Improving the health forecasting alert system for cold weather and heat-waves in England: a proof-of-concept using temperature-mortality relationships

Objectives In this study a prototype of a new health forecasting alert system is developed, which is aligned to the approach used in the Met Office’s (MO) National Severe Weather Warning Service (NSWWS). This is in order to improve information available to responders in the health and social care system by linking temperatures more directly to risks of mortality, and developing a system more coherent with other weather alerts. The prototype is compared to the current system in the Cold Weather and Heatwave plans via a case-study approach to verify its potential advantages and shortcomings. Method The prototype health forecasting alert system introduces an “impact vs likelihood matrix” for the health impacts of hot and cold temperatures which is similar to those used operationally for other weather hazards as part of the NSWWS. The impact axis of this matrix is based on existing epidemiological evidence, which shows an increasing relative risk of death at extremes of outdoor temperature beyond a threshold which can be identified epidemiologically. The likelihood axis is based on a probability measure associated with the temperature forecast. The new method is tested for two case studies (one during summer 2013, one during winter 2013), and compared to the performance of the current alert system. Conclusions The prototype shows some clear improvements over the current alert system. It allows for a much greater degree of flexibility, provides more detailed regional information about the health risks associated with periods of extreme temperatures, and is more coherent with other weather alerts which may make it easier for front line responders to use. It will require validation and engagement with stakeholders before it can be considered for use.

Seasonal forecasts of tropical cyclone activity in a high-atmospheric-resolution coupled prediction system

Seasonal forecast skill of the basinwide and regional tropical cyclone (TC) activity in an experimental coupled prediction system based on the ECMWF System 4 is assessed. As part of a collaboration between the Center for Ocean–Land–Atmosphere Studies (COLA) and the ECMWF called Project Minerva, the system is integrated at the atmospheric horizontal spectral resolutions of T319, T639, and T1279. Seven-month hindcasts starting from 1 May for the years 1980–2011 are produced at all three resolutions with at least 15 ensemble members. The Minerva system demonstrates statistically significant skill for retrospective forecasts of TC frequency and accumulated cyclone energy (ACE) in the North Atlantic (NA), eastern North Pacific (EP), and western North Pacific. While the highest scores overall are achieved in the North Pacific, the skill in the NA appears to be limited by an overly strong influence of the tropical Pacific variability. Higher model resolution improves skill scores for the ACE and, to a lesser extent, the TC frequency, even though the influence of large-scale climate variations on these TC activity measures is largely independent of resolution changes. The biggest gain occurs in transition from T319 to T639. Significant skill in regional TC forecasts is achieved over broad areas of the Northern Hemisphere. The highest-resolution hindcasts exhibit additional locations with skill in the NA and EP, including land-adjacent areas. The feasibility of regional intensity forecasts is assessed. In the presence of the coupled model biases, the benefits of high resolution for seasonal TC forecasting may be underestimated.

The “pain matrix” in pain-free individuals

Human functional imaging provides a correlative picture of brain activity during pain. A particular set of central nervous system structures (eg, the anterior cingulate cortex, thalamus, and insula) consistently respond to transient nociceptive stimuli causing pain. Activation of this so-called pain matrix or pain signature has been related to perceived pain intensity, both within and between individuals,1,2 and is now considered a candidate biomarker for pain in medicolegal settings and a tool for drug discovery. The pain-specific interpretation of such functional magnetic resonance imaging (fMRI) responses, although logically flawed,3,4 remains pervasive. For example, a 2015 review states that “the most likely interpretation of activity in the pain matrix seems to be pain.”4 Demonstrating the nonspecificity of the pain matrix requires ruling out the presence of pain when highly salient sensory stimuli are presented. In this study, we administered noxious mechanical stimuli to individuals with congenital insensitivity to pain and sampled their brain activity with fMRI. Loss-of-function SCN9A mutations in these individuals abolishes sensory neuron sodium channel Nav1.7 activity, resulting in pain insensitivity through an impaired peripheral drive that leaves tactile percepts fully intact.5 This allows complete experimental disambiguation of sensory responses and painful sensations