Heat StressNCT07032493
Identifying the Limits of Survivability in Heat-exposed Older Females
A study testing Humidity-Ramp Protocol, Above-inflection fixed-condition exposure (5%) and Below-inflection fixed-condition exposure (5%) in people with Heat Stress and Temperature Change, Body, run by University of Ottawa at 2 sites in Canada.
Trial summary
Climate change increases extreme heat events, elevating global heat-illness risk. Females have reduced heat loss capacity (~5%) compared to males, driven by differences in skin blood flow and sweating responses. Read more about this study
- Who is it for?
- Ages 65 to 85 years, women onlyHealthy volunteers can take part
- Conditions the study is for
- Heat Stress, Temperature Change, Body, Aging
- What is being tested?
- Humidity-Ramp Protocol, Above-inflection fixed-condition exposure (5%) and Below-inflection fixed-condition exposure (5%)
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 12 participants
- Where
- 2 sitesCanada
- Study dates
- 16 Jul 2025to 1 May 2026
- Phase
- Interventional
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 65 to 85 years
- Women only
- Healthy volunteers accepted
- Older adult
Who may be able to join
- Non-smoking.
- English or French speaking.
- Ability to provide informed consent.
- With or without a) chronic hypertension (elevated resting blood pressure; as defined by Heart and Stroke Canada and Hypertension Canada), b) type 2 diabetes as defined by Diabetes Canada, with at least 5 years having elapsed since time of diagnosis
Who cannot join
- Episode(s) of severe hypoglycemia (requiring the assistance of another person) within the previous year, or inability to sense hypoglycemia (hypoglycemia unawareness).
- Serious complications related to diabetes (gastroparesis, renal disease, uncontrolled hypertension, severe autonomic neuropathy).
- Uncontrolled hypertension - BP >150 mmHg systolic or >95 mmHg diastolic in a sitting position.
- Restrictions in physical activity due to disease (e.g. intermittent claudication, renal impairment, active proliferative retinopathy, unstable cardiac or pulmonary disease, disabling stroke, severe arthritis, etc.).
- Use of or changes in medication judged by the patient or investigators to make participation in this study inadvisable.
- Cardiac abnormalities identified during screening
Trial locations and contacts
2 sites in 1 country.
Canada2 sites
University of Ottawa
Ottawa, Ontario, K1N6N5
University of Ottawa
Ottawa, Ontario
About this study
Official title: Identifying the Upper Environmental Limits of Thermal Compensation in Older Human Females Using a Rapid Humidity Ramp Protocol
Climate change increases extreme heat events, elevating global heat-illness risk. Females have reduced heat loss capacity (~5%) compared to males, driven by differences in skin blood flow and sweating responses. While findings on sex-mediated mortality are mixed, some studies suggest older females (≥65 years), face higher heat-related mortality/morbidity risks, evidenced by disproportionate female deaths in the 2021 Western Heat Dome. The effects of extreme uncompensable heat on older females remain understudied.
Heat exposure initially causes net heat gain, raising core/skin temperatures and triggering heat-loss responses. Under compensable heat stress, heat loss balances gain, stabilizing core temperature. Uncompensable heat stress (exceeding maximal dissipation capacity) causes continuous core temperature rise, posing severe health risks. The specific temperature and relative humidity (RH) limits where compensability is lost are critical survival determinants, influenced by age and sex.
Read more
Ramping protocols identify these limits: participants face progressively increasing heat stress (e.g., staged humidity rises) while core temperature is monitored. Core temperature typically stabilizes initially, then exhibits an abrupt rapid increase at an inflection point, operationally defined as the limit of compensability. Despite increasing use, ramping protocol validity for accurately identifying this threshold remains unverified.
This project assesses ramping protocol validity for determining uncompensable conditions in older females and evaluates cumulative thermal and cardiovascular strain, as well as psychological and cognitive responses to both uncompensable and compensable heat. Participants will complete five trials. Trial 1 (Ramping): Rest at 42°C, 28% RH for 70min, then incremental RH increases (3% every 10min) to 70% RH. Individual core temperature (rectal) inflection points are identified from the ramping trial. Trials 2-5 (Fixed Conditions, Randomized): i) ~10% below inflection; ii) ~5% below inflection; iii) ~5% above inflection; iv) Thermo-neutral control (26°C, 45% RH). Comparing the rate of rectal temperature change and cumulative strain during prolonged fixed exposures (especially below vs. above inflection) will validate if the ramping inflection point represents the true limit of compensability for older females.
- Conditions
- Heat Stress, Temperature Change, Body, Aging, Thermoregulation, Heat Exposure
- Being tested
- Humidity-Ramp Protocol, Above-inflection fixed-condition exposure (5%), Below-inflection fixed-condition exposure (5%), Below-inflection fixed-condition exposure (10%), Control fixed-condition exposure
- Keywords
- heat strain, women, heat illness, Environmental limits for compensability, heat wave, hot weather, extreme heat events
- Medical subject headings
- Heat Stress Disorders, Body Temperature Changes
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Humidity-Ramp ProtocolOther
Participants are exposed to 42°C and 28% relative humidity for 70 minutes. Thereafter, humidity is increased 3% until an ambient humidity of 70% is achieved. The humidity at which rectal temperature inflect is subsequently determined.
Above-inflection fixed-condition exposure (5%)Other
After a 1 hour equilibrium at 42°C and 28% relative humidity, humidity will be increased 3% every 10 min until it is ~5% higher than the participants' rectal esophageal temperature inflection point identified in the humidity ramp protocol. These conditions will be held constant for the remainder of the 9-hour exposure period (starting from the beginning of equilibrium). Tap water will be provided at regular intervals to limit dehydration.
Below-inflection fixed-condition exposure (5%)Other
After a 1 hour equilibrium at 42°C and 28% relative humidity, humidity will be increased 3% every 10 min until it is ~5% lower than the participants' individual rectal temperature inflection point identified in the humidity ramp protocol. These conditions will be held constant for the remainder of the 9-hour exposure period (starting from the beginning of equilibrium). Tap water will be provided at regular intervals to limit dehydration.
Below-inflection fixed-condition exposure (10%)Other
After a 1 hour equilibrium at 42°C and 28% relative humidity, humidity will be increased 3% every 10 min until it is ~10% lower than the participants' individual rectal temperature inflection point identified in the humidity ramp protocol. These conditions will be held constant for the remainder of the 9-hour exposure period (starting from the beginning of equilibrium). Tap water will be provided at regular intervals to limit dehydration.
Control fixed-condition exposureOther
Participants are exposed for 9-hours to 28°C with 35% relative humidity. Participant will be allowed to drink tap water ad libitum.
| Study group | Role | What they receive |
|---|---|---|
| Humidity-ramp protocol | Other | The humidity-ramp protocol will necessarily be performed first. The order of the fixed-condition exposures will be randomized. Receives: Other: Humidity-Ramp Protocol |
| Below-inflection fixed-condition heat exposure (5%) | Experimental | Participants will complete all exposures. The humidity-ramp protocol will necessarily be performed first. The order of the fixed-condition exposures will be randomized. Receives: Other: Below-inflection fixed-condition exposure (5%) |
| Control fixed-condition heat exposure | Active comparator | Participants will complete all exposures. The humidity-ramp protocol will necessarily be performed first. The order of the fixed-condition exposures will be randomized. Receives: Other: Control fixed-condition exposure |
| Below-inflection fixed-condition heat exposure (10%) | Experimental | Participants will complete all exposures. The humidity-ramp protocol will necessarily be performed first. The order of the fixed-condition exposures will be randomized. Receives: Other: Below-inflection fixed-condition exposure (10%) |
| Above-inflection fixed-condition heat exposure (5%) | Experimental | Participants will complete all exposures. The humidity-ramp protocol will necessarily be performed first. The order of the fixed-condition exposures will be randomized. Receives: Other: Above-inflection fixed-condition exposure (5%) |
What is being measured
The primary outcome is the main question the study is designed to answer.
Rectal temperature rate of change
Rate of change of rectal temperature measured over the final 2-hours of heat exposure
Measured: End of fixed-condition heat exposure (hour 9 or termination)
Secondary outcomes (12)
Number of participants unable to finish fixed-condition heat exposure
Number of participants who could not complete each fixed-condition heat exposure due to participant withdrawal or achieving a core temperature of 39.5°C
Measured: End of fixed-condition heat exposure (hour 9 or termination)
Mean skin temperature rate of change
Rate of change of skin temperature measured over the final 2-hours of heat exposure
Measured: End of fixed-condition heat exposure (hour 9 or termination)
Core temperature (AUC)
Area under the curve (AUC) of rectal temperature (in degree-hours) measured over the fixed-condition heat exposure
Measured: End of fixed-condition heat exposure (hour 9 or termination)
Predicted time until 40.2°C esophageal temperature
Estimated time for rectal temperature to reach 40.2°C, a commonly-cited criteria for severe heat-illness (e.g., heat stroke), calculated from the end-exposure rectal temperature and its rate of change (assuming this rate of change is sustained)
Measured: End of fixed-condition heat exposure (hour 9 or termination)
Heart rate rate of change
Rate of change of heart rate measured over the final 2-hours of heat exposure
Measured: End of fixed-condition heat exposure (hour 9 or termination)
Heart rate (AUC)
Area under the curve (AUC) of heart rate measured over the fixed-condition heat exposure
Measured: End of fixed-condition heat exposure (hour 9 or termination)
Thermal sensation
Self-reported thermal sensation at the end of the fixed-condition exposures using and 8-point scale ranging from neutral (0) to extremely hot (8).
Measured: End of fixed-condition heat exposure (hour 9 or termination)
Thermal comfort
Thermal comfort assessed via a visual analog scale ranging from extremely uncomfortable to extremely comfortable (midpoint: neutral).
Measured: End of fixed-condition heat exposure (hour 9 or termination)
Sweat rate
Sweat rate at the end of the fixed-condition exposures (calculated via change in body weight)
Measured: End of fixed-condition heat exposure (hour 9 or termination)
Net fluid loss
Net fluid loss estimated as the percentage change in body mass over the fixed-condition exposures.
Measured: End of fixed-condition heat exposure (hour 9 or termination)
Profiles of Mood States (POMS)
Potential changes in mood (7 subscales of mood: tension, anger, depression, fatigue, confusion, vigor and esteem-related affect). The POMS-40 is a validated, self-administered questionnaire that examines seven distinct aspects of mood state across two positive subscales (Esteem-Related Affect, and Vigor) and five negative subscales (Fatigue, Tension, Confusion, Anger, and Depression), which are described across 40 distinct adjectives (reference). For each individual item, participants were asked to describe "how you feel right now" by responding using a 5-point Likert scale (0 = "Not at all", 1 = "A little", 2 = "Moderately", 3 = "Quite a lot", or 4 = "Extremely"). The values of items associated with a specific subscale (e.g., Fatigue) were summed to calculate its score.
Measured: Prior to (hour 0) and at the end of fixed-condition heat exposure (hour 9 or termination)
Environmental Symptoms Questionnaire (ESQ)
Self-reported environmental reactions and medical symptomatology associated with prolonged heat exposure. The ESQ-IV is a validated 68-item, self-administered questionnaire that has been used successfully in identifying symptomatology during exposure to a wide variety of environmental conditions, including heat exposure [24, 25]. Participants are asked to assess and described "how you have been feeling today" by responding to each item using a 6-point Likert scale (0 = "Not at all", 1 = "Slight", 2 = "Somewhat", 3 = "Moderate", 4 = "Quite a bit", or 5 = "Extreme"). Total Symptom Score was calculated from this data by taking the sum of the intensity ratings from all 68 individual items using reverse scores for the three positive items from the list ("I Felt Good", "I Felt Alert", and "I Felt Wide Awake").
Measured: Prior to (hour 0) and at the end of fixed-condition heat exposure (hour 9 or termination)
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted24 Jun 2025
- Study start16 Jul 2025
- Primary completion1 May 2026
- Study completion1 May 2026
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for Heat StressStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Basic science
- Allocation
- Randomised
- Intervention model
- Crossover
- Masking
- Double blind
- Who is masked
- Participant, Outcomes assessor
- Enrolment
- 12 participants (actual)
Sponsor and investigators
- Lead sponsor
- University of Ottawa
- Sponsor type
- University, hospital or other
- Responsible party
- Principal investigator, Glen P. Kenny, University of Ottawa
- Investigators
- Glen P Kenny, PhD, Principal investigator, University of Ottawa
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07032493
- Sponsor's protocol ID
- HEPRU-2025-05-A
- Status last verified
- Jun 2026
- First submitted
- 14 Jun 2025
- Last updated
- 11 Jun 2026
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- Yes: De-identified participant data will be made available upon reasonable request and signed access agreement.
Study at a glance
From the registry record, last updated by the sponsor on 11 Jun 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Identifying the Upper Environmental Limits of Thermal Compensation in Older Human Females Using a Rapid Humidity Ramp Protocol
- ClinicalTrials.gov ID
- NCT07032493
- Acronym / sponsor ID
- HEPRU-2025-05-A
- Conditions
- Heat Stress, Temperature Change, Body, Aging, Thermoregulation, Heat Exposure
- Keywords
- heat strain, women, heat illness, Environmental limits for compensability, heat wave, hot weather, extreme heat events
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 12 participants (actual)
- Lead sponsor
- University of OttawaUniversity, hospital or other
- Study start
- 16 Jul 2025 (actual)
- Primary completion
- 1 May 2026 (actual)
- Study completion
- 1 May 2026 (actual)
- First posted
- 24 Jun 2025 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
Climate change increases extreme heat events, elevating global heat-illness risk. Females have reduced heat loss capacity (~5%) compared to males, driven by differences in skin blood flow and sweating responses. While findings on sex-mediated mortality are mixed, some studies suggest older females (≥65 years), face higher heat-related mortality/morbidity risks, evidenced by disproportionate female deaths in the 2021 Western Heat Dome. The effects of extreme uncompensable heat on older females remain understudied.
Heat exposure initially causes net heat gain, raising core/skin temperatures and triggering heat-loss responses. Under compensable heat stress, heat loss balances gain, stabilizing core temperature. Uncompensable heat stress (exceeding maximal dissipation capacity) causes continuous core temperature rise, posing severe health risks. The specific temperature and relative humidity (RH) limits where compensability is lost are critical survival determinants, influenced by age and sex.
Ramping protocols identify these limits: participants face progressively increasing heat stress (e.g., staged humidity rises) while core temperature is monitored. Core temperature typically stabilizes initially, then exhibits an abrupt rapid increase at an inflection point, operationally defined as the limit of compensability. Despite increasing use, ramping protocol validity for accurately identifying this threshold remains unverified.
This project assesses ramping protocol validity for determining uncompensable conditions in older females and evaluates cumulative thermal and cardiovascular strain, as well as psychological and cognitive responses to both uncompensable and compensable heat. Participants will complete five trials. Trial 1 (Ramping): Rest at 42°C, 28% RH for 70min, then incremental RH increases (3% every 10min) to 70% RH. Individual core temperature (rectal) inflection points are identified from the ramping trial. Trials 2-5 (Fixed Conditions, Randomized): i) ~10% below inflection; ii) ~5% below inflection; iii) ~5% above inflection; iv) Thermo-neutral control (26°C, 45% RH). Comparing the rate of rectal temperature change and cumulative strain during prolonged fixed exposures (especially below vs. above inflection) will validate if the ramping inflection point represents the true limit of compensability for older females.
Study design
- Primary purpose
- Basic science
- Allocation
- Randomised
- Intervention model
- Crossover
- Masking
- Double blind (participant, outcomes assessor)
- Number of arms
- 5
| Arm | Type | Receives |
|---|---|---|
| Humidity-ramp protocol | Other | Other: Humidity-Ramp ProtocolThe humidity-ramp protocol will necessarily be performed first. The order of the fixed-condition exposures will be randomized. |
| Below-inflection fixed-condition heat exposure (5%) | Experimental | Other: Below-inflection fixed-condition exposure (5%)Participants will complete all exposures. The humidity-ramp protocol will necessarily be performed first. The order of the fixed-condition exposures will be randomized. |
| Control fixed-condition heat exposure | Active comparator | Other: Control fixed-condition exposureParticipants will complete all exposures. The humidity-ramp protocol will necessarily be performed first. The order of the fixed-condition exposures will be randomized. |
| Below-inflection fixed-condition heat exposure (10%) | Experimental | Other: Below-inflection fixed-condition exposure (10%)Participants will complete all exposures. The humidity-ramp protocol will necessarily be performed first. The order of the fixed-condition exposures will be randomized. |
| Above-inflection fixed-condition heat exposure (5%) | Experimental | Other: Above-inflection fixed-condition exposure (5%)Participants will complete all exposures. The humidity-ramp protocol will necessarily be performed first. The order of the fixed-condition exposures will be randomized. |
Who may qualify
- Ages
- 65 to 85 years
- Sex
- Female only
- Healthy volunteers
- Accepted
- Age groups
- Older adult
Key inclusion criteria (4 listed)
- Non-smoking.
- English or French speaking.
- Ability to provide informed consent.
- With or without a) chronic hypertension (elevated resting blood pressure; as defined by Heart and Stroke Canada and Hypertension Canada), b) type 2 diabetes as defined by Diabetes Canada, with at least 5 years having elapsed since time of diagnosis
Key exclusion criteria (6 listed)
- Episode(s) of severe hypoglycemia (requiring the assistance of another person) within the previous year, or inability to sense hypoglycemia (hypoglycemia unawareness).
- Serious complications related to diabetes (gastroparesis, renal disease, uncontrolled hypertension, severe autonomic neuropathy).
- Uncontrolled hypertension - BP >150 mmHg systolic or >95 mmHg diastolic in a sitting position.
- Restrictions in physical activity due to disease (e.g. intermittent claudication, renal impairment, active proliferative retinopathy, unstable cardiac or pulmonary disease, disabling stroke, severe arthritis, etc.).
- Use of or changes in medication judged by the patient or investigators to make participation in this study inadvisable.
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Humidity-Ramp ProtocolParticipants are exposed to 42°C and 28% relative humidity for 70 minutes. Thereafter, humidity is increased 3% until an ambient humidity of 70% is achieved. The humidity at which rectal temperature inflect is subsequently determined. | Other | Humidity-ramp protocol |
| Above-inflection fixed-condition exposure (5%)After a 1 hour equilibrium at 42°C and 28% relative humidity, humidity will be increased 3% every 10 min until it is ~5% higher than the participants' rectal esophageal temperature inflection point identified in the humidity ramp protocol. These conditions will be held constant for the remainder of the 9-hour exposure period (starting from the beginning of equilibrium). Tap water will be provided at regular intervals to limit dehydration. | Other | Above-inflection fixed-condition heat exposure (5%) |
| Below-inflection fixed-condition exposure (5%)After a 1 hour equilibrium at 42°C and 28% relative humidity, humidity will be increased 3% every 10 min until it is ~5% lower than the participants' individual rectal temperature inflection point identified in the humidity ramp protocol. These conditions will be held constant for the remainder of the 9-hour exposure period (starting from the beginning of equilibrium). Tap water will be provided at regular intervals to limit dehydration. | Other | Below-inflection fixed-condition heat exposure (5%) |
| Below-inflection fixed-condition exposure (10%)After a 1 hour equilibrium at 42°C and 28% relative humidity, humidity will be increased 3% every 10 min until it is ~10% lower than the participants' individual rectal temperature inflection point identified in the humidity ramp protocol. These conditions will be held constant for the remainder of the 9-hour exposure period (starting from the beginning of equilibrium). Tap water will be provided at regular intervals to limit dehydration. | Other | Below-inflection fixed-condition heat exposure (10%) |
| Control fixed-condition exposureParticipants are exposed for 9-hours to 28°C with 35% relative humidity. Participant will be allowed to drink tap water ad libitum. | Other | Control fixed-condition heat exposure |
Primary outcome
Rectal temperature rate of change
Time frame: End of fixed-condition heat exposure (hour 9 or termination)
Rate of change of rectal temperature measured over the final 2-hours of heat exposure
12 secondary outcomes
Number of participants unable to finish fixed-condition heat exposure
Time frame: End of fixed-condition heat exposure (hour 9 or termination)
Mean skin temperature rate of change
Time frame: End of fixed-condition heat exposure (hour 9 or termination)
Core temperature (AUC)
Time frame: End of fixed-condition heat exposure (hour 9 or termination)
Predicted time until 40.2°C esophageal temperature
Time frame: End of fixed-condition heat exposure (hour 9 or termination)
Heart rate rate of change
Time frame: End of fixed-condition heat exposure (hour 9 or termination)
Heart rate (AUC)
Time frame: End of fixed-condition heat exposure (hour 9 or termination)
Thermal sensation
Time frame: End of fixed-condition heat exposure (hour 9 or termination)
Thermal comfort
Time frame: End of fixed-condition heat exposure (hour 9 or termination)
Sweat rate
Time frame: End of fixed-condition heat exposure (hour 9 or termination)
Net fluid loss
Time frame: End of fixed-condition heat exposure (hour 9 or termination)
Profiles of Mood States (POMS)
Time frame: Prior to (hour 0) and at the end of fixed-condition heat exposure (hour 9 or termination)
Environmental Symptoms Questionnaire (ESQ)
Time frame: Prior to (hour 0) and at the end of fixed-condition heat exposure (hour 9 or termination)
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 11 Jun 2026.
- Individual participant dataSharing planned: Yes. De-identified participant data will be made available upon reasonable request and signed access agreement.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Glen P Kenny, PhD principal investigator
University of Ottawa
2 sites in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Humidity-Ramp Protocol, Above-inflection fixed-condition exposure (5%) and Below-inflection fixed-condition exposure (5%) in people with Heat Stress and Temperature Change, Body, run by University of Ottawa at 2 sites in Canada.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 4 inclusion and 6 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 11 Jun 2026. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 2 sites in Canada. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Rectal temperature rate of change (time frame: End of fixed-condition heat exposure (hour 9 or termination)). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 11 Jun 2026.