Review article: Scoping review of the characteristics and outcomes of adults presenting to the emergency department during heatwaves.

As a result of climate change heatwaves are expected to increase in frequency and intensity and will have detrimental impacts on human health globally. EDs are often the critical point of care for acute heat illnesses and other conditions associated with heat exposure. Existing literature has focused on heatwave-related hospitalisation and mortality. This scoping review aimed to identify, evaluate and summarise current literature regarding patient characteristics and outcomes of ED admissions from heatwaves. A scoping review of the literature was conducted using six databases: Medline, EMBASE, EMCARE, CINAHL, PsycINFO, and Scopus, using MeSH terms and keywords related to 'heatwave' and 'Emergency Department'. Articles were included if they were: published in English from January 2000 to August 2021, related to ED, and examined high temperature periods consistent with heatwave criteria. Articles were appraised using the Mixed Methods Appraisal Tool (MMAT). Thirty-one studies were included, mostly from the United States, Australia, and France. The study designs include retrospective case analysis, case-control, and time-series analysis. Eight studies examined known heatwaves, 21 used different criteria to identify heatwave occurrence, and two focused on heat-related illness. The selected articles display a moderate-high quality on MMAT. ED admissions for both heat-related illnesses and other conditions increased during heatwaves, with up to 18.5 times risk increase. The risk was elevated for all population groups, and substantially in the elderly, male patients with certain comorbidities, medications, or lower socioeconomic status. Outcomes including hospitalisation and mortality rates after ED admissions showed positive associations with heatwaves. The heatwaves resulting from climate change will place increasing demands on EDs providing care for increasingly susceptible populations. Significant public heatwave planning across multiple sectors is required to reduce the risk of overwhelming EDs with these patients.

Heat Illness Requiring Emergency Care for People Experiencing Homelessness: A Case Study Series.

Extreme heat and hot weather has a negative impact on human health and society. Global warming has resulted in an increase in the frequency and duration of heatwaves. Heat-related illnesses are a significant negative consequence of high temperatures and can be life-threatening medical emergencies. The severity of the symptoms can depend on the pre-existing medical conditions and vary from mild headaches to severe cases that can lead to coma and death. The risk of heat-related illness may be higher for people experiencing homelessness due to a lack of access to cool places and water, and the complex interactions between mental illness, medications and substance use disorder. This paper presents two cases of people experiencing homelessness who were admitted to the emergency department of a hospital in Sydney, Australia during a heatwave in November 2020. Both cases were adult males with known risk factors for heat-related illness including hypertension and schizophrenia (Case One) and hepatitis C, cirrhosis, and alcohol use disorder (Case Two). These cases show that severe weather can not only be detrimental to homeless people's health but can also cause a significant economic toll, evident by the $70,184 AUD expenditure on the care for these two cases. This case report highlights the requirement to determine the risk of heat-related illness to people experiencing homelessness and need to protect this vulnerable population from weather-related illness and death.

Optimal break structures and cooling strategies to mitigate heat stress during a Rugby League match simulation.

OBJECTIVES: To examine, 1) optimal structure of break periods to mitigate physiological heat strain during rugby league play (Stage 1); and ii) effectiveness of three different cooling strategies applied during breaks (Stage 2). DESIGN: Counter-balanced crossover design. METHODS: In 37 °C, 50% RH, 11 males completed six simulated 80-min (two 40-min halves) rugby league matches on a treadmill with different break structures: regular game (RG) (12-min halftime), 1-min or 3-min "quarter-time" breaks halfway through each half with a 12-min halftime break (R1C and R3C), a 20-min halftime break (EH), or 1-min or 3-min quarter-time breaks with a 20-min halftime break (E1C and E3C) [Stage 1]. Nine participants completed Stage 2, which assessed the application of either ice towels (ICE), an electric fan (FAN) or a misting fan (MST) during breaks in the E3C protocol which, in Stage 1, prevailed as the optimal break structure. RESULTS: Stage 1: Irrespective of quarter-time break duration, reductions in rectal temperature (-0.24 °C ±â€¯0.24) and heart rate (-61 ±â€¯10 bpm) during the halftime break were greater with a 20-min compared to a 12-min break (-0.08 ±â€¯0.13 °C, p = 0.005; -55 ±â€¯-9 bpm, p = 0.021). Stage 2: End-game rises in rectal temperature were smaller (p < 0.006) in MST (1.41 ±â€¯0.22 °C), FAN (1.55 ±â€¯0.36 °C) and ICE (1.60 ±â€¯0.21 °C) than in CON (1.80 ±â€¯0.39 °C). The end-halftime heart rate was lower (p < 0.001) in ICE (89 ±â€¯13 bpm), MST (90 ±â€¯10 bpm) and FAN (92 ±â€¯13 bpm) than in CON (99 ±â€¯18 bpm). CONCLUSIONS: Combining an extended halftime period and quarter-time breaks with MST application is the optimal cooling strategy for rugby league players in hot, humid conditions.

Electric fan use for cooling during hot weather: a biophysical modelling study.

BACKGROUND: In hot weather, electric fans can potentially provide effective cooling for people, with lower greenhouse gas emissions and cost than air conditioning. However, international public health organisations regularly discourage fan use in temperatures higher than 35°C, despite little evidence. We aimed to determine humidity-dependent temperature thresholds at which electric fans would become detrimental in different age groups. METHODS: We used biophysical modelling to determine the upper humidity-dependent temperature thresholds at which fan use would become detrimental (ie, worsen heat stress) for healthy young adults (aged 18-40 years), healthy older adults (aged ≥65 years), and older adults taking anticholinergic medication. We also obtained hourly environmental data for the period Jan 1, 2007, to Dec 31, 2019, for 108 populous cities to determine the number of days fan use would be effective for cooling, standardised to a 31-day hot weather month. We established simplified temperature thresholds for future fan use recommendations on the basis of temperatures below which fan use would never have been detrimental between Jan 1, 2007, and Dec 31, 2019, across all prevailing levels of ambient humidity. FINDINGS: According to our model, fan use would have been beneficial on 30·0 (96·6%) of 31 hot weather days for healthy young adults and 29·4 (94·9%) of 31 hot weather days for both older adults and older adults taking anticholinergic medication between Jan 1, 2007, and Dec 31, 2019. Adherence to the current WHO recommendation of fan use below temperatures of 35°C only, fan use would have been recommended on 27·2 days (87·7%) of 31 hot weather days. According to our simplified thresholds for fan use (at temperatures <39·0°C for healthy young adults, <38·0°C for healthy older adults, and <37·0°C for older adults taking anticholinergic medication), fan use would have been recommended on 29·6 (95·5%) of 31 hot weather days in healthy young adults, 29·4 (94·8%) days in healthy older adults, and 28·8 (93·0%) days in older adults taking anticholinergic medication between Jan 1, 2007, and Dec 31, 2019. INTERPRETATION: Electric fan use, particularly for healthy young adults, would not have worsened heat stress on the majority of study days between 2007 and 2019. Our newly proposed thresholds for fan use provide simple guidelines that improve future heatwave fan use recommendations. FUNDING: None.

Listening to motivational music mitigates heat-related reductions in exercise performance.

PURPOSE: To examine whether listening to motivational music mitigates heat-related reductions in exercise performance, and leads to a greater increase in thermal and cardiovascular strain. METHODS: Twelve participants (26 ±â€¯5 y, 77.5 ±â€¯17.0 kg, 49 ±â€¯8 ml·min-1·kg-1) completed 30-min of cycling preload at 50% VO2max followed by a 5-min rest and 15-min cycling time trial on seven separate occasions; three familiarisation sessions in a 20 °C room and four experimental trials in a climatic chamber regulated at either 21 °C, 50%RH (NEU) or 36 °C, 50%RH (HOT), each with and without the participant listening to self-selected motivational music during the 5-min rest and 15-min time trial. Measures of total work, core temperature and heart rate and blood pressure (from which rate-pressure product for cardiovascular strain was calculated), were recorded. RESULTS: Without music, total work was lower (p < .001) in the HOT condition (168 ±â€¯59 kJ) relative to the NEU condition (193 ±â€¯60 kJ). With music, total work was greater relative to no music in both the NEU condition (203 ±â€¯60 kJ vs 193 ±â€¯60 kJ; p = .008) and HOT condition (183 ±â€¯63 kJ vs 168 ±â€¯60 kJ; p = .029). The greater total work in the HOT condition with music relative to no music resulted in a higher (p = .006) core temperature (38.7 ±â€¯0.4 °C vs 38.6 ±â€¯0.5 °C) and a higher (p < .001) rate-pressure product (34.8 ±â€¯7.1 mmHg·beats·min-1·10-3 vs 27.8 ±â€¯3.7 mmHg·beats·min-1·10-3). CONCLUSION: Listening to motivational music mitigated heat-related reductions in exercise performance with an improvement in performance in the heat of ~10%. This improved exercise performance led to a greater increase in thermal and cardiovascular strain in the heat but did not exceed levels typically associated with an elevated health risk in a young, healthy population.

Electrical Properties of Ultrathin Platinum Films by Plasma-Enhanced Atomic Layer Deposition.

The ability to deposit thin and conformal films has become of great importance because of downscaling of devices. However, because of nucleation difficulty, depositing an electrically stable and thin conformal platinum film on an oxide nucleation layer has proven challenging. By using plasma-enhanced atomic layer deposition (PEALD) and TiO2 as a nucleation layer, we achieved electrically continuous PEALD platinum films down to a thickness of 3.7 nm. Results show that for films as thin as 5.7 nm, the Mayadas-Shatzkes (MS) model for electrical conductivity and the Tellier-Tosser model for temperature coefficient of resistance hold. Although the experimental values start to deviate from the MS model below 5.7 nm because of incomplete Pt coverage, the films still show root mean square electrical stability better than 50 ppm over time, indicating that these films are not only electrically continuous but also sufficiently reliable for use in many practical applications.

Heat stress and fetal risk. Environmental limits for exercise and passive heat stress during pregnancy: a systematic review with best evidence synthesis.

OBJECTIVE: Pregnant women are advised to avoid heat stress (eg, excessive exercise and/or heat exposure) due to the risk of teratogenicity associated with maternal hyperthermia; defined as a core temperature (Tcore) ≥39.0°C. However, guidelines are ambiguous in terms of critical combinations of climate and activity to avoid and may therefore unnecessarily discourage physical activity during pregnancy. Thus, the primary aim was to assess Tcore elevations with different characteristics defining exercise and passive heat stress (intensity, mode, ambient conditions, duration) during pregnancy relative to the critical maternal Tcore of ≥39.0°C. DESIGN: Systematic review with best evidence synthesis. DATA SOURCES: EMBASE, MEDLINE, SCOPUS, CINAHL and Web of Science were searched from inception to 12 July 2017. STUDY ELIGIBILITY CRITERIA: Studies reporting the Tcore response of pregnant women, at any period of gestation, to exercise or passive heat stress, were included. RESULTS: 12 studies satisfied our inclusion criteria (n=347). No woman exceeded a Tcore of 39.0°C. The highest Tcore was 38.9°C, reported during land-based exercise. The highest mean end-trial Tcore was 38.3°C (95% CI 37.7°C to 38.9°C) for land-based exercise, 37.5°C (95% CI 37.3°C to 37.7°C) for water immersion exercise, 36.9°C (95% CI 36.8°C to 37.0°C) for hot water bathing and 37.6°C (95% CI 37.5°C to 37.7°C) for sauna exposure. CONCLUSION: The highest individual core temperature reported was 38.9°C. Immediately after exercise (either land based or water immersion), the highest mean core temperature was 38.3°C; 0.7°C below the proposed teratogenic threshold. Pregnant women can safely engage in: (1) exercise for up to 35 min at 80%-90% of their maximum heart rate in 25°C and 45% relative humidity (RH); (2) water immersion (≤33.4°C) exercise for up to 45 min; and (3) sitting in hot baths (40°C) or hot/dry saunas (70°C; 15% RH) for up to 20 min, irrespective of pregnancy stage, without reaching a core temperature exceeding the teratogenic threshold.

Parallel preparation of plan-view transmission electron microscopy specimens by vapor-phase etching with integrated etch stops.

Specimen preparation remains a practical challenge in transmission electron microscopy and frequently limits the quality of structural and chemical characterization data obtained. Prevailing methods for thinning of specimens to electron transparency are serial in nature, time consuming, and prone to producing artifacts and specimen failure. This work presents an alternative method for the preparation of plan-view specimens using isotropic vapor-phase etching with integrated etch stops. An ultrathin amorphous etch-stop layer simultaneously serves as an electron transparent support membrane whose thickness is defined by a controlled growth process such as atomic layer deposition with sub-nanometer precision. This approach eliminates the need for mechanical polishing or ion milling to achieve electron transparency, and reduces the occurrence of preparation induced artifacts. Furthermore, multiple specimens from a plurality of samples can be thinned in parallel due to high selectivity of the vapor-phase etching process. These features enable dramatic reductions in preparation time and cost without sacrificing specimen quality and provide advantages over wet etching techniques. Finally, we demonstrate a platform for high-throughput transmission electron microscopy of plan-view specimens by combining the parallel preparation capabilities of vapor-phase etching with wafer-scale micro- and nanofabrication.

Thermal Conduction in Vertically Aligned Copper Nanowire Arrays and Composites.

The ability to efficiently and reliably transfer heat between sources and sinks is often a bottleneck in the thermal management of modern energy conversion technologies ranging from microelectronics to thermoelectric power generation. These interfaces contribute parasitic thermal resistances that reduce device performance and are subjected to thermomechanical stresses that degrade device lifetime. Dense arrays of vertically aligned metal nanowires (NWs) offer the unique combination of thermal conductance from the constituent metal and mechanical compliance from the high aspect ratio geometry to increase interfacial heat transfer and device reliability. In the present work, we synthesize copper NW arrays directly onto substrates via templated electrodeposition and extend this technique through the use of a sacrificial overplating layer to achieve improved uniformity. Furthermore, we infiltrate the array with an organic phase change material and demonstrate the preservation of thermal properties. We use the 3ω method to measure the axial thermal conductivity of freestanding copper NW arrays to be as high as 70 W m(-1) K(-1), which is more than an order of magnitude larger than most commercial interface materials and enhanced-conductivity nanocomposites reported in the literature. These arrays are highly anisotropic, and the lateral thermal conductivity is found to be only 1-2 W m(-1) K(-1). We use these measured properties to elucidate the governing array-scale transport mechanisms, which include the effects of morphology and energy carrier scattering from size effects and grain boundaries.

Reducing thermal conductivity of binary alloys below the alloy limit via chemical ordering.

Substitutional solid solutions that exist in both ordered and disordered states will exhibit markedly different physical properties depending on their exact crystallographic configuration. Many random substitutional solid solutions (alloys) will display a tendency to order given the appropriate kinetic and thermodynamic conditions. Such order-disorder transitions will result in major crystallographic reconfigurations, where the atomic basis, symmetry, and periodicity of the alloy change dramatically. Consequently, the dominant scattering mechanism in ordered alloys will be different than that in disordered alloys. In this study, we present a hypothesis that ordered alloys can exhibit lower thermal conductivities than their disordered counterparts at elevated temperatures. To validate this hypothesis, we investigate the phononic transport properties of disordered and ordered AB Lennard-Jones alloys via non-equilibrium molecular dynamics and harmonic lattice dynamics calculations. It is shown that the thermal conductivity of an ordered alloy is the same as the thermal conductivity of the disordered alloy at ≈0.6T(melt) and lower than that of the disordered alloy above 0.8T(melt).