Extreme summer heat in Phoenix, Arizona (USA) under global climate change (2041-2070)

Summer extreme heat events in the arid Phoenix, Arizona (USA) metropolitan region for the period 2041-2070 are projected based on the ensemble of ten climate models from the North American Regional Climate Change Assessment Program for the SRES A2 greenhouse gas emissions scenario by the Intergovernmental Panel on Climate Change. Extreme heat events are identified by measures related to two thresholds of the maximum daily air temperature distribution for the historical reference period 1971-2000. Comparing this reference period to the model ensemble-mean, the frequency of extreme heat events is projected to increase by a factor of six to 1.9 events per summer and the average number of event days per year is projected to increase by a factor of 14. The inter-model range for the average number of EHE days per summer is larger for the projected climate, 10.6 to 42.2 days, than for simulations of the past climate simulations (1.5 to 2.4 days)

Occupation and Environmental Heat-Associated Deaths in Maricopa County, Arizona: A Case-Control Study

Background: Prior research shows that work in agriculture and construction/extraction occupations increases the risk of environmental heat-associated death. Purpose: To assess the risk of environmental heat-associated death by occupation. Methods: This was a case-control study. Cases were heat-caused and heat-related deaths occurring from May-October during the period 2002–2009 in Maricopa County, Arizona. Controls were selected at random from non-heat-associated deaths during the same period in Maricopa County. Information on occupation, age, sex, and race-ethnicity was obtained from death certificates. Logistic regression analysis was used to estimate odds ratios for heat-associated death. Results: There were 444 cases of heat-associated deaths in adults (18+ years) and 925 adult controls. Of heat-associated deaths, 332 (75%) occurred in men; a construction/extraction or agriculture occupation was described on the death certificate in 115 (35%) of these men. In men, the age-adjusted odds ratios for heat-associated death were 2.32 (95% confidence interval 1.55, 3.48) in association with construction/extraction and 3.50 (95% confidence interval 1.94, 6.32) in association with agriculture occupations. The odds ratio for heat-associated death was 10.17 (95% confidence interval 5.38, 19.23) in men with unknown occupation. In women, the age-adjusted odds ratio for heat-associated death was 6.32 (95% confidence interval 1.48, 27.08) in association with unknown occupation. Men age 65 years and older in agriculture occupations were at especially high risk of heat-associated death. Conclusion: The occurrence of environmental heat-associated death in men in agriculture and construction/extraction occupations in a setting with predictable periods of high summer temperatures presents opportunities for prevention

Extreme summer heat in Phoenix, Arizona (USA) under global climate change (2041-2070)

Summer extreme heat events in the arid Phoenix, Arizona (USA) metropolitan region for the period 2041-2070 are projected based on the ensemble of ten climate models from the North American Regional Climate Change Assessment Program for the SRES A2 greenhouse gas emissions scenario by the Intergovernmental Panel on Climate Change. Extreme heat events are identified by measures related to two thresholds of the maximum daily air temperature distribution for the historical reference period 1971-2000. Comparing this reference period to the model ensemble-mean, the frequency of extreme heat events is projected to increase by a factor of six to 1.9 events per summer and the average number of event days per year is projected to increase by a factor of 14. The inter-model range for the average number of EHE days per summer is larger for the projected climate, 10.6 to 42.2 days, than for simulations of the past climate simulations (1.5 to 2.4 days).Projektionen für extreme Hitzeereignisse in den Sommermonaten in Phoenix, Arizona (USA) wurden für den Zeitraum 2041-2070 unter der Annahme des SRES A2 Treibhausgasemissionsszenarios des Intergovernmental Panel on Climate Change erstellt. Dafür wurden Simulationsergebnisse eines Ensembles von zehn Klimamodellen ausgewertet, die im Rahmen des North American Regional Climate Change Assessment Programmes angewendet wurden. Die extremen Hitzeereignisse wurden mit Hilfe von Kriterien bestimmt, die auf Schwellenwerttemperaturen für die maximalen täglichen Lufttemperaturen für die Referenzperiode 1971-2000 beruhen. In der Zukunft versechsfacht sich im Ensemblemittel die Häufigkeit der Extremereignisse (~ 1.9 Ereignisse pro Sommer) im Vergleich zum Referenzzeitraum mit einer vierzehnfachen mittleren Anzahl der Hitzetage pro Sommer. Dabei vergrößert sich die Schwankungsbreite der Modelle bezüglich der mittleren Anzahl der Hitzetage pro Sommer in der Zukunft gegenüber der der Vergangenheit von 1.5-2.4 auf 10.6-42.2

Heat-Related Deaths in Hot Cities: Estimates of Human Tolerance to High Temperature Thresholds

In this study we characterized the relationship between temperature and mortality in central Arizona desert cities that have an extremely hot climate. Relationships between daily maximum apparent temperature (ATmax) and mortality for eight condition-specific causes and all-cause deaths were modeled for all residents and separately for males and females ages \u3c65 and ≥65 during the months May–October for years 2000–2008. The most robust relationship was between ATmax on day of death and mortality from direct exposure to high environmental heat. For this condition-specific cause of death, the heat thresholds in all gender and age groups (ATmax = 90–97 °F; 32.2‒ 36.1 °C) were below local median seasonal temperatures in the study period (ATmax = 99.5 °F; 37.5 °C). Heat threshold was defined as ATmax at which the mortality ratio begins an exponential upward trend. Thresholds were identified in younger and older females for cardiac disease/stroke mortality (ATmax = 106 and 108 °F; 41.1 and 42.2 °C) with a one-day lag. Thresholds were also identified for mortality from respiratory diseases in older people (ATmax = 109 °F; 42.8 °C) and for all-cause mortality in females (ATmax = 107 °F; 41.7 °C) and males \u3c65 years (ATmax = 102 °F; 38.9 °C). Heat-related mortality in a region that has already made some adaptations to predictable periods of extremely high temperatures suggests that more extensive and targeted heat-adaptation plans for climate change are needed in cities worldwide

Multiple Trigger Points for Quantifying Heat-Health Impacts: New Evidence from a Hot Climate

Background: Extreme heat is a public health challenge. The scarcity of directly comparable studies on the association of heat with morbidity and mortality and the inconsistent identification of threshold temperatures for severe impacts hampers the development of comprehensive strategies aimed at reducing adverse heat-health events. Objectives: This quantitative study was designed to link temperature with mortality and morbidity events in Maricopa County, Arizona, USA with a focus on the summer season. Methods: Using Poisson regression models that controlled for temporal confounders, we assessed daily temperature-health associations for a suite of mortality and morbidity events, diagnoses, and temperature metrics. Minimum risk temperatures, increasing risk temperatures, and excess risk temperatures were statistically identified to represent different “trigger points” at which heat-health intervention measures might be activated. Results: We found significant and consistent associations of high environmental temperature with all-cause mortality, cardiovascular mortality, heat-related mortality, and mortality resulting from conditions that are consequences of heat and dehydration. Hospitalizations and emergency department visits due to heat-related conditions and conditions associated with consequences of heat and dehydration were also strongly associated with high temperatures and there were several times more of those events than deaths. For each temperature metric, we observed large contrasts in trigger points (up to 22°C) across multiple health events and diagnoses. Conclusion: Consideration of multiple health events and diagnoses together with a comprehensive approach to identify threshold temperatures revealed large differences in trigger points for possible interventions related to heat. Providing an array of heat trigger points applicable for different end-users may improve public health response to a problem projected to worsen in the coming decades

ACC/AHA Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction—Executive Summary A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1999 Guidelines for the Management of Patients With Acute Myocardial Infarction)

Although considerable improvement has occurred in the process of care for patients with ST-elevation myocardial infarction (STEMI), room for improvement exists (1–3). The purpose of the present guideline is to focus on the numerous advances in the diagnosis and management of patients with STEMI since 1999. This is reflected in the changed name of the guideline: “ACC/AHA Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction.” The final recommendations for indications for a diagnostic procedure, a particular therapy, or an intervention in patients with STEMI summarize both clinical evidence and expert opinion (Table 1).To provide clinicians with a set of recommendations that can easily be translated into the practice of caring for patients with STEMI, this guideline is organized around the chronology of the interface between the patient and the clinician. The full guideline is available at http://www.acc.org/clinical/guidelines/stemi/index.htm

ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non–ST-Elevation Myocardial Infarction A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non–ST-Elevation Myocardial Infarction) Developed in Collaboration with the American College of Emergency Physicians, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons Endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic Emergency Medicine

"The ACC/AHA Task Force on Practice Guidelines was formed to make recommendations regarding the diagnosis and treatment of patients with known or suspected cardiovascular disease (CVD). Coronary artery disease (CAD) is the leading cause of death in the United States. Unstable angina (UA) and the closely related condition of non–ST-segment elevation myocardial infarction (NSTEMI) are very common manifestations of this disease. The committee members reviewed and compiled published reports through a series of computerized literature searches of the English-language literature since 2002 and a final manual search of selected articles. Details of the specific searches conducted for particular sections are provided when appropriate. Detailed evidence tables were developed whenever necessary with the specific criteria outlined in the individual sections. The recommendations made were based primarily on these published data. The weight of the evidence was ranked highest (A) to lowest (C). The final recommendations for indications for a diagnostic procedure, a particular therapy, or an intervention in patients with UA/NSTEMI summarize both clinical evidence and expert opinion.

Speech Communication

Contains table of contents for Part IV, table of contents for Section 1, an introduction, reports on seven research projects and a list of publications.C.J. Lebel FellowshipDennis Klatt Memorial FundNational Institutes of Health Grant T32-DC00005National Institutes of Health Grant R01-DC00075National Institutes of Health Grant F32-DC00015National Institutes of Health Grant R01-DC00266National Institutes of Health Grant P01-DC00361National Institutes of Health Grant R01-DC00776National Science Foundation Grant IRI 89-10561National Science Foundation Grant IRI 88-05680National Science Foundation Grant INT 90-2471