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Revisiting classical experiments on the impact of air resistance on metabolic rate, we aimed to overcome limitations of previous research, notably: low participant numbers ( n = 1-3), highly turbulent wind, and confounding effects of rising body temperature. In a custom-built wind tunnel with reduced turbulence, 14 participants (8 males, 6 females) walked (5 km·h -1 ) and ran on a treadmill (70%V̇o 2max ) at 0, 2, 4, and 6 m·s -1 headwind or tailwind in a counterbalanced design, with rest breaks between each exposure to avoid rises in body core temperature. Oxygen consumption (V̇o 2 ) exhibited strong linear relationships versus wind direction, dynamic pressure, and air speed squared (V wr 2 ), lower in magnitude for headwind than tailwind. A moderate linear relationship was observed between heart rate, wind direction, dynamic pressure, and V wr 2 . Below 4 m·s -1 , the effect of wind was well within inter- and intraindividual variation and equipment uncertainty, and only at wind speeds ≥4 m·s -1 did the differences in physiological responses reach statistical significance. Our data indicate that at running speeds below 4 m·s -1 (14.4 km/h), indoor treadmills and outdoor running are comparable in terms of the metabolic impact of air movement relative to the person. However, this does not extend to the thermoregulatory effect of wind, with outdoor running providing a higher cooling rate due to the self-generated wind created during running. By removing the confounding impact of core temperature rises, the observed effects of headwind were lower and those of tailwind larger than observed previously. In the context of middle-distance running, the headwind created by running at 21.5 km·h -1 would result in a 2.2% increase of V̇o 2 . A relative tailwind of the same speed would lead to a 3.1% reduction. NEW & NOTEWORTHY Revisiting classical work by Pugh and Davies on the metabolic effects of air speed and direction, shortcomings in the original studies were addressed. Using more participants, less turbulent wind, and avoiding confounding effects of work-induced core temperature increases, new equations describing the impact of air speed/direction were developed. This study observed a lower impact of headwind and a larger impact of tailwind in the absence of an exercise-induced core temperature increase.

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

The majority of research dealing with the impacts of the Himalayan climate on human physiology focuses on low air temperature, high wind speed, and low air pressure and oxygen content, potentially leading to hypothermia and hypoxia. Only a few studies describe the influence of the weather conditions in the Himalayas on the body's ability to maintain thermal balance. The aim of the present research is to trace the heat exchange between humans and their surroundings during a typical, 6-day summit attempt of Mount Everest in the spring and winter seasons. Additionally, an emergency night outdoors without tent protection is considered. Daily variation of the heat balance components were calculated by the MENEX&#95;HA model using meteorological data collected at automatic weather stations installed during a National Geographic expedition in 2019-2020. The data represent the hourly values of the measured meteorological parameters. The research shows that in spite of extreme environmental conditions in the sub-summit zone of Mount Everest during the spring weather window, it is possible to keep heat equilibrium of the climbers' body. This can be achieved by the use of appropriate clothing and by regulating activity level. In winter, extreme environmental conditions in the sub-summit zone make it impossible to maintain heat equilibrium and lead to hypothermia. The emergency night in the sub-peak zone leads to gradual cooling of the body which in winter can cause severe hypothermia of the climber's body. At altitudes < 7000 m, climbers should consider using clothing that allows variation of insulation and active regulation of their fit around the body., (© 2023. The Author(s).)

Manual outdoor work is essential in many agricultural systems. Climate change will make such work more stressful in many regions due to heat exposure. The physical work capacity metric (PWC) is a physiologically based approach that estimates an individual's work capacity relative to an environment without any heat stress. We computed PWC under recent past and potential future climate conditions. Daily values were computed from five earth system models for three emission scenarios (SSP1-2.6, SSP3-7.0, and SSP5-8.5) and three time periods: 1991-2010 (recent past), 2041-2060 (mid-century) and 2081-2100 (end-century). Average daily PWC values were aggregated for the entire year, the growing season, and the warmest 90-day period of the year. Under recent past climate conditions, the growing season PWC was below 0.86 (86% of full work capacity) on half the current global cropland. With end-century/SSP5-8.5 thermal conditions this value was reduced to 0.7, with most affected crop-growing regions in Southeast and South Asia, West and Central Africa, and northern South America. Average growing season PWC could falls below 0.4 in some important food production regions such as the Indo-Gangetic plains in Pakistan and India. End-century PWC reductions were substantially greater than mid-century reductions. This paper assesses two potential adaptions-reducing direct solar radiation impacts with shade or working at night and reducing the need for hard physical labor with increased mechanization. Removing the effect of direct solar radiation impacts improved PWC values by 0.05 to 0.10 in the hottest periods and regions. Adding mechanization to increase horsepower (HP) per hectare to levels similar to those in some higher income countries would require a 22% increase in global HP availability with Sub-Saharan Africa needing the most. There may be scope for shifting to less labor-intensive crops or those with labor peaks in cooler periods or shift work to early morning., (© 2024 The Authors. Global Change Biology published by John Wiley & Sons Ltd.)

A real-time, noninvasive, and clinically applicable aging test in humans has yet to be established. Herein we propose a sweat- and wearable-based test to determine biological age. This test would empower users to monitor their aging process and take an active role in managing their lifestyle and health., Competing Interests: Declaration of interests No interests are declared by the authors., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Humans are unique among mammals in having a functionally naked body with a hair-covered scalp. Scalp hair is exceptionally variable across populations within Homo sapiens . Neither the function of human scalp hair nor the consequences of variation in its morphology have been studied within an evolutionary framework. A thermoregulatory role for human scalp hair has been previously suggested. Here, we present experimental evidence on the potential evolutionary function of human scalp hair and variation in its morphology. Using a thermal manikin and human hair wigs at different wind speeds in a temperature and humidity-controlled environment, with and without simulated solar radiation, we collected data on the convective, radiative, and evaporative heat fluxes to and from the scalp in relation to properties of a range of hair morphologies, as well as a naked scalp. We find evidence for a significant reduction in solar radiation influx to the scalp in the presence of hair. Maximal evaporative heat loss potential from the scalp is reduced by the presence of hair, but the amount of sweat required on the scalp to balance the incoming solar heat (i.e., zero heat gain) is reduced in the presence of hair. Particularly, we find that hair that is more tightly curled offers increased protection against heat gain from solar radiation.

Critical environmental limits are temperature-humidity thresholds above which heat balance cannot be maintained for a given metabolic heat production. This study examined the association between individual characteristics [sex, body surface area (A D ), aerobic capacity (V̇o 2max ), and body mass (m b )] and critical environmental limits in young adults at low metabolic rates. Forty-four (20 M/24 F; 23 ± 4 yr) subjects were exposed to progressive heat stress in an environmental chamber at two low net metabolic rates (M net ); minimal activity (MinAct; M net = ∼160 W) and light ambulation (LightAmb; M net = ∼260 W). In two hot-dry (HD; ≤25% rh) environments, ambient water vapor pressure (P a = 12 or 16 mmHg) was held constant and dry-bulb temperature (T db ) was systematically increased. In two warm-humid (WH; ≥50% rh) environments, T db was held constant at 34°C or 36°C, and P a was systematically increased. The critical wet-bulb globe temperature (WBGT crit ) was determined for each condition. During MinAct, after entry of M net into the forward stepwise linear regression model, no individual characteristics were entered into the model for WH ( R 2 adj = 0.01, P = 0.27) or HD environments ( R 2 adj = -0.01, P = 0.44). During LightAmb, only m b was entered into the model for WH environments ( R 2 adj = 0.44, P < 0.001), whereas only V̇o 2max was entered for HD environments ( R 2 adj = 0.22; P = 0.002). These data demonstrate negligible importance of individual characteristics on WBGT crit during low-intensity nonweight-bearing (MinAct) activity with a modest impact of m b and V̇o 2max during weight-bearing (LightAmb) activity in extreme thermal environments. NEW & NOTEWORTHY Our laboratory has recently published a series of papers establishing the upper ambient temperature-humidity thresholds for maintaining heat balance, termed critical environmental limits, in young adults. However, no studies have investigated the relative influence of individual characteristics, such as sex, body size, and aerobic fitness, on those environmental limits. Here, we demonstrate the contributions of sex, body mass, body surface area, and maximal aerobic capacity on critical wet-bulb globe temperature (WBGT) limits in young adults.

The purpose of this study was to characterize thermoregulatory and performance responses of elite road-race athletes, while competing in hot, humid, night-time conditions during the 2019 IAAF World Athletic Championships. Male and female athletes, competing in the 20 km racewalk ( n = 20 males, 24 females), 50 km racewalk ( n = 19 males, 8 females), and marathon ( n = 15 males, 22 females) participated. Exposed mean skin (T sk ) and continuous core body (T c ) temperature were recorded with infrared thermography and ingestible telemetry pill, respectively. The range of ambient conditions (recorded roadside) was 29.3°C-32.7°C air temperature, 46%-81% relative humidity, 0.1-1.7 m·s -1 air velocity, and 23.5°C-30.6°C wet bulb globe temperature. T c increased by 1.5 ± 0.1°C but mean T sk decreased by 1.5 ± 0.4°C over the duration of the races. T sk and T c changed most rapidly at the start of the races and then plateaued, with T c showing a rapid increase again at the end, in a pattern mirroring pacing. Performance times were between 3% and 20% (mean = 113 ± 6%) longer during the championships compared with the personal best (PB) of athletes. Overall mean performance relative to PB was correlated with the wet-bulb globe temperature (WBGT) of each race ( R 2 = 0.89), but not with thermophysiological variables ( R 2 ≤ 0.3). As previously reported in exercise heat stress, in this field study T c rose with exercise duration, whereas T sk showed a decline. The latter contradicts the commonly recorded rise and plateau in laboratory studies at similar ambient temperatures but without realistic air movement. NEW & NOTEWORTHY This paper provides a kinetic observation of both core and skin temperatures in 108 elite athletes, during various outdoor competition events, adding to the very limited data so far available in the literature taken during elite competitions. The field skin temperature findings contrast previous laboratory findings, likely due to differences in relative air velocity and its impact on the evaporation of sweat. The rapid rise in skin temperature following cessation of exercise highlights the importance of infrared thermography measurements being taken during motion, not during breaks, when being used as a measurement of skin temperature during exercise.

As a global industry, sport makes potentially significant contributions to climate change through both carbon emissions and influence over sustainability practices. Yet, evidence regarding impacts is uneven and spread across many disciplines. This paper investigates the impacts of sport emissions on climate and identifies knowledge gaps. We undertook a systematic and iterative meta-analysis of relevant literature (1992-2022) on organized and individual sports. Using a defined search protocol, 116 sources were identified that map to four sport-related themes: (1) carbon emissions and their measurement; (2) emissions control and decarbonization; (3) carbon sinks and offsets; and (4) behavior change. We find that mega sport events, elite sport, soccer, skiing, and golf have received most attention, whereas grass-roots and women's sport, activity in Africa and South America, cricket, tennis, and volleyball are understudied. Other knowledge gaps include carbon accounting tools and indicators for smaller sports clubs and active participants; cobenefits and tradeoffs between mitigation-adaptation efforts in sport, such as around logistics, venues, sports equipment, and facilities; geopolitical influence; and scope for climate change litigation against hosts and/or sponsors of carbon-intensive events. Among these, researchers should target cobenefits given their scope to deliver wins for both climate mitigation and risk management of sport., (© 2022 The Authors. Annals of the New York Academy of Sciences published by Wiley Periodicals LLC on behalf of New York Academy of Sciences.)

A common effort for both military and civil healthcare is to achieve knowledge-based health care in cold weather injuries and fatal accidents in harsh arctic environment. The Cold Weather Operations Conference in November 2021, having more than 300 participants from 20 countries, was addressing the prevention and treatment of injuries and trauma care in cold weather conditions and the challenges for military prehospital casualty care. The intention of the programme was to stimulate further research and systematic knowledge-based clinical work. The abstracts from the conference present cold weather research and clinical experience relevant for readers of the International Journal of Circumpolar Health.

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., (© 2022. The Author(s).)

Many populations experience high seasonal temperatures. Pregnant women are considered vulnerable to extreme heat because ambient heat exposure has been linked to pregnancy complications including preterm birth and low birthweight. The physiological mechanisms that underpin these associations are poorly understood. We reviewed the existing research evidence to clarify the mechanisms that lead to adverse pregnancy outcomes in order to inform public health actions. A multi-disciplinary expert group met to review the existing evidence base and formulate a consensus regarding the physiological mechanisms that mediate the effect of high ambient temperature on pregnancy. A literature search was conducted in advance of the meeting to identify existing hypotheses and develop a series of questions and themes for discussion. Numerous hypotheses have been generated based on animal models and limited observational studies. There is growing evidence that pregnant women are able to appropriately thermoregulate; however, when exposed to extreme heat, there are a number of processes that may occur which could harm the mother or fetus including a reduction in placental blood flow, dehydration, and an inflammatory response that may trigger preterm birth. There is a lack of substantial evidence regarding the processes that cause heat exposure to harm pregnant women. Research is urgently needed to identify what causes the adverse outcomes in pregnancy related to high ambient temperatures so that the impact of climate change on pregnant women can be mitigated., (© 2022. The Author(s).)

The present research describes the development and validation of a cardiovascular model (CVR Model) for use in conjunction with advanced thermophysiological models, where usually only a total cardiac output is estimated. The CVR Model detailed herein estimates cardio-dynamic parameters (changes in cardiac output, stroke volume, and heart rate), regional blood flow, and muscle oxygen extraction, in response to rest and physical workloads, across a range of ages and aerobic fitness levels, as well as during exposure to heat, dehydration, and altitude. The model development strategy was to first establish basic resting and exercise predictions for cardio-dynamic parameters in an "ideal" environment (cool, sea level, and hydrated person). This basic model was then advanced for increasing levels of altitude, heat strain, and dehydration, using meta-analysis and reaggregation of published data. Using the estimated altitude- and heat-induced changes in maximum oxygen extraction and maximum cardiac output, the decline in maximum oxygen consumption at high altitude and in the heat was also modeled. A validation of predicted cardiovascular strain using heart rate was conducted using a dataset of 101 heterogeneous individuals (1,371 data points) during rest and exercise in the heat and at altitude, demonstrating that the CVR Model performs well ( R 2 = 0.82-0.84) in predicting cardiovascular strain, particularly at a group mean level ( R 2 = 0.97). The development of the CVR Model is aimed at providing the Fiala thermal Physiology & Comfort (FPC) Model and other complex thermophysiological models with improved estimations of cardiac strain and exercise tolerance, across a range of individuals during acute exposure to environmental stressors. NEW & NOTEWORTHY The present research promotes the adaption of thermophysiological modeling to the estimation of cardiovascular strain in individuals exercising under acute environmental stress. Integration with advanced models of human thermoregulation opens doors for detailed numerical analysis of athletes' performance and physiology during exercise, occupational safety, and individual work tolerability. The research provides a simple-to-validate metric of cardiovascular function (heart rate), as well as a method to evaluate key principles influencing exercise- and thermoregulation in humans.

In a series of three companion papers published in this Journal, we identify and validate the available thermal stress indicators (TSIs). In this first paper of the series, we conducted a systematic review (registration: INPLASY202090088) to identify all TSIs and provide reliable information regarding their use (funded by EU Horizon 2020; HEAT-SHIELD). Eight databases (PubMed, Agricultural and Environmental Science Collection, Web of Science, Scopus, Embase, Russian Science Citation Index, MEDLINE, and Google Scholar) were searched from database inception to 15 April 2020. No restrictions on language or study design were applied. Of the 879 publications identified, 232 records were considered for further analysis. This search identified 340 instruments and indicators developed between 200 BC and 2019 AD. Of these, 153 are nomograms, instruments, and/or require detailed non-meteorological information, while 187 can be mathematically calculated utilizing only meteorological data. Of these meteorology-based TSIs, 127 were developed for people who are physically active, and 61 of those are eligible for use in occupational settings. Information regarding the equation, operating range, interpretation categories, required input data, as well as a free software to calculate all 187 meteorology-based TSIs is provided. The information presented in this systematic review should be adopted by those interested in performing on-site monitoring and/or big data analytics for climate services to ensure appropriate use of the meteorology-based TSIs. Studies two and three in this series of companion papers present guidance on the application and validation of these TSIs, to guide end users of these indicators for more effective use., Competing Interests: No potential conflict of interest was reported by the author(s)., (© 2022 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.)

The present comprehensive review (i) summarizes the current knowledge on the impacts of occupational heat stress on outdoor workers, (ii) provides a historical background on this issue, (iii) presents a meta-analysis of published data, (iv) explores inter-individual and intra-individual factors, (v) discusses the available heat mitigation strategies, (vi) estimates physical work capacity, labour productivity, and metabolic rate for the year 2030, and (vii) provides an overview of existing policy and legal frameworks on occupational heat exposure. Meta-analytic findings from 38 field studies that involved monitoring 2,409 outdoor workers across 41 jobs in 21 countries suggest that occupational heat stress increases the core (r = 0.44) and skin (r = 0.44) temperatures, as well as the heart rate (r = 0.38) and urine specific gravity (r = 0.13) of outdoor workers (all p < 0.05). Moreover, it diminishes the capacity of outdoor workers for manual labour (r = -0.82; p < 0.001) and is responsible for more than two thirds of the reduction in their metabolic rate. Importantly, our analysis shows that physical work capacity is projected to be highly affected by the ongoing anthropogenic global warming. Nevertheless, the metabolic rate and, therefore, labour productivity are projected to remain at levels higher than the workers' physical work capacity, indicating that people will continue to work more intensely than they should to meet their financial obligations for food and shelter. In this respect, complementary measures targeting self-pacing, hydration, work-rest regimes, ventilated garments, and mechanization can be adopted to protect outdoor workers., Competing Interests: No potential conflict of interest was reported by the authors., (© 2022 Informa UK Limited, trading as Taylor & Francis Group.)

Purpose: To determine associations between thermal responses, medical events, performance, heat acclimation and health status during a World Athletics Championships in hot-humid conditions., Methods: From 305 marathon and race-walk starters, 83 completed a preparticipation questionnaire on health and acclimation. Core (T core ; ingestible pill) and skin (T skin ; thermal camera) temperatures were measured in-competition in 56 and 107 athletes, respectively. 70 in-race medical events were analysed retrospectively. Performance (% personal best) and did not finish (DNF) were extracted from official results., Results: Peak T core during competition reached 39.6°C±0.6°C (maximum 41.1°C). T skin decreased from 32.2°C±1.3°C to 31.0°C±1.4°C during the races (p<0.001). T core was not related to DNF (25% of starters) or medical events (p≥0.150), whereas T skin , T skin rate of decrease and T core -to-T skin gradient were (p≤0.029). A third of the athletes reported symptoms in the 10 days preceding the event, mainly insomnia, diarrhoea and stomach pain, with diarrhoea (9% of athletes) increasing the risk of in-race medical events (71% vs 17%, p<0.001). Athletes (63%) who performed 5-30 days heat acclimation before the competition: ranked better (18±13 vs 28±13, p=0.009), displayed a lower peak T core (39.4°C±0.4°C vs 39.8°C±0.7°C, p=0.044) and larger in-race decrease in T skin (-1.4°C±1.0°C vs -0.9°C±1.2°C, p=0.060), than non-acclimated athletes. Although not significant, they also showed lower DNF (19% vs 30%, p=0.273) and medical events (19% vs 32%, p=0.179)., Conclusion: T skin , T skin rate of decrease and T core -to-T skin gradient were important indicators of heat tolerance. While heat-acclimated athletes ranked better, recent diarrhoea represented a significant risk factor for DNF and in-race medical events., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

In a series of three companion papers published in this Journal, we identify and validate the available thermal stress indicators (TSIs). In this third paper, we conducted field experiments across nine countries to evaluate the efficacy of 61 meteorology-based TSIs for assessing the physiological strain experienced by individuals working in the heat. We monitored 372 experi-enced and acclimatized workers during 893 full work shifts. We continuously assessed core body temperature, mean skin temperature, and heart rate data together with pre/post urine specific gravity and color. The TSIs were evaluated against 17 published criteria covering physiological parameters, practicality, cost effectiveness, and health guidance issues. Simple meteorological parameters explained only a fraction of the variance in physiological heat strain (R 2  = 0.016 to 0.427; p < 0.001), reflecting the importance of adopting more sophisticated TSIs. Nearly all TSIs correlated with mean skin temperature (98%), mean body temperature (97%), and heart rate (92%), while 66% of TSIs correlated with the magnitude of dehydration and 59% correlated with core body temperature (r = 0.031 to 0.602; p < 0.05). When evaluated against the 17 published criteria, the TSIs scored from 4.7 to 55.4% (max score = 100%). The indoor (55.4%) and outdoor (55.1%) Wet-Bulb Globe Temperature and the Universal Thermal Climate Index (51.7%) scored higher compared to other TSIs (4.7 to 42.0%). Therefore, these three TSIs have the highest potential to assess the physiological strain experienced by individuals working in the heat., Competing Interests: No potential conflict of interest was reported by the authors., (© 2022 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.)

In a series of three companion papers published in this Journal, we identify and validate the available thermal stress indicators (TSIs). In this second paper of the series, we identified the criteria to consider when adopting a TSI to protect individuals who work in the heat, and we weighed their relative importance using a Delphi exercise with 20 experts. Two Delphi iterations were adequate to reach consensus within the expert panel (Cronbach's α = 0.86) for a set of 17 criteria with varying weights that should be considered when adopting a TSI to protect individuals who work in the heat. These criteria considered physiological parameters such as core/skin/mean body temperature, heart rate, and hydration status, as well as practicality, cost effectiveness, and health guidance issues. The 17 criteria were distributed across three occupational health-and-safety pillars: (i) contribution to improving occupational health (55% of total importance), (ii) mitigation of worker physiological strain (35.5% of total importance), and (iii) cost-effectiveness (9.5% of total importance). Three criteria [(i) relationship of a TSI with core temperature, (ii) having categories indicating the level of heat stress experienced by workers, and (iii) using its heat stress categories to provide recommendations for occupational safety and health] were considered significantly more important when selecting a TSI for protecting individuals who work in the heat, accumulating 37.2 percentage points. These 17 criteria allow the validation and comparison of TSIs that presently exist as well as those that may be developed in the coming years., Competing Interests: No potential conflict of interest was reported by the author(s)., (© 2022 Informa UK Limited, trading as Taylor & Francis Group.)

Increasing air movement can alleviate or exacerbate occupational heat strain, but the impact is not well defined across a wide range of hot environments, with different clothing levels. Therefore, we combined a large empirical study with a physical model of human heat transfer to determine the climates where increased air movement (with electric fans) provides effective body cooling. The model allowed us to generate practical advice using a high-resolution matrix of temperature and humidity. The empirical study involved a total of 300 1-h work trials in a variety of environments (35, 40, 45, and 50 °C, with 20 up to 80% relative humidity) with and without simulated wind (3.5 vs 0.2 m∙s -1 ), and wearing either minimal clothing or a full body work coverall. Our data provides compelling evidence that the impact of fans is strongly determined by air temperature and humidity. When air temperature is ≥ 35 °C, fans are ineffective and potentially harmful when relative humidity is below 50%. Our simulated data also show the climates where high wind/fans are beneficial or harmful, considering heat acclimation, age, and wind speed. Using unified weather indices, the impact of air movement is well captured by the universal thermal climate index, but not by wet-bulb globe temperature and aspirated wet-bulb temperature. Overall, the data from this study can inform new guidance for major public and occupational health agencies, potentially maintaining health and productivity in a warming climate., (© 2021. The Author(s).)

Purpose: This study investigated the influence of whole body cooling on local thermal sensitivity to warm (40°C) and cold (20°C) stimuli in 10 young (age: 24 ± 2 yrs) and 10 older males (age: 69 ± 4 yrs)., Methods: Local warm and cold sensitivity was assessed at eight body regions using a 25 cm 2 pressure controlled thermal probe after 40 min of whole body exposure to a thermoneutral (NEUT: 25°C/40% RH) and a cold (COLD: 12°C/50% RH) environment. Gastrointestinal temperature (T gi ), mean and local skin temperature, heart rate, whole body thermal sensation and comfort, and skin blood flow were also measured., Results: Whole body cooling blunted local cold sensitivity but warm sensitivity was maintained in both age groups. Furthermore, a significant age-related decline (from young to older group) in sensitivity to a warm stimulus was observed in both NEUT and COLD conditions. Older males also had a greater ΔT gi compared to the young but had similar thermal sensation and comfort responses., Conclusion: The observed interaction effect of local cold stimulation and whole body cooling may be related to both stimuli triggering similar TRP channels, whereas the lack of interaction between local warm stimuli and whole body cooling may be related to these two stimuli triggering different TRP channels. The findings reiterate the potential thermoregulatory risks (e.g. cold injury and hypothermia) associated with ageing, even with such short exposure times., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Heat stress decreases human physical work capacity (PWC), but the extent to which solar radiation (SOLAR) compounds this response is not well understood. This study empirically quantified how SOLAR impacts PWC in the heat, considering wide, but controlled, variations in air temperature, humidity, and clothing coverage. We also provide correction equations so PWC can be quantified outdoors using heat stress indices that do not ordinarily account for SOLAR (including the Heat Stress Index, Humidex, and Wet-Bulb Temperature). Fourteen young adult males (7 donning a work coverall, 7 with shorts and trainers) walked for 1 h at a fixed heart rate of 130 beats∙min - 1, in seven combinations of air temperature (25 to 45°C) and relative humidity (20 or 80%), with and without SOLAR (800 W/m 2 from solar lamps). Cumulative energy expenditure in the heat, relative to the work achieved in a cool reference condition, was used to determine PWC%. Skin temperature was the primary determinant of PWC in the heat. In dry climates with exposed skin (0.3 Clo), SOLAR caused PWC to decrease exponentially with rising air temperature, whereas work coveralls (0.9 Clo) negated this effect. In humid conditions, the SOLAR-induced reduction in PWC was consistent and linear across all levels of air temperature and clothing conditions. Wet-Bulb Globe Temperature and the Universal Thermal Climate Index represented SOLAR correctly and did not require a correction factor. For the Heat Stress Index, Humidex, and Wet-Bulb Temperature, correction factors are provided enabling forecasting of heat effects on work productivity., (© 2021. The Author(s).)

Purpose: To determine sweating responses of pre-pubertal children during intermittent exercise in a warm environment and create whole-body maps of regional sweat rate (RSRs) distribution across the body., Methods: Thirteen pre-pubertal children; six girls and seven boys (8.1 ± 0.8 years) took part. Sweat was collected using the technical absorbent method in the last 5 min of a 30-min intermittent exercise protocol performed at 30 ℃, 40% relative humidity and 2 m·s -1 frontal wind., Results: Mean gross sweat loss (GSL) was 126 ± 47 g·m -2 ·h -1 and metabolic heat production was 278 ± 50 W·m 2 . The lower anterior torso area had the lowest RSR with a median (IQR) sweat rate (SR) of 40 (32) g·m -2 ·h -1 . The highest was the forehead with a median SR of 255 (163) g·m -2 ·h -1 . Normalised sweat maps (the ratio of each region's SR to the mean SR for all measured pad regions) showed girls displayed lower ratio values at the anterior and posterior torso, and higher ratios at the hands, feet and forehead compared to boys. Absolute SRs were similar at hands and feet, but girls sweated less in most other areas, even after correction for metabolic rate., Conclusion: Pre-pubertal children have different RSRs across the body, also showing sex differences in sweat distribution. Distributions differ from adults. Hands and feet RSR remain stable, but SR across other body areas increase with maturation. These data can increase specificity of models of human thermoregulation, improve the measurement accuracy of child-sized thermal manikins, and aid companies during product design and communication., (© 2021. The Author(s).)

Purpose: To characterise hydration, cooling, body mass loss, and core (T core ) and skin (T sk ) temperatures during World Athletics Championships in hot-humid conditions., Methods: Marathon and race-walk (20 km and 50 km) athletes (n=83, 36 women) completed a pre-race questionnaire. Pre-race and post-race body weight (n=74), T core (n=56) and T sk (n=49; thermography) were measured., Results: Most athletes (93%) had a pre-planned drinking strategy (electrolytes (83%), carbohydrates (81%)) while ice slurry was less common (11%; p<0.001). More men than women relied on electrolytes and carbohydrates (91%-93% vs 67%-72%, p≤0.029). Drinking strategies were based on personal experience (91%) rather than external sources (p<0.001). Most athletes (80%) planned pre-cooling (ice vests (53%), cold towels (45%), neck collars (21%) and ice slurry (21%)) and/or mid-cooling (93%; head/face dousing (65%) and cold water ingestion (52%)). Menthol usage was negligible (1%-2%). Pre-race T core was lower in athletes using ice vests (37.5°C±0.4°C vs 37.8°C±0.3°C, p=0.024). T core (pre-race 37.7°C±0.3°C, post-race 39.6°C±0.6°C) was independent of event, ranking or performance (p≥0.225). Pre-race T sk was correlated with faster race completion (r=0.32, p=0.046) and was higher in non-finishers (did not finish (DNF); 33.8°C±0.9°C vs 32.6°C±1.4°C, p=0.017). Body mass loss was higher in men than women (-2.8±1.5% vs -1.3±1.6%, p<0.001), although not associated with performance., Conclusion: Most athletes' hydration strategies were pre-planned based on personal experience. Ice vests were the most adopted pre-cooling strategy and the only one minimising T core , suggesting that event organisers should be cognisant of logistics (ie, freezers). Dehydration was moderate and unrelated to performance. Pre-race T sk was related to performance and DNF, suggesting that T sk modulation should be incorporated into pre-race strategies., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective . To investigate the use of infrared thermography (IRT) for skin temperature measurement of moving athletes during competition and its sensitivity to factors that are traditionally standardised. Approach . Thermograms were collected for 18 female athletes during the 20 km racewalk at the 2019 World Athletics Championships, with a medium-wave, cooled indium antimonide medium wave infrared band (MWIR) and a long-wave, uncooled microbolometer longwave infrared band (LWIR) infrared camera. Main results . The MWIR provided greater clarity images of motion due to a shorter exposure and response time and produced a higher percentage of acceptable images. Analysing acceptable images only, the LWIR and WMIR produced good levels of agreement, with a bias of -0.1 ± 0.6 °C in mean skin temperature for the LWIR. As the surface area of an ROI was reduced, the measured temperature became less representative of the whole ROI. Compared to measuring the whole area ROI, a single central pixel produced a bias of 0.3 ± 0.3 °C (MWIR) and 0.1 ± 0.4 °C (LWIR) whilst using the maximum and minimum temperature pixels resulted in deviations of 1.3 ± 0.4 °C and -1.1 ± 0.3 °C (MWIR) and 1.2 ± 0.3 °C and -1.3 ± 0.4 °C (LWIR). The sensitivity to air and reflected temperatures was lower for the LWIR camera, due to the higher emissivity of skin in its wavelength. Significance . IRT provides an appropriate tool for the measurement of skin temperature during real-world competition and critically during athlete motion. The cheaper LWIR camera provides a feasible alternative to the MWIR in low rate of motion scenarios, with comparable precision and sensitivity to analysis. However, the LWIR is limited when higher speeds prevent the accurate measurement and ability to capture motion., (Creative Commons Attribution license.)

Hot ambient conditions and associated heat stress can increase mortality and morbidity, as well as increase adverse pregnancy outcomes and negatively affect mental health. High heat stress can also reduce physical work capacity and motor-cognitive performances, with consequences for productivity, and increase the risk of occupational health problems. Almost half of the global population and more than 1 billion workers are exposed to high heat episodes and about a third of all exposed workers have negative health effects. However, excess deaths and many heat-related health risks are preventable, with appropriate heat action plans involving behavioural strategies and biophysical solutions. Extreme heat events are becoming permanent features of summer seasons worldwide, causing many excess deaths. Heat-related morbidity and mortality are projected to increase further as climate change progresses, with greater risk associated with higher degrees of global warming. Particularly in tropical regions, increased warming might mean that physiological limits related to heat tolerance (survival) will be reached regularly and more often in coming decades. Climate change is interacting with other trends, such as population growth and ageing, urbanisation, and socioeconomic development, that can either exacerbate or ameliorate heat-related hazards. Urban temperatures are further enhanced by anthropogenic heat from vehicular transport and heat waste from buildings. Although there is some evidence of adaptation to increasing temperatures in high-income countries, projections of a hotter future suggest that without investment in research and risk management actions, heat-related morbidity and mortality are likely to increase., Competing Interests: Declaration of interests AC reports grants from the New South Wales Department of Planning, Industry, and Environment and National Health and Medical Research Council during the conduct of the study. OJ reports grants from Tennis Australia, Cricket Australia, National Health and Medical Research Council, Multiple Sclerosis Australia, and Wellcome Trust, outside the submitted work. JV reports speaker honorariums from Northern Arizona University, Climate 2020: Seven Generations for Arizona—Flagstaff, AZ, November, 2019, and Aquarium of the Pacific, The Effects of Earth's Health on Human Health, Long Beach, CA, March, 2020. All other authors have no competing interests., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Heat extremes (ie, heatwaves) already have a serious impact on human health, with ageing, poverty, and chronic illnesses as aggravating factors. As the global community seeks to contend with even hotter weather in the future as a consequence of global climate change, there is a pressing need to better understand the most effective prevention and response measures that can be implemented, particularly in low-resource settings. In this Series paper, we describe how a future reliance on air conditioning is unsustainable and further marginalises the communities most vulnerable to the heat. We then show that a more holistic understanding of the thermal environment at the landscape and urban, building, and individual scales supports the identification of numerous sustainable opportunities to keep people cooler. We summarise the benefits (eg, effectiveness) and limitations of each identified cooling strategy, and recommend optimal interventions for settings such as aged care homes, slums, workplaces, mass gatherings, refugee camps, and playing sport. The integration of this information into well communicated heat action plans with robust surveillance and monitoring is essential for reducing the adverse health consequences of current and future extreme heat., Competing Interests: Declaration of interests OJ reports grants from Tennis Australia, Cricket Australia, National Health and Medical Research Council, Multiple Sclerosis Australia, and Wellcome Trust, outside the submitted work. AC reports grants from the New South Wales Department of Planning, Industry, and Environment and National Health and Medical Research Council during the conduct of the study. JV reports Speaker Honorariums from Northern Arizona University, Climate 2020: Seven Generations for Arizona (Flagstaff, AZ, USA) in November, 2019 and Aquarium of the Pacific, The Effects of Earth's Health on Human Health (Long Beach, CA, USA) in March, 2020. All other authors have no competing interests., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Objectives: To provide perspectives from the HEAT-SHIELD project (www.heat-shield.eu): a multi-national, inter-sectoral, and cross-disciplinary initiative, incorporating twenty European research institutions, as well as occupational health and industrial partners, on solutions to combat negative health and productivity effects caused by working on a warmer world., Methods: In this invited review, we focus on the theoretical and methodological advancements developed to combat occupational heat stress during the last five years of operation., Results: We outline how we created climate forecast models to incorporate humidity, wind and solar radiation to the traditional temperature-based climate projections, providing the basis for timely, policy-relevant, industry-specific and individualized information. Further, we summarise the industry-specific guidelines we developed regarding technical and biophysical cooling solutions considering effectiveness, cost, sustainability, and the practical implementation potential in outdoor and indoor settings, in addition to field-testing of selected solutions with time-motion analyses and biophysical evaluations. All recommendations were adjusted following feedback from workshops with employers, employees, safety officers, and adjacent stakeholders such as local or national health policy makers. The cross-scientific approach was also used for providing policy-relevant information based on socioeconomic analyses and identification of vulnerable regions considered to be more relevant for political actions than average continental recommendations and interventions., Discussion: From the HEAT-SHIELD experiences developed within European settings, we discuss how this inter-sectoral approach may be adopted or translated into actionable knowledge across continents where workers and societies are affected by escalating environmental temperatures., (Copyright © 2021. Published by Elsevier Ltd.)

Objectives: To derive an empirical model for the impact of aerobic fitness (maximal oxygen consumption; V̇O 2max in mL∙kg -1 ∙min -1 ) on physical work capacity (PWC) in the heat., Design: Prospective, repeated measures., Methods: Total work completed during 1 h of treadmill walking at a fixed heart rate of 130 b∙min -1 was assessed in 19 young adult males across a variety of warm and hot climate types, characterised by wet-bulb globe temperatures (WBGT) ranging from 12 to 40 °C. For data presentation and obtaining initial parameter estimates for modelling, participants were grouped into low (n = 6, 74 trials), moderate (n = 8, 76 trials), and high (n = 5, 29 trials) fitness, with group mean V̇O 2max 42, 52, and 64 mL∙kg -1 ∙min -1 , respectively. For the heated conditions (WBGT 18 to 40 °C), we calculated PWC% by expressing total energy expenditure (kJ above resting) in each trial relative to that achieved in a cool reference condition (WBGT = 12 °C = 100% PWC)., Results: The relative reduction in energy expenditure (PWC%) caused by heat was significantly smaller by up to 16% for the fit participants compared to those with lower aerobic capacity. V̇O 2max also modulated the relationship between sweat rate and body temperature changes to increasing WBGT. Including individual V̇O 2max data in the PWC prediction model increased the predicting power by 4%., Conclusions: Incorporating individual V̇O 2max improved the predictive power of the heat stress index WBGT for Physical Work Capacity in the heat. The largest impact of V̇O 2max on PWC was observed at a WBGT between 25 and 35 °C., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Purpose: To assess five theoretical foundations underlying thermosensory testing using local thermal stimuli., Methods: Thermal sensation, discomfort and the confidence of thermal sensation scores were measured in 9 female and 8 male volunteers in response to 17 physical contact temperature stimuli, ranging between 18-42 °C. These were applied to their dorsal forearm and lateral torso, across two sessions., Results: Thermal sensation to physical temperature relationships followed a positive linear and sigmoidal fit at both forearm (r 2  = 0.91/r 2  = 0.91, respectively) and lateral torso (r 2  = 0.90/ r 2  = 0.91, respectively). Thermal discomfort to physical temperature relationships followed second and third-order fits at both forearm (r 2  = 0.33/r 2  = 0.34, respectively) and lateral torso (r 2  = 0.38/r 2  = 0.39, respectively) test sites. There were no sex-related or regional site differences in thermal sensation and discomfort across a wide range of physical contact temperatures. The median confidence of an individual's thermal sensation rating was measured at 86%., Conclusion: The relation between thermal sensation and physical contact temperature was well described by both linear and sigmoidal models, i.e., the distance between the thermal sensation anchors is close to equal in terms of physical temperatures changes for the range studied. Participants rated similar thermal discomfort level in both cold and hot thermal stimuli for a given increase or decrease in physical contact temperature or thermal sensation. The confidence of thermal sensation rating did not depend on physical contact temperature.

Occupational heat stress directly hampers physical work capacity (PWC), with large economic consequences for industries and regions vulnerable to global warming. Accurately quantifying PWC is essential for forecasting impacts of different climate change scenarios, but the current state of knowledge is limited, leading to potential underestimations in mild heat, and overestimations in extreme heat. We therefore developed advanced empirical equations for PWC based on 338 work sessions in climatic chambers (low air movement, no solar radiation) spanning mild to extreme heat stress. Equations for PWC are available based on air temperature and humidity, for a suite of heat stress assessment metrics, and mean skin temperature. Our models are highly sensitive to mild heat and to our knowledge are the first to include empirical data across the full range of warm and hot environments possible with future climate change across the world. Using wet bulb globe temperature (WBGT) as an example, we noted 10% reductions in PWC at mild heat stress (WBGT = 18°C) and reductions of 78% in the most extreme conditions (WBGT = 40°C). Of the different heat stress indices available, the heat index was the best predictor of group level PWC (R 2 = 0.96) but can only be applied in shaded conditions. The skin temperature, but not internal/core temperature, was a strong predictor of PWC (R 2 = 0.88), thermal sensation (R 2 = 0.84), and thermal comfort (R 2 = 0.73). The models presented apply to occupational workloads and can be used in climate projection models to predict economic and social consequences of climate change.

Purpose: The physiological strain index (PSI) was developed to assess individuals' heat strain, yet evidence supporting its use to identify individuals at potential risk of reaching a thermal tolerance limit (TTL) is limited. The aim of this study was to assess whether PSI can identify individuals at risk of reaching a TTL., Methods: Fifteen females and 21 males undertook a total of 136 trials, each consisting of two 40-60 minute periods of treadmill walking separated by ~ 15 minutes rest, wearing permeable or impermeable clothing, in a range of climatic conditions. Heart rate (HR), skin temperature (T sk ), rectal temperature (T re ), temperature sensation (TS) and thermal comfort (TC) were measured throughout. Various forms of the PSI-index were assessed including the original PSI, PSI fixed , adaptive-PSI (aPSI) and a version comprised of a measure of heat storage (PSI HS ). Final physiological and PSI values and their rate of change (ROC) over a trial and in the last 10 minutes of a trial were compared between trials completed (C, 101 trials) and those terminated prematurely (TTL, 35 trials)., Results: Final PSI original , PSI fixed , aPSI, PSI HS did not differ between TTL and C (p > 0.05). However, differences between TTL and C occurred in final T sk , T re -T sk , TS, TC and ROC in PSI fixed , T re , T sk and HR (p < 0.05)., Conclusion: These results suggest the PSI, in the various forms, does not reliably identify individuals at imminent risk of reaching their TTL and its validity as a physiological safety index is therefore questionable. However, a physiological-perceptual strain index may provide a more valid measure.

The assessment of human internal/core temperature ( T core ) is relevant in many scientific disciplines, but also for public health authorities when attempting to identify individuals with fever. Direct assessment of T core is often invasive, impractical on a large scale, and typically requires close contact between the observer and the target subject. Non-contact infrared thermometry (NCIT) represents a practical solution in which T core can potentially be assessed from a safe distance and in mass screening scenarios, by measuring skin temperature at specific anatomical locations. However, the COVID-19 pandemic has clearly demonstrated that these devices are not being used correctly, despite expert guided specifications available in International Standard Organization (ISO) documents. In this review, we provide an overview of the most pertinent factors that should be considered by users of NCIT. This includes the most pertinent methodological and physiological factors, as well as an overview on the ability of NCIT to track human T core . For practical use, we provide a checklist based on relevant ISO standards which are simple to follow and should be consulted prior to using NCIT for assessment of human T core . Our intention is for users of NCIT to adopt this checklist, which may improve the performance of NCIT for its ability to track T core ., Competing Interests: No potential conflict of interest was reported by the authors., (© 2021 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.)

Purpose: Given the pressing impact of global warming and its detrimental effect on the health of older populations, understanding age-related changes in thermoregulatory function is essential. Age differences in regional sweat distribution have been observed previously, but given the typically small measurement areas assessed, the development of whole body sweat maps for older individuals is required. Therefore, this study investigated age-related differences in regional sweat distribution in a hot environment (32 °C/50%RH) in young and older adults, using a body mapping approach., Methods: Technical absorbent pads were applied to the skin of 14 young (age 24 ± 2 years) and 14 older (68 ± 5 years) males to measure regional sweat rate (RSR) at rest (30 min) and during exercise (30 min), at a fixed heat production (200 W m -2 ). Gastrointestinal (T gi ) and skin temperature (T sk ), heart rate, thermal sensation, and thermal comfort were also measured., Results: Whole body sweat maps showed that despite equal heat production, healthy older males had significantly lower gross sweat loss (GSL) than the young and significantly lower RSR at almost all body regions at rest and at the hands, legs, ankles, and feet during exercise. The lower sweat loss in the older group coincided with a greater increase in T gi and a consistently higher T sk at the legs, despite subjectively feeling slightly cooler than younger individuals., Conclusion: These findings support the evidence of age-related deterioration in both autonomic and subjective responses in the heat and highlight the lower extremities as the most affected body region.

Treatment and management of severe acute respiratory syndrome coronavirus-2, which causes coronavirus disease (COVID-19), requires increased adoption of personal protective equipment (PPE) to be worn by workers in healthcare and industry. In warm occupational settings, the added burden of PPE threatens worker health and productivity, a major lesson learned during the West-African Ebola outbreak which ultimately constrained disease control. In this paper, we comment on the link between COVID-19 PPE and occupational heat strain, cooling solutions available to mitigate occupational heat stress, and practical considerations surrounding their effectiveness and feasibility. While the choice of cooling solution depends on the context of the work and what is practical, mitigating occupational heat stress benefits workers in the healthcare and industrial sectors during the COVID-19 disease outbreak., (© The Author(s) 2020. Published by Oxford University Press on behalf of the British Occupational Hygiene Society.)

Background: Extreme heat events are increasing in frequency, severity, and duration. It is well known that heat stress can have a negative impact on occupational health and productivity, particularly during physical work. However, there are no up-to-date reviews on how vulnerability to heat changes as a function of individual characteristics in relation to the risk of hyperthermia and work capacity loss. The objective of this narrative review is to examine the role of individual characteristics on the human heat stress response, specifically in relation to hyperthermia risk and productivity loss in hot workplaces. Finally, we aim to generate practical guidance for industrial hygienists considering our findings. Factors included in the analysis were body mass, body surface area to mass ratio, body fat, aerobic fitness and training, heat adaptation, aging, sex, and chronic health conditions., Findings: We found the relevance of any factor to be dynamic, based on the work-type (fixed pace or relative to fitness level), work intensity (low, moderate, or heavy work), climate type (humidity, clothing vapor resistance), and variable of interest (risk of hyperthermia or likelihood of productivity loss). Heat adaptation, high aerobic fitness, and having a large body mass are the most protective factors during heat exposure. Primary detrimental factors include low fitness, low body mass, and lack of heat adaptation. Aging beyond 50 years, being female, and diabetes are less impactful negative factors, since their independent effect is quite small in well matched participants. Skin surface area to mass ratio, body composition, hypertension, and cardiovascular disease are not strong independent predictors of the heat stress response., Conclusion: Understanding how individual factors impact responses to heat stress is necessary for the prediction of heat wave impacts on occupational health and work capacity. The recommendations provided in this report could be utilized to help curtail hyperthermia risk and productivity losses induced by heat., (Copyright © 2020 Foster, Hodder, Lloyd and Havenith.)

Background: Climate change is set to exacerbate occupational heat strain, the combined effect of environmental and internal heat stress on the body, threatening human health and wellbeing. Therefore, identifying effective, affordable, feasible and sustainable solutions to mitigate the negative effects on worker health and productivity, is an increasingly urgent need., Objectives: To systematically identify and evaluate methods that mitigate occupational heat strain in order to provide scientific-based guidance for practitioners., Methods: An umbrella review was conducted in biomedical databases employing the following eligibility criteria: 1) ambient temperatures > 28 °C or hypohydrated participants, 2) healthy adults, 3) reported psychophysiological (thermal comfort, heart rate or core temperature) and/or performance (physical or cognitive) outcomes, 4) written in English, and 5) published before November 6, 2019. A second search for original research articles was performed to identify interventions of relevance but lacking systematic reviews. All identified interventions were independently evaluated by all co-authors on four point scales for effectiveness, cost, feasibility and environmental impact., Results: Following screening, 36 systematic reviews fulfilled the inclusion criteria. The most effective solutions at mitigating occupational heat strain were wearing specialized cooling garments, (physiological) heat acclimation, improving aerobic fitness, cold water immersion, and applying ventilation. Although air-conditioning and cooling garments in ideal settings provide best scores for effectiveness, the limited applicability in certain industrial settings, high economic cost and high environmental impact are drawbacks for these solutions. However, (physiological) acclimatization, planned breaks, shading and optimized clothing properties are attractive alternative solutions when economic and ecological sustainability aspects are included in the overall evaluation., Discussion: Choosing the most effective solution or combinations of methods to mitigate occupational heat strain will be scenario-specific. However, this paper provides a framework for integrating effectiveness, cost, feasibility (indoors and outdoor) and ecologic sustainability to provide occupational health and safety professionals with evidence-based guidelines.

We evaluated the paper by Maley et al. (2020) in this journal "Infrared cameras overestimate skin temperature during rewarming from cold Exposure" for the evidence provided in support of its title and conclusions. Several methodological issues were identified as well as issues with the data interpretation: 1: Only one camera was used but a conclusion was made for 'cameras' in general; 2: The camera accuracy (±2 °C) is too low to do a meaningful comparison without using local reference values or an on-site calibrator with higher accuracy; 3: Thermistor measurements are taken as a gold standard while issues such as temperature gradients and taping are known; 4: Both methods are not compared at the same location and a natural, physiological, gradient may be present between their locations; 5. The impact of the sensor and tape on delays in the change of the underlying tissue temperature is not considered; 6: Only a single pixel was used for the analysis, which has been shown to be problematic. We concluded that the paper by Maley et al. does not provide conclusive evidence that infrared cameras overestimate skin temperature during rewarming from cold exposure., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Purpose: To compare two analytical methods for the estimation of the shivering onset inflection point, segmental regression and visual inspection of data, and to assess the test-retest reliability and validity of four metrics of shivering measurement; oxygen uptake (V̇O 2 ), electromyography (EMG), mechanomyography (MMG) and bedside shivering assessment scale (BSAS)., Methods: Ten volunteers attended three identical experimental sessions involving passive deep-body cooling via cold water immersion at 10 °C. V̇O 2 , EMG, and MMG were continuously assessed, while the time elapsed at each BSAS stage was recorded. Metrics were graphed as a function of time and rectal temperature (T re ). Inflection points for intermittent and constant shivering were visually identified for every graph and compared to segmental regression., Results: Excellent agreement was seen between segmental regression and visual inspection (ICC, 0.92). All measurement metrics presented good-to-excellent test-retest reliability (ICC's > 0.75 and 0.90 respectively), with the exception of visual identification of intermittent shivering for V̇O 2 measurement (ICC, 0.73) and segmental regression for EMG measurement (ICC, 0.74). In the assessment of signal-to-noise ratio (SNR), EMG showed the largest SNR at the point of shivering onset followed by MMG and finally V̇O 2 ., Conclusions: Segmental regression provides a successful analytical method for identifying shivering onset. Good-to-excellent reliability can be seen across V̇O 2 , EMG, MMG, and BSAS, yet given the observed lag times, SNRs, along with known advantages/disadvantaged of each metric, it is recommended that no single metric is used in isolation. An integrative, real-time measure of shivering is proposed.

This study investigates foot sweat distribution with and without shoes and the relationship between foot sweat distribution and perceived wetness to enhance guidance for footwear design. Fourteen females performed low-intensity running with nude feet and low- and high-intensity running with shoes (55%VO 2max and 75%VO 2max , respectively) on separate occasions. Right foot sweat rates were measured at 14 regions using absorbent material applied during the last 5 min of each work intensity. Perceptual responses were recorded for the body, foot and four foot regions. Foot sweat production was 22% greater nude ( p  < .001) and with shoes did not increase with exercise intensity ( p  = .14). Highest sweat rates were observed at the medial ankle and dorsal regions; lowest sweat rates at the toes. Perceptions of wetness and foot discomfort did not correspond with regions of high sweat production or low skin temperature but rather seemed dominated by tactile interactions caused by foot movement within the shoe. Practitioner summary: This study provides a detailed view of foot sweat distribution for female runners with and without shoes, providing important guidance for sock and footwear design. Importantly, perceptions of wetness and foot discomfort did not correspond with areas of high sweat production. Instead tactile interactions between the foot, sock/shoe play an important role. Abbreviations: VO 2max : maximal oxygen consumption; HR: heart rate; RH: relative humidity; GSL: gross sweat loss; Nude-I1: without socks and shoes, low intensity running; Shod-I1: with socks and shoes, low intensity running; Shod-I2: with socks and shoes, high intensity running.

Competing Interests: Competing interests: None declared.

In our previous laboratory study a 'destructive' gravimetric method was developed to quantify local garment sweat absorption. While this currently is the only methodology that permits direct and analytical measurements of garment regional sweat absorption, the latter approach is time-consuming and expensive, therefore, of limited applicability. As such, in this study, we wanted to assess whether infrared thermography could be used as an indirect method to estimate garment regional sweat absorption, right after exercise, in a 'non-destructive' fashion. Spatial and temporal sweat absorption data, obtained in our previous study, were correlated with spatial and temporal temperature data obtained in the same experiment with an infrared thermal camera. The data suggest that infrared thermography is a good tool to qualitatively predict regional sweat absorption in garments at separate individual time points; however, temporal changes are not predicted well, due to a moisture content threshold above which variations in sweat content cannot be discriminated by further temperature changes.

The assessment of energy cost (EC) at the workplace remains a key topic in occupational health due to the ever-increasing prevalence of work-related issues. This review provides a detailed list of EC estimations in jobs/tasks included in tourism, agriculture, construction, manufacturing, and transportation industries. A total of 61 studies evaluated the EC of 1,667 workers while performing a large number of tasks related to each of the aforementioned five industries. Agriculture includes the most energy-demanding jobs (males: 6.0 ± 2.5 kcal/min; females: 2.9 ± 1.0 kcal/min). Jobs in the construction industry were the 2nd most demanding (males: 4.9 ± 1.6 kcal/min; no data for females). The industry with the 3rd highest EC estimate was manufacturing (males: 3.8 ± 1.1 kcal/min; females: 3.0 ± 1.3 kcal/min). Transportation presented relatively moderate EC estimates (males: 3.1 ± 1.0 kcal/min; no data for females). Tourism jobs demonstrated the lowest EC values (2.5 ± 0.9 kcal/min for males and females). It is hoped that this information will aid the development of future instruments and guidelines aiming to protect workers' health, safety, and productivity. Future research should provide updated EC estimates within a wide spectrum of occupational settings taking into account the sex, age, and physiological characteristics of the workers as well as the individual characteristics of each workplace.

Purpose: Cycling time-trial performance can be compromised by moderate to high ambient temperatures. It has become commonplace to implement precooling prior to competition to alleviate this performance decline. However, little is known about the ambient temperature threshold above which precooling becomes an effective strategy for enhancing endurance performance. The aim of this study was to investigate the effect of precooling in different environmental temperatures on time-trial (TT) performance., Methods: Trained cyclists completed 2 TTs with (COLD) and without (CON) precooling using an ensemble of  ice vest and sleeves in ambient temperatures of 24°C, 27°C, and 35°C., Results: TT performance was faster following COLD in both 35°C (6.2%) and 27°C (2.6%; both Ps < .05) but not 24°C (1.2%). Magnitude-based inferential statistics indicate that COLD was very likely beneficial to performance in 35°C, likely beneficial in 27°C, and possibly beneficial in 24°C. Mean power was 2.4%, 2.5%, and 5.6% higher following COLD and considered to be likely beneficial in 24°C and very likely beneficial in 27°C and 35°C. COLD reduced mean skin temperature throughout the warm-up and into the TT in all ambient temperatures (P < .05). Sweat loss was lower following COLD in 24°C and 27°C but not 35°C. There was no effect of COLD on gastrointestinal temperature at any point., Conclusions: Precooling with an ice vest and sleeves is likely to have a positive effect on TT performance at temperatures above 24°C, with a clear relationship between ambient temperature and the magnitude of effect of precooling.

Purpose : Produce a detailed upper-body sweat map and evaluate changes in gross and regional sweating rates (RSR) and distribution following heat acclimation (HA). Methods : Six males (25 ± 4 yrs) completed six consecutive HA days (45°C, 20% rh) requiring 90 minutes intermittent exercise to maintain a 1.4°C rectal temperature (Tre) rise. Pre- and post-HA upper-body RSR were measured at 55% (Intensity-1; I1) and 75% VO2 max (Intensity-2; I2) using a modified absorbent technique. Results : From day one to six of HA, work rate increased (n.s.), heart rate, Tre, and skin temperature were similar, and gross sweat loss (GSL) increased (P < 0.001). During pre and post-HA experiments, relative workloads were similar (Pre-I1 54 ± 3, Post-I1 57 ± 5%VO2max; Pre-I2 73 ± 4, Post-I2 76 ± 7%VO2max). Post-HA GSL was significantly higher (Pre 449 ± 90 g.m-2 h-1, Post 546 g.m-2 h-1; P < 0.01). Highest RSR were observed on the central back both pre and post-HA at I1 (pre 854 ± 269 post 1178 ± 402g.m-2 h-1) and I2 (pre 1221 ± 351 post 1772 ± 396 g.m-2 h-1). Absolute RSR increased significantly in 12 (I1) to 14 (I2) of the 17 regions. Ratio data indicated significant post-HA relative RSR redistribution, with decreased relative contributions to whole-body sweating on the back, chest staying the same and arms increasing. Conclusions : Hot-dry HA significantly increased GSL in aerobically trained males at I2. Absolute RSR significantly increased in I1 and I2, with a preferential relative redistribution towards the periphery of the upper-body.

Background: Occupational heat strain (ie, the effect of environmental heat stress on the body) directly threatens workers' ability to live healthy and productive lives. We estimated the effects of occupational heat strain on workers' health and productivity outcomes., Methods: Following PRISMA guidelines for this systematic review and meta-analysis, we searched PubMed and Embase from database inception to Feb 5, 2018, for relevant studies in any labour environment and at any level of occupational heat strain. No restrictions on language, workers' health status, or study design were applied. Occupational heat strain was defined using international health and safety guidelines and standards. We excluded studies that calculated effects using simulations or statistical models instead of actual measurements, and any grey literature. Risk of bias, data extraction, and sensitivity analysis were performed by two independent investigators. Six random-effects meta-analyses estimated the prevalence of occupational heat strain, kidney disease or acute kidney injury, productivity loss, core temperature, change in urine specific gravity, and odds of occupational heat strain occurring during or at the end of a work shift in heat stress conditions. The review protocol is available on PROSPERO, registration number CRD42017083271., Findings: Of 958 reports identified through our systematic search, 111 studies done in 30 countries, including 447 million workers from more than 40 different occupations, were eligible for analysis. Our meta-analyses showed that individuals working a single work shift under heat stress (defined as wet-bulb globe temperature beyond 22·0 or 24·8°C depending on work intensity) were 4·01 times (95% CI 2·45-6·58; nine studies with 11 582 workers) more likely to experience occupational heat strain than an individual working in thermoneutral conditions, while their core temperature was increased by 0·7°C (0·4-1·0; 17 studies with 1090 workers) and their urine specific gravity was increased by 14·5% (0·0031, 0·0014-0·0048; 14 studies with 691 workers). During or at the end of a work shift under heat stress, 35% (31-39; 33 studies with 13 088 workers) of workers experienced occupational heat strain, while 30% (21-39; 11 studies with 8076 workers) reported productivity losses. Finally, 15% (11-19; ten studies with 21 721 workers) of individuals who typically or frequently worked under heat stress (minimum of 6 h per day, 5 days per week, for 2 months of the year) experienced kidney disease or acute kidney injury. Overall, this analysis include a variety of populations, exposures, and occupations to comply with a wider adoption of evidence synthesis, but resulted in large heterogeneity in our meta-analyses. Grading of Recommendations, Assessment, Development and Evaluation analysis revealed moderate confidence for most results and very low confidence in two cases (average core temperature and change in urine specific gravity) due to studies being funded by industry., Interpretation: Occupational heat strain has important health and productivity outcomes and should be recognised as a public health problem. Concerted international action is needed to mitigate its effects in light of climate change and the anticipated rise in heat stress., Funding: EU Horizon 2020 research and innovation programme., (Copyright © 2018 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND license. Published by Elsevier Ltd.. All rights reserved.)

Clothing comfort is determined by multiple material and design factors. Wetness at the skin-clothing interface mainly impacts wear comfort. The current study investigated the combined effect of fabric contact area, fabric absolute sweat content and fabric moisture saturation percentage on wetness and stickiness sensations, during exercise. Moreover, factors causing wear (dis)comfort during exercise were identified. Higher fabric saturation percentage induced greater stickiness sensation, despite lower fabric contact area and absolute sweat content (typically associated with lower stickiness). Wetness perception did not change between fabrics with different saturation percentages, contact areas and sweat contents. Therefore, fabric saturation percentage mainly affects stickiness sensation of wet fabrics, overruling the impact of fabric contact area and absolute sweat content. No overall model of wear discomfort across all data could be developed, however, models for different time points were produced, with texture and stickiness sensations being the best predictors of wear discomfort at baseline and during exercise, respectively. This suggests that the factors determining clothing (dis)comfort are dynamics and alter importance during exercise activity., (Copyright © 2018 Elsevier Ltd. All rights reserved.)