Excessive Heat Exposure Research Articles

Development of an enhanced electrical injera baking pan (Ethiopian Traditional mitad) using steel powder additives and gypsum insulation

Electric Injera baking Pan are prevalent in Ethiopia but are highly inefficient, resulting in significant heat loss, high energy consumption, and increased energy bills. This research investigates improving these devices using steel powder as an additive and gypsum as an insulator. The study examines thermal conductivity, baking time, energy consumption, heat loss, and insulation effectiveness. The objectives of this research are to improve the thermal conductivity of the baking surface while ensuring even heat distribution, enhance the insulation properties of the pan to reduce heat loss, improve the safety of the user by reducing the risk of excessive heat exposure to the outer surfaces, and reduce the overall energy consumption of the Injera baking process. Temperatures were measured using an infrared thermometer, digital thermometer, and thermocouple. Four samples (A0, A1, A2, & A3) with different steel powder compositions (0 %, 15 %, 25 %, and 35 %) and a constant 75 % clay soil composition were tested. The analysis showed an average baking energy of 0.45 kWh per kg of injera (0.198 kWh per injera) and a thermal efficiency of 86.4 % when baking 4.395 kg of injera. The total heat energy loss was 1402.78 KJ (14.08 % of 10300 KJ input energy). The losses were distributed among the retained (92.17 %), the baking plate (3.95 %), the bottom enclosure (2.08 %), the side enclosure (1.04 %), and the cover lid (0.76 %).

Children With Cardiac Disease and Heat Exposure: Catastrophic Converging Consequences?

To highlight the worrying paucity of investigative research aimed at differentiating how higher ambient temperatures further tax an already compromised cardiovascular system in children. This commentary describes basic thermoregulatory concepts relevant to the healthy pediatric population and summarizes common heart diseases observed in this population. We describe how heat stress and exercise are important factors clinicians should more readily consider when treating children with heart disease. Countermeasures to physical inactivity are suggested for children, parents, clinicians, and policymakers to consider. As sudden, excessive heat exposures continue to impact our rapidly warming world, vulnerable populations like children with underlying heart conditions are at greater heat health risk, especially when coupled with the negative physical activity and fitness trends observed worldwide.

Tingkat Pengetahuan Orang Tua tentang Penanganan Hipertermia pada Anak di Puskesmas Pahandut

Background: Hyperthermia is an abnormally high body temperature caused by thermoregulatory dysfunction. High fever can lead to shock, which, if not treated promptly, can result in death. Hyperthermia in children is commonly caused by viral infections, excessive heat exposure, dehydration, allergies, and immune system disorders. Objective: To determine the level of parental knowledge regarding the management of hyperthermia in children at Pahandut Health Center. Method: This study used a questionnaire design with a sample of 31 respondents at Pahandut Health Center. Results: The research results showed the level of parental knowledge about hyperthermia management at Pahandut Health Center, with 31 respondents categorized as follows: 14 respondents (45%) had good knowledge, 14 respondents (45%) had sufficient knowledge, and 3 respondents (10%) had poor knowledge. Conclusion: The study highlights the importance of parental knowledge in preventing hyperthermia in children.

Extreme heat adaptation in urban areas: a comparative case study of New York City and New Orleans

ABSTRACT As the risk of extreme heat in urban centres becomes more frequent and intense, a comparative case study of New York City, New York's and New Orleans, Louisiana's policy responses to dangerous heat highlights past approaches to protecting vulnerable populations, where improvements can be made to best suit local needs, and the areas where solutions may still be implemented. Two cities at the forefront of the climate crisis in the United States, their policy approaches are guided by their histories, their existing adaptations and behaviours, and the harsh reality the changing climate has wrought. New York City has prioritised cooling centres as a safety measure, as the city is regularly seeing hundreds of heat-related deaths per year, often in unairconditioned homes. New Orleans has prioritised the installation of back-up energy generation following mass blackouts caused by Hurricane Ida in 2021 and deaths of at least 10 residents in the resulting excessive heat exposure. In New York, census tracts with the highest percentage of Black, elderly, and foreign-born populations were most likely to have reduced access to a cooling centre. In New Orleans, tracts with the highest percentage of Black, elderly, unemployed, and impoverished populations were most likely to have reduced access to a cooling centre. Comparing both city's codes, regulations, and policies, reviewing their emergency management communication strategies on social media, and performing GIS analysis on cooling centre locations against vulnerability criteria paints a clear picture of where heat policy stands in both cities and where it could potentially expand.

Investigating the transient conditions of “Sabat” space and its influence on pedestrian sensations during thermal walks. Algiers’ Casbah case study

Cities are already witnessing the impacts of climate change. Prolonged heat exposure have a direct effect on pedestrians’ thermoregulatory system, causing serious heat-related issues in the form of fatigue and thermal exhaustion. While the human body is capable of maintaining heat balance, excessive heat exposure combined with increasing heat loads can deteriorate the thermoregulatory process which leads to discomfort. Walkability is one of the significant challenges for climate change mitigation. Balancing the dichotomy of walking to mitigate climate change, and mitigating climate change to walk emphasizes the importance of promoting resilient walkability. In this context, the term “resilience” is used to highlight the need to design urban spaces able to adapt to increased urban heat, enabling pedestrians to tolerate and recover from discomfort conditions. This study investigates the potential of the “Sabat”, a traditional semi-outdoor space with lift-up design, and its distribution in generating transient thermal aeraulic conditions, and reducing fatigue sensation, hence, supporting a positive walking experience. Thermal walks have been conducted in Casbah of Algiers during temperate and hot weather conditions, in the context of uphill walking. Results revealed the alliesthesial effect of cool-shaded and ventilated Sabats to reduce fatigue sensation, which was confirmed by the significant correlation at lag-(-1) (r = 0.504, p < 0.001). Findings shed light on the importance of maintaining dynamic alliesthesia to create modulated restorative opportunities and offer starting point for hypothesizing broader trends for future implementation of Sabat design in modern cities.

Regulation of body temperature and blood pressure in women: Mechanisms and implications for heat illness risk.

Increasing global temperatures due to ongoing climate change phenomena have resulted in increased risk of exertional heat illness in otherwise healthy, young individuals who work or play in the heat. With increasing participation of women in athletic, military and industrial activities that involve exertion in the heat, there is a growing need to study female physiology in this context. Mechanisms controlling blood pressure and body temperature have substantial overlap in humans, largely due to autonomic mechanisms which contribute to both. Similarly, illnesses that result from excessive heat exposure can often be traced back to imbalances in one or more of these autonomic mechanisms. In recent years, there has been increased recognition of the importance of sex as a biological variable for basic and applied research in these areas. The goal of this paper is to present an update on the integrative physiology and pathophysiology of responses to heat stress in women (thermoregulation and blood pressure regulation). In this context, it is often the case that differences between sexes are presented as 'advantages' and 'disadvantages' of one sex over the other. In our opinion, this is an over-simplification of the physiology which ignores the nuances and complexities of the integrative physiology of responses to heat exposure and exercise, and their relevance for practical outcomes.

Enhancing Mechanical Properties and Flux of Nanofibre Membranes for Water Filtration.

Nanofibres have gained attention for their highly porous structure, narrow pore size, and high specific surface area. One of the most efficient techniques for producing nanofibres is electrospinning. These fibres are used in various fields, including water filtration. Although they possess the ability to filter various components, the fibres generally have low mechanical strength, which can mitigate their performance over time. To address this, studies have focused on enhancing nanofibre membrane strength for water filtration. Previous analyses show that the mechanical properties of nanofibre mats can be improved through solvent vapour treatment, thermal treatment, and chemical crosslinking. These treatments promote interfibre bonding, leading to the improvement of mechanical strength. However, excessive treatment alters nanofibre behaviour. Excessive heat exposure reduces interfibre bonding, while too much solvent vapour decreases pore size and mechanical strength. Thus, a comprehensive understanding of these post-treatments is crucial. This review examines post-treatments aiming to increase the mechanical strength of nanofibre mats, discussing their advantages and disadvantages. Understanding these treatments is essential for optimising nanofibre membrane performance in water filtration and other applications.

Hierarchical PBO Nanofiber/PPS Melt-Blown Mats with a Controllable Porous Microstructure for Thermal Protection under Harsh Conditions

Thermal insulation is critical in protecting against excessive heat exposure to minimize burn injuries. However, the current thermal insulation fabrics are still limited because of their inadequate thermal insulation, poor wearability, and a complicated process. Herein, a fibrous network-confined sol–gel transition strategy is developed to fill poly(p-phenylene benzobisoxazole) nanofibers into poly(p-phenylene sulfide) melt-blown mats. The obtained hierarchical nano/microfiber mats (HNMMs) show typical features of high porosity, a low packing density, small pore sizes, and high thermal stability. Benefiting from the synergistic effect, HNMMs demonstrate low thermal conductivity (0.029 W/mK), outstanding heat resistance (43.7 cal/cm2), high air permeability (115 mm/s), and high water vapor transmission [1568 g/(m2·d)]. The comprehensive performances indicate that such HNMMs have promising potential in personal and industrial thermal insulation in harsh environments.

Two decades of nighttime surface urban heat island intensity analysis over nine major populated cities of India and implications for heat stress

Warmer global climate and urban heat islands (UHIs) interact, by exacerbating heatwaves and increasing the extreme heat days in cities. The implications of added heat stress in urban environments due to intensifying surface UHIs (SUHIs) is of utmost concern. Seasonal, annual and decadal nighttime SUHI intensities (SUHIIs), from 2001 to 2020, for nine major populated cities of India are analyzed. This includes five megacities- Delhi, Mumbai, Kolkata, Bangalore, and Chennai, and four incipient megacities- Hyderabad, Ahmedabad, Surat, and Pune. The key role of increasing urbanization (pre- and post-2010) in expansion and intensification of nighttime SUHIs in India is highlighted. For all cities either pre-monsoon (MAM) or winter (December-February; DJF) seasons show the strongest SUHII development. During the 2001–2010, and the 2011–2020 decade, a nighttime SUHII maxima of respectively (i) 2.1°C and 2.5°C for Delhi, (ii) 1.3°C and 1.5°C for Mumbai, (iii) 1.3°C and 1.5°C for Kolkata, (iv) 0.6°C and 1.0°C Bangalore, (v) 1.7°C and 1.9°C for Chennai, (vi) 1.8°C and 2.3°C for Hyderabad, (vii) 2.8°C and 3.1°C for Ahmedabad, (viii) 1.9°C and 2.4°C for Surat, and (ix) 0.8°C and 1.3°C for Pune is noted. Further, all incipient megacities showed a mean annual growth rate of nighttime SUHII of over 0.007°C/year, substantially greater than in the megacities. High SUHII magnitudes, greater growth rates of SUHII, and huge populations, severely compounds the vulnerability of Indian cities to excessive heat exposure risk, especially during MAM heatwaves. Lastly, the implications of nighttime SUHII findings from the present study, on the increase in heat stress, the loss of labor productivity and the rise in heat-related mortality rate is emphasized. The study recommends implementation of city-specific action plans to mitigate the heat stressed urban environment. Targeted use of cooling strategies in localized hotspots within the urban areas where high intensity SUHIs are likely to form is also suggested.

Modeling and investigating the effect of parasol installation on solar radiant temperature reduction using COMSOL Multiphysics

Objectives. Occupational activities in open spaces can experience excessive heat exposure caused by sunlight and other artificial sources in these professional environments can be one of the current and future challenges of occupational safety and health due to increasing global warming. Use of lightweight portable parasols is the first available control measure to reduce the radiation emitted by the sun in outdoor workplaces, which has been used for a long time. Methods. Due to the lack of study and results on the effect of using parasols in scientific literature, this modeling study was conducted to investigate the effect of sunshade installation on radiant temperature reduction of the sun in outdoor work using COMSOL Multiphysics version 5.5. Results. In general, six different shapes of portable parasols in different positions were modeled and the average radiant temperature reduction effectiveness (TRE) was about 30% in the presence of different parasols. The designed conical, simple and pyramidal sunshades showed the most effectiveness, respectively. Conclusions. The results show that changing variables such as the axis, installation height and shape is more effective for improving parasol efficiency to reduce the radiant temperature below it.

Elderly People's Perceptions of Heat Stress and Adaptation to Heat: An Interview Study.

Objectives: Heatwaves are having a disproportionate impact on the elderly population, as demonstrated by pronounced mortality and morbidity. The present study aimed to explore elders’ subjective experiences of heat impacts and adaptive strategies. Methods: Semi-structured interviews with 19 elderly Swedes were conducted, focusing on their experiences of the extremely hot summer of 2018. Results: Most informants suffered during the heatwave, although some found it pleasant. The readiness to implement adaptive measures was generally high among the healthiest, who were able to avoid excessive heat and adjust their daily routines. In contrast, those highly dependent on care from others had limited options for avoiding the heat, and little capacity to take up adaptive measures. Discussion: With heat becoming an increasing problem, it is important to adjust elderly care so that the most vulnerable elderly people can avoid excessive heat exposure.

Catalase Activity in Hot-Air Dried Mango as an Indicator of Heat Exposure for Rapid Detection of Heat Stress

The growing market for dried fruits requires more attention to quality parameters. Mango and other tropical fruits are commonly dried at temperatures ranging from 40 °C to 80 °C. Convincing evidence suggests that the nutritional quality of dried fruits is best preserved when dried at low temperatures ≤50 °C, whereas increasing drying temperatures lead to the degradation of the most valuable nutrients inside the fruit. Currently, there is no system or direct measurement method that can assist in identifying the quality deterioration of dried fruits caused by excessive heat exposure during drying. From this perspective, the activity of the heat-sensitive enzyme ‘catalase’ was used for the first time to evaluate and compare mango slices dried at 40 °C, 60 °C and 80 °C. Various methods, including direct and indirect flotation tests and spectrophotometric measurements, were explored to measure the residual catalase activity in the dried samples. Results showed that the spectrophotometry and indirect flotation test produced the best results, revealing a significant difference (p &lt; 0.05) in the catalase activity of mango slices dried at 40 °C, 60 °C and 80 °C, which the direct-dried mango flotation test failed to predict. Furthermore, this study demonstrates the potential applicability of catalase activity to indicate heat stress in dried mango slices processed at different temperatures.

Segmental anhidrosis and heat intolerance

A 62 year-old woman with no previous medical history presented to the Dermatology department with sweating disorders for several years. She described segmental hyperhidrosis and hyperemia while running. This excessive sweating occurred in the left hemiface, the left half of the trunk, the left upper limb and the right lower limb (Fig. 1A). This was associated with heat intolerance and previous faintness during sport. She did not describe any chest pain before faintness and the cardiac auscultation was normal. The neurological examination revealed a diffuse areflexia in the absence of any sensory or motor disorders. By illuminating the right eye, we observed a delay in ipsilateral pupillary contraction, whereas we observed an absence of the consensual photomotor reflex of the right eye by illuminating the left eye (Adie's tonic pupil, Fig. 1B and C, and Supplementary file 1). However, she did not complain of reduced visual acuity. Ross syndrome is a rare autonomic disorder caused by a selective degenerative process of the postganglionic cholinergic sudomotor neurons [[1]Sommer C. Lindenlaub T. Zillikens D. Toyka K.V. Naumann M. Selective loss of cholinergic sudomotor fibers causes anhidrosis in Ross syndrome.Ann Neurol. 2002; 52: 247-250Google Scholar]. Ross syndrome is diagnosed by the presence of a triad of symptoms associating segmental anhidrosis (with compensatory hyperhidrosis), Adie's tonic pupil and areflexia [[2]Mishra A.K. Kharkongor M. Kuriakose C.K. George A.A. Peter D. Carey R.A.B. et al.Is ross syndrome an autoimmune entity? A case series of 11 patients.Can J Neurol Sci. 2017; 44: 318-321Google Scholar]. The main complaint of patients is generally the segmental compensatory hyperhidrosis, the anhidrosis in contrast is not even noticed. The two other signs must be specifically examined for to make the diagnosis. The deep tendon hyporeflexia or areflexia affects the four limbs, whereas the tonic pupil is observed on the pathological and anhidrotic side of the face. It has been proposed to treat hyperhidrosis with botulinum toxin [[3]Bergmann I. Dauphin M. Naumann M. Flachenecker P. Müllges W. Koltzenburg M. et al.Selective degeneration of sudomotor fibers in Ross syndrome and successful treatment of compensatory hyperhidrosis with botulinum toxin.Muscle Nerve. 1998; 21: 1790-1793Google Scholar], but this treatment may theoretically increase the heat intolerance and the risk of faintness during sport. Even if the disorder is benign, the objective is to avoid any faintness. Clinicians should advise patients with Ross syndrome to wear light clothing for sports and to avoid excessive heat exposure.

Too Hot to Nest? In a Hot Summer the Tortoise Chersina angulata Can Switch From Nesting to Facultative Viviparity

In a captive colony of Chersina angulata in Cape Town, South Africa, we observed in 2015/16 retention of the last egg clutch inside the female until the hatching stage was reached, conforming to the generally accepted definition of viviparity. Retrospective climatic analysis indicates egg retention until the hatching stage co-occurred with unusually hot summer weather: the average air temperatures in December 2015 and January and February 2016 were higher than during the preceding five and the following 5 years when facultative viviparity could not be observed. Late December and January appears to be the critical period for females to either deposit their last clutch of the nesting season into a nest, or to retain the last clutch for embryonic development inside the female. Over the 28 December to 24 January period the minimum, average and maximum air temperatures in 2015–16 were about 3°C higher than in the five following years. This association of facultative viviparity with unusual summer heat suggests that hot ambient temperatures at the end of the nesting season may cue females to switch from oviposition to facultative viviparity. Compared to incubation in a nest this phenotypic plasticity of the reproductive mode—to retain during hot summers the season’s last clutch inside the female—may buffer the developing embryos from excessive heat exposure: females can thermo-regulate by moving among microhabitats whereas sun exposed shallow nests cannot escape high ground temperatures. This novel reproductive strategy has the potential to enhance the resilience of species to global warming.

Effect of heat exposure on dehydration and kidney function among sea salt workers in Thailand.

Excessive heat exposure and dehydration among agricultural workers have been reported to reduce kidney function and lead to chronic kidney disease of unknown etiology (CKDu). This cross-sectional study aimed to assess heat exposure, factors related to dehydration and the relationship between dehydration and biomarkers of kidney function among sea salt workers in Thailand. Wet bulb globe temperature (WBGT) was used at the time workers started work outdoors on salt farms. Urine-specific gravity, urine osmolarity, and serum creatinine were collected from 50 workers after work. The results showed that more than 50% of the participants were dehydrated after work. The maximum hours spent working per day was 10. The average water intake was 1.51 L. Urine specific gravity was highly significant correlated with urine osmolality (rs = 0.400, p<0.01), and urine osmolality was significantly correlated with the estimated glomerular filtration rate (eGFR) (rs = 0.349, p<0.05). In bivariate analysis adjusted for age, sex, and current alcohol consumption, we found that a WBGTTWA ≥ 30°C (OR = 0.08, 95% CI = 0.01-0.44, p = 0.003) and hours spent working (OR=2.22, 95% CI = 1.42-3.47, p <0.001) were independently associated with dehydration. This suggests that workers should increase their time spent on breaks and increase water consumption. Educational program on heat exposure and heat-related illness prevention strategies should be provided.

Development of Sustainable Indoor Air Quality for Air-Conditioning System Using Smart Control Techniques

Air-conditioning as a technical solution to protect inhabitants from excessive heat exposure creates the challenge of expanding indoor health effects. While air-conditioning has mostly been applied as an improvement to living conditions, health and environmental problems associated with its use frequently occurs. Therefore, this paper challenges and extends existing knowledge on sustainability related to the smart air-conditioning systems. The decrease of CO2 level in building requires an intelligent control system because energy utilisation has been legitimately connected with wellbeing and eventually to operational expenses. A building’s indoor environmental essential factors of comfort are IAQ, visual and thermal. Through an appropriate structured controller, the performance of indoor control system can be altogether improved. It merits creating innovative control techniques to optimise the indoor environment quality for air-conditioning system. The newly proposed backpropagation neural network was optimised using Matlab to control the CO2 level appropriately while carefully taking into account the performance of system controllers such as the stability, adaptability, speed response and overshoot. The controller of indoor environment was designed, and the proportional-integral-derivative control was utilised as a result of its suitability. The smart controllers were designed to regulate the parameters automatically to ensure the optimised control output. The indoor CO2 possesses an appropriate time constant and settling time of 2.1s and 27.3s, respectively. Therefore, utilising smart control techniques to exterminate various indoor health effects is expected to produce sustainable living conditions.

Novel Use of Water Immersion in the Management of Exertional Heat Stress

ABSTRACT Heat-related illness can result in increased morbidity and mortality from excessive or prolonged heat exposure that overcomes the body’s ability to dissipate the heat load and maintain thermal homeostasis. Postexposure treatment of heat illness has been extensively evaluated along with the role of cold water immersion in the treatment of heat illness. Heat stress mitigation and heat adaptation strategies are currently evolving, including water immersion, to mitigate heat stress and induce heat adaptation. Mitigation strategies are critical to occupations that are not always amenable to heat adaptation because of intermittent and sometimes unexpected introduction to extreme heat exposures complicated by personal protective equipment. Heat adaptation is recommended to mitigate heat-related injuries, and various strategies provide athletes and high-risk occupations a way to adapt to unaccustomed environments. Two approaches to heat stress mitigation and adaptation explored in this article are cold and hot water immersion therapies. These strategies have demonstrated promising results with the potential for minimal disruption in training or work-related schedules.

The Effects of Clothing Insulation and Acclimation on the Thermal Comfort of Underground Mine Workers

Excessive heat exposure is among the health and safety hazards that have adverse effects on the mine workers. The very nature of the underground climate makes it a convenient avenue for heat generation and accumulation from several heat sources including autocompression, equipment, and heat from strata. This study investigated the effects of clothing insulation and acclimation on the thermal comfort of mine workers who are exposed to heat in underground working environments. Several clothing ensembles have been considered to analyze the effect of the thermal resistance of clothing on the thermal comfort of workers. To investigate the impact of the clothing insulation, the thermal comfort limit of an underground miner was calculated in the form of maximum allowable exposure time for an 8-h shift. Parametric analyses were subsequently performed using an already developed thermal comfort model using MATLAB software. The results demonstrate that clothing insulation has a significant effect on the thermal comfort of mine workers. Increase in the clothing insulation decreases the maximum allowable exposure time of mine workers. This is especially true for the new and non-acclimated workers. Since acclimatized workers can tolerate a higher level of the dehydration and are capable of losing more water by sweat per shift, the maximum allowable exposure time for the acclimated workers are higher than non-acclimated workers. These analyses have shown that acclimated workers can have more continuous work per shift compared with non-acclimated workers. For example, in an environmental condition with clothing that a non-acclimated worker cannot work more than 5 h, an acclimated worker can work a full 8-h shift.

Heat stress risk among New York City public school kitchen workers: a quantitative exposure assessment

Despite the known human health risks associated with excessive heat exposure, particularly in occupational settings, data describing potential heat exposures in school kitchens is scarce, and no published studies to date have performed a quantitative heat exposure assessment for workers employed in this setting. The purpose of this study was to quantify the extent of heat stress in New York City public school kitchens and to assess potential risk of heat-related illness and/or acute injury. Full-shift indoor Wet Bulb Globe Temperature (WBGT) indices, as well as indoor CO2 and CO concentrations were measured for ten school kitchens. A quantitative exposure assessment for three metabolic work-rate scenarios (light, moderate, heavy) was performed in accordance with the Occupational Safety and Health Administration’s (OSHA) Heat Hazard Assessment methodology. The overall mean indoor WBGT index for all ten sites was approximately 25.0 °C (77.0 °F; Standard Deviation [SD] = 2.0 °C). Regarding the estimated Action Limit, 10% of school kitchens sampled exceeded this recommended limit for the light work-rate scenario; 60% of schools exceeded this limit for the moderate work-rate scenario; and 80% of schools exceeded this limit for the heavy work-rate scenario. For the Threshold Limit Value (TLV), none of the kitchens exceeded this limit for the light or moderate work-rate scenarios; 30% of kitchens were in excess of this limit for the heavy work-rate scenario. Mean full-shift CO2 and CO air concentrations ranged from 435–911 ppm (mean = 648; SD = 158) and 0.0–3.2 ppm (mean = 0.9; SD = 0.9), respectively. The data collected in the current study suggest that kitchen staff employed in New York City public schools may be exposed to excessive indoor heat levels. Adequate work-rest schedules should be implemented for kitchen workers, in addition to other feasible engineering and administrative controls to mitigate potential risk of heat-related illness and/or acute injury.

A Case for Expanding Thermochromic Vial Monitor Technology to Insulin and Other Biologics

Insulin quality and efficacy determine glycemic control, which determines quality of life for people with diabetes. Insulin efficacy is reduced by heat exposure, especially in tropical climates, remote areas, and with improper handling. Insulin doses can be adjusted based on blood glucose monitoring, which may compensate for lack of viability. However, a measured response may be difficult with other biopharmaceuticals. Thermochromic vial monitor technology developed for oral polio vaccines (vaccine vial monitors) is an inexpensive, easily available, visible modality which can be used for insulin and other biopharmaceuticals to detect excessive heat exposure and thus reduced potency at any point in the cold-chain, till the end-users, thus improving patient care. Regulatory authorities must urgently consider the need to impose mandatory use of this technology for all biopharmaceuticals, including insulin, to ensure efficacy till end usage.