July 2023 has been confirmed as Earth\'s hottest month on record, and it was characterized by extraordinary heatwaves across southern Europe. Field data collected under real heatwave periods could add important evidence to understand human adaptability to extreme heat. However, field studies on human physiological responses to heatwave periods remain limited. We performed field thermo-physiological measurements in a healthy 37-years male undergoing resting and physical activity in an outdoor environment in the capital of Sicily, Palermo, during (July 21; highest level of local heat-health alert) and following (August 10; lowest level of local heat-health alert) the peak of Sicily\'s July 2023 heatwave. Results indicated that ~40 min of outdoor walking and light running in 33.8°C Wet Bulb Globe Temperature (WBGT) conditions (July 21) resulted in significant physiological stress (i.e., peak heart rate: 209 bpm; core temperature: 39.13°C; mean skin temperature: 37.2°C; whole-body sweat losses: 1.7 kg). Importantly, significant physiological stress was also observed during less severe heat conditions (August 10; WBGT: 29.1°C; peak heart rate: 190 bpm; core temperature: 38.48°C; whole-body sweat losses: 2 kg). These observations highlight the physiological strain that current heatwave conditions pose on healthy young individuals. This ecologically-valid empirical evidence could inform more accurate heat-health planning.

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Women receiving intrathecal morphine for cesarean delivery may experience hypothermia with paradoxical symptoms of sweating, nausea, and shivering. Despite being relatively rare in comparison to commonly experienced symptoms of perioperative hypothermia, hypothermia with paradoxical symptoms affects early maternal recovery and comfort. The cause is undetermined, and treatment approaches vary. Regular active-warming strategies may not be tolerated because of the paradoxical symptoms of sweating and feeling overheated. This case series aims to explore the phenomenon through the evaluation of health care records of women receiving intrathecal morphine for cesarean delivery at a single, tertiary health care institution in Australia from 2015 to 2018. We also summarize published literature to review treatment approaches used in the care of women experiencing profound heat loss while feeling overheated.

The near ubiquitous presence of numerical simulation has made case-specific calculations of body temperatures following death possible so that accurate calculations of body temperatures can provide valuable information for estimating the time of death and can aid in forensic investigations. Here, a computational approach is described that has been validated against multiple, independent, and experimental investigations. The approach only requires one subjective input parameter (the heat transfer coefficient). A simple algorithm serves as a guidepost to the selection of this parameter. The algorithm incorporates clothing and the space in which the body is housed. Heat transfer coefficients that range from h = 2 W/m2 /°C for bodies that are heavily clothed to h = 9 W/m2 /°C for bodies that are nude (in air). The method also requires setting of ambient temperature conditions (ambient temperature)-however, that input is often available. The paucity of inputs makes this technique remarkably easy to employ. The new method is also able to calculate cadaver cooling rates for situations where the cadaver is in a timewise or spatially changing thermal environment (diurnal temperature variations, bodies partially submerged in water, changes to weather, insolation, etc.). Results from the present calculations are compared with a large body of measurements from the literature; it was found that the predictions and measurements were in excellent agreement, regardless of the ambient temperature conditions and the nature of the clothing of the body. This new calculation approach can be used with reasonable accuracy for determining cadaver cooling and time since death.

A 14-year-old runner indigenous to the tropics collapsed during his first 10-km race in a hot and humid climate. Dizziness, stumbling, and loss of consciousness were symptoms of exertional heat stroke. Two days postcollapse, blood tests revealed elevated hepatic transaminases consistent with hepatic injury. We discuss the return-to-competition progression, which included a gradual increase in exercise duration, initially in a cool and then in a tropical climate, and 2 field-based (wet-bulb globe temperature > 29.0°C) running evaluations that simulated the environmental conditions and training intensity the athlete would encounter in his sport. The thermoregulatory results guided the training progression, his tolerance to running in the heat improved, blood values normalized, and he was cleared to compete in a tropical climate. This exploration case report presents a novel field-based protocol that replicates the physiological demands of training in the tropics to evaluate thermoregulatory responses during exercise-heat stress in young runners after exertional heat stroke to facilitate a safe return to competition.

BACKGROUND: The extreme thermal environment driven by climate change disrupts thermoregulation in pregnant women and may threaten the survival of the developing fetus.
OBJECTIVE: To investigate the acute effect of maternal exposure to thermophysiological stress (measured with Universal Thermal Climate Index, UTCI) on the risk of stillbirth and modification of this effect by sociodemographic disparities.
METHODS: We conducted a space-time-stratified case-crossover analysis of daily UTCI and 2835 singleton stillbirths between 1st January 2000 and 31st December 2015 across multiple small areas in Western Australia. Distributed lag non-linear models were combined with conditional quasi-Poisson regression to investigate the effects of the UTCI exposure from the preceding 6 days to the day of stillbirth. We also explored effect modification by fetal and maternal sociodemographic factors.
RESULTS: The median UTCI was 13.9 °C (representing no thermal stress) while the 1st and 99th percentiles were 0.7 °C (slight cold stress) and 31.7 °C (moderate heat stress), respectively. Relative to median UTCI, we found positive associations between acute maternal cold and heat stresses and higher risks of stillbirth, increasing with the intensity and duration of the thermal stress episodes. The cumulative risk from the preceding 6 days to the day of stillbirth was stronger in the 99th percentile (RR = 1.19, 95% CI: 1.17, 1.21) than the 1st percentile (RR = 1.14, 95% CI: 1.12, 1.15), relative to the median UTCI. The risks were disproportionately higher in term and male stillborn fetuses, smoking, unmarried, ≤19 years old, non-Caucasian, and low socioeconomic status mothers.
CONCLUSIONS: Acute maternal exposure to both cold and heat stresses may contribute to the risk of stillbirth and be exacerbated by sociodemographic disparities. The findings suggest public health attention, especially for the identified higher-risk groups. Future studies should consider the use of a human thermophysiological index, rather than surrogates such as ambient temperature.

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Responses to climate change are particularly complicated in species that engage in symbioses, as the niche of one partner may be modified by that of the other. We explored thermal traits in gut symbionts of honeybees and bumblebees, which are vulnerable to rising temperatures. In vitro assays of symbiont strains isolated from 16 host species revealed variation in thermal niches. Strains from bumblebees tended to be less heat-tolerant than those from honeybees, possibly due to bumblebees maintaining cooler nests or inhabiting cooler climates. Overall, however, bee symbionts grew at temperatures up to 44°C and withstood temperatures up to 52°C, at or above the upper thermal limits of their hosts. While heat-tolerant, most strains of the symbiont Snodgrassella grew relatively slowly below 35°C, perhaps because of adaptation to the elevated body temperatures that bees maintain through thermoregulation. In a gnotobiotic bumblebee experiment, Snodgrassella was unable to consistently colonize bees reared at 29°C under conditions that limit thermoregulation. Thus, host thermoregulatory behaviour appears important in creating a warm microenvironment for symbiont establishment. Bee-microbiome-temperature interactions could affect host health and pollination services, and inform research on the thermal biology of other specialized gut symbionts.

Body temperature affects various aspects of ectotherm biology. Reptiles, as ectotherms, gain and control their temperature mainly through behavioural adjustments, although some body traits may also be advantageous. According to the thermal melanism hypothesis (TMH) dark colour may be thermally advantageous in cold environments. Additionally, differences in thermoregulatory capacity may also affect performance. We analysed the role of melanism in the thermoregulation and sprint speed performance of three species of Liolaemus lizards from Argentinean Patagonia. Liolaemus shitan, L. elongatus and L. gununakuna are phylogenetically close, with similar body sizes and life history traits, but differ in their melanic colouration, L. shitan being the darkest and L. gununakuna the lightest species. We estimated sprint speed performance curves and heating rates, and recorded final body temperature and sprint speed achieved after a fixed heating time, from two different initial body temperatures, and with and without movement restriction. Performance curves were similar for all the species, but for L. gununakuna the curve was more flattened. Darker species showed faster heating rates, ran faster after fixed heating trials at the lowest temperature, and reached higher body temperatures than L. gununakuna, but this was compensated for by behavioural adjustments of the lighter lizards. Similarity of sprint speed performance may be due to the conservative nature of this character in these species, while variation in heating ability, particularly when starting from low temperatures, may reflect plasticity in this trait. The latter provides support for the TMH in these lizards, as melanism helps them increase their body temperature. This may be especially advantageous at the beginning of the day or on cloudy days, when temperatures are lower.

Here we describe a unique case of clozapine-associated hypothermia during initial titration of this medication in an acute inpatient psychiatry setting. Only a handful of cases on this topic have been published. We discuss possible pharmacologic mechanisms supporting or refuting the propensity of clozapine to induce hypothermia, as well as risk factors for clozapine-induced hypothermia, and a comparison to clozapine-induced hyperthermia.
A 70 year-old African American female with treatment-refractory schizoaffective disorder developed hypothermia with a nadir temperature of 89 °F (31.7 °C) after 7 days on clozapine, on a total dose of 50 mg twice daily. Accompanying symptoms included bradycardia, hypotension, QTc prolongation, tachypnea, hypoxemia, and an absence of shivering. The patient was transferred to the ICU, and rewarmed within 10 h with the discontinuation of her clozapine, ziprasidone, and carvedilol. Broad spectrum antibiotics were initiated, but discontinued shortly after, as the patient had no leukocytosis, and blood cultures were negative.
While hypoglycemia, hypothyroidism, sepsis, and stroke were effectively ruled out, alternative drug-disease (including chronic kidney disease), and drug-drug interactions were considered possible contributing features. Benzodiazepines, valproic acid, ziprasidone, and the numerous antihypertensive agents the patient was taking were considered as either primary or compounding factors for hypothermia. After exclusion or inclusion of these alternative causes, we calculated a score of 4 (possible) for clozapine-induced hypothermia on the Naranjo Scale.
Clozapine-induced hypothermia may occur more commonly than clinicians believe. Practitioners should be cognizant of this potentially fatal phenomenon, and monitor for temperature dysregulations while on clozapine, especially during initial titration, in those with multiple comorbid factors, and on additional medications that may contribute to hypothermia.