Ming-Hsu Li

Associating emergency room visits with first and prolonged extreme temperature event in Taiwan: A population-based cohort study

The present study evaluated emergency room visit (ERV) risks for all causes and cardiopulmonary diseases associated with temperature and long-lasting extreme temperatures from 2000 to 2009 in four major cities in Taiwan. The city-specific daily average temperatures at the high 95th, 97th, and 99th percentiles, and the low 10th, 5th, and 1st percentiles were defined as extreme heat and cold. A distributed lag non-linear model was used to estimate the cumulative relative risk (RR) of ERV for morbidities associated with temperatures (0 to 3-day lags), extreme heat and cold lasting for 2 to 9 days or longer, and with the annual first extreme heat or cold event after controlling for covariates. Low temperatures were associated with slightly higher ERV risks than high temperatures for circulatory diseases. After accounting for 4-day cumulative temperature effect, the ERV risks for all causes and respiratory diseases were found to be associated with extreme cold at the 5th percentile lasting for >8 days and 1st percentile lasting for >3 days. The annual first extreme cold event of 5th percentile or lower temperatures was also significantly associated with ERV, with RRs ranging from 1.09 to 1.12 for all causes and from 1.15 to 1.26 for respiratory diseases. The annual first extreme heat event of 99th percentile temperature was associated with higher ERV for all causes and circulatory diseases. Annual first extreme temperature event and intensified prolonged extreme cold events are associated with increased ERVs in Taiwan.

High-temperature indices associated with mortality and outpatient visits: Characterizing the association with elevated temperature

Abstract This study aimed to identify optimal high-temperature indices to predict risks of all-cause mortality and outpatient visits for subtropical islanders in warm seasons (May to October). Eight high-temperature indices, including three single measurements (average, maximum and minimum temperature) and five composite indices (heat index, humidex, temperature humidity index, apparent temperature and wet-bulb globe temperature), and their standardized Z scores, were used in distributed lag non-linear models. Cumulative 8-day (lag zero to seven days) relative risks (RRs) and 95% confidence intervals were estimated, 1 and 2 standardized deviations above the medium (i.e., at 84.1th and 97.7th percentile, respectively), by comparing with Z scores for the lowest risks of mortality and outpatient visits as references. Analyses were performed for Taipei in north, Central Taiwan and Southern Taiwan. Results showed that standardized Z-values of high-temperature indices associated with the lowest health risk were approximately 0 in Taipei and Central Taiwan, and −1 in Southern Taiwan. As the apparent temperature was at Z=2, the cumulative 8-day mortality risk increased significantly, by 23% in Taipei and 28% in Southern Taiwan, but not in Central Taiwan. The maximum temperature displayed consistently a high correlation with all-cause outpatient visits at Z=1; with the cumulative 8-day RRs for outpatient visits increased by 7%, 3%, and 4% in the three corresponding areas. In conclusion, this study has demonstrated methods to compare multiple high-temperature indices associated with all-cause mortality and outpatient visits for population residing in a subtropical island. Apparent temperature is an optimal indicator for predicting all-cause mortality risk, and maximum temperature is recommended to associate with outpatient visits. The impact of heat varied with study areas, evaluated health outcomes, and high-temperature indices. The increased extreme heat is associated with stronger risk for all-cause mortality than for outpatient visits.

Relationships between cold-temperature indices and all causes and cardiopulmonary morbidity and mortality in a subtropical island.

Abstract This study aimed to identify optimal cold-temperature indices that are associated with the elevated risks of mortality from, and outpatient visits for all causes and cardiopulmonary diseases during the cold seasons (November to April) from 2000 to 2008 in Northern, Central and Southern Taiwan. Eight cold-temperature indices, average, maximum, and minimum temperatures, and the temperature humidity index, wind chill index, apparent temperature, effective temperature (ET), and net effective temperature and their standardized Z scores were applied to distributed lag non-linear models. Index-specific cumulative 26-day (lag 0–25) mortality risk, cumulative 8-day (lag 0–7) outpatient visit risk, and their 95% confidence intervals were estimated at 1 and 2 standardized deviations below the median temperature, comparing with the Z score of the lowest risks for mortality and outpatient visits. The average temperature was adequate to evaluate the mortality risk from all causes and circulatory diseases. Excess all-cause mortality increased for 17–24% when average temperature was at Z=−1, and for 27–41% at Z=−2 among study areas. The cold-temperature indices were inconsistent in estimating risk of outpatient visits. Average temperature and THI were appropriate indices for measuring risk for all-cause outpatient visits. Relative risk of all-cause outpatient visits increased slightly by 2–7% when average temperature was at Z=−1, but no significant risk at Z=−2. Minimum temperature estimated the strongest risk associated with outpatient visits of respiratory diseases. In conclusion, the relationships between cold temperatures and health varied among study areas, types of health event, and the cold-temperature indices applied. Mortality from all causes and circulatory diseases and outpatient visits of respiratory diseases has a strong association with cold temperatures in the subtropical island, Taiwan.

Meteorology-hydrology study targets Typhoon Nari and Taipei flood

Typhoon Nari struck Taiwan on 16 September 2001, taking 92 lives. Analysis reveals that the storms heavy rains were due to warmer ocean temperatures, Naris unique track and slow-moving speed, and the terrain of Taiwan. Analysis further suggests that the heavy rains in Nari contained many small raindrops. The typhoon rains overwhelmed existing flood protection capacities downstream of the Chi-Lung River in a part of Taipei that has no regulatory reservoirs, resulting in major flooding. Preliminary findings underscore several key issues for future study, the goal of which will be to improve quantitative precipitation estimation/prediction, hydrologic modeling, and flood prediction.

Interval number fuzzy linear programming for climate change impact assessments of reservoir active storage

The major uncertainty in the climate change impact study inherits from applying the predictions of General Circulation Models (GCMs). Different results might be obtained by using various GCMs’ predictions, which causes difficulties on the decision making of water resources management. This study proposed an integrated hydrological simulations and optimization framework, consisting of a fuzzy linear programming model with interval numbers, a streamflow simulation model, and agricultural water demand projections, to evaluate the impacts of climate change on reservoir active storage. The reservoir inflows are simulated by the WatBal model, while agricultural water demands are predicted based on the projected change of potential evapotranspiration. Inflows and water demands are used to formulate an interval number fuzzy linear programming model. Fuzzy relationships are used to describe tolerable deficits of water resources, and the interval number is employed to indicate ranges of possible inflows and water demands. This systematic framework is applied to study the Tsengwen reservoir watershed to provide an optimal interval of active storage. The results further indicate the higher tolerable deficit, the smaller difference between superior and inferior active storage.