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Introduction: In the recent past, spells of extreme heat associated with appreciable mortality have been documented in developed countries, including North America and Europe. However, far fewer research reports are available from developing countries or specific cities in South Asia. In May 2010, Ahmedabad, India, faced a heat wave where the temperatures reached a high of 46.8°C with an apparent increase in mortality. The purpose of this study is to characterize the heat wave impact and assess the associated excess mortality. Methods: We conducted an analysis of all-cause mortality associated with a May 2010 heat wave in Ahmedabad, Gujarat, India, to determine whether extreme heat leads to excess mortality. Counts of all-cause deaths from May 1–31, 2010 were compared with the mean of counts from temporally matched periods in May 2009 and 2011 to calculate excess mortality. Other analyses included a 7-day moving average, mortality rate ratio analysis, and relationship between daily maximum temperature and daily all-cause death counts over the entire year of 2010, using month-wise correlations. Results: The May 2010 heat wave was associated with significant excess all-cause mortality. 4,462 all-cause deaths occurred, comprising an excess of 1,344 all-cause deaths, an estimated 43.1% increase when compared to the reference period (3,118 deaths). In monthly pair-wise comparisons for 2010, we found high correlations between mortality and daily maximum temperature during the locally hottest “summer” months of April (r = 0.69, p<0.001), May (r = 0.77, p<0.001), and June (r = 0.39, p<0.05). During a period of more intense heat (May 19–25, 2010), mortality rate ratios were 1.76 [95% CI 1.67–1.83, p<0.001] and 2.12 [95% CI 2.03–2.21] applying reference periods (May 12–18, 2010) from various years. Conclusion: The May 2010 heat wave in Ahmedabad, Gujarat, India had a substantial effect on all-cause excess mortality, even in this city where hot temperatures prevail through much of April-June. [ABSTRACT FROM AUTHOR]

Over the course of the 20th century, the United States became an urban nation: 80% of Americans now live in metropolitan areas. Supplying basic sanitary services--drinking water, sewers, and garbage removal--to these cities is a gargantuan task, yet most people have little understanding of urban infrastructure systems and their enormous regional ecologic impacts. Municipalization of sanitary services, especially since 1880, distanced people from their wastes and gave city dwellers a simplistic experience of one-way material flow through cities, without knowledge of the environmental costs. Most sanitary infrastructures were built primarily for durability and lack the elasticity to meet changing needs. The challenge now is to adapt sanitary systems for flexibility and simultaneously move from unchecked material consumption toward resource-based thinking. [ABSTRACT FROM AUTHOR]