A daughter who gave up full-time work to help look after her mother reveals her emotional and financial struggle

• Unpaid UK carers ‘face financial hit that can last decades’

We’re in the haematology department at the hospital and they call my mum in. We go inside, sit down and the doctor tells us the results of the test: she has myeloma – blood cancer – but will need a bone marrow test to confirm it.

I nearly faint, my heart sinks and I can see my mum’s face filled with sadness. Everything we hear after that is a blur but I know from that point things will be tough and that I am about to become a carer.

Police warn of ‘potentially contaminated batch’ after adults taken to hospital in County Durham

Seven people have been taken to hospital after taking the sleeping medication zopiclone, prompting concerns over a “potentially contaminated batch”.

Cleveland police said it had received reports on Friday of the adults being taken to North Tees General hospital in Stockton-on-Tees, County Durham.

Experts warn ‘health tourists’ to do their research, saying savings can lead to higher costs for work to be redone

Patients seeking medical treatments in Turkey and other countries should do their research and not be tempted by low prices, experts have warned.

From Brazilian butt lifts to Hollywood smiles and even organ transplants, the range of procedures offered by overseas providers is staggering, with myriad companies now promoting packages covering flights, accommodation and post-operative hotel accommodation.

Investigation details industry campaign including legal threats and charm offensive aimed at Tory MPs

Rishi Sunak abandoned his “legacy” policy to ban smoking for future generations amid a backlash from the tobacco industry in the form of legal threats, lobbying and a charm offensive aimed at Conservative MPs, an investigation reveals.

The UK had been on course to become the first country to ban smoking for future generations, via the tobacco and vaping bill, which Downing Street hoped would help define Sunak’s place in British political history.

Charlotte Edwardes interviews the Labour leader as he closes in on power, but who exactly is the man who wants to run Britain? Plus the extraordinary story of the woman who stepped in as a surrogate for her daughter’s baby, and Sam Pyrah examines the latest scientific understanding about why we dream what we do

The recall of Uncle Frog’s Mushroom Gummies has sparked concerns that the product contains psychoactive cannabinoids

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A cannabis product could be to blame for more than six people being hospitalised with symptoms including seizure-like twitching, vomiting and hallucinations after consuming gummies marketed as containing mushrooms, according to experts.

The Cordyceps and Lion’s Mane flavours of Uncle Frog’s Mushroom Gummies were recalled this week by Food Standards Australia New Zealand after reports of hospitalisations in New South Wales, South Australia and Victoria.

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Enlarge (credit: Diamond Shruumz)

After weeks of reports of severe illnesses across the country, the maker of Diamond Shruumz microdosing chocolates, gummies, and candy cones has finally issued a recall. It covers all lots and all flavors of all the brand's products.

The illnesses have been marked by several severe symptoms, which notably include seizures, loss of consciousness, and the need for intubation and intensive care. To date, there have been 39 people sickened, including 23 hospitalizations across 20 states, according to the Food and Drug Administration and the Centers for Disease Control and Prevention. The FDA first issued a warning on the brand's chocolate bars on June 7, when there were reports of eight cases, including six hospitalizations, in four states.

Diamond Shruumz's parent company, Prophet Premium Blends, said in the recall notice that it had received only two complaints about the products to date and, upon receiving those complaints, reviewed recent laboratory analyses (Certificates of Analysis) of its products. According to the company, those CoAs noted "higher than normal amounts of muscimol," which is one of two key compounds found in hallucinogenic Amanita mushrooms. Muscimol "could be a potential cause of symptoms consistent with those observed in persons who became ill after eating Diamond Shruumz products," the company said in the recall notice.

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Enlarge / Bees fly to their hive. (credit: Getty | Federico Gambarini)

In what may be the biological equivalent to getting struck by lightning, a very unlucky man in the Philadelphia area took a very rare bee sting directly to the eyeball—and things went badly from there.

As one might expect, the 55-year-old went to the emergency department, where doctors tried to extract the injurious insect's stinger from the man's right eye. But it soon became apparent that they didn't get it all.

Two days after the bee attack, the man went to the Wills Eye Hospital with worsening vision and pain in the pierced eye. At that point, the vision in his right eye had deteriorated to only being able to count fingers. The eye was swollen, inflamed, and bloodshot. Blood was visibly pooling at the bottom of his iris. And right at the border between the man's cornea and the white of his eye, ophthalmologists spotted the problem: a teeny spear-like fragment of the bee's stinger still stuck in place.

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Claimants include family of 11-year-old girl who spent three weeks on dialysis after eating chicken salad sandwich

Tesco and Asda are being sued by customers, including the family of an 11-year-old girl, who were left seriously ill after eating own-brand sandwiches linked to an outbreak of E coli.

The supermarkets face legal action after a child and adult were left in hospital. One person has been confirmed to have died and more than 120 others including a six-year-old have been hospitalised in the UK due to the bacteria.

The so-called toughest vape laws in the world are unfair and might create a new black market, seasoned vapers say

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While many might see vaping as a grotesque threat to the health of young people, and will welcome the so-called toughest vape laws in the world, seasoned vapers beg to differ.

Mark* has been vaping for more than 15 years. He used the device to break a 15-year, two-pack-a-day addiction to cigarettes. He loves his vapes. Mark says the new laws, which kick in on 1 July, are infantilising, contradictory and a backwards step.

Leaked documents from Philip Morris reveal ‘secret’ strategy to market its heated tobacco product IQOS

The tobacco company Philip Morris International has been accused of “manipulating science for profit” through funding research and advocacy work with scientists.

Campaigners say that leaked documents from PMI and its Japanese affiliate also reveal plans to target politicians, doctors and the 2020 Tokyo Olympics as part of the multinational’s marketing strategy to attract non-smokers to its heated tobacco product, IQOS.

Viral video of Prince William prompts experts to laud benefits of men ‘communicating their hormones’, from lifting mood to boosting trust

In his early 20s, Prince William was often seen stumbling out of night clubs after a night of grooving. Now, however, as though a clock has struck 12, this youthful cavorting appears to have transformed into something altogether more cringeworthy: dad dancing.

In a viral video captured at a Taylor Swift concert, the heir to the throne was filmed with his arms aloft, chest shimmying swiftly – and somewhat stiffly – to the beat.

I recoiled in horror: I could see a thick black body hanging out of my nostril

It was September 2014. I’d just started working front of house in a fancy hotel in Edinburgh. I spent most of my shifts with a paper napkin pressed to my nostril, as I had been getting lots of nosebleeds. I would soon find out why.

A few weeks earlier, I’d been travelling in Vietnam. I had rented a moped and had the time of my life driving around. I soon crashed but luckily was wearing a helmet, so only got a small bump on my head.

This article first appeared in The Checkup, MIT Technology Review’s weekly biotech newsletter. To receive it in your inbox every Thursday, and read articles like this first, sign up here. 

This week I’ve been thinking about thought. It was all brought on by reading my colleague Niall Firth’s recent cover story about the use of artificial intelligence in video games. The piece describes how game companies are working to incorporate AI into their products to create more immersive experiences for players.

These companies are applying large language models to generate new game characters with detailed backstories—characters that could engage with a player in any number of ways. Enter in a few personality traits, catchphrases, and other details, and you can create a background character capable of endless unscripted, never-repeating conversations with you.

This is what got me thinking. Neuroscientists and psychologists have long been using games as research tools to learn about the human mind. Numerous video games have been either co-opted or especially designed to study how people learn, navigate, and cooperate with others, for example. Might AI video games allow us to probe more deeply, and unravel enduring mysteries about our brains and behavior?

I decided to call up Hugo Spiers to find out. Spiers is a neuroscientist at University College London who has been using a game to study how people find their way around. In 2016, Spiers and his colleagues worked with Deutsche Telekom and the games company Glitchers to develop Sea Hero Quest, a mobile video game in which players have to navigate a sea in a boat. They have since been using the game to learn more about how people lose navigational skills in the early stages of Alzheimer’s disease.

The use of video games in neuroscientific research kicked into gear in the 1990s, Spiers tells me, following the release of 3D games like Wolfenstein 3D and Duke Nukem. “For the first time, you could have an entirely simulated world in which to test people,” he says.

Scientists could observe and study how players behaved in these games: how they explored their virtual environment, how they sought rewards, how they made decisions. And research volunteers didn’t need to travel to a lab—their gaming behavior could be observed from wherever they happened to be playing, whether that was at home, at a library, or even inside an MRI scanner.

For scientists like Spiers, one of the biggest advantages of using games in research is that people want to play them. The use of games allows scientists to explore fundamental experiences like fun and curiosity. Researchers often offer a small financial incentive to volunteers who take part in their studies. But they don’t have to pay people to play games, says Spiers.

You’re much more likely to have fun if you’re motivated. It’s just not quite the same when you’re doing something purely for the money. And not having to pay participants allows researchers to perform huge studies on smaller budgets. Spiers has been able to collect data on over 4 million people from 195 countries, all of whom have willingly played Sea Hero Quest.  

AI could help researchers go even further. A rich, immersive world filled with characters that interact in realistic ways could help them study how our minds respond to various social settings and how we relate to other individuals. By observing how players interact with AI characters, scientists can learn more about how we cooperate—and compete—with others. It would be far cheaper and easier than hiring actors to engage with research volunteers, says Spiers.

Spiers himself is interested in learning how people hunt, whether for food, clothes, or a missing pet. “We still use these bits of our brain that our ancestors would have used daily, and of course some traditional communities still hunt,” he tells me. “But we know almost nothing about how the brain does this.” He envisions using AI-driven nonplayer characters to learn more about how humans cooperate for hunting.

There are other, newer questions to explore. At a time when people are growing attached to “virtual companions,” and an increasing number of AI girlfriends and boyfriends are being made available, AI video-game characters could also help us understand these novel relationships. “People are forming a relationship with an artificial agent,” says Spiers. “That’s inherently interesting. Why would you not want to study that?”

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Read more from MIT Technology Review’s archive:

My fellow London-based colleagues had a lot of fun generating an AI game character based on Niall. He turned out to be a sarcastic, smug, and sassy monster.

Google DeepMind has developed a generative AI model that can generate a basic but playable video game from a short description, a hand-drawn sketch, or a photo, as my colleague Will Heaven wrote earlier this year. The resulting games look a bit like Super Mario Bros.

Today’s world is undeniably gamified, argues Bryan Gardiner. He explores how we got here in another article from the Play issue of the magazine.

Large language models behave in unexpected ways. And no one really knows why, as Will wrote in March.

Technologies can be used to study the brain in lots of different ways—some of which are much more invasive than others. Tech that aims to read your mind and probe your memories is already being used, as I wrote in a previous edition of The Checkup.

From around the web:

Bad night of sleep left you needing a pick-me-up? Scientists have designed an algorithm to deliver tailored sleep-and-caffeine-dosing schedules to help tired individuals “maximize the benefits of limited sleep opportunities and consume the least required amount of caffeine.” (Yes, it may have been developed with the US Army in mind, but surely we all stand to benefit?) (Sleep)

Is dog cloning a sweet way to honor the memory of a dearly departed pet, or a “frivolous and wasteful and ethically obnoxious” pursuit in which humans treat living creatures as nothing more than their own “stuff”? This feature left me leaning toward the latter view, especially after learning that people tend to like having dogs with health problems … (The New Yorker)

States that have enacted the strongest restrictions to abortion access have also seen prescriptions for oral contraceptives plummet, according to new research. (Mother Jones)

And another study has linked Texas’s 2021 ban on abortion in early pregnancy with an increase in the number of infant deaths recorded in the state. In 2022, across the rest of the US, the number of infant deaths ascribed to anomalies present at birth decreased by 3.1%. In Texas, this figure increased by 22.9%. (JAMA Pediatrics)

We are three months into the bird flu outbreak in US dairy cattle. But the country still hasn’t implemented a sufficient testing infrastructure and doesn’t fully understand how the virus is spreading. (STAT)

New coalition formed to push for repeal of colonial-era laws and reduce barriers to access for those seeking mental health help

Pressure to decriminalise suicide in four Caribbean nations is mounting as a new coalition has come together for the first time to fight for the repeal of colonial-era laws.

A group of people with experience of poor mental health, government officials, activists, legal experts and healthcare workers, led by organisations in the Caribbean, will advocate for legislative reform. They want to reduce barriers for people seeking help and ensure that mental health services can operate without fear of legal repercussions and ultimately save lives.

The party’s pledge for the NHS is ‘hugely ambitious’, says one expert, though others are more optimistic.

• UK election live – latest updates

Labour appears poised to win a historic election victory on 4 July. In the series Life under Labour, we look at Keir Starmer’s five key political missions and ask what is at stake and whether he can deliver the change the country is crying out for.

“If they came into power, the Labour party would inherit a really terrible set of problems in the NHS that are both broader and deeper than the ones they faced in 1997. This feels a lot worse,” says Siva Anandaciva, the chief analyst at the King’s Fund thinktank.

More than half of international medical graduates questioned say NHS induction inadequate

Many doctors from overseas are left feeling lost, anxious and not ready to care for patients after joining the NHS because they are not properly looked after, research has found.

Many international medical graduates (IMGs) feel the NHS does not help them prepare for life as a doctor in the UK and the practicalities of moving to a new country, according to a survey.

38% said they had too little time to shadow other doctors to gain valuable insights.

45% were not trained on cultural differences between the NHS and their country of origin and what is acceptable in the UK compared with in their home nation.

48% said their induction did not involve being given enough knowledge or training before starting to work clinically.

51% did not receive help or advice with practical issues after moving to the UK such as finding a place to live, opening a bank account, registering with a GP or paying council tax.

41% said they were left feeling alone and isolated.

38% questioned their decision to work in the NHS.

More than 21,000 old sites may be releasing ‘forever chemicals’ into land often left as open space

• ‘It’s a poison and it’s killing us’: the hidden dangers of old UK landfills

Thousands of polluted landfills across England could be leaking toxic chemicals into the environment and harming people who live nearby, experts have warned.

A few decades ago, the method for getting rid of industrial and domestic waste was to stick it in a hole in the ground, cover it up and hope for the best. It was known as “dilute and disperse” and it assumed toxic substances would seep into the surrounding soils, air and water and become harmless.

Water quality testing by campaigners shows levels up to 27 times acceptable limit for bathing as rowers told to take precautions

Harmful E coli bacteria have been found at very high levels at Henley, days before elite rowers compete in the international regatta there.

Water quality testing in the Henley Mile, part of the regatta course outside the Oxfordshire town, has revealed mean levels of 1,213 E coli colony forming units (CFU) per 100ml of water, across 27 tests. Where E coli levels are above 900 CFU/100ml, the water quality is deemed poor, according to bathing water designations, and is a threat to public health.

Early onset ischaemic stroke more likely to affect adolescents with low cognitive function, study finds

Teenagers with lower levels of mental ability may be three times more likely to experience a stroke before the age of 50, research suggests.

The association held true even after accounting for a range of factors, prompting experts to say more comprehensive assessments beyond traditional stroke risk factors were now needed to ward off disability and death.

Exclusive: Shadow health secretary discusses plans for waiting lists and patient safety if Labour wins election

NHS managers who silence and scapegoat whistleblowers will be banned from working in the service, the shadow health secretary has said, as part of a determined drive by Labour to eradicate a culture of cover-ups.

In an interview with the Guardian, Wes Streeting pledged to push through the formal regulation of NHS managers and warned the Care Quality Commission (CQC) that its inspectors must get much better at exposing risks to patients’ safety in order to regain the confidence of frontline staff.

The doctors should get a pay rise, but they are not the only public servants with a case for better terms

Junior doctors deserve a pay rise. Entry requirements are among the most competitive of all professions, and even were the health service not on its knees, the early years of a medical career would be demanding. Looking after people who are ill or injured is difficult and high-stakes work. Under current conditions, with vast waiting lists, workforce shortages, a rising population of chronically unwell people and, in some places, buildings that are not fit for purpose, it can be a punishing job.

It is two years this month since the British Medical Association voted for pay rises of up to 30% over five years. Consultants agreed a deal with the government last year, as did nurses. But junior doctors, who make up about half of all NHS doctors in England, have held out. In March, in a further ballot, 98% opted to keep striking in pursuit of a 35% pay rise, on a 62% turnout. The five-day strike that started on Thursday is their 11th. When it ends they will have been on strike for a total of 44 days since they first walked out in March last year. At least 1.3m cancelled appointments have been among the results.

Five-day strike by junior doctors is the 11th action in their long-running pay dispute

“I’m itching to get back to work, to get back to the grindstone,” says Matthew Alexander, a junior radiology doctor. “Nobody wants to be here, nobody wants to be on strike.” Alexander, 30, is one of about 50 junior doctors on a Thursday morning picket line at the Friarage hospital in Northallerton, a bustling market town in Rishi Sunak’s sprawling North Yorkshire constituency.

It’s a sunny day; there’s cheerful, enthusiastic chanting and lots of support from drivers who honk their horns, but it is abundantly clear that only Betty, a laid-back 11-year-old jackapoo, is anywhere approaching happy to be here.

The numbers that have been coming out of Gaza have been almost too shocking to comprehend

Dead or dismembered Palestinians don’t seem to shock anyone any more. A couple of hundred killed over here, dozens burned to death over there, a bunch of children dead from malnutrition: every day there seems to be another massacre that barely makes a blip on public consciousness. After eight months of intense bombing, the most abject civilian suffering has been dangerously normalized.

Still, as steeled as people may have become to the horrors in Gaza, you’d have to be completely broken not to be devastated by Save the Children’s new report on the missing children of Gaza. While more than 15,000 children are estimated to have been killed by Israel’s relentless assault on the strip, Save the Children has estimated that up to 21,000 children are missing.

Arwa Mahdawi is a Guardian columnist and the author of Strong Female Lead

Do you have an opinion on the issues raised in this article? If you would like to submit a response of up to 300 words by email to be considered for publication in our letters section, please click here.

It’s complicated. Sometimes I still want people to take my illness into account. And then there is the regret of all I’ve lost by returning to everyday life

On Thursday, I saw off my family to school and work, deliberated over what to wear, then cycled the five-ish miles to the Guardian office in the sunshine. I checked emails and chatted to colleagues about plans for the day. It was all very much like 27 June 2022, with one major difference: at lunchtime I didn’t pop out to the hospital and come back with a breast cancer diagnosis.

Realising it’s already two years on from that day is a shock, but what’s weirder is to think of the same day a year ago. I had finished my chemo and radiotherapy and had had my surgery but I was still on targeted drugs and felt absolutely exhausted – just the thought of getting on my bike made me need a sit-down. My hair was thin and several different lengths, I looked strangely grey and I was working just two days a week.

Hilary Osborne is the Guardian’s money and consumer editor

Exclusive: Rohan Bandil says ‘this was not the intention’ after hallucinations and unexpected toxicity leads to health warnings and nationwide recall

• Mushroom gummies recalled Australia-wide after customers hospitalised
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The sole director of an Australian company that distributed mushroom gummies from the US that resulted in people being taken to hospital with symptoms including “disturbing hallucinations” has apologised and declared “this was not the intention”.

Food Standards Australia New Zealand on Wednesday issued a recall of two flavours of Uncle Frog’s Mushroom Gummies after reports of hospitalisations in New South Wales, South Australia and Victoria.

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The Marches, Shropshire: With the glory of summertime comes hayfever, which we are only making worse

Purple and silver: the solstice grass flowers. This is the first year that the whole five acres of Brogyntyn park has been left uncut, and Oswestry has designated it a wildflower meadow. The transformation is enchanting. The many buttercups, ox-eye daisies and few orchids have privilege, but the grasses are the liberated proletariat that have never realised its full potential before.

Common grass names have an earthy poetry: fescue, false oat, foxtail, fog, bent, brome, couch, cocks foot, timothy, rye, sweet vernal, squitch. For a couple of days it stops raining and warms up a bit. When the sun comes out, so does the pollen. VH, a red sign on the weather map, announces a very high pollen count (more than 150 grains per cubic metre of air). About half of the people in the UK report hayfever symptoms – allergic rhinitis. It can mean itchy eyes, runny noses, sore throats and sneezes for millions, but for some the reaction can be deadly serious. Dogs, cats and horses are also affected, as if sacrificing an immune system is a trade-off for domestication.

Authorities say products contain ‘unapproved novel food ingredients’ as company Uncle Frog states ‘consuming the whole bag could … make people feel weird’

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People have been hospitalised across Australia with symptoms including “disturbing” hallucinations, dizziness and involuntary twitching after ingesting mushroom gummies made by a Byron Bay business.

A South Australian teenage boy was found unresponsive earlier this month after consuming several of the Uncle Frog’s Mushroom Gummies, the state health department said on Thursday. He was treated and has since recovered.

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About 25,000 BMA members begin five-day action at 7am that some union leaders say will achieve little

Junior doctors in England will strike today for the 11th time over pay, amid concern in their union that a stoppage so close to the general election is an “own goal”.

Senior figures in the British Medical Association (BMA) believe the strike is pointless and “naive” and risks irritating Labour, which looks likely to be in power by next Friday and asked the union to call it off.

UPFs should also be heavily taxed due to impact on health and mortality, says scientist who coined term

Ultra-processed foods (UPFs) are displacing healthy diets “all over the world” despite growing evidence of the risks they pose and should be sold with tobacco-style warnings, according to the nutritional scientist who first coined the term.

Prof Carlos Monteiro of the University of São Paulo will highlight the increasing danger UPFs present to children and adults at the International Congress on Obesity this week.

Research discovers the cost of some healthcare products fluctuates wildly, according to time of year you buy them

Dentists agree that brushing twice a day is the best way to look after your teeth. But depending on what month it is, dental hygiene can be a dramatically more expensive habit to maintain.

New research has shown that the cost of a tube of toothpaste at some times of the year can be double its price at other times. The price of other popular health products such as Gillette razors can also double depending when they are bought.

Researchers say in most cases condition is mild but it can increase risk of heart attacks and strokes

One in four healthy people aged 60 and over in the UK have undiagnosed heart valve disease, research suggests.

The conditions develops when one or more of the heart valves do not work properly. The main problems are caused by the valves either not opening fully or not closing correctly.

The CDC issued a health advisory Tuesday, warning healthcare providers and the general public that the United States is at an increased risk of dengue infections. Dengue is a mosquito-borne disease that can be pretty brutal—severe cases are sometimes known as “breakbone fever”—but some of us can relax a little: the mosquitoes that transmit it only live in some parts of the U.S. 

What is dengue? 

Dengue is a viral illness, and the virus is transmitted by mosquitoes—specifically Aedes species. (Yes, there are different species of mosquitoes.) It is mainly found in tropical and subtropical regions.

There are four types of dengue, numbered simply 1, 2, 3, and 4. If you contract and recover from one of them, you’ll be immune to that type, but remain susceptible to the others. Getting a second dengue infection, of a different type than the first, increases the risk that your illness will be more severe. 

The symptoms of a mild case of dengue include high fever, body aches, and often a rash. You may also experience nausea and vomiting, and a headache and/or pain behind the eyes. Most people recover in 1 to 2 weeks, the World Health Organization says. 

In severe cases of dengue, more symptoms may appear after the fever has gone away. The WHO lists these as including severe abdominal pain, bleeding gums or nose, blood in the vomit or stool, and feelings of extreme fatigue, thirst, and weakness. Dengue is the world’s most common insect-transmitted disease.

There is no antiviral treatment for dengue, only supportive care. There was a vaccine for it, available for children in areas where dengue is endemic, but the manufacturer discontinued it due to lack of demand, the CDC said in its health advisory. Puerto Rico declared a dengue epidemic earlier this year, and they are using their remaining available doses before they expire.

Most cases of dengue in the continental U.S. are from travelers, but we do have some local transmission

With the CDC’s advisory making headlines, it’s important to keep in mind where dengue is being transmitted right now. Most of the continental U.S. does not have local transmission of dengue; you can’t walk outside and catch it right now. 

So why the advisory? Well, many of the places you can catch dengue are popular vacation destinations. There are also several U.S. territories and freely associated states that have “frequent or continuous” dengue transmission, according to the CDC:

• Puerto Rico

• American Samoa

• U.S. Virgin Islands

• Federated States of Micronesia

• Marshall islands

• Palau

In the continental U.S., it is possible to contract dengue locally, but so far there aren’t many of these cases. Florida, Hawaii, Texas, Arizona, and California have all had locally transmitted dengue cases. 

So far this year, there have been 1,498 cases in Puerto Rico, and 745 travel-related cases in the U.S. (meaning that somebody traveled to an area with dengue, then brought the virus back with them). A travel case can turn into a local outbreak, although this isn't common. Say your neighbor just got back from a vacation in Puerto Rico, and you both live in Florida. It's possible for a mosquito to bite that person, and then to bite you. Therefore, the CDC is asking healthcare providers to keep in mind that a person who hasn't traveled might still have contracted dengue locally, if they live in an area with the right kind of mosquitoes.

Where do dengue-carrying mosquitoes live? 

Dengue is transmitted by Aedes mosquitoes, especially Aedes aegypti, but sometimes Aedes albopictus. These mosquitoes are small and have black and white patterns (if you look closely), and they bite during the day, not just dusk and dawn. They can also breed in very small containers of standing water, like the saucers underneath flowerpots. 

These differences separate them from Culex mosquitoes, which are the more common type in much of the U.S. Culex mosquitoes aren’t considered “competent” vectors of dengue, so if your area only has Culex, you only have to worry about travel cases, not (likely) local ones.

So where are Aedes mosquitoes? The CDC’s most recent maps are from 2017, but here they are. A. aegypti is “very likely” to thrive in most of the south, from Florida to Texas and up into Kentucky and parts of Oklahoma and Missouri. There are also “very likely” areas in Texas, Arizona, and California.

Credit: CDC

Aedes albopictus can live and reproduce in many of the same areas, but are less likely to thrive in Arizona and California. On the other hand, the northernmost part of their range extends a bit further, up into Ohio, New Jersey, and parts of Pennsylvania.

In the seven years since these maps were published, it’s possible that the mosquitoes’ range has grown. Aedes mosquitoes like warm temperatures, and climate change has given us more of those. Dengue is also transmitted more readily in warmer and wetter parts of the year, and we’ve been getting more of those as well. 

How can I protect myself from dengue? 

The CDC recommends that we all take steps to protect ourselves from mosquito bites. This includes using EPA-registered repellents on your skin. I like Cutter Skinsations (7% DEET, good enough for my backyard) but there’s also Repel 100 if you want very strong protection. 

Air conditioning, window screens, and loose-fitting, long-sleeved clothing also make the CDC’s top mosquito bite prevention tips. If you’re traveling to a warm or tropical area, the CDC wants you to make sure to prevent bites while you’re there, too. Large bottles of insect repellent, since it’s a liquid, will have to go in your checked baggage, but I like prepackaged repellent wipes like these for your carry-on. 

The CDC also wants you to seek medical care if you get symptoms that may be dengue and if you are in an area that is known to have dengue transmission. The incubation period is seven to 10 days, so it’s possible you may not start to show symptoms until after you get home. The CDC has a list and map here of locations outside the U.S. where dengue risk is high.

Beset by the doctors’ strike, the prime minister swelters under the glare of a shining Keir Starmer

We would like to hear from people who have had emergency NHS care after travelling abroad for treatment

The NHS is having to provide emergency care to patients suffering serious complications following weight loss surgery and hair transplants abroad amid a “boom” in medical tourism, doctors have warned.

If you have had medical treatment abroad and have returned to the UK for follow up care, we would like to hear from you. What treatment did you receive and what were your reasons for travelling abroad? What complications did you experience and how did the NHS help?

This article first appeared in The Checkup, MIT Technology Review’s weekly biotech newsletter. To receive it in your inbox every Thursday, and read articles like this first, sign up here. 

Earlier this week, the US surgeon general, also known as the “nation’s doctor,” authored an article making the case that health warnings should accompany social media. The goal: to protect teenagers from its harmful effects. “Adolescents who spend more than three hours a day on social media face double the risk of anxiety and depression symptoms,” Vivek Murthy wrote in a piece published in the New York Times. “Additionally, nearly half of adolescents say social media makes them feel worse about their bodies.”

His concern instinctively resonates with me. I’m in my late 30s, and even I can end up feeling a lot worse about myself after a brief stint on Instagram. I have two young daughters, and I worry about how I’ll respond when they reach adolescence and start asking for access to whatever social media site their peers are using. My children already have a fascination with cell phones; the eldest, who is almost six, will often come into my bedroom at the crack of dawn, find my husband’s phone, and somehow figure out how to blast “Happy Xmas (War Is Over)” at full volume.

But I also know that the relationship between this technology and health isn’t black and white. Social media can affect users in different ways—often positively. So let’s take a closer look at the concerns, the evidence behind them, and how best to tackle them.

Murthy’s concerns aren’t new, of course. In fact, almost any time we are introduced to a new technology, some will warn of its potential dangers. Innovations like the printing press, radio, and television all had their critics back in the day. In 2009, the Daily Mail linked Facebook use to cancer.

More recently, concerns about social media have centered on young people. There’s a lot going on in our teenage years as our brains undergo maturation, our hormones shift, and we explore new ways to form relationships with others. We’re thought to be more vulnerable to mental-health disorders during this period too. Around half of such disorders are thought to develop by the age of 14, and suicide is the fourth-leading cause of death in people aged between 15 and 19, according to the World Health Organization. Many have claimed that social media only makes things worse.

Reports have variously cited cyberbullying, exposure to violent or harmful content, and the promotion of unrealistic body standards, for example, as potential key triggers of low mood and disorders like anxiety and depression. There have also been several high-profile cases of self-harm and suicide with links to social media use, often involving online bullying and abuse. Just this week, the suicide of an 18-year-old in Kerala, India, was linked to cyberbullying. And children have died after taking part in dangerous online challenges made viral on social media, whether from inhaling toxic substances, consuming ultra-spicy tortilla chips, or choking themselves.

Murthy’s new article follows an advisory on social media and youth mental health published by his office in 2023. The 25-page document, which lays out some of known benefits and harms of social media use as well as the “unknowns,” was intended to raise awareness of social media as a health issue. The problem is that things are not entirely clear cut.

“The evidence is currently quite limited,” says Ruth Plackett, a researcher at University College London who studies the impact of social media on mental health in young people. A lot of the research on social media and mental health is correlational. It doesn’t show that social media use causes mental health disorders, Plackett says.

The surgeon general’s advisory cites some of these correlational studies. It also points to survey-based studies, including one looking at mental well-being among college students after the rollout of Facebook in the mid-2000s. But even if you accept the authors’ conclusion that Facebook had a negative impact on the students’ mental health, it doesn’t mean that other social media platforms will have the same effect on other young people. Even Facebook, and the way we use it, has changed a lot in the last 20 years.

Other studies have found that social media has no effect on mental health. In a study published last year, Plackett and her colleagues surveyed 3,228 children in the UK to see how their social media use and mental well-being changed over time. The children were first surveyed when they were aged between 12 and 13, and again when they were 14 to 15 years old.

Plackett expected to find that social media use would harm the young participants. But when she conducted the second round of questionnaires, she found that was not the case. “Time spent on social media was not related to mental-health outcomes two years later,” she tells me.

Other research has found that social media use can be beneficial to young people, especially those from minority groups. It can help some avoid loneliness, strengthen relationships with their peers, and find a safe space to express their identities, says Plackett. Social media isn’t only for socializing, either. Today, young people use these platforms for news, entertainment, school, and even (in the case of influencers) business.

“It’s such a mixed bag of evidence,” says Plackett. “I’d say it’s hard to draw much of a conclusion at the minute.”

In his article, Murthy calls for a warning label to be applied to social media platforms, stating that “social media is associated with significant mental-health harms for adolescents.”

But while Murthy draws comparisons to the effectiveness of warning labels on tobacco products, bingeing on social media doesn’t have the same health risks as chain-smoking cigarettes. We have plenty of strong evidence linking smoking to a range of diseases, including gum disease, emphysema, and lung cancer, among others. We know that smoking can shorten a person’s life expectancy. We can’t make any such claims about social media, no matter what was written in that Daily Mail article.

Health warnings aren’t the only way to prevent any potential harms associated with social media use, as Murthy himself acknowledges. Tech companies could go further in reducing or eliminating violent and harmful content, for a start. And digital literacy education could help inform children and their caregivers how to alter the settings on various social media platforms to better control the content children see, and teach them how to assess the content that does make it to their screens.

I like the sound of these measures. They might even help me put an end to the early-morning Christmas songs. 

Now read the rest of The Checkup

Read more from MIT Technology Review’s archive:

Bills designed to make the internet safer for children have been popping up across the US. But individual states take different approaches, leaving the resulting picture a mess, as Tate Ryan-Mosley explored.

Dozens of US states sued Meta, the parent company of Facebook, last October. As Tate wrote at the time, the states claimed that the company knowingly harmed young users, misled them about safety features and harmful content, and violated laws on children’s privacy.  

China has been implementing increasingly tight controls over how children use the internet. In August last year, the country’s cyberspace administrator issued detailed guidelines that include, for example, a rule to limit use of smart devices to 40 minutes a day for children under the age of eight. And even that use should be limited to content about “elementary education, hobbies and interests, and liberal arts education.” My colleague Zeyi Yang had the story in a previous edition of his weekly newsletter, China Report.

Last year, TikTok set a 60-minute-per-day limit for users under the age of 18. But the Chinese domestic version of the app, Douyin, has even tighter controls, as Zeyi wrote last March.

One way that social media can benefit young people is by allowing them to express their identities in a safe space. Filters that superficially alter a person’s appearance to make it more feminine or masculine can help trans people play with gender expression, as Elizabeth Anne Brown wrote in 2022. She quoted Josie, a trans woman in her early 30s. “The Snapchat girl filter was the final straw in dropping a decade’s worth of repression,” Josie said. “[I] saw something that looked more ‘me’ than anything in a mirror, and I couldn’t go back.”

From around the web

Could gentle shock waves help regenerate heart tissue? A trial of what’s being dubbed a “space hairdryer” suggests the treatment could help people recover from bypass surgery. (BBC)

“We don’t know what’s going on with this virus coming out of China right now.” Anthony Fauci gives his insider account of the first three months of the covid-19 pandemic. (The Atlantic)

Microplastics are everywhere. It was only a matter of time before scientists found them in men’s penises. (The Guardian)

Is the singularity nearer? Ray Kurzweil believes so. He also thinks medical nanobots will allow us to live beyond 120. (Wired)

In a clean room in his lab, Sean Moore peers through a microscope at a bit of intestine, its dark squiggles and rounded structures standing out against a light gray background. This sample is not part of an actual intestine; rather, it’s human intestinal cells on a tiny plastic rectangle, one of 24 so-called “organs on chips” his lab bought three years ago.

Moore, a pediatric gastroenterologist at the University of Virginia School of Medicine, hopes the chips will offer answers to a particularly thorny research problem. He studies rotavirus, a common infection that causes severe diarrhea, vomiting, dehydration, and even death in young children. In the US and other rich nations, up to 98% of the children who are vaccinated against rotavirus develop lifelong immunity. But in low-income countries, only about a third of vaccinated children become immune. Moore wants to know why.

His lab uses mice for some protocols, but animal studies are notoriously bad at identifying human treatments. Around 95% of the drugs developed through animal research fail in people. Researchers have documented this translation gap since at least 1962. “All these pharmaceutical companies know the animal models stink,” says Don Ingber, founder of the Wyss Institute for Biologically Inspired Engineering at Harvard and a leading advocate for organs on chips. “The FDA knows they stink.” 

But until recently there was no other option. Research questions like Moore’s can’t ethically or practically be addressed with a randomized, double-blinded study in humans. Now these organs on chips, also known as microphysiological systems, may offer a truly viable alternative. They look remarkably prosaic: flexible polymer rectangles about the size of a thumb drive. In reality they’re triumphs of bioengineering, intricate constructions furrowed with tiny channels that are lined with living human tissues. These tissues expand and contract with the flow of fluid and air, mimicking key organ functions like breathing, blood flow, and peristalsis, the muscular contractions of the digestive system.

More than 60 companies now produce organs on chips commercially, focusing on five major organs: liver, kidney, lung, intestines, and brain. They’re already being used to understand diseases, discover and test new drugs, and explore personalized approaches to treatment.

As they continue to be refined, they could solve one of the biggest problems in medicine today. “You need to do three things when you’re making a drug,” says Lorna Ewart, a pharmacologist and chief scientific officer of Emulate, a biotech company based in Boston. “You need to show it’s safe. You need to show it works. You need to be able to make it.” 

All new compounds have to pass through a preclinical phase, where they’re tested for safety and effectiveness before moving to clinical trials in humans. Until recently, those tests had to run in at least two animal species—usually rats and dogs—before the drugs were tried on people. 

But in December 2022, President Biden signed the FDA Modernization Act, which amended the original FDA Act of 1938. With a few small word changes, the act opened the door for non-animal-based testing in preclinical trials. Anything that makes it faster and easier for pharmaceutical companies to identify safe and effective drugs means better, potentially cheaper treatments for all of us. 

Moore, for one, is banking on it, hoping the chips help him and his colleagues shed light on the rotavirus vaccine responses that confound them. “If you could figure out the answer,” he says, “you could save a lot of kids’ lives.”

While many teams have worked on organ chips over the last 30 years, the OG in the field is generally acknowledged to be Michael Shuler, a professor emeritus of chemical engineering at Cornell. In the 1980s, Shuler was a math and engineering guy who imagined an “animal on a chip,” a cell culture base seeded with a variety of human cells that could be used for testing drugs. He wanted to position a handful of different organ cells on the same chip, linked to one another, which could mimic the chemical communication between organs and the way drugs move through the body. “This was science fiction,” says Gordana Vunjak-Novakovic, a professor of biomedical engineering at Columbia University whose lab works with cardiac tissue on chips. “There was no body on a chip. There is still no body on a chip. God knows if there will ever be a body on a chip.”

Shuler had hoped to develop a computer model of a multi-organ system, but there were too many unknowns. The living cell culture system he dreamed up was his bid to fill in the blanks. For a while he played with the concept, but the materials simply weren’t good enough to build what he imagined. 

“You can force mice to menstruate, but it’s not really menstruation. You need the human being.”

Linda Griffith, founding professor of biological engineering at MIT and a 2006 recipient of a MacArthur “genius grant”

He wasn’t the only one working on the problem. Linda Griffith, a founding professor of biological engineering at MIT and a 2006 recipient of a MacArthur “genius grant,” designed a crude early version of a liver chip in the late 1990s: a flat silicon chip, just a few hundred micrometers tall, with endothelial cells, oxygen and liquid flowing in and out via pumps, silicone tubing, and a polymer membrane with microscopic holes. She put liver cells from rats on the chip, and those cells organized themselves into three-dimensional tissue. It wasn’t a liver, but it modeled a few of the things a functioning human liver could do. It was a start.

Griffith, who rides a motorcycle for fun and speaks with a soft Southern accent, suffers from endometriosis, an inflammatory condition where cells from the lining of the uterus grow throughout the abdomen. She’s endured decades of nausea, pain, blood loss, and repeated surgeries. She never took medical leaves, instead loading up on Percocet, Advil, and margaritas, keeping a heating pad and couch in her office—a strategy of necessity, as she saw no other choice for a working scientist. Especially a woman. 

And as a scientist, Griffith understood that the chronic diseases affecting women tend to be under-researched, underfunded, and poorly treated. She realized that decades of work with animals hadn’t done a damn thing to make life better for women like her. “We’ve got all this data, but most of that data does not lead to treatments for human diseases,” she says. “You can force mice to menstruate, but it’s not really menstruation. You need the human being.” 

Or, at least, the human cells. Shuler and Griffith, and other scientists in Europe, worked on some of those early chips, but things really kicked off around 2009, when Don Ingber’s lab in Cambridge, Massachusetts, created the first fully functioning organ on a chip. That “lung on a chip” was made from flexible silicone rubber, lined with human lung cells and capillary blood vessel cells that “breathed” like the alveoli—tiny air sacs—in a human lung. A few years later Ingber, an MD-PhD with the tidy good looks of a younger Michael Douglas, founded Emulate, one of the earliest biotech companies making microphysiological systems. Since then he’s become a kind of unofficial ambassador for in vitro technologies in general and organs on chips in particular, giving hundreds of talks, scoring millions in grant money, repping the field with scientists and laypeople. Stephen Colbert once ragged on him after the New York Times quoted him as describing a chip that “walks, talks, and quacks like a human vagina,” a quote Ingber says was taken out of context.

Ingber began his career working on cancer. But he struggled with the required animal research. “I really didn’t want to work with them anymore, because I love animals,” he says. “It was a conscious decision to focus on in vitro models.” He’s not alone; a growing number of young scientists are speaking up about the distress they feel when research protocols cause pain, trauma, injury, and death to lab animals. “I’m a master’s degree student in neuroscience and I think about this constantly. I’ve done such unspeakable, horrible things to mice all in the name of scientific progress, and I feel guilty about this every day,” wrote one anonymous student on Reddit. (Full disclosure: I switched out of a psychology major in college because I didn’t want to cause harm to animals.)

EMULATE

Taking an undergraduate art class led Ingber to an epiphany: mechanical forces are just as important as chemicals and genes in determining the way living creatures work. On a shelf in his office he still displays a model he built in that art class, a simple construction of sticks and fishing line, which helped him realize that cells pull and twist against each other. That realization foreshadowed his current work and helped him design dynamic microfluidic devices that incorporated shear and flow. 

Ingber coauthored a 2022 paper that’s sometimes cited as a watershed in the world of organs on chips. Researchers used Emulate’s liver chips to reevaluate 27 drugs that had previously made it through animal testing and had then gone on to kill 242 people and necessitate more than 60 liver transplants. The liver chips correctly flagged problems with 22 of the 27 drugs, an 87% success rate compared with a 0% success rate for animal testing. It was the first time organs on chips had been directly pitted against animal models, and the results got a lot of attention from the pharmaceutical industry. Dan Tagle, director of the Office of Special Initiatives for the National Center for Advancing Translational Sciences (NCATS), estimates that drug failures cost around $2.6 billion globally each year. The earlier in the process failing compounds can be weeded out, the more room there is for other drugs to succeed.

“The capacity we have to test drugs is more or less fixed in this country,” says Shuler, whose company, Hesperos, also manufactures organs on chips. “There are only so many clinical trials you can do. So if you put a loser into the system, that means something that could have won didn’t get into the system. We want to change the success rate from clinical trials to a much higher number.”

In 2011, the National Institutes of Health established NCATS and started investing in organs on chips and other in vitro technologies. Other government funders, like the Defense Advanced Research Projects Agency and the Food and Drug Administration, have followed suit. For instance, NIH recently funded NASA scientists to send heart tissue on chips into space. Six months in low gravity ages the cardiovascular system 10 years, so this experiment lets researchers study some of the effects of aging without harming animals or humans. 

Scientists have made liver chips, brain chips, heart chips, kidney chips, intestine chips, and even a female reproductive system on a chip (with cells from ovaries, fallopian tubes, and uteruses that release hormones and mimic an actual 28-day menstrual cycle). Each of these chips exhibits some of the specific functions of the organs in question. Cardiac chips, for instance, contain heart cells that beat just like heart muscle, making it possible for researchers to model disorders like cardiomyopathy. 

Shuler thinks organs on chips will revolutionize the world of research for rare diseases. “It is a very good model when you don’t have enough patients for normal clinical trials and you don’t have a good animal model,” he says. “So it’s a way to get drugs to people that couldn’t be developed in our current pharmaceutical model.” Shuler’s own biotech company used organs on chips to test a potential drug for myasthenia gravis, a rare neurological disorder. In 2022,the FDA approved the drug for clinical trials based on that data—one of six Hesperos drugs that have so far made it to that stage. 

Each chip starts with a physiologically based pharmacokinetic model, known as a PBPK model—a mathematical expression of how a chemical compound behaves in a human body. “We try and build a physical replica of the mathematical model of what really occurs in the body,” explains Shuler. That model guides the way the chip is designed, re-creating the amount of time a fluid or chemical stays in that particular organ—what’s known as the residence time. “As long as you have the same residence time, you should get the same response in terms of chemical conversion,” he says.

Tiny channels on each chip, each between 10 and 100 microns in diameter, help bring fluids and oxygen to the cells. “When you get down to less than one micron, you can’t use normal fluid dynamics,” says Shuler. And fluid dynamics matters, because if the fluid moves through the device too quickly, the cells might die; too slowly, and the cells won’t react normally. 

Chip technology, while sophisticated, has some downsides. One of them is user friendliness. “We need to get rid of all this tubing and pumps and make something that’s as simple as a well plate for culturing cells,” says Vunjak-Novakovic. Her lab and others are working on simplifying the design and function of such chips so they’re easier to operate and are compatible with robots, which do repetitive tasks like pipetting in many labs. 

Cost and sourcing can also be challenging. Emulate’s base model, which looks like a simple rectangular box from the outside,starts at around $100,000 and rises steeply from there. Most human cells come from commercial suppliers that arrange for donations from hospital patients. During the pandemic, when people had fewer elective surgeries, many of those sources dried up. As microphysiological systems become more mainstream, finding reliable sources of human cells will be critical.

“As your confidence in using the chips grows, you might say, Okay, we don’t need two animals anymore— we could go with chip plus one animal.”

Lorna Ewart, Chief Scientific Officer, Emulate

Another challenge is that every company producing organs on chips uses its own proprietary methods and technologies. Ingber compares the landscape to the early days of personal computing, when every company developed its own hardware and software, and none of them meshed well. For instance, the microfluidic systems in Emulate’s intestine chips are fueled by micropumps, while those made by Mimetas, another biotech company, use an electronic rocker and gravity to circulate fluids and air. “This is not an academic lab type of challenge,” emphasizes Ingber. “It’s a commercial challenge. There’s no way you can get the same results anywhere in the world with individual academics making [organs on chips], so you have to have commercialization.”

Namandje Bumpus, the FDA’s chief scientist, agrees. “You can find differences [in outcomes] depending even on what types of reagents you’re using,” she says. Those differences mean research can’t be easily reproduced, which diminishes its validity and usefulness. “It would be great to have some standardization,” she adds.

On the plus side, the chip technology could help researchers address some of the most deeply entrenched health inequities in science. Clinical trials have historically recruited white men, underrepresenting people of color, women (especially pregnant and lactating women), the elderly, and other groups. And treatments derived from those trials all too often fail in members of those underrepresented groups, as in Moore’s rotavirus vaccine mystery. “With organs on a chip, you may be able to create systems by which you are very, very thoughtful—where you spread the net wider than has ever been done before,” says Moore.

FELICE FRANKEL

Another advantage is that chips will eventually reduce the need for animals in the lab even as they lead to better human outcomes. “There are aspects of animal research that make all of us uncomfortable, even people that do it,” acknowledges Moore. “The same values that make us uncomfortable about animal research are also the same values that make us uncomfortable with seeing human beings suffer with diseases that we don’t have cures for yet. So we always sort of balance that desire to reduce suffering in all the forms that we see it.”

Lorna Ewart, who spent 20 years at the pharma giant AstraZeneca before joining Emulate, thinks we’re entering a kind of transition time in research, in which scientists use in vitro technologies like organs on chips alongside traditional cell culture methods and animals. “As your confidence in using the chips grows, you might say, Okay, we don’t need two animals anymore—we could go with chip plus one animal,” she says. 

In the meantime, Sean Moore is excited about incorporating intestine chips more and more deeply into his research. His lab has been funded by the Gates Foundation to do what he laughingly describes as a bake-off between intestine chips made by Emulate and Mimetas. They’re infecting the chips with different strains of rotavirus to try to identify the pros and cons of each company’s design. It’s too early for any substantive results, but Moore says he does have data showing that organ chips are a viable model for studying rotavirus infection. That could ultimately be a real game-changer in his lab and in labs around the world.

“There’s more players in the space right now,” says Moore. “And that competition is going to be a healthy thing.” 

Harriet Brown writes about health, medicine, and science. Her most recent book is Shadow Daughter: A Memoir of Estrangement. She’s a professor of magazine, news, and digital journalism at Syracuse University’s Newhouse School. 

Chris Pashley's Background and Experience

The constant vigilance required to protect against evolving threats, and the sheer volume of routine tasks that demand attention contribute significantly to burnout.

The post Cybersecurity Worker Burnout Costing Businesses Big appeared first on Security Boulevard.

NHS Dumfries and Galloway Breach

Risks and Recommendations

With a record-breaking heat dome roasting the eastern half of the United States this week, it’s important to not only stay cool for comfort but to actively avoid experiencing heat exhaustion and its more serious cousin, heat stroke. Knowing the signs of both can help keep you and your friends and family safe.

Heat stroke is a serious condition that can result in seizures, organ failure, and more. And before you get heat stroke, you’ll experience a milder condition called heat exhaustion. Both conditions occur when the body overheats. Normally, our bodies try to cool us down by bringing hot blood from our core to the surface of the skin, where we radiate that heat into our environment. The evaporation that results from sweating also helps to cool our skin. We get into trouble when the environment is too hot or too humid for these mechanisms to cool us down.

Who is at risk for heat exhaustion and heat stroke?

Heat stroke in healthy people is often associated with exercise, since working out raises your core temperature. This is especially the case if you’re not very fit, or if you’re used to working out in cooler weather. As you get used to exercising in the heat, your body learns how to cool itself more efficiently.

Things that increase the risk of heat exhaustion and heat stroke include:

• Exercising in high temperatures and humidity

• Poor fitness

• Being large (regardless of your body type—having a lot of fat or a lot of muscle both affect your ability to cool down)

• Dehydration

• Wearing or carrying gear, like football pads or a hiking pack

• Drinking alcohol

• Using certain medications or supplements, including beta blockers and diuretics

• Any disability or illness that makes it harder for you to get out of the heat or to cool yourself

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Signs and symptoms of heat exhaustion

Heat exhaustion occurs when your core body temperature is elevated, but not enough to involve your brain. If you or an overheated friend shows any sign of being confused, for example, assume it’s heat stroke and get medical help right away.

Signs and symptoms of heat exhaustion may include, according to the CDC:

• Dizziness

• Nausea and vomiting

• Headache

• Fatigue or weakness

• Heavy sweating

• Cold, pale, and clammy skin

• A fast, weak pulse

If you begin to feel these symptoms, start cooling yourself down right away: move to the shade or air conditioning, loosen your clothing, have a cold drink, and keep watch for any signs that you’re feeling worse or not getting better. If you haven’t recovered within an hour, seek medical help.

Signs and symptoms of heat stroke

Heat stroke occurs when the body’s temperature is extremely high (over 104, taken rectally) and can affect the brain as well as the body. The person with heat stroke may be too confused to realize that they are in danger, so watch out for the signs in other people.

Heat stroke is a serious condition, so if you suspect it, get medical help right away. If you’re at an event with medical staff (like if you’re running a marathon or playing in a football game), alert them. Otherwise, call 911 or the emergency number for your area. Signs of heat stroke can include some of the symptoms above, like headache, dizziness, and nausea, plus:

• Confusion, irritability, or hallucination

• Passing out or collapsing

• Trouble walking

• Seizures

• Reddened skin, with or without sweating

You can help the person cool down while you wait for help. Medical staff may decide it’s best to cool the person down before transporting them to a hospital, but that depends on whether the person needs other medical treatment. The ideal way of cooling down a person with heat stroke is to put them in a tub of cold water with ice, and stir the water constantly.

If that’s not possible, a cold shower or a cold hose can work, or apply icy wet towels to the person’s body and swap them out every three minutes or whenever they stop being icy cold.

Nobody likes to feel sluggish and sweaty, so when the sun is set to “broil,” I understand that you’d rather take your workout to an air-conditioned gym. But the human body really can acclimate to exercising in the heat! After a few weeks, these temperatures will be your new normal—and research suggests you may enjoy a small performance boost when the weather cools down again.

Hot workouts can be dangerous, so I trust that you know common sense advice about running in the heat. Among the most important: Drink to thirst (or a little bit more), and stop and get help if you start feeling symptoms of heat illness like nausea, dizziness, or weakness. And while it’s great to work on your ability to run in the heat, don’t be stupid about it—stay inside if the temperature is hotter than you can handle, and stay aware of smog and ozone levels (which get worse on hot days) if you live in an urban area.

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Why exercising in the heat feels so miserable

Running is miserable and heat is miserable, therefore running in the heat is miserable. But there’s more to it than that, and exercising in the heat feels even worse than you'd expect from stacking those two factors together.

Your brain perceives effort differently in the heat, so even before you overheat, you feel sluggish. In a study published in the European Journal of Physiology, cyclists who worked out in a lab with a temperature of 95 degrees were slower than when they did the same time trial at 59 degrees. That makes sense, but here’s the weird part: They didn’t overheat and then slow down. They were slower from the start. It seems our brains slow our bodies down proactively on hot days in order to conserve energy.

As a workout continues, our bodies heat up. In another study, published in the Journal of Applied Physiology, when asked to cycle to exhaustion, participants pooped out when their core temperatures reached 104 degrees, no matter what temperature they started at. The athletes that took the longest to reach that temperature were the ones who wore a fancy water-cooling jacket. You can mimic this effect in your own workouts by drinking ice-cold beverages and pouring water over your head. The longer you can keep your body cool, the longer you can keep up a hard effort.

It's the heat and the humidity

But cooling your body isn’t a complete solution. Dumping a cup of ice water over your head or putting one into your belly only provides momentary relief, and water-cooling jackets aren’t practical outside of physiology labs. So let’s look at what happens in real world conditions.

Your body tries to cool off, in part, by sweating. When moisture evaporates from your skin, it takes some body heat with it. In humid weather, though, sweat doesn’t evaporate as easily because the air is already full of water vapor. So when we’re talking about “heat,” we really mean something more like “perceived heat,” which is a combination of heat and humidity. This heat index chart shows the relationship:

Credit: NOAA

You’ll run slower in the heat (and humidity). While you can find charts like this one that predict how much slower you will run a race, the truth is that heat's effect on your running depends on whether you’re used to the heat, and on your body size.

That’s right—not your fitness level, but your actual physical size. People who are larger have more muscle, fat, or both. Muscle generates heat, and fat acts as an insulator. On the other hand, smaller folks generate less heat, but have more skin through which to dissipate that heat—the ol’ surface area to volume ratio. This is why petite runners place better in races on hot days.

Some people think being more fit makes you better at dealing with heat, but that's only partially true: The fitter you are, the more body heat you produce, just because you’re so good at working hard. Short of changing your body shape (which is possible, but hardly a short-term fix), what can you do to tolerate exercising in the heat better? The answer is simple: Spend more time exercising in the heat.

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Why you should start a heat adaptation protocol

Running in the heat makes you better at running in the heat—and it makes you better, period.

Say you do all your workouts outdoors this summer, while your equally fit twin does identical workouts on a treadmill in an air-conditioned gym. Who do you think will finish first in a 5K on a hot weekend in August? That’s right, you will.

But even if the weather is unseasonably cool on that August day, your heat training will still help you beat your twin. Part of the magic of heat training is that it increases the amount of blood in your veins (the better to put it towards your skin for cooling, while still having enough to fuel your muscles). The effect has been compared to a mild, totally legal version of blood doping. Scientists are still debating exactly how this effect works, and whether it always happens when people attempt to adapt to heat adaptation, but overall the evidence is strong enough that I believe we should all try to get some of those adaptations if we can do so safely.

Here’s the bad news: Heat adaptation takes work. It’s not enough to sit around in the air conditioning all summer, only venturing outside for occasional workouts. A study published in the European Journal of Applied Physiology found that people who made no particular effort to exercise in the heat didn’t have any better heat tolerance in the fall than in the spring. If you want the advantages of heat training, you have to work for them.

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How to adapt to exercising in the heat

Option 1: Train normally, but without avoiding the heat, for two weeks

In scientific research, heat acclimation protocols for athletes generally involve 7 to 10 consecutive days of exercising in the heat, for 60 to 90 minutes each day. A simpler method that can be done by entire teams, or by individuals, is to simply do your normal training in the heat for about two weeks.

Take it easy at first. Remember that your body is still trying to convince you that you are super tired and need to slow down. Safety guidelines for workers provide a reality check here. On their first day in the heat, the Occupational Safety and Health Administration (OSHA) recommends giving workers just 20% of their usual workload. Within a week, they should slowly ramp up to 100%.

Option 2: Spend two hours in the heat every day, whether you're exercising or not

This US Army training protocol provides a good road map for adapting yourself to the heat: Spend at least two hours in the heat each day, it says, and include cardiovascular exercise (like running, cycling, or anything that gets your heart rate up) as part of that. If you can’t handle two hours without feeling symptoms like nausea or dizziness, do what you can and view the two-hour benchmark as a goal to work toward.

You can expect to be better adapted to the heat after about two weeks of spending two hours per day in the heat, although you may be able to start seeing results in just a few days.

Option 3: Visit the sauna after each workout

A way to combine the protocols above, without relying on the weather, is to step into a sauna or hot bath after your workout. If your gym has a sauna, this is a great way to use it. The post-workout sauna time will help your heat adaptation, and you can do it even if your workout was done in less-than-sweltering temperatures. The time spent in the sauna can be 15 to 30 minutes, starting with a shorter time and working up to longer.

How to keep your heat adaptations even when the weather cools off

To stay adapted to the heat, you have to keep spending time in it. You can take a few days off, but if you slack off for a week, you’ll start to lose your hot weather superpowers. This snowballs quickly: you'll lose about 75% of your adaptations after three weeks, according to the Army’s estimates.

To keep up your heat training in cool weather, you can try wearing long sleeves and tights, like elite runner Kara Goucher did when training for a world championship race in muggy Osaka. (She won a bronze medal, the first American ever to do so). She also spent a few weeks in Osaka before the race began; traveling to experience the heat might be an option worth considering if you’re a dedicated athlete with vacation time to burn.

You can also try the opposite of this keep-cool advice, and choose to run at the hottest time of day on asphalt roads with no shade. Or return to the sauna protocol after your cooler-weather workouts. Whatever you do, stay safe, and enjoy your new superpowers.