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OBJECTIVE: To measure the association between ambient heat and hypoglycemia-related emergency department visit or hospitalization in insulin users. RESEARCH DESIGN AND METHODS: We identified cases of serious hypoglycemia among adults using insulin aged ≥65 in the U.S. (via Medicare Part A/B/D-eligible beneficiaries) and Taiwan (via National Health Insurance Database) from June to September, 2016–2019. We then estimated odds of hypoglycemia by heat index (HI) percentile categories using conditional logistic regression with a time-stratified case-crossover design. RESULTS: Among ∼2 million insulin users in the U.S. (32,461 hypoglycemia case subjects), odds ratios of hypoglycemia for HI >99th, 95–98th, 85–94th, and 75–84th percentiles compared with the 25–74th percentile were 1.38 (95% CI, 1.28–1.48), 1.14 (1.08–1.20), 1.12 (1.08–1.17), and 1.09 (1.04–1.13) respectively. Overall patterns of associations were similar for insulin users in the Taiwan sample (∼283,000 insulin users, 10,162 hypoglycemia case subjects). CONCLUSIONS: In two national samples of older insulin users, higher ambient temperature was associated with increased hypoglycemia risk. [ABSTRACT FROM AUTHOR]

The decrease of temperatures along an elevation gradient imposes physiological constraints on reptiles that ultimately determine their distribution ranges. Forest patterns are likely to interact with this process, but very few studies have examined their contribution in determining distribution limits. We examined the role played by thermal physiology and forest cover in determining the elevational ranges of a lizard, Eutropis longicaudata. We integrated this species' thermal traits in simulating its maximum activity time under different conditions of forest cover and elevation using a NicheMapR model. In addition, we evaluated the influence of winter temperatures on the range limit by examining the simulated soil temperatures at the occurrence sites. Laboratory experiments showed that E. longicaudata has a high preferred body temperature and low cold tolerance. The model predicts that maximum activity time decreases with elevation and forest cover. Although unforested areas may provide longer active time in all simulated elevations, mountain areas in Taiwan are heavily forested and are predicted to allow only a very short period of activity above 1000 m elevation. All sightings were indeed located in areas below 1000 m elevation, in which the predicted average soil temperature is above 10 °C in January in cold years. Our results show that reptile physiological response does respond strongly to the change of microclimate induced by forest cover and elevation. Overall, this suggests that forest cover is a major determinant of some reptiles' elevational range. • The lizard, Eutropis longicaudata , is restricted to lowland areas in Taiwan. • Thermal physiology imposes a constraint on its elevational range. • Forest patterns may interact with elevation to shape the upper limit of the range. [ABSTRACT FROM AUTHOR]

1. Temperature rise due to climate change affects seasonal activity times, leading to a discordance of phenology among species and changing the strength of interaction between species. Understanding how temperature changes will affect the length of a species' activity period is essential in order to forecast its response to climate warming. 2. We investigated the thermal physiology and monthly activity of a skink from subtropical areas in Taiwan, Scincella formosensis. In addition, we predicted its response to climate warming and potential landscape vegetation changes using a mechanistic model, Niche MapperTM. We incorporated the animals' thermal traits and climatic data to simulate thermally suitable time for activity each month in two sites (open area, dense forest). 3. We found that this species restricts its activity to the cool months of the year, and that juveniles emerge in June. The thermally suitable period for activity is predicted to be longer in cool months than warm months. 4. Our model predicts that a 3 °C increase in temperature will curtail the thermally suitable time for activity in open areas in late spring and result in very minimal time for activity in the summer, even when dense forest is available. These results add to the growing body of literature indicating that a temperature rise will have a widespread impact on sub/tropical forest reptiles. • The subtropical forest lizard, Scincella formosensis , is a winter-active species. • Thermal physiology of this species largely accounts for its annual activity pattern. • Climate warming (3 °C increase) will curtail the length of annual activity period of this species. • Adults barely have thermally suitable time for activity during summer in climate warming. [ABSTRACT FROM AUTHOR]

1. The invasive many-lined sun skink, Eutropis multifasciata , is established in much of southern Taiwan and is spreading northward. We investigated whether winter temperatures constrain further dispersion of this skink by comparing its cold tolerance to the spatial distribution of winter temperatures in Taiwan. 2. We measured the 28-day survival rate of this species at 4 constant temperatures (10−16 °C in 2 °C increments) and its critical thermal minimum (CTmin), i.e., the body temperature at which the righting reflex is lost during the cooling process. For comparison with the spatial distribution of temperatures over Taiwan, we used the biophysical model Niche Mapper™ in order to simulate the soil temperatures, where lizards are inactive in the winter, during the coldest month of the year, January, under three climatic scenarios (average temperature, average−3 °C, average+3 °C). 3. Our results indicate that this species has low tolerance to cold. Combining cold tolerance data with soil temperature data suggests that its upper elevation limit could range from 1000 m to 1500 m, above which the weather is lethal and precludes overwintering. The locations of sightings of E. multifasciata are consistent with this prediction, with no known locations above 500 m elevation. 4. This study highlights that the winter climate is a major factor in determining population establishment and hence in limiting this species' range. Future studies would benefit from accounting for low winter temperatures and their potential influence on range limits of invasive species. • The range limits of Eutropis multifasciata in Taiwan were predicted with cold tolerance data and simulated soil temperatures. • We show that winter cold likely leads to death of this species in most mountain areas, preventing its further invasion. • Winter temperature variation in northern Taiwan is predicted to be disadvantageous for this species to establish populations. • Our simulated results accord with the current distribution pattern, which was obtained with a road-kill dataset. [ABSTRACT FROM AUTHOR]

The geographic distribution of species can be affected by environmental factors. The adult highaltitude lizard Takydromus hsuehshanensis (altitude > 1800 m) has been shown to tolerate summer lowland air temperature; its absence in lowland areas may therefore be caused by other factors. We employed a transplant experiment to monitor survival in different life stages and female reproduction in lowland areas. We maintained the T. hsuehshanensis adults in semi-natural outdoor enclosures with sufficient food, water, and the exclusion of potential predators. The results showed that (1) the survival rates of adults gradually decreased to 23.4% from one summer to the next, (2) illness occurred in adults during the winter, and (3) reproductive capacity (2 eggs/female), hatching success (31.7%), and hatchling survival rate (0% at the end of 11 weeks) were very low during the active season. We suggest that environmental factors synergistically caused these impairments in T. hsuehshanensis across different life stages and different seasons. This may partially explain its current altitudinal distribution.