Changing European storm loss potentials under modified climate conditions according to ensemble simulations of the ECHAM5/MPI-OM1 GMC

A simple storm loss model is applied to an ensemble of ECHAM5/MPI-OM1 GCM simulations in order to estimate changes of insured loss potentials over Europe in the 21st century. Losses are computed based on the daily maximum wind speed for each grid point. The calibration of the loss model is performed using wind data from the ERA40-Reanalysis and German loss data. The obtained annual losses for the present climate conditions (20C, three realisations) reproduce the statistical features of the historical insurance loss data for Germany. The climate change experiments correspond to the SRES-Scenarios A1B and A2, and for each of them three realisations are considered. On average, insured loss potentials increase for all analysed European regions at the end of the 21st century. Changes are largest for Germany and France, and lowest for Portugal/Spain. Additionally, the spread between the single realisations is large, ranging e.g. for Germany from −4% to +43% in terms of mean annual loss. Moreover, almost all simulations show an increasing interannual variability of storm damage. This assessment is even more pronounced if no adaptation of building structure to climate change is considered. The increased loss potentials are linked with enhanced values for the high percentiles of surface wind maxima over Western and Central Europe, which in turn are associated with an enhanced number and increased intensity of extreme cyclones over the British Isles and the North Sea.

Investigating the prevalence and causes of prescribing errors in general practice: the PRACtICe Study

Aim: To determine the prevalence and nature of prescribing errors in general practice; to explore the causes, and to identify defences against error. Methods: 1) Systematic reviews; 2) Retrospective review of unique medication items prescribed over a 12 month period to a 2% sample of patients from 15 general practices in England; 3) Interviews with 34 prescribers regarding 70 potential errors; 15 root cause analyses, and six focus groups involving 46 primary health care team members Results: The study involved examination of 6,048 unique prescription items for 1,777 patients. Prescribing or monitoring errors were detected for one in eight patients, involving around one in 20 of all prescription items. The vast majority of the errors were of mild to moderate severity, with one in 550 items being associated with a severe error. The following factors were associated with increased risk of prescribing or monitoring errors: male gender, age less than 15 years or greater than 64 years, number of unique medication items prescribed, and being prescribed preparations in the following therapeutic areas: cardiovascular, infections, malignant disease and immunosuppression, musculoskeletal, eye, ENT and skin. Prescribing or monitoring errors were not associated with the grade of GP or whether prescriptions were issued as acute or repeat items. A wide range of underlying causes of error were identified relating to the prescriber, patient, the team, the working environment, the task, the computer system and the primary/secondary care interface. Many defences against error were also identified, including strategies employed by individual prescribers and primary care teams, and making best use of health information technology. Conclusion: Prescribing errors in general practices are common, although severe errors are unusual. Many factors increase the risk of error. Strategies for reducing the prevalence of error should focus on GP training, continuing professional development for GPs, clinical governance, effective use of clinical computer systems, and improving safety systems within general practices and at the interface with secondary care.