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Background The regional disparity of heatwave-related mortality over a long period has not been sufficiently assessed across the globe, impeding the localisation of adaptation planning and risk management towards climate change. We quantified the global mortality burden associated with heatwaves at a spatial resolution of 0.5°x0.5° and the temporal change from 1990 to 2019. Methods and findings We collected data on daily deaths and temperature from 750 locations of 43 countries or regions, and 5 meta-predictors in 0.5°x0.5° resolution across the world. Heatwaves were defined as location-specific daily mean temperature [greater than or equal to]95th percentiles of year-round temperature range with duration [greater than or equal to]2 days. We first estimated the location-specific heatwave-mortality association. Secondly, a multivariate meta-regression was fitted between location-specific associations and 5 meta-predictors, which was in the third stage used with grid cell-specific meta-predictors to predict grid cell-specific association. Heatwave-related excess deaths were calculated for each grid and aggregated. During 1990 to 2019, 0.94% (95% CI: 0.68-1.19) of deaths [i.e., 153,078 cases (95% eCI: 109,950-194,227)] per warm season were estimated to be from heatwaves, accounting for 236 (95% eCI: 170-300) deaths per 10 million residents. The ratio between heatwave-related excess deaths and all premature deaths per warm season remained relatively unchanged over the 30 years, while the number of heatwave-related excess deaths per 10 million residents per warm season declined by 7.2% per decade in comparison to the 30-year average. Locations with the highest heatwave-related death ratio and rate were in Southern and Eastern Europe or areas had polar and alpine climates, and/or their residents had high incomes. The temporal change of heatwave-related mortality burden showed geographic disparities, such that locations with tropical climate or low incomes were observed with the greatest decline. The main limitation of this study was the lack of data from certain regions, e.g., Arabian Peninsula and South Asia. Conclusions Heatwaves were associated with substantial mortality burden that varied spatiotemporally over the globe in the past 30 years. The findings indicate the potential benefit of governmental actions to enhance health sector adaptation and resilience, accounting for inequalities across communities., Author(s): Qi Zhao 1,2, Shanshan Li 2,*, Tingting Ye 2, Yao Wu 2, Antonio Gasparrini 3, Shilu Tong 4,5, Ales Urban 6,7, Ana Maria Vicedo-Cabrera 8,9, Aurelio Tobias 10, Ben [...]

Background More intense tropical cyclones (TCs) are expected in the future under a warming climate scenario, but little is known about their mortality effect pattern across countries and over decades. We aim to evaluate the TC-specific mortality risks, periods of concern (POC) and characterize the spatiotemporal pattern and exposure-response (ER) relationships on a multicountry scale. Methods and findings Daily all-cause, cardiovascular, and respiratory mortality among the general population were collected from 494 locations in 18 countries or territories during 1980 to 2019. Daily TC exposures were defined when the maximum sustained windspeed associated with a TC was [greater than or equal to]34 knots using a parametric wind field model at a 0.5° x 0.5° resolution. We first estimated the TC-specific mortality risks and POC using an advanced flexible statistical framework of mixed Poisson model, accounting for the population changes, natural variation, seasonal and day of the week effects. Then, a mixed meta-regression model was used to pool the TC-specific mortality risks to estimate the overall and country-specific ER relationships of TC characteristics (windspeed, rainfall, and year) with mortality. Overall, 47.7 million all-cause, 15.5 million cardiovascular, and 4.9 million respiratory deaths and 382 TCs were included in our analyses. An overall average POC of around 20 days was observed for TC-related all-cause and cardiopulmonary mortality, with relatively longer POC for the United States of America, Brazil, and Taiwan (>30 days). The TC-specific relative risks (RR) varied substantially, ranging from 1.04 to 1.42, 1.07 to 1.77, and 1.12 to 1.92 among the top 100 TCs with highest RRs for all-cause, cardiovascular, and respiratory mortality, respectively. At country level, relatively higher TC-related mortality risks were observed in Guatemala, Brazil, and New Zealand for all-cause, cardiovascular, and respiratory mortality, respectively. We found an overall monotonically increasing and approximately linear ER curve of TC-related maximum sustained windspeed and cumulative rainfall with mortality, with heterogeneous patterns across countries and regions. The TC-related mortality risks were generally decreasing from 1980 to 2019, especially for the Philippines, Taiwan, and the USA, whereas potentially increasing trends in TC-related all-cause and cardiovascular mortality risks were observed for Japan. Conclusions The TC mortality risks and POC varied greatly across TC events, locations, and countries. To minimize the TC-related health burdens, targeted strategies are particularly needed for different countries and regions, integrating epidemiological evidence on region-specific POC and ER curves that consider across-TC variability., Author(s): Wenzhong Huang 1, Zhengyu Yang 1, Yiwen Zhang 1, Thomas Vogt 2, Ben Armstrong 3, Wenhua Yu 1, Rongbin Xu 1, Pei Yu 1, Yanming Liu 1, Antonio Gasparrini [...]

BACKGROUND: Epidemiological evidence on the health risks of sulfur dioxide (S[O.sub.2]) is more limited compared with other pollutants, and doubts remain on several aspects, such as the form of the exposure-response relationship, the potential role of co-pollutants, as well as the actual risk at low concentrations and possible temporal variation in risks. OBJECTIVES: Our aim was to assess the short-term association between exposure to S[O.sub.2] and daily mortality in a large multilocation data set, using advanced study designs and statistical techniques. METHODS: The analysis included 43,729,018 deaths that occurred in 399 cities within 23 countries between 1980 and 2018. A two-stage design was applied to assess the association between the daily concentration of S[O.sub.2] and mortality counts, including first-stage time-series regressions and second-stage multilevel random-effect meta-analyses. Secondary analyses assessed the exposure-response shape and the lag structure using spline terms and distributed lag models, respectively, and temporal variations in risk using a longitudinal meta- regression. Bi-pollutant models were applied to examine confounding effects of particulate matter with an aerodynamic diameter of RESULTS: The average daily concentration of S[O.sub.2] across the 399 cities was 11.7 [micro]g/[m.sup.3], with 4.7% of days above the World Health Organization (WHO) guideline limit (40 [micro]g/[m.sup.3], 24-h average), although the exceedances occurred predominantly in specific locations. Exposure levels decreased considerably during the study period, from an average concentration of 19.0 [micro]g/[m.sup.3] in 1980-1989 to 6.3 [micro]g/[m.sup.3] in 2010-2018. For all locations combined, a 10-[micro]g/[m.sup.3] increase in daily S[O.sub.2] was associated with an RR of mortality of 1.0045 [95% confidence interval (CI): 1.0019, 1.0070], with the risk being stable over time but with substantial between-country heterogeneity. Short-term exposure to S[O.sub.2] was associated with an excess mortality fraction of 0.50% [95% empirical CI (eCI): 0.42%, 0.57%] in the 399 cities, although decreasing from 0.74% (0.61%, 0.85%) in 1980-1989 to 0.37% (0.27%, 0.47%) in 2010-2018. There was some evidence of nonlinearity, with a steep exposure-response relationship at low concentrations and the risk attenuating at higher levels. The relevant lag window was 0-3 d. Significant positive associations remained after controlling for other pollutants. DISCUSSION: The analysis revealed independent mortality risks associated with short-term exposure to S[O.sub.2], with no evidence of a threshold. Levels below the current WHO guidelines for 24-h averages were still associated with substantial excess mortality, indicating the potential benefits of stricter air quality standards. https://doi.org/10.1289/EHP11112, Introduction Sulfur dioxide (S[O.sub.2]) is an important air pollutant linked with increased health risks. (1,2) It originates largely from the combustion of fossil fuels to generate electricity and transportation. (1,3,4) [...]

This paper examines how the stated roles and qualifications of Canadian university presidents and provosts have evolved over the past thirty years and the growing presence of recruiting firms. The study analysed 153 job advertisements published by 22 universities between 1987 and 2017. Roles were categorized according to aspects of organizational life: human resource, political, structural, and symbolic, while we distinguished qualifications as involving traits as well as cultural, human, and social 'capitals.' Overall, the expected qualifications for presidential and provostial candidates have increased consistently and their roles have expanded in scope. Trait qualifications and symbolic roles, while mostly absent in 1987, became prevalent by 2017, suggesting a slow but clear shift towards managerialist and charismatic depictions of leadership. This increase took place concurrently with universities' increasing reliance on recruiting firms., Author(s): Eric Lavigne [sup.1] , Creso M. Sá [sup.1] Author Affiliations: (1) grid.17063.33, 0000 0001 2157 2938, Department of Leadership, Higher and Adult Education, University of Toronto, , 252 Bloor [...]

Background: We do not currently understand how spatiotemporal variations in the composition of fine particulate air pollution [fine particulate matter with aerodynamic diameter [less than or equal to] 2.5 [micro]m ([PM.sub.2.5])] affects population health risks. However, recent evidence suggests that joint concentrations of transition metals and sulfate may influence the oxidative potential (OP) of [PM.sub.2.5] and associated health impacts. Objectives: The purpose of the study was to evaluate how combinations of transition metals/OP and sulfur content in outdoor [PM.sub.2.5] influence associations with acute cardiovascular events. Methods: We conducted a national case-crossover study of outdoor [PM.sub.2.5] and acute cardiovascular events in Canada between 2016 and 2017 (93,344 adult cases). Monthly mean transition metal and sulfur (S) concentrations in [PM.sub.2.5] were determined prospectively along with estimates of OP using acellular assays for glutathione ([OP.sup.GSH]), ascorbate ([OP.sup.AA]), and dithiothreitol depletion ([OP.sup.DTT]). Conditional logistic regression models were used to estimate odds ratios (OR) [95% confidence intervals (CI)] for [PM.sub.2.5] across strata of transition metals/OP and sulfur. Results: Among men, the magnitudes of observed associations were strongest when both transition metal and sulfur content were elevated. For example, an OR of 1.078 (95% CI: 1.049, 1.108) (per 10 [micro]g/[m.sup.3]) was observed for cardiovascular events in men when both copper and S were above the median, whereas a weaker association was observed when both elements were below median values (OR= 1.019, 95% CI: 1.007, 1.031). A similar pattern was observed for OP metrics. [PM.sub.2.5] was not associated with acute cardiovascular events in women. Discussion: The combined transition metal and sulfur content of outdoor [PM.sub.2.5] influences the strength of association with acute cardiovascular events in men. Regions with elevated concentrations of both sulfur and transition metals in [PM.sub.2.5] should be examined as priority areas for regulatory interventions. https://doi.org/10.1289/EHP9449, Introduction Numerous epidemiological studies have documented the acute cardio-respiratory health impacts of outdoor fine particulate air pollution [fine particulate matter with aerodynamic diameter [less than or equal to] 2.5 [micro]m [...]

Background: Living in greener areas of cities was linked to increased physical activity levels, improved mental well-being, and lowered harmful environmental exposures, all of which may affect human health. However, whether living in greener areas may be associated with lower risk of cardiovascular disease incidence, progression, and premature mortality is unclear. OBJECTIVES: We conducted a cohort study to examine the associations between residential green spaces and the incidence of acute myocardial infarction (AMI) and heart failure (HF), post-AMI and HF hospital readmissions, and mortality. METHODS: We simultaneously followed four large population-based cohorts in Ontario, Canada, including the entire adult population, adults free of AMI and HF, and survivors of AMI or HF from 2000 to 2014. We estimated residential exposure to green spaces using satellite-derived observations and ascertained health outcomes using validated disease registries. We estimated the associations using spatial random-effects Cox proportional hazards models. We conducted various sensitivity analyses, including further adjusting for property values and performing exploratory mediation analysis. Results: Each interquartile range increase in residential greenness was associated with a 7% [95% confidence interval (CI): 4%, 9%] decrease in incident AMI and a 6% (95% CI: 4%, 7%) decrease in incident HF. Residential greenness was linked to a ~10% decrease in cardiovascular mortality in both adults free of AMI and HF and the entire adult population. These associations remained consistent in sensitivity analyses and were accentuated among younger adults. Additionally, we estimated that the decreases in AMI and HF incidence associated with residential greenness explained ~53% of the protective association between residential greenness and cardiovascular mortality. Conversely, residential greenness was not associated with any delay in readmission or mortality among AMI and HF patients. Conclusions: Living in urban areas with more green spaces was associated with improved cardiovascular health in people free of AMI and HF but not among individuals who have already developed these conditions. https://doi.org/10.1289/EHP6161, Introduction Globally, cardiovascular disease (CVD) is a major public health concern, affecting ~ 423 million people and resulting in 18 million deaths each year (WHO 2013a). Although CVD mortality has [...]

Background: Previous literature suggests that higher ambient temperature may play a role in increasing the risk of suicide. However, no multicountry study has explored the shape of the association and the role of moderate and extreme heat across different locations. Objectives: We examined the short-term temperature-suicide relationship using daily time-series data collected for 341 locations in 12 countries for periods ranging from 4 to 40 y. Methods: We conducted a two-stage meta-analysis. First, we performed location-specific time-stratified case-crossover analyses to examine the temperature-suicide association for each location. Then, we used a multivariate meta-regression to combine the location-specific lag-cumulative nonlinear associations across all locations and by country. Results: A total of 1,320,148 suicides were included in this study. Higher ambient temperature was associated with an increased risk of suicide in general, and we observed a nonlinear association (inverted J-shaped curve) with the highest risk at 27[degrees]C. The relative risk (RR) for the highest risk was 1.33 (95% CI: 1.30, 1.36) compared with the risk at the first percentile. Country-specific results showed that the nonlinear associations were more obvious in northeast Asia (Japan, South Korea, and Taiwan). The temperature with the highest risk of suicide ranged from the 87th to 88th percentiles in the northeast Asian countries, whereas this value was the 99th percentile in Western countries (Canada, Spain, Switzerland, the UK, and the United States) and South Africa, where nearly linear associations were estimated. The country-specific RRs ranged from 1.31 (95% CI: 1.19, 1.44) in the United States to 1.65 (95% CI: 1.40, 1.93) in Taiwan, excluding countries where the results were substantially uncertain. Discussion: Our findings showed that the risk of suicide increased with increasing ambient temperature in many countries, but to varying extents and not necessarily linearly. This temperature-suicide association should be interpreted cautiously, and further evidence of the relationship and modifying factors is needed. https://doi.org/10.1289/EHP4898, Introduction Suicide is a significant public health concern. It is the second leading cause of death among young people 15-29 years of age, and there were an estimated 803,900 deaths [...]

During editing, the article title, 'The Role of Humidity in Associations of High Temperature with Mortality: A Multicountry, Multicity Study,' was inadvertently changed to 'The Role of Humidity in Associations [...]

Background: There is strong experimental evidence that physiologic stress from high temperatures is greater if humidity is higher. However, heat indices developed to allow for this have not consistently predicted mortality better than dry-bulb temperature. Objectives: We aimed to clarify the potential contribution of humidity an addition to temperature in predicting daily mortality in summer by using a large multicountry dataset. Methods: In 445 cities in 24 countries, we fit a time-series regression model for summer mortality with a distributed lag nonlinear model (DLNM) for temperature (up to lag 3) and supplemented this with a range of terms for relative humidity (RH) and its interaction with temperature. City-specific associations were summarized using meta-analytic techniques. Results: Adding a linear term for RH to the temperature term improved fit slightly, with an increase of 23% in RH (the 99th percentile anomaly) associated with a 1.1% [95% confidence interval (CI): 0.8, 1.3] decrease in mortality. Allowing curvature in the RH term or adding terms for interaction of RH with temperature did not improve the model fit. The humidity-related decreased risk was made up of a positive coefficient at lag 0 outweighed by negative coefficients at lags of 1-3 d. Key results were broadly robust to small model changes and replacing RH with absolute measures of humidity. Replacing temperature with apparent temperature, a metric combining humidity and temperature, reduced goodness of fit slightly. Discussion: The absence of a positive association of humidity with mortality in summer in this large multinational study is counter to expectations from physiologic studies, though consistent with previous epidemiologic studies finding little evidence for improved prediction by heat indices. The result that there was a small negative average association of humidity with mortality should be interpreted cautiously; the lag structure has unclear interpretation and suggests the need for future work to clarify. https://doi.org/10.1289/EHP5430, Introduction There is strong experimental physiologic evidence that the stress put on the human organism by high air temperatures is higher, by many measures, if humidity is higher, in particular [...]

Background Heatwaves are a critical public health problem. There will be an increase in the frequency and severity of heatwaves under changing climate. However, evidence about the impacts of climate change on heatwave-related mortality at a global scale is limited. Methods and findings We collected historical daily time series of mean temperature and mortality for all causes or nonexternal causes, in periods ranging from January 1, 1984, to December 31, 2015, in 412 communities within 20 countries/regions. We estimated heatwave-mortality associations through a two-stage time series design. Current and future daily mean temperature series were projected under four scenarios of greenhouse gas emissions from 1971-2099, with five general circulation models. We projected excess mortality in relation to heatwaves in the future under each scenario of greenhouse gas emissions, with two assumptions for adaptation (no adaptation and hypothetical adaptation) and three scenarios of population change (high variant, median variant, and low variant). Results show that, if there is no adaptation, heatwave-related excess mortality is expected to increase the most in tropical and subtropical countries/regions (close to the equator), while European countries and the United States will have smaller percent increases in heatwave-related excess mortality. The higher the population variant and the greenhouse gas emissions, the higher the increase of heatwave-related excess mortality in the future. The changes in 2031-2080 compared with 1971-2020 range from approximately 2,000% in Colombia to 150% in Moldova under the highest emission scenario and high-variant population scenario, without any adaptation. If we considered hypothetical adaptation to future climate, under high-variant population scenario and all scenarios of greenhouse gas emissions, the heatwave-related excess mortality is expected to still increase across all the countries/regions except Moldova and Japan. However, the increase would be much smaller than the no adaptation scenario. The simple assumptions with respect to adaptation as follows: no adaptation and hypothetical adaptation results in some uncertainties of projections. Conclusions This study provides a comprehensive characterisation of future heatwave-related excess mortality across various regions and under alternative scenarios of greenhouse gas emissions, different assumptions of adaptation, and different scenarios of population change. The projections can help decision makers in planning adaptation and mitigation strategies for climate change., Author(s): Yuming Guo 1,*, Antonio Gasparrini 2, Shanshan Li 1,*, Francesco Sera 2, Ana Maria Vicedo-Cabrera 2, Micheline de Sousa Zanotti Stagliorio Coelho 3,4, Paulo Hilario Nascimento Saldiva 3, Eric [...]

Objectives: The city of Windsor is recognized to have poor air quality in comparison with other Canadian cities. However, relatively few studies have evaluated associations between day-to-day fluctuations in air pollution levels and respiratory health in Windsor. In this study, we examined associations between short-term changes in ambient air pollution and emergency department (ED) visits for asthma in Windsor. Methods: A time-stratified case-crossover design was applied to 3,728 ED visits for asthma that occurred in Windsor area hospitals between 2002 and 2009. Daily air pollution levels for the region were estimated using Environment Canada's network of fixed-site monitors. ED visits were identified through the National Ambulatory Care Reporting System (NACRS). Odds ratios and their corresponding 95% confidence intervals were estimated using conditional logistic regression, and were adjusted for the confounding influence of daily number of influenza ED visits and weather variables using natural spline functions. Results: Statistically significant associations were observed between ambient air pollution levels and ED visits for asthma in Windsor. Effects were particularly pronounced among children 2 to 14 years of age between April and September. Namely, increases in the interquartile range with 1-day lagged exposure to SO2, NO2 and CO levels were associated with increased risks of an asthma visit of 19%, 25% and 36%, respectively. Conclusion: Exposure in Windsor to ambient air pollution increases the risk of ED visits for asthma, particularly among children. Key words: Air pollution; asthma; child; risk; cross-over studies Objectifs : La ville de Windsor est reconnue pour avoir une qualite d'air inferieure comparativement a d'autres villes canadiennes. Toutefois, peu d'etudes ont evalue l'association entre des fluctuations quotidiennes dans les niveaux de polluants atmospheriques et des problemes respiratoires a Windsor. Le but de cette etude est d'evaluer l'association entre le changement a court terme de polluants atmospheriques et les admissions a l'urgence dans la ville de Windsor. Methodes : Un devis d'etude cas-temoins de croisement stratifie sur le temps a ete applique a 3 728 visites dans les departements d'urgence des hopitaux de la ville de Windsor entre 2002 et 2009. Les niveaux de polluants atmospheriques pour cette region ont ete estimes en utilisant les sites de surveillance de la pollution atmospherique d'Environnement Canada. Les visites a l'urgence ont ete identifiees avec le Systeme national d'information sur les soins ambulatoires (SNISA). Des rapports de cote (RC) accompagnes d'intervalle de confiance a 95 % ont ete generes en utilisant la regression logistique conditionnelle et ont ete ajustes pour les facteurs confondants d'admissions quotidiennes a l'urgence pour un diagnostique d'influenza et des variables climatiques en utilisant des fonctions splines naturelles. Resultats : Des associations statistiquement significatives ont ete observes entre les polluants atmospheriques et les admissions a l'urgence pour de l'asthme a Windsor. Les effets etaient particulierement prononces chez les enfants de 2 a 14 ans entre les mois d'avril et septembre. Specifiquement, une augmentation dans l'ecart interquartile avec un decalage d'une journee dans l'exposition au S[O.sub.2], N[O.sub.2] et CO augmentait le risque d'une visite a l'urgence pour de l'asthme de 19 %, 25 % et 36 %, respectivement. Conclusion : L'exposition a la pollution de l'air ambiante a Windsor augmente le risque d'admission a l'urgence pour de l'asthme, particulierement chez les enfants. Mots cles : pollution de l'air; asthme; enfant; risque; cas-temoins de croisement, Ambient air pollution is recognized to adversely affect respiratory health. Several studies conducted in Canada (1-3) and elsewhere (4-7) have found that day-to-day increases in pollution levels are associated with [...]

Background: Few studies have examined variation in the associations between heat waves and mortality in an international context. Objectives: We aimed to systematically examine the impacts of heat waves on mortality with lag effects internationally. Methods: We collected daily data of temperature and mortality from 400 communities in 18 countries/regions and defined 12 types of heat waves by combining community-specific daily mean temperature [greater than or equal to] 90th, 92.5th, 95th, and 97.5th percentiles of temperature with duration [greater than or equal to] 2, 3, and 4 d. We used time-series analyses to estimate the community-specific heat wave-mortality relation over lags of 0-10 d. Then, we applied meta-analysis to pool heat wave effects at the country level for cumulative and lag effects for each type of heat wave definition. Results: Heat waves of all definitions had significant cumulative associations with mortality in all countries, but varied by community. The higher the temperature threshold used to define heat waves, the higher heat wave associations on mortality. However, heat wave duration did not modify the impacts. The association between heat waves and mortality appeared acutely and lasted for 3 and 4 d. Heat waves had higher associations with mortality in moderate cold and moderate hot areas than cold and hot areas. There were no added effects of heat waves on mortality in all countries/regions, except for Brazil, Moldova, and Taiwan. Heat waves defined by daily mean and maximum temperatures produced similar heat wave-mortality associations, but not daily minimum temperature. Conclusions: Results indicate that high temperatures create a substantial health burden, and effects of high temperatures over consecutive days are similar to what would be experienced if high temperature days occurred independently. People living in moderate cold and moderate hot areas are more sensitive to heat waves than those living in cold and hot areas. Daily mean and maximum temperatures had similar ability to define heat waves rather than minimum temperature. https://doi.org/10.1289/EHP1026, Introduction Globally, there is increasing interest in assessing heat wave-related health effects after major heat waves in the United States and Europe, for example, Chicago in 1995 and Europe in [...]

BACKGROUND: The evidence and method are limited for the associations between mortality and temperature variability (TV) within or between days. OBJECTIVES: We developed a novel method to calculate TV and investigated TV-mortality associations using a large multicountry data set. METHODS: We collected daily data for temperature and mortality from 372 locations in 12 countries/regions (Australia, Brazil, Canada, China, Japan, Moldova, South Korea, Spain, Taiwan, Thailand, the United Kingdom, and the United States). We calculated TV from the standard deviation of the minimum and maximum temperatures during the exposure days. Two-stage analyses were used to assess the relationship between TV and mortality. In the first stage, a Poisson regression model allowing over-dispersion was used to estimate the community-specific TV-mortality relationship, after controlling for potential confounders. In the second stage, a meta-analysis was used to pool the effect estimates within each country. RESULTS: There was a significant association between TV and mortality in all countries, even after controlling for the effects of daily mean temperature. In stratified analyses, TV was still significantly associated with mortality in cold, hot, and moderate seasons. Mortality risks related to TV were higher in hot areas than in cold areas when using short TV exposures (0-1 days), whereas TV-related mortality risks were higher in moderate areas than in cold and hot areas when using longer TV exposures (0-7 days). CONCLUSIONS: The results indicate that more attention should be paid to unstable weather conditions in order to protect health. These findings may have implications for developing public health policies to manage health risks of climate change. http://dx.doi.org/10.1289/EHP149, Introduction Time series data on daily air pollution concentrations, weather conditions, and daily measures of health outcomes (e.g., mortality, hospital admissions), have been used to assess how environmental factors may [...]

BACKGROUND: Recent investigations have reported a decline in the heat-related mortality risk during the last decades. However, these studies are frequently based on modeling approaches that do not fully characterize the complex temperature-mortality relationship, and are limited to single cities or countries. OBJECTIVES: We assessed the temporal variation in heat-mortality associations in a multi-country data set using flexible modelling techniques. METHODS: We collected data for 272 locations in Australia, Canada, Japan, South Korea, Spain, the United Kingdom, and the United States, with a total 20,203,690 deaths occurring in summer months between 1985 and 2012. The analysis was based on two-stage time-series models. The temporal variation in heat-mortality relationships was estimated in each location with time-varying distributed lag nonlinear models, expressed through an interaction between the transformed temperature variables and time. The estimates were pooled by country through multivariate meta-analysis. RESULTS: Mortality risk due to heat appeared to decrease over time in several countries, with relative risks associated to high temperatures significantly lower in 2006 compared with 1993 in the United States, Japan, and Spain, and a nonsignificant decrease in Canada. Temporal changes are difficult to assess in Australia and South Korea due to low statistical power, and we found little evidence of variation in the United Kingdom. In the United States, the risk seems to be completely abated in 2006 for summer temperatures below their 99th percentile, but some significant excess persists for higher temperatures in all the countries. CONCLUSIONS: We estimated a statistically significant decrease in the relative risk for heat-related mortality in 2006 compared with 1993 in the majority of countries included in the analysis. http://dx.doi.org/10.1289/ehp.1409070, Introduction High ambient temperature is an established risk factor for human health, with overwhelming evidence on the associated excess risk for mortality or morbidity outcomes (Basu 2009; Basu and Samet [...]

BACKGROUND: Prenatal exposure to fine particulate matter air pollution with aerodynamic diameter [less than or equal to] 2.5 [micro]m ([PM.sub.2.5]) has been associated with preterm delivery and low birth weight (LBW), but few studies have examined possible effect modification by [PM.sub.2.5] oxidative potential. OBJECTIVES: The aim of this study was to evaluate if regional differences in the oxidative potential of [PM.sub.2.5] modify the relationship between [PM.sub.2.5] and adverse birth outcomes. METHODS: A retrospective cohort study was conducted using 196,171 singleton births that occurred in 31 cities in the province of Ontario, Canada, from 2006 to 2012. Daily air pollution data were collected from ground monitors, and city-level [PM.sub.2.5] oxidative potential was measured. We used random-effects meta-analysis to combine the estimates of effect from regression models across cities on preterm birth, term LBW, and term birth weight and used meta-regression to evaluate the modifying effect of [PM.sub.2.5] oxidative potential. RESULTS: An interquartile increase (2.6 [micro]g/[m.sup.3]) in first-trimester [PM.sub.2.5] was positively associated with term LBW among women in the highest quartile of glutathione (GSH)-related oxidative potential [odds ratio (OR)= 1.28; 95% confidence interval (CI): 1.10, 1.48], but not the lowest quartile (OR = 0.99; 95% CI: 0.87, 1.14; p-interaction = 0.03). [PM.sub.2.5] on the day of delivery also was associated with preterm birth among women in the highest quartile of GSH-related oxidative potential [hazard ratio (HR) = 1.02; 95% CI: 1.01, 1.04], but not the lowest quartile [HR = 0.97; 95% CI: 0.95, 1.00; p-interaction = 0.04]. Between-city differences in ascorbate (AA)-related oxidative potential did not significantly modify associations with [PM.sub.2.5]. CONCLUSIONS: Between-city differences in GSH-related oxidative potential may modify the impact of [PM.sub.2.5] on the risk of term LBW and preterm birth., Introduction A large number of studies have suggested associations between ambient fine particulate matter with aerodynamic diameter [less than or equal to] 2.5 [micro]m ([PM.sub.2.5]) and adverse birth outcomes, with [...]

Background: In many places, daily mortality has been shown to increase after days with particularly high or low temperatures, but such daily time-series studies cannot identify whether such increases reflect substantial life shortening or short-term displacement of deaths (harvesting). Objectives: To clarify this issue, we estimated the association between annual mortality and annual summaries of heat and cold in 278 locations from 12 countries. Methods: Indices of annual heat and cold were used as predictors in regressions of annual mortality in each location, allowing for trends over time and clustering of annual count anomalies by country and pooling estimates using meta-regression. We used two indices of annual heat and cold based on preliminary standard daily analyses: a) mean annual degrees above/below minimum mortality temperature (MMT), and b) estimated fractions of deaths attributed to heat and cold. The first index was simpler and matched previous related research; the second was added because it allowed the interpretation that coefficients equal to 0 and 1 are consistent with none (0) or all (1) of the deaths attributable in daily analyses being displaced by at least 1 y. Results: On average, regression coefficients of annual mortality on heat and cold mean degrees were 1.7% [95% confidence interval (CI): 0.3, 3.1] and 1.1% (95% CI: 0.6, 1.6) per degree, respectively, and daily attributable fractions were 0.8 (95% CI: 0.2, 1.3) and 1.1 (95% CI: 0.9, 1.4). The proximity of the latter coefficients to 1.0 provides evidence that most deaths found attributable to heat and cold in daily analyses were brought forward by at least 1 y. Estimates were broadly robust to alternative model assumptions. Conclusions: These results provide strong evidence that most deaths associated in daily analyses with heat and cold are displaced by at least 1 y. https://doi.org/10.1289/EHP1756, Introduction In many locations worldwide, daily time-series analyses have identified adverse associations between daily mortality and temperatures that are toward the hot and cold ends of the temperature range for [...]

The article describes ancient numerological and mythical systems that provided a unified theory of creation. Topics include Chinese alchemy, yin and yang, the Tantric Shakti, and the origin of the mathematical symbols for zero and one.