiotemporal changes in the health effects of climate change considering specific regional characteristics remain poorly understood. We aimed to use credible climate and population projections to estimate future heatwave-attributable deaths under different emission scenarios and to explore the drivers underlying these patterns of changes.

METHODS

We derived climate data from a regional climate model driven by three CMIP5 GCM models and calculated future heatwaves in China under Representative Concentration Pathway (RCP) 2.6, RCP4.5, and RCP8.5. The future gridded population data were based on Shared Socioeconomic Pathway 2 assumption with different fertility rates. By applying climate zone-specific exposure-response functions to mortality during heatwave events, we projected the scale of heatwave-attributable deaths under each RCP scenario. We further analyzed the factors driving changes in heatwave-related deaths and main sources of uncertainty using a decomposition method. We compared differences in death burden under the 1.5°C target, which is closely related to achieving carbon neutrality by mid-century.

FINDINGS

The number of heatwave-related deaths will increase continuously to the mid-century even under RCP2.6 and RCP4.5 scenarios, and will continue increasing throughout the century under RCP8.5. There will be 20,303 deaths caused by heatwaves in 2090 under RCP2.6, 35,025 under RCP4.5, and 72,260 under RCP8.5, with half of all heatwave-related deaths in any scenario concentrated in east and central China. Climate effects are the main driver for the increase in attributable deaths in the near future till 2060, explaining 78% of the total change. Subsequent population decline cannot offset the losses caused by higher incidence of heatwaves and an aging population under RCP8.5. Although health loss under the 1.5°C warming scenario is 1.6-fold higher than the baseline period 1986-2005, limiting the temperature rise to 1.5°C can reduce the annual mortality burden in China by 3,534 deaths in 2090 compared with RCP2.6 scenarios.

INTERPRETATION

With accelerating climate change and population aging, the effects of future heatwaves on human health in China are likely to increase continuously even under a low emission scenario. Significant health benefits are expected if the optimistic 1.5°C goal is achieved, suggesting that carbon neutrality by mid-century is a critical target for China's sustainable development. Policymakers need to tighten climate mitigation policies tailored to local conditions while enhancing climate resilience technically and infrastructurally, especially for vulnerable elderly people.

FUNDING

National Key R&D Program of China (2018YFA0606200), Wellcome Trust (209734/Z/17/Z), Natural Science Foundation of China (41790471), and Guangdong Major Project of Basic and Applied Basic Research (2020B0301030004).

Stable Symbiodiniaceae composition in three coral species during the 2017 natural bleaching event in subtropical Hong Kong

Adaptive changes in endosymbiotic Symbiodiniaceae communities have been reported during and after bleaching events in tropical coral species, but little is known about such shifts in subtropical species. Here we examined the Symbiodiniaceae communities in three coral species (Montipora peltiformis, Pavona decussata, and Platygyra carnosa) based on samples collected during and after the 2017 bleaching event in subtropical Hong Kong waters. In all of the collected samples, ITS2 meta-sequencing revealed that P. decussata and P. carnosa were predominantly associated with Cladocopium C1 and C1c, whereas M. peltiformis was mainly associated with two Cladocopium C21 types and C1. For each species, the predominant endosymbionts exhibited high fidelity, and the relatively low abundance ITS2-types showed minor changes between the bleached and recovered corals. Our study provided the first details of coral-algal association in Hong Kong waters, suggesting the selection of certain genotypes as a potential adaptive mechanism to the marginal environmental conditions.

The influence of heatwave temperatures on fracture patient presentation to hospital

INTRODUCTION

As global warming continues at its current rate, heatwaves are likely to become an increasing phenomenon. At present, knowledge of the influence of heatwave temperatures on fracture patient presentation to hospital remains limited.

METHODS

This was a retrospective descriptive epidemiology study performed through hospital database review, linked to meteorological data. Emergency Department and Fracture Patient Presentation Data was obtained for the adult (16+) South Glasgow population (population count - 525,839) and the adult (16+) population covered by the West of Scotland Major Trauma Centre (population count - 2,218,326) from May 2021 to August 2021. This was combined with maximum temperature data, along with humidity and humidex data. Humidex is a measure which quantifies the temperature experienced by the patient, through a combined score incorporating both maximum temperature and humidity RESULTS: During the study period, there was one temperature heatwave (19th to 25th July), and four humidex heatwaves (27^th June to 3rd July, 15th to 17th July, 19th to 27th July, 22nd to 26th August). During the temperature heatwave, there was a significantly higher incidence of orthopaedic polytrauma patient presentation (IRR 2.37: p < 0.027), as well as ED patient presentation (IRR 1.07: p < 0.036). The humidex heatwaves were associated with a significantly higher incidence of orthopaedic polytrauma patient presentation (IRR 2.31: p < 0.002) and overall fracture patient presentation (IRR 1.18: p < 0.002). Positive correlations were found between orthopaedic polytrauma patient presentation vs temperature (R=0.217: p < 0.016), ED patient presentation vs temperature (R=0.427: p < 0.001), fracture patient presentation vs temperature (R=0.394: p < 0.001), and distal radius fracture patient presentation vs temperature (R=0.246: p < 0.006).

CONCLUSION

This study finds that heatwave temperatures result in a significantly increased number of orthopaedic polytrauma patients presenting to a Major Trauma Centre. Given the significant resources these patients require for care, Major Trauma Centres should be aware of such findings, and consider staff and resources profiles in response.

Additive effects of heatwave and water stresses on soybean seed yield is caused by impaired carbon assimilation at pod formation but not at flowering

Heatwave (HW) combined with water stress (WS) are critical environmental factors negatively affecting crop development. This study aimed to quantify the individual and combined effects of HW and WS during early reproductive stages on leaf and nodule functioning and their relation with final soybean seed yield (SY). For this purpose, during flowering (R2) and pod formation (R4) soybean (Glycine max L. Merr.) plants were exposed to different temperature (ambient[25ºC] versus HW[40ºC]) and water availability (full capacity versus WS[20% field capacity]). HW, WS and their combined impact on yield depended on the phenological stage at which stress was applied being more affected at R4. For gas exchange, WS severely impaired photosynthetic machinery, especially when combined with HS. Impaired photoassimilate supply at flowering caused flower abortion and a significant reduction in final SY due to interacting stresses and WS. On the other hand, at pod formation (R4), decreased leaf performance caused additive effect on SY by decreasing pod setting and seed size with combined stresses. At the nodule level, WS (alone or in combination with HW) caused nodule impairment, which was reflected by lower leaf N. Such response was linked with a poor malate supply to bacteroids and feed-back inhibition caused by nitrogenous compounds accumulation. In summary, our study noted that soybean sensitivity to interacting heat and water stresses was highly conditioned by the phenological stage at which it occurs with, R4 stage being the critical moment. To our knowledge this is the first soybean work integrating combined stresses at early reproductive stages.