North Atlantic Oscillation response to transient greenhouse gas forcing and the impact on European winter climate: a CMIP2 multi-model assessment

This study investigates the response of wintertime North Atlantic Oscillation (NAO) to increasing concentrations of atmospheric carbon dioxide (CO2) as simulated by 18 global coupled general circulation models that participated in phase 2 of the Coupled Model Intercomparison Project (CMIP2). NAO has been assessed in control and transient 80-year simulations produced by each model under constant forcing, and 1% per year increasing concentrations of CO2, respectively. Although generally able to simulate the main features of NAO, the majority of models overestimate the observed mean wintertime NAO index of 8 hPa by 5-10 hPa. Furthermore, none of the models, in either the control or perturbed simulations, are able to reproduce decadal trends as strong as that seen in the observed NAO index from 1970-1995. Of the 15 models able to simulate the NAO pressure dipole, 13 predict a positive increase in NAO with increasing CO2 concentrations. The magnitude of the response is generally small and highly model-dependent, which leads to large uncertainty in multi-model estimates such as the median estimate of 0.0061 +/- 0.0036 hPa per %CO2. Although an increase of 0.61 hPa in NAO for a doubling in CO2 represents only a relatively small shift of 0.18 standard deviations in the probability distribution of winter mean NAO, this can cause large relative increases in the probabilities of extreme values of NAO associated with damaging impacts. Despite the large differences in NAO responses, the models robustly predict similar statistically significant changes in winter mean temperature (warmer over most of Europe) and precipitation (an increase over Northern Europe). Although these changes present a pattern similar to that expected due to an increase in the NAO index, linear regression is used to show that the response is much greater than can be attributed to small increases in NAO. NAO trends are not the key contributor to model-predicted climate change in wintertime mean temperature and precipitation over Europe and the Mediterranean region. However, the models' inability to capture the observed decadal variability in NAO might also signify a major deficiency in their ability to simulate the NAO-related responses to climate change.

Resolution of the uncertainties in the radiative forcing of HFC-134a

HFC-134a (CF3CH2F) is the most rapidly growing hydrofluorocarbon in terms of atmospheric abundance. It is currently used in a large number of household refrigerators and air-conditioning systems and its concentration in the atmosphere is forecast to increase substantially over the next 50–100 years. Previous estimates of its radiative forcing per unit concentration have differed significantly 25%. This paper uses a two-step approach to resolve this discrepancy. In the first step six independent absorption cross section datasets are analysed. We find that, for the integrated cross section in the spectral bands that contribute most to the radiative forcing, the differences between the various datasets are typically smaller than 5% and that the dependence on pressure and temperature is not significant. A “recommended'' HFC-134a infrared absorption spectrum was obtained based on the average band intensities of the strongest bands. In the second step, the “recommended'' HFC-134a spectrum was used in six different radiative transfer models to calculate the HFC-134a radiative forcing efficiency. The clear-sky instantaneous radiative forcing, using a single global and annual mean profile, differed by 8%, between the 6 models, and the latitudinally-resolved adjusted cloudy sky radiative forcing estimates differed by a similar amount.

The impact of global freshwater forcing on the thermohaline circulation: adjustment of North Atlantic convection sites in a CGCM

On the time scale of a century, the Atlantic thermohaline circulation (THC) is sensitive to the global surface salinity distribution. The advection of salinity toward the deep convection sites of the North Atlantic is one of the driving mechanisms for the THC. There is both a northward and a southward contributions. The northward salinity advection (Nsa) is related to the evaporation in the subtropics, and contributes to increased salinity in the convection sites. The southward salinity advection (Ssa) is related to the Arctic freshwater forcing and tends on the contrary to diminish salinity in the convection sites. The THC changes results from a delicate balance between these opposing mechanisms. In this study we evaluate these two effects using the IPSL-CM4 ocean-atmosphere-sea-ice coupled model (used for IPCC AR4). Perturbation experiments have been integrated for 100 years under modern insolation and trace gases. River runoff and evaporation minus precipitation are successively set to zero for the ocean during the coupling procedure. This allows the effect of processes Nsa and Ssa to be estimated with their specific time scales. It is shown that the convection sites in the North Atlantic exhibit various sensitivities to these processes. The Labrador Sea exhibits a dominant sensitivity to local forcing and Ssa with a typical time scale of 10 years, whereas the Irminger Sea is mostly sensitive to Nsa with a 15 year time scale. The GIN Seas respond to both effects with a time scale of 10 years for Ssa and 20 years for Nsa. It is concluded that, in the IPSL-CM4, the global freshwater forcing damps the THC on centennial time scales.

The impact of a closed-loop electronic prescribing and administration system on prescribing errors, administration errors and staff time: a before-and-after study

Objectives: To assess the impact of a closed-loop electronic prescribing, automated dispensing, barcode patient identification and electronic medication administration record (EMAR) system on prescribing and administration errors, confirmation of patient identity before administration, and staff time. Design, setting and participants: Before-and-after study in a surgical ward of a teaching hospital, involving patients and staff of that ward. Intervention: Closed-loop electronic prescribing, automated dispensing, barcode patient identification and EMAR system. Main outcome measures: Percentage of new medication orders with a prescribing error, percentage of doses with medication administration errors (MAEs) and percentage given without checking patient identity. Time spent prescribing and providing a ward pharmacy service. Nursing time on medication tasks. Results: Prescribing errors were identified in 3.8% of 2450 medication orders pre-intervention and 2.0% of 2353 orders afterwards (p<0.001; χ2 test). MAEs occurred in 7.0% of 1473 non-intravenous doses pre-intervention and 4.3% of 1139 afterwards (p = 0.005; χ2 test). Patient identity was not checked for 82.6% of 1344 doses pre-intervention and 18.9% of 1291 afterwards (p<0.001; χ2 test). Medical staff required 15 s to prescribe a regular inpatient drug pre-intervention and 39 s afterwards (p = 0.03; t test). Time spent providing a ward pharmacy service increased from 68 min to 98 min each weekday (p = 0.001; t test); 22% of drug charts were unavailable pre-intervention. Time per drug administration round decreased from 50 min to 40 min (p = 0.006; t test); nursing time on medication tasks outside of drug rounds increased from 21.1% to 28.7% (p = 0.006; χ2 test). Conclusions: A closed-loop electronic prescribing, dispensing and barcode patient identification system reduced prescribing errors and MAEs, and increased confirmation of patient identity before administration. Time spent on medication-related tasks increased.

The impact of a closed-loop electronic prescribing and automated dispensing system on the ward pharmacist’s time and activities

Objective To assess the impact of a closed-loop electronic prescribing and automated dispensing system on the time spent providing a ward pharmacy service and the activities carried out. Setting Surgical ward, London teaching hospital. Method All data were collected two months pre- and one year post-intervention. First, the ward pharmacist recorded the time taken each day for four weeks. Second, an observational study was conducted over 10 weekdays, using two-dimensional work sampling, to identify the ward pharmacist's activities. Finally, medication orders were examined to identify pharmacists' endorsements that should have been, and were actually, made. Key findings Mean time to provide a weekday ward pharmacy service increased from 1 h 8 min to 1 h 38 min per day (P = 0.001; unpaired t-test). There were significant increases in time spent prescription monitoring, recommending changes in therapy/monitoring, giving advice or information, and non-productive time. There were decreases for supply, looking for charts and checking patients' own drugs. There was an increase in the amount of time spent with medical and pharmacy staff, and with 'self'. Seventy-eight per cent of patients' medication records could be assessed for endorsements pre- and 100% post-intervention. Endorsements were required for 390 (50%) of 787 medication orders pre-intervention and 190 (21%) of 897 afterwards (P < 0.0001; chi-square test). Endorsements were made for 214 (55%) of endorsement opportunities pre-intervention and 57 (30%) afterwards (P < 0.0001; chi-square test). Conclusion The intervention increased the overall time required to provide a ward pharmacy service and changed the types of activity undertaken. Contact time with medical and pharmacy staff increased. There was no significant change in time spent with patients. Fewer pharmacy endorsements were required post-intervention, but a lower percentage were actually made. The findings have important implications for the design, introduction and use of similar systems.