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Abstract In this study, we evaluated the thermal environments of different tennis courts using wet-bulb globe temperature (WBGT) meters. WBGT meters were installed in an outdoor hard court, sand-filled artificial grass court, and clay court (a softball field), and measurements were taken hourly from 9:00 to 17:00 on weekdays from June 1 to September 21, 2022. The results were compared with data from different courts and the nearest Japan Meteorological Agency station (JMA WBGT) based on the Japan Sports Association’s guidelines for exercise to prevent heat stroke. The median WBGT on each court was significantly higher for hard courts at the “Warning” (25 ≤ JMA WBGT

In this study, we evaluated the thermal environments of different tennis courts using wet-bulb globe temperature (WBGT) meters. WBGT meters were installed in an outdoor hard court, sand-filled artificial grass court, and clay court (a softball field), and measurements were taken hourly from 9:00 to 17:00 on weekdays from June 1 to September 21, 2022. The results were compared with data from different courts and the nearest Japan Meteorological Agency station (JMA WBGT) based on the Japan Sports Association's guidelines for exercise to prevent heat stroke. The median WBGT on each court was significantly higher for hard courts at the "Warning" (25 ≤ JMA WBGT < 28) level or above, sand-filled artificial grass courts at the "Severe Warning" (28 ≤ JMA WBGT < 31) level or above, and clay courts at the "Danger" (31 ≤ JMA WBGT) level than the JMA WBGT. Compared with the JMA WBGT, hard and sand-filled artificial grass courts are played on under particularly hot conditions. The results of this study could indicate to tournament organizers and coaches the importance of measuring the WBGT on each court surface from an early stage to prevent heat-related incidents. [ABSTRACT FROM AUTHOR]

The worldwide prevalence and incidence rates of end-stage renal disease have been increasing, and the trend is pronounced in Taiwan. This is especially evident in southern Taiwan, where the wet-bulb globe temperature (WBGT) is consistently higher than in other regions. The association between kidney function and WBGT has not been fully investigated. Therefore, the aim of this study was to evaluate the association between estimated glomerular filtration rate (eGFR) and WBGT and variations in this association across different geographic regions in Taiwan. We used the Taiwan Biobank (TWB) to obtain data on community-dwelling individuals, linked these data with WBGT data obtained from the Central Weather Bureau and then processed the data using a machine learning model. WBGT data were recorded during the working period of the day from 8:00 a.m. to 5:00 p.m. These data were then compiled as 1-year, 3-year and 5-year averages, recorded prior to the survey year of the TWB of each participant. We identified 114 483 participants who had WBGT data during 2012–2020. Multivariable analysis showed that, in northern Taiwan, increases in 1- and 3-year averages of WBGT during the working period (β = −0.092, P  = .043 and β = −0.193, P  < .001, respectively) were significantly associated with low eGFR. In southern Taiwan, increases in 1-, 3- and 5-year averages of WBGT during the working period (β = −0.518, P  < .001; β = −0.690, P  < .001; and β = −0.386, P  = .001, respectively) were gnificantly associated with low eGFR. These findings highlight the importance of heat protection for people working outdoors or in high-temperature environments as a measure to prevent negative impacts on kidney function. Moreover, we observed that in southern Taiwan, every 1°C increase in WBGT had a greater impact on the decrease in eGFR compared with other regions in Taiwan. [ABSTRACT FROM AUTHOR]

We propose a novel quantification of absolute human heat tolerance based on empirical assessment of the environment and individual modifiers. Human "heat tolerance" has no accepted definition or physiological underpinnings; rather, it is almost always discussed in relative or comparative terms. We propose to use environmental limits to heat balance accounting for metabolic rate and clothing, that is, the environments for which heat stress becomes uncompensable for a specified metabolic rate and clothing, as a novel metric for quantifying heat tolerance. [ABSTRACT FROM AUTHOR]

The Simplified Wet Bulb Globe Temperature (sWBGT) is widely used in heat stress assessments for climate-change studies, but its limitations have not been thoroughly explored. Building on recent critiques of sWBGT's use for current climate on global scale, this study examines sWBGT's biases using dynamically-downscaled sub-daily climate projections under multiple future emission scenarios. The analysis is aimed at understanding caveats in the application of sWBGT and the uncertainties in existing climate change analysis dependent on sWBGT. Results indicate sWBGT's biases are heavily influenced by local near-surface air temperature, with overestimation of heat stress in East Asia regions, particularly hot and humid areas, due to static assumptions of radiation and wind speed. This overestimation is amplified in warmer climates, leading to exaggerated projected heat stress increases in future. In contrast, underestimations are found for heat stress levels attributed to low wind speeds and strong radiations, such as over the Tibetan Plateau and certain extreme events. Additionally, sWBGT underestimates variability in extreme heatwave events compared to WBGT in both current and future climates, irrespective of overestimation in absolute heatwave intensities. This study emphasizes the limitations of sWBGT, especially in future warmer climates. Importance of sub-daily data for capturing daily maximum heat stress level and reflecting diurnal variations in different components is also discussed. In conclusion, we recommend using Liljegren's model (i.e., physics-based calculation) with high-resolution sub-daily climate data for more accurate outdoor heat stress assessments in climate change studies.

New Findings: What is the central question of this study?The aim was to identify the factors predicting the body core temperature of athletes at the end of a 10 km self‐paced run in a hot environment.What is the main finding and its importance?Hyperthermia in athletes subjected to self‐paced running depends on several factors, highlighting the integrated control of core temperature during exercise under environmental heat stress. Five of the seven variables that significantly predicted core temperature are not invasive and, therefore, practical for use outside the laboratory environment: heart rate, sweat rate, wet‐bulb globe temperature, running speed and maximal oxygen consumption. Measurement of body core temperature (Tcore) is paramount to determining the thermoregulatory strain of athletes. However, standard measurement procedures of Tcore are not practical for extended use outside the laboratory environment. Therefore, determining the factors that predict Tcore during a self‐paced run is crucial for creating more effective strategies to minimize the heat‐induced impairment of endurance performance and reduce the occurrence of exertional heatstroke. The aim of this study was to identify the factors predicting Tcore values attained at the end of a 10 km time trial (end‐Tcore) under environmental heat stress. Initially, we extracted data obtained from 75 recordings of recreationally trained men and women. Next, we ran hierarchical multiple linear regression analyses to understand the predictive power of the following variables: wet‐bulb globe temperature, average running speed, initial Tcore, body mass, differences between Tcore and skin temperature (Tskin), sweat rate, maximal oxygen uptake, heart rate and change in body mass. Our data indicated that Tcore increased continuously during exercise, attaining 39.6 ± 0.5°C (mean ± SD) after 53.9 ± 7.5 min of treadmill running. This end‐Tcore value was primarily predicted by heart rate, sweat rate, differences between Tcore and Tskin, wet‐bulb globe temperature, initial Tcore, running speed and maximal oxygen uptake, in this order of importance (β power values corresponded to 0.462, −0.395, 0.393, 0.327, 0.277, 0.244 and 0.228, respectively). In conclusion, several factors predict Tcore in athletes subjected to self‐paced running under environmental heat stress. Moreover, considering the conditions investigated, heart rate and sweat rate, two practical (non‐invasive) variables, have the highest predictive power. [ABSTRACT FROM AUTHOR]

Background: Evidence describing the relationship between short-term temperature exposure and kidney-related conditions is insufficient. It remains unclear how temperature specification affects estimation of these associations. This study aimed to assess associations between short-term temperature exposure and seven kidney-related conditions and to evaluate the influence of temperature specification. Methods: We obtained data on hospital encounters in New York State (2007–2016). We assessed associations with a case-crossover design using conditional logistic regression with distributed lag non-linear models. We compared model performance (i.e., AIC) and association curves using 1) five temperature spatial resolutions; 2) temperature on an absolute versus relative scale; 3) seven temperature metrics incorporating humidity, wind speed, and/or solar radiation; and 4) five intraday temperature measures (e.g., daily minimum and daytime mean). Results: We included 1,209,934 unplanned adult encounters. Temperature metric and intraday measure had considerably greater influence than spatial resolution and temperature scale. For outcomes not associated with temperature exposure, almost all metrics or intraday measures showed good model performance; for outcomes associated with temperature, there were meaningful differences in performance across metrics or intraday measures. For parsimony, we modelled daytime mean outdoor wet-bulb globe temperature, which showed good performance for all outcomes. At lag 0–6 days, we observed increased risk at the 95th percentile of temperature versus the minimum morbidity temperature for acute kidney failure (odds ratio [OR] = 1.36, 95% confidence interval [CI]: 1.09, 1.69), urolithiasis (OR = 1.41, 95% CI: 1.16, 1.70), dysnatremia (OR = 1.26, 95% CI: 1.01, 1.59), and volume depletion (OR = 1.88, 95% CI: 1.41, 2.51), but not for glomerular diseases, renal tubulo-interstitial diseases, and chronic kidney disease. Conclusions: High-temperature exposure over one week is a risk factor for acute kidney failure, urolithiasis, dysnatremia, and volume depletion. The differential model performance across temperature metrics and intraday measures indicates the importance of careful selection of exposure metrics when estimating temperature-related health burden.

Urbanization has resulted in high temperatures in cities, which are exacerbated by an increase in urban impervious surfaces (road space). This study investigated the effect of urban road characteristics on roadside temperature. Different temperature indices were measured at four sites in Seoul with different road designs by using weather measuring devices and infrared thermal cameras. The differences between air and roadside air temperatures decreased from site 1 (no vegetation) to site 4 (roadside trees and vegetated medians). The analysis results showed that roadside wet-bulb globe and surface thermal temperatures sensitively changed according to road characteristics, unlike air temperature. The lowest temperatures were consistently observed at site 4. This cooling tendency was the strongest in the afternoon, which indicates the effectiveness of vegetation for preventing the commonly observed temperature rise in the afternoon. That is, roadside trees and vegetation in the median strip can prevent temperature rise and contribute to urban temperature reduction. Therefore, more roadside trees and median planting, as well as taller trees and denser vegetation along roads, can be used to provide a greater reduction of roadside temperatures and to improve urban climates. [ABSTRACT FROM AUTHOR]

Introduction: Heat stress is a critical problem in hot industries, especially in incredibly hot climates. It can greatly impair the work process and put the health of workers at risk. This study aims to investigate the applicability of the WBGT index in determining the allowable working time in very hot weather conditions in one of the steel industries in Ahvaz. Material and Methods: This study was conducted in different sectors of a steel industry in Ahwaz. The physiological parameters of sixty workers working in different parts of the industry were evaluated. Environmental variables and the Wet-Bulb globe temperature (WBGT) Index were also simultaneously measured during work shifts. The acceptable work time was calculated based on the reserve heart rate (RHR) and the WBGT index. Results: The heat stress index among all occupational groups, based on the WBGT index, was incredibly high and surpassed the recommended level (P

Ultraviolet (UV) parasols are a reasonable countermeasure against heat stress as they are portable and inexpensive. This study compared the heat stress mitigation effect of a UV parasol with that of street trees and drymist spraying on a hot and humid summer day in Japan. We observed meteorological elements and calculated the universal thermal climate index (UTCI) and wet-bulb globe temperature (WBGT) under UV parasol, street trees, dry-mist spraying, and direct sunlight. The observed UTCI and WBGT under the UV parasol were lower than those in direct sunlight by 4.4°C and 1.3°C, respectively, because of the decrease in black-globe temperature caused by the reduced downward shortwave radiation. This demonstrated that UV parasol reduced heatstroke risk by one level. The effect of the UV parasol was = 75 % of that of the street trees from the perspective of UTCI. The street trees reduced the UTCI and WBGT by 5.9°C and 1.9°C, respectively, compared with those in direct sunlight, resulting in the reduction of heatstroke risk by one level. In contrast, dry-mist spraying did not mitigate heat stress in conditions with moderate winds. Although the results of this study were obtained from observations on a single day, comparison with earlier studies confirms that the values observed in this study are representative results on summer days in Japan. [ABSTRACT FROM AUTHOR]

Wet-bulb globe temperature (WBGT)-a standard measure for workplace heat stress regulation-incorporates the complex, nonlinear interaction among temperature, humidity, wind and radiation. This complexity requires WBGT to be calculated iteratively following the recommended approach developed by Liljegren and colleagues. The need for iteration has limited the wide application of Liljegren's approach, and stimulated various simplified WBGT approximations that do not require iteration but are potentially seriously biased. By carefully examining the self-nonlinearities in Liljegren's model, we develop a zero-iteration analytic approximation of WBGT while maintaining sufficient accuracy and the physical basis of the original model. The new approximation slightly deviates from Liljegren's full model-by less than 1°C in 99% cases over 93% of global land area. The annual mean and 75%-99% percentiles of WBGT are also well represented with biases within ± 0.5 °C globally. This approximation is clearly more accurate than other commonly used WBGT approximations. Physical intuition can be developed on the processes controlling WBGT variations from an energy balance perspective. This may provide a basis for applying WBGT to understanding the physical control of heat stress., Competing Interests: The authors declare no conflicts of interest relevant to this study., (© 2024 The Author(s). GeoHealth published by Wiley Periodicals LLC on behalf of American Geophysical Union.)

Little is known about the separate and combined influences of humidity conditions, sex, and aerobic fitness on heat tolerance in unacclimatized males and females. The purpose of the current study was to describe heat tolerance, in terms of critical WBGT (WBGTcrit), in unacclimatized young males and females in hot-dry (HD) and warm-humid (WH) environments. Eighteen subjects (9 M/9F; 21 ± 2 yr) were tested during exercise at 30% V̇O2max in a controlled environmental chamber. Progressive heat stress exposures were performed with either (1) constant dry-bulb temperature (Tdb) of 34 and 36 °C and increasing ambient water vapor pressure (Pa) (Pcrit trials; WH); or (2) constant Pa of 12 and 16 mmHg and increasing Tdb (Tcrit trials; HD). Chamber Tdb and Pa, and subject esophageal temperature (Tes), were continuously monitored throughout each trial. After a 30-min equilibration period, progressive heat stress continued until subject heat balance could no longer be maintained and a clear rise in Tes was observed. Absolute WBGTcrit and WBGTcrit adjusted to a metabolic rate of 300 W (WBGT300), and the difference between WBGTcrit and occupational exposure limits (OEL; ΔOEL) was assessed. WBGTcrit, WBGT300, and ΔOEL were higher in WH compared to HD (p < 0.0001) for females but were the same between environments for males (p ≥ 0.21). WBGTcrit was higher in females compared to males in WH (p < 0.0001) but was similar between sexes in HD (p = 0.44). When controlling for metabolic rate, WBGT300 and ΔOEL were higher in males compared to females in WH and HD (both p < 0.0001). When controlling for sex, V̇O2max was not associated with WBGT300 or ΔOEL for either sex (r ≤ 0.12, p ≥ 0.49). These findings suggest that WBGTcrit is higher in females compared to males in WH, but not HD, conditions. Additionally, the WBGTcrit is lower in females, but not males, in HD compared to WH conditions. [ABSTRACT FROM AUTHOR]

Using human location data from mobile phones, we developed a method to detail transportation modes around Shinagawa Station in Tokyo and analyzed the impact of hot weather conditions on traffic behavior. Each user's movement history was collected based on the global positioning system (GPS) communication of applications. We estimated the modes of transportation (train, car, walking, and stationary) for each user. By conducting route searches based on each user's data, we calculated the traffic volume for each mode of transportation, linking the estimated population data to network data and confirming accuracy against official census data. In August 2019, we examined the relationship between the estimated transportation modes and the hourly wet-bulb globe temperature (WBGT), which was calculated by the Ministry of the Environment using values measured by the Tokyo Regional Meteorological Observatory. The results indicated that as WBGT increases, fewer pedestrians walk and more remain stationary. Sensitivity to WBGT was four times greater at 20:00 p.m. than at 08:00 a.m., despite similar WBGT levels. This may be because fewer people go out during the hottest part of the day, and the sum of those who go out during the day, i.e., those who return home, is greatly reduced. However, this trend was not observed on weekdays. The results suggest that the impact of summer heat is latent during weekdays due to the demands of work and errands but becomes more pronounced during free time, such as holidays and nighttime. • Proposed methodology can extract highly detailed modes of human transportation. • Pedestrian responses to weather based on land use and time of day were estimated. • High WBGT leads to decreased walking activity, especially on holidays. • Reduction in pedestrian numbers due to WBGT rise is greater at night than in morning. [ABSTRACT FROM AUTHOR]

Wet‐bulb globe temperature (WBGT) is a widely applied heat stress index. However, most applications of WBGT within the heat stress impact literature that do not use WBGT at all, but use one of the ad hoc approximations, typically the simplified WBGT (sWBGT) or the environmental stress index (ESI). Surprisingly, little is known about how well these approximations work for the global climate and climate change settings that they are being applied to. Here, we assess the bias distribution as a function of temperature, humidity, wind speed, and radiative conditions of both sWBGT and ESI relative to a well‐validated, explicit physical model for WBGT developed by Liljegren, within an idealized context and the more realistic setting of ERA5 reanalysis data. sWBGT greatly overestimates heat stress in hot‐humid areas. ESI has much smaller biases in the range of standard climatological conditions. Over subtropical dry regions, both metrics can substantially underestimate extreme heat. We show systematic overestimation of labor loss by sWBGT over much of the world today. We recommend discontinuing the use of sWBGT. ESI may be acceptable for assessing average heat stress or integrated impact over a long period like a year, but less suitable for health applications, extreme heat stress analysis, or as an operational index for heat warning, heatwave forecasting, or guiding activity modification at the workplace. Nevertheless, Liljegren's approach should be preferred over these ad hoc approximations and we provide a fast Python implementation to encourage its widespread use. Plain Language Summary: Wet‐bulb globe temperature (WBGT) is a widely applied heat stress index. However, most applications of WBGT within the climate change heat stress impact literature that do not use WBGT at all but use one of the ad hoc approximations, typically the simplified WBGT (sWBGT) or sometimes the environmental stress index (ESI). But we know little about how well these approximations work for measuring heat stress. Here, we evaluate the performance of sWBGT and ESI against a well‐validated, explicit physical model of WBGT. sWBGT greatly overestimates heat stress under a hot, humid climate. ESI performs much better in measuring average heat stress. But they both may seriously underestimate severe heat stress, especially in hot, dry regions. Our results suggest that previous studies using sWBGT tend to dramatically overestimate heat stress and its economic and health implications, which may further misinform policymaking. We recommend discontinuing the use of sWBGT. ESI may be acceptable for assessing average heat stress, but less suitable for the warning or forecasting of extreme heat, or providing guidance for dealing with workplace heat stress. Nevertheless, the well‐validated physical model of WBGT should be preferred over these approximations and we provide a Python implementation to encourage its widespread use. Key Points: We evaluate biases of two common approximations to Wet‐bulb globe temperature (WBGT) in comparison with explicitly calculated WBGT and consider labor implicationsSimplified WBGT generally overestimates heat stress and resulting labor loss, whereas environmental stress index is less biased. Both methods underestimate peak heat stressBoth methods are systematically biased. We offer a computationally efficient Python implementation to encourage accurate WBGT calculations [ABSTRACT FROM AUTHOR]

Abstract Wet‐bulb globe temperature (WBGT) is a widely applied heat stress index. However, most applications of WBGT within the heat stress impact literature that do not use WBGT at all, but use one of the ad hoc approximations, typically the simplified WBGT (sWBGT) or the environmental stress index (ESI). Surprisingly, little is known about how well these approximations work for the global climate and climate change settings that they are being applied to. Here, we assess the bias distribution as a function of temperature, humidity, wind speed, and radiative conditions of both sWBGT and ESI relative to a well‐validated, explicit physical model for WBGT developed by Liljegren, within an idealized context and the more realistic setting of ERA5 reanalysis data. sWBGT greatly overestimates heat stress in hot‐humid areas. ESI has much smaller biases in the range of standard climatological conditions. Over subtropical dry regions, both metrics can substantially underestimate extreme heat. We show systematic overestimation of labor loss by sWBGT over much of the world today. We recommend discontinuing the use of sWBGT. ESI may be acceptable for assessing average heat stress or integrated impact over a long period like a year, but less suitable for health applications, extreme heat stress analysis, or as an operational index for heat warning, heatwave forecasting, or guiding activity modification at the workplace. Nevertheless, Liljegren's approach should be preferred over these ad hoc approximations and we provide a fast Python implementation to encourage its widespread use.

In this study, wet‐bulb globe temperature (WBGT) was measured under wisteria trellises, under tents, and in direct sunlight. In addition, a subject experiment was conducted to consider the relaxation effect of the greenery. In terms of WBGT, the risk of heatstroke under the wisteria trellis was one level lower than that in direct sunlight. The mitigation effect of the wisteria trellis was greater than that of the tent. The difference in WBGT beneath the wisteria trellis and under the tent was primarily due to varied black‐globe temperature (i.e., the difference in radiation environment). The wisteria trellis blocked most of the solar radiation, and its effect on the small aggregation of leaves reduced the increase in the leaf surface temperature and downward longwave radiation. The tent material allowed more solar radiation and increased the temperature of the tent surface. The questionnaire responses revealed that the subjects felt cooler and more comfortable under the wisteria trellis than under the tent, with or without a blindfold. [ABSTRACT FROM AUTHOR]

Exertional heat illness (EHI) is a syndrome that occurs when metabolic heat production from muscular contraction exceeds the rate at which it can be dissipated. Core body temperature rises to critical levels, causing hyperthermia and central nervous system dysfunction. Best practice for the prevention of EHI centres around early detection, rapid response and aggressive cooling. Advance planning enables risk mitigation measures. The more that is known about EHI in horses, the better prepared those in the positions of responsibility can be to anticipate events in which the risk of EHI may be elevated. This prospective, observational study investigated environmental risk factors associated with the occurrence of EHI. From 2014 to 2018, the number of horses exhibiting the symptoms of post‐race EHI was recorded at 73 convenience sampled race meetings. Of the 4809 starters, the signs of EHI were recorded for 457. Thermal environmental data were measured and included ambient temperature, radiant heat, vapor pressure (humidity) and wind speed (WS). Mixed linear regression models were computed to assess the associations between the occurrence and incidence of post‐race EHI and the four thermal environmental variables. The analysis showed that vapor pressure and WS had the largest effects on the occurrence of post‐race EHI. The major limitations were that the race meetings selected were convenience sampled according to attendance by the first author and individual horse data were not available. EHI is influenced by a complex interaction of independently acting environmental variables, but warm, windless, humid days are most likely to result in the cases of EHI. [ABSTRACT FROM AUTHOR]

Abstract In this study, wet‐bulb globe temperature (WBGT) was measured under wisteria trellises, under tents, and in direct sunlight. In addition, a subject experiment was conducted to consider the relaxation effect of the greenery. In terms of WBGT, the risk of heatstroke under the wisteria trellis was one level lower than that in direct sunlight. The mitigation effect of the wisteria trellis was greater than that of the tent. The difference in WBGT beneath the wisteria trellis and under the tent was primarily due to varied black‐globe temperature (i.e., the difference in radiation environment). The wisteria trellis blocked most of the solar radiation, and its effect on the small aggregation of leaves reduced the increase in the leaf surface temperature and downward longwave radiation. The tent material allowed more solar radiation and increased the temperature of the tent surface. The questionnaire responses revealed that the subjects felt cooler and more comfortable under the wisteria trellis than under the tent, with or without a blindfold.

Background: Although experts have advocated for regionally specific heat safety guidelines for decades, guidelines have not been universally adopted. Purpose: To describe the rate and risk factors associated with exertional heat illness (EHI). Study Design: Descriptive epidemiology study. Methods: For a 3-month period (August-October) over 6 years (2013-2018), athletic trainers at 13 high schools in North Central Florida recorded varsity football practice time and length, wet-bulb globe temperature (WBGT), and incidences of EHI, including heat stroke, heat exhaustion, and heat syncope. Results: Athletes sustained 54 total EHIs during 163,254 athlete-exposures (AEs) for the 3-month data collection periods over 6 years (incidence rate [IR], 3.31 /10,000 AEs). Heat exhaustion accounted for 59.3% (32/54), heat syncope 38.9% (21/54), and heat stroke 1.9% (1/54) of all EHIs recorded. Of the EHIs, 94.4% (51/54) were experienced within the first 19 practices. The first 19 practices had an IR of 7.48 of 10,000 AEs, and the remaining 44 practices had an IR of 0.32 of 10,000 AEs, demonstrating that the risk of EHI for practices 1 to 19 was 23.7 times that of the remaining practices. When comparing morning to afternoon practices, 35.2% (19/54) EHI incidents occurred during morning practices. The risk of EHI during practices with WBGT >82°F (27.8°C) was 3.5 times that of practices with WBGT <82°F. Conclusion: In the current study, the risk of EHI was greatest in the first 19 practices of the season and during practices with WBGT >82°F. As modifiable risk factors for EHI, increased vigilance and empowerment to adhere to acclimatization guidelines can mitigate EHI risk. Health care providers must continue to advocate for implementation of regulations and the authority to make decisions to ensure patient safety. [ABSTRACT FROM AUTHOR]

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Aim Wearing personal protective equipment (PPE) is essential to prevent infection transmission, but the risk of heatstroke increases with wearing PPE in a humid and hot environment. Therefore, we aimed to examine how environmental parameters change the body physiology in a hot environment during the coronavirus disease (COVID‐19) pandemic. Methods This was a retrospective cohort study extracted from the MEDIC Japan heatstroke prevention database, which was recorded between 1 August and 7 September, 2020. Its database is a registry collection from seven healthy health‐care providers. Subjects recorded their own vital signs (forehead and tympanic temperature, blood pressure, pulse rate, and oxygen saturation) and environmental factors (type of weather, wet‐bulb globe temperature [WBGT], air temperature, humidity, and location) every hour during their working shift. Results From 323 records, a weak positive but statistically significant correlation was observed between WBGT and pulse rate (correlation coefficient [95% confidence interval], r = 0.34 [0.23, 0.45]) and between WBGT and core body temperature. Forehead temperature had a stronger correlation than tympanic temperature (forehead, r = 0.33 [0.21, 0.43]; tympanic, r = 0.17 [0.05, 0.28]), which also showed a larger effect (forehead, η2 = 0.08; tympanic, η2 = 0.05). The effect size of oxygen saturation measured outdoors was large (η2 = 0.30). Forehead temperature increased abruptly at 28°C WBGT and at 33°C air temperature. Conclusion A hot environment significantly affected forehead temperature, and the daytime imposed a high risk of heatstroke. To avoid heatstroke, environmental parameters are important to note as outdoor environments had a large effect on vital sign changes depending on the time of day.

Heat exposure affects human performance in many ways. Both physiological (i.e., glycogen sparing, oxygen uptake, thermoregulation) and biomechanical mechanisms (i.e., contact time, knee flexion, muscle activity) are affected, hence reducing performance. However, the exposure affects persons differently. Not all athletes necessarily experience an identical thermal condition similarly, and this point has been overlooked to date. We analyzed endurance performances of the top 1000 runners for every year during the last 12 New York City Marathons. Thermal conditions were estimated with wet-bulb globe temperature (WBGT) and universal thermal climate index (UTCI). Under identical thermal exposure, the fastest runners experienced a larger decline in performance than the slower ones. The empirical evidence offered here not only shows that thermal conditions affect runners differently, but also that some groups might consistently suffer more than others. Further research may inspect other factors that could be affected by thermal conditions, as pacing and race strategy.

We investigate the effect of statistical post‐processing on the probabilistic skill of discomfort index (DI) and indoor wet‐bulb globe temperature (WBGTid) ensemble forecasts, both calculated from the corresponding forecasts of temperature and dew point temperature. Two different methodological approaches to calibration are compared. In the first case, we start with joint post‐processing of the temperature and dew point forecasts and then create calibrated samples of DI and WBGTid using samples from the obtained bivariate predictive distributions. This approach is compared with direct post‐processing of the heat index ensemble forecasts. For this purpose, a novel ensemble model output statistics model based on a generalized extreme value distribution is proposed. The predictive performance of both methods is tested on the operational temperature and dew point ensemble forecasts of the European Centre for Medium‐Range Weather Forecasts and the corresponding forecasts of DI and WBGTid. For short lead times (up to day 6), both approaches significantly improve the forecast skill. Among the competing post‐processing methods, direct calibration of heat indices exhibits the best predictive performance, very closely followed by the more general approach based on joint calibration of temperature and dew point temperature. Additionally, a machine learning approach is tested and shows comparable performance for the case when one is interested only in forecasting heat index warning level categories. [ABSTRACT FROM AUTHOR]

Heat exposure affects human performance in many ways. Both physiological (i.e., glycogen sparing, oxygen uptake, thermoregulation) and biomechanical mechanisms (i.e., contact time, knee flexion, muscle activity) are affected, hence reducing performance. However, the exposure affects persons differently. Not all athletes necessarily experience an identical thermal condition similarly, and this point has been overlooked to date. We analyzed endurance performances of the top 1000 runners for every year during the last 12 New York City Marathons. Thermal conditions were estimated with wet-bulb globe temperature (WBGT) and universal thermal climate index (UTCI). Under identical thermal exposure, the fastest runners experienced a larger decline in performance than the slower ones. The empirical evidence offered here not only shows that thermal conditions affect runners differently, but also that some groups might consistently suffer more than others. Further research may inspect other factors that could be affected by thermal conditions, as pacing and race strategy. [ABSTRACT FROM AUTHOR]

Context: Interscholastic heat policies for football have not been evidence based. Therefore, their effectiveness in mitigating exertional heat illness has not been assessed. Objective: To discuss the development of the Georgia High School Association heat policy and assess the effectiveness of revised guidelines. Design: Descriptive epidemiology study. Setting: Georgia high schools. Patients or other participants: Interscholastic football players in grades 9 through 12. Main outcome measure(s): Heat syncope and heat exhaustion (HS/HE) illness rates (IRs) were calculated per 1000 athlete-exposures (AEs), and relative risk (RR) was calculated as a ratio of postpolicy (POST) IR divided by prepolicy (PRE) IR. Results: A total of 214 HS/HE cases (172 PRE, 42 POST) and 341 348 AEs (178 230 PRE, 163 118 POST) were identified. During the first 5 days of the PRE period, approximately 50% of HS/HE illnesses occurred; HS/HE IRs doubled when practice sessions increased from 2 to 2.5 hours and tripled for practices ≥3 hours. The HS/HE IRs in the PRE period increased from 0.44/1000 AEs for wet-bulb globe temperatures (WBGTs) of <82°F (<27.8°C) to >2.0/1000 AEs for WBGTs from 87°F (30.6°C) to 89.9°F (32.2°C). The RRs comparing PRE and POST policy periods were 0.29 for WBGTs of <82.0°F (<27.80°C), 0.65 for WBGTs from 82.0°F (27.8°C) to 86.9°F (30.5°C), and 0.23 for WBGTs from 87.0°F (30.6°C) to 89.9°F (32.2°C). No HS/HE illnesses occurred in the POST period for WBGTs at >90°F (>32.3°C). Conclusions: Results from the PRE period guided the Georgia High School Association to revise its heat and humidity policy to include a mandated 5-day acclimatization period when no practices may exceed 2 hours and the use of WBGT-based activity-modification categories. The new policy reduced HS/HE IRs by 35% to 100%, depending on the WBGT category. Our results may be generalizable to other states with hot and humid climates similar to that of Georgia. [ABSTRACT FROM AUTHOR]

Objectives Assess the impact of summer heat exposure (June–September) on residential construction workers in Al-Ahsa, Saudi Arabia by evaluating (i) heart rate (HR) responses, hydration status, and physical workload among workers in indoor and outdoor construction settings, (ii) factors related to physiological responses to work in hot conditions, and (iii) how well wet-bulb globe temperature-based occupational exposure limits (WBGTOELs) predict measures of heat strain. Methods Twenty-three construction workers (plasterers, tilers, and laborers) contributed 260 person-days of monitoring. Workload energy expenditure, HR, fluid intake, and pre- and postshift urine specific gravity (USG) were measured. Indoor and outdoor heat exposures (WBGT) were measured continuously and a WBGTOEL was calculated. The effects of heat exposure and workload on heart rate reserve (HRR), a measure of cardiovascular strain, were examined with linear mixed models. A metric called 'heat stress exceedance' (HSE) was constructed to summarize whether the environmental heat exposure (WBGT) exceeded the heat stress exposure limit (WBGTOEL). The sensitivity and specificity of the HSE as a predictor of cardiovascular strain (HRR ≥30%) were determined. Results The WBGTOEL was exceeded frequently, on 63 person-days indoors (44%) and 91(78%) outdoors. High-risk HRR occurred on 26 and 36 person-days indoors and outdoors, respectively. The HSE metric showed higher sensitivity for HRR ≥30% outdoors (89%) than indoors (58%) and greater specificity indoors (59%) than outdoors (27%). Workload intensity was generally moderate, with light intensity work more common outdoors. The ability to self-pace work was associated with a lower frequency of HRR ≥30%. USG concentrations indicated that workers began and ended their shifts dehydrated (USG ≥1.020). Conclusions Construction work where WBGTOEL is commonly exceeded poses health risks. The ability of workers to self-pace may help reduce risks. [ABSTRACT FROM AUTHOR]

Exertional heat stroke is one of the top three causes of death in young athletes, particularly high school football players. Despite evidence that these deaths are completely avoidable with appropriate prevention and treatment, deaths still occur at an alarming rate. Wet bulb globe temperature (WBGT) is the preferred method of both the National Athletic Trainers' Association and American College of Sports Medicine to measure heat intensity. Based on the WBGT, activity modification guidelines (AMG) dictate work-to-rest ratios, activity levels and duration, protective equipment worn, and length and frequency of hydration breaks. Due to the cost of handheld WBGT monitors, smartphone apps that estimate WBGT have been considered an alternative. However, it is unclear how WBGT values estimated by these smartphone apps compare to those measured on-site using handheld WBGT monitors. We compared WBGT values estimated by a commercial smartphone app to those taken on-site at the same time and place. Thirteen athletic trainers measured WBGT in the field during high school football practices over a three-month season in North Central Florida. A paired sample t-test indicated the smartphone app significantly overestimated WBGT (29.0°C ± 4.1°C) compared to on-site measures (26.4°C ± 3.2°C) (r =0.580; t(943)=-23.38, p <0.0001). The smartphone app-estimated values were consistently greater than on-site measures, resulting in potentially unnecessary activity modifications and cancellations if the app was used in place of on-site handheld WBGT monitors. Despite being significantly cheaper than handheld WBGT monitors, at this time, smartphone apps are not ready for widespread use to guide activity modification decisions. [ABSTRACT FROM AUTHOR]

The current study aimed at comparing the correlation coefficients between wet-bulb globe temperature (WBGT) and a number of parameters, including the discomfort index (DI), modified discomfort index (MDI), predicted mean vote (PMV), predicted percentage of dissatisfaction (PPD), predicted heat strain (PHS), physiological strain index (PSI) and physiological strain index heart rate (PSIhr). In total, 30 workers of a pelletizing factory participated in this study. Environmental parameters and workers' physiological parameters were measured in 10 working stations. The results showed that effective WBGT (WBGTeff) strongly correlates with DI, MDI, PMV, PPD, PHS, PSI and PSIhr. WBGTeff had the highest correlation coefficients with PMV, MDI, PHS and PSIhr. Based on the obtained results, it was concluded that heat stress exceeded the standard limit for a number of indices in some of the working stations. Thus, some controlling measures should be taken to reduce heat stress in these stations. [ABSTRACT FROM AUTHOR]

Heat stress causes physiological changes, and changes in hematological parameters and hormonal levels in the human body, known as thermal strain. This study was conducted to determine the effect of exposure to heat stress on hematological parameters and oxidative stress in the bakers of Shahroud City, Iran. A total of 163 bakery workers (exposed group) and 135 office workers (unexposed group) with a minimum of 1-year working experience were selected. Exposure to heat stress was measured using ISO-7243 criteria on the hottest days of the year (late July and August). Wet-bulb globe temperature (WBGT) was calculated based on indoor environments. Oxidative stress indices including malondialdehyde (MDA), nitric oxide (NO), total antioxidant capacity (TAC) in the bakers' and office workers' serum and hematological parameters were measured. Statistical analysis was done through independent t -test, and multivariate linear regression using SPSS v24. Analysis of hematological parameters showed that about 70% and 68% of the bakers had abnormal mean cell volume (MCV) and white blood cell (WBC) count, respectively, while only around 12% of them had abnormal mean cell hemoglobin concentration (MCHC). The counts of red blood cells (RBC), WBC, lymphocytes (LYM), and MCV showed significant differences in different occupational groups (p < 0.05). The levels of MDA and NO were significantly higher in bakers with WBGT more than the threshold value (p < 0.05). The WBGT index for assessing heat stress can be used as a predictor variable for MDA and NO levels. In addition, heat stress exposure could be a risk factor for abnormal WBC, RBC, LYM, and MCV. [ABSTRACT FROM AUTHOR]

This study addresses the measurement of the globe temperature. For this purpose, two globe thermometers with different diameters (50 and 150 mm) and a variety of thermal environmental conditions were considered. The assessments of the response times and of the influences of the globe diameter and the air velocity on the measured globe temperatures are discussed. The results of the response times clearly put in evidence that the values usually stated in the literature can be questioned and that longer measurement periods must be considered. In fact, response times >30 min were obtained in 68% of the tests performed. Moreover, differences >20ºC were obtained between the 150 and 50 mm sensors, highlighting the influence of the globe diameter. The analysis of the effect of the air velocity on the globe temperature shows mean relative differences >30% between tests in still air and with the higher air velocity considered (1.81 m s–1). On the basis of measurements carried out with the 50 mm globe, correction equations to the standard globe temperature for both natural and forced convection are proposed. [ABSTRACT FROM AUTHOR]

This study investigates indoor heat stress among employees engaged in bakeries in Assiut city. Heat stress is one of the occupational hazards especially in arid climates that impose negative impacts on workers such as heat rashes, heat exhaustion, heat cramps, heat fainting or heat stroke. In this research, 100 subjects were chosen randomly from 20 bakery stations to testify heat stress impacts. Heat stress levels were measured using wet-bulb globe temperature index (WBGT) to evaluate the impacts of environmental factors on the employees. The response of worker's body to this heat stress is expressed as physiological strain index (PSI) that can be estimated by measuring heart rate and core temperature. Results obtained from WBGT index measurements indicated that the average value of heat stress in bakeries reached 31.6 °C that is exceeding than threshold limit value (28 °C) and action limit (25 °C) recommended by American Conference of Government Industrial Hygienists. In addition, WBGT values were compared with the Egyptian Environmental Law 4/1994 and Egyptian Labor Low 12/2003. PSI values fall in the range of 200 < M (metabolic rate) < 260 indicating that workload in bakeries environment lies in the moderate class. According to the questionnaire data, several workers faced heat disorders including heat exhaustion (23 cases), heat cramps (17 cases), and heat stroke (5 cases). Application of control measures such as engineering control, administrative control, and personal protective equipment should be applied. [ABSTRACT FROM AUTHOR]

Abstract Background A critical adaptation strategy for reducing heat-related health risk under climate change is to establish a heat warning system with a proper threshold that requires evaluation of heat-health relationships using empirical data. Objectives This work presents a new approach to selecting proper health-based thresholds for a heat warning system which are different from thresholds of heat-health relationship. Methods The proposed approach examined heat-health relationships through analyzing 15 years of health records with a modified generalized additive model (GAM), compared risk ratio increments (RRIs) of threshold candidates against a reference, assessed frequency of days above these candidates, and presented results graphically for easy communication. The candidate with the maximum RRI and proper occurring frequency is potentially the best threshold. Three heat indicators, including wet-bulb globe temperature (WBGT), temperature (T), and apparent temperature (AT), as well as three health outcomes, including all-cause mortality, heat-related hospital admissions, and heat-related emergency visits were evaluated. Results Risk ratios for all three health outcomes showed a consistent rising trend with increasing threshold candidates for all three heat indicators among different age and gender groups. WBGT had the most obvious increasing trend of RRIs with the three health outcomes. The maximum RRI was observed in heat-related emergency visits (242%), followed by heat-related hospital admissions (73%), and all-cause mortality (9%). The RRIs assessed for the three health outcomes pointed to the same thresholds, 33.0 °C, 34.0 °C, and 37.5 °C for WBGT, T, and AT, respectively. The number of days above these thresholds and for warning to be issued ranged between 0 and 7 days during 2000–2014. Discussion This study demonstrated a new approach to determining heat-warning thresholds with different heat indicators and health outcomes. The proposed approach provides a straightforward, feasible, and flexible scientific tool that assists the authorities around the world in selecting a proper threshold for a heat warning system. Highlights • This work shows a new approach to select proper thresholds for heat warning systems. • Modified generalized additive model and risk ratio increments (RRIs) were applied. • Threshold of wet-bulb globe temperature (WBGT) at 33.0 °C were identified for Taiwan. • WBGT had the most obvious increasing trend of RRIs among three heat indicators. • The maximum RRI of WBGT was observed in emergency visits (242%). [ABSTRACT FROM AUTHOR]

Abstract This study aims to clarify the regional characteristics of climate change and its impact on heatstroke risk inside the cities of Tokyo and Sendai, Japan. First, meteorological simulations using the Weather Research and Forecasting model (WRF) were performed. Pseudo global warming data were used as the boundary conditions for WRF simulations for the global-scale current and future climates in the 2000s and 2050s. The increase in wet-bulb globe temperature (WBGT) was larger in Sendai than in Tokyo, and the increase in WBGT in the coastal areas of both cities became larger than that in the inland area. Then, heatstroke risk and incidence rate, which represent the potential risk, were analyzed based on the WBGT distribution. Furthermore, contributions of three types of temperature (wet-bulb, globe, and dry-bulb temperatures) in increasing the WBGT were analyzed in order to clarify the primary meteorological factors for the increase in WBGT in each region. It was found that the wet-bulb temperature is the dominant factor in the increase in WBGT in most regions. Highlights • Future climate and heatstroke risk in Tokyo and Sendai, Japan were predicted. • Air temperature and absolute humidity increased largely in coastal areas. • The increase in heatstroke risk was highest in urban areas. • In coastal areas in Tokyo, heatstroke risk will exist during the 2050s. • Wet-bulb temperature was the dominant factor increasing wet-bulb globe temperature. [ABSTRACT FROM AUTHOR]

Urbanization is one of the most significant contributing factors to anthropogenic climate change. However, a lack of projected city land use data has posed significant challenges to factoring urbanization into climate change modeling. Thus, the results from current models may contain considerable errors in estimating future climate scenarios. The Pearl River Delta region was selected as a case study to provide insight into how large-scale urbanization and different climate change scenarios impact the local climate. This study adopts projected land use data from freely available satellite imagery and applies dynamic simulation land use results to the Weather Research and Forecasting Model (WRF). The simulation periods cover the summer periods in 2010 and 2029–2031, the latter of which is averaged to represent the year 2030. The WRF simulation used the observed local climate conditions in 2010 to represent the current scenario and the projected local climate changes for 2030 as the future scenario. Under all three future climate change scenarios, the warming trend is prominent (around 1–2 °C increase), with a widespread reduction in wind speed in inland areas (1–2 ms−1). The vulnerability of human health to thermal stress was evaluated by adopting the wet-bulb globe temperature (WBGT). The results from the future scenarios suggest a high public health risk due to rising temperatures in the future. This study provides a methodology for a more comprehensive understanding of future urbanization and its impact on regional climate by using freely available satellite images and WRF simulation tools. The simulated temperature and WBGT results can serve local governments and stakeholders in city planning and the creation of action plans that will reduce the potential vulnerability of human health to excessive heat.

High temperature accompanied with high humidity may result in unbearable and oppressive weather. In this study, future changes of extreme high temperature and heat stress in mainland China are examined based on daily maximum temperature (Tx) and daily maximum wet-bulb globe temperature (Tw). Tw has integrated the effects of both temperature and humidity. Future climate projections are derived from the bias-corrected climate data of five general circulation models under the Representative Concentration Pathways (RCPs) 2.6 and 8.5 scenarios. Changes of hot days and heat waves in July and August in the future (particularly for 2020-50 and 2070-99), relative to the baseline period (1981-2010), are estimated and analyzed. The results show that the future Tx and Tw of entire China will increase by 1.5-5°C on average around 2085 under different RCPs. Future increases in Tx and Tw exhibit high spatial heterogeneity, ranging from 1.2 to 6°C across different regions and RCPs. By around 2085, the mean duration of heat waves will increase by 5 days per annum under RCP8.5. According to Tx, heat waves will mostly occur in Northwest and Southeast China, whereas based on Tw estimates, heat waves will mostly occur over Southeast China and the mean heat wave duration will be much longer than those from Tx. The total extreme hot days (Tx or Tw > 35°C) will increase by 10-30 days. Southeast China will experience the severest heat stress in the near future as extreme high temperature and heat waves will occur more often in this region, which is particularly true when heat waves are assessed based on Tw. In comparison to those purely temperature-based indices, the index Tw provides a new perspective for heat stress assessment in China. [ABSTRACT FROM AUTHOR]