Describing seasonal variability in the distribution of daily effective temperatures for 1985-2009 compared to 1904-1984 for De Bilt, Holland

This paper proposes a method for describing the distribution of observed temperatures on any day of the year such that the distribution and summary statistics of interest derived from the distribution vary smoothly through the year. The method removes the noise inherent in calculating summary statistics directly from the data thus easing comparisons of distributions and summary statistics between different periods. The method is demonstrated using daily effective temperatures (DET) derived from observations of temperature and wind speed at De Bilt, Holland. Distributions and summary statistics are obtained from 1985 to 2009 and compared to the period 1904–1984. A two-stage process first obtains parameters of a theoretical probability distribution, in this case the generalized extreme value (GEV) distribution, which describes the distribution of DET on any day of the year. Second, linear models describe seasonal variation in the parameters. Model predictions provide parameters of the GEV distribution, and therefore summary statistics, that vary smoothly through the year. There is evidence of an increasing mean temperature, a decrease in the variability in temperatures mainly in the winter and more positive skew, more warm days, in the summer. In the winter, the 2% point, the value below which 2% of observations are expected to fall, has risen by 1.2 °C, in the summer the 98% point has risen by 0.8 °C. Medians have risen by 1.1 and 0.9 °C in winter and summer, respectively. The method can be used to describe distributions of future climate projections and other climate variables. Further extensions to the methodology are suggested.

Description and process evaluation of pharmacists’ interventions in a pharmacist-led information technology-enabled multicentre cluster randomised controlled trial for reducing medication errors in general practice (PINCER trial)

Objective To undertake a process evaluation of pharmacists' recommendations arising in the context of a complex IT-enabled pharmacist-delivered randomised controlled trial (PINCER trial) to reduce the risk of hazardous medicines management in general practices. Methods PINCER pharmacists manually recorded patients’ demographics, details of interventions recommended, actions undertaken by practice staff and time taken to manage individual cases of hazardous medicines management. Data were coded and double entered into SPSS v15, and then summarised using percentages for categorical data (with 95% CI) and, as appropriate, means (SD) or medians (IQR) for continuous data. Key findings Pharmacists spent a median of 20 minutes (IQR 10, 30) reviewing medical records, recommending interventions and completing actions in each case of hazardous medicines management. Pharmacists judged 72% (95%CI 70, 74) (1463/2026) of cases of hazardous medicines management to be clinically relevant. Pharmacists recommended 2105 interventions in 74% (95%CI 73, 76) (1516/2038) of cases and 1685 actions were taken in 61% (95%CI 59, 63) (1246/2038) of cases; 66% (95%CI 64, 68) (1383/2105) of interventions recommended by pharmacists were completed and 5% (95%CI 4, 6) (104/2105) of recommendations were accepted by general practitioners (GPs), but not completed at the end of the pharmacists’ placement; the remaining recommendations were rejected or considered not relevant by GPs. Conclusions The outcome measures were used to target pharmacist activity in general practice towards patients at risk from hazardous medicines management. Recommendations from trained PINCER pharmacists were found to be broadly acceptable to GPs and led to ameliorative action in the majority of cases. It seems likely that the approach used by the PINCER pharmacists could be employed by other practice pharmacists following appropriate training.

Climate change scenarios for precipitation extremes in Portugal

Precipitation indices are commonly used as climate change indicators. Considering four Climate Variability and Predictability-recommended indices, this study assesses possible changes in their spatial patterns over Portugal under future climatic conditions. Precipitation data from the regional climate model Consortium for Small-Scale Modelling–Climate version of the Local Model (CCLM) ensemble simulations with ECHAM5/MPI-OM1 boundary conditions are used for this purpose. For recent–past, medians and probability density functions of the CCLM-based indices are validated against station-based and gridded observational dataset from ENSEMBLES-based (gridded daily precipitation data provided by the European Climate Assessment & Dataset project) indices. It is demonstrated that the model is able to realistically reproduce not only precipitation but also the corresponding extreme indices. Climate change projections for 2071–2100 (A1B and B1 SRES scenarios) reveal significant decreases in total precipitation, particularly in autumn over northwestern and southern Portugal, though changes exhibit distinct local and seasonal patterns and are typically stronger for A1B than for B1. The increase in winter precipitation over northeastern Portugal in A1B is the most important exception to the overall drying trend. Contributions of extreme precipitation events to total precipitation are also expected to increase, mainly in winter and spring over northeastern Portugal. Strong projected increases in the dry spell lengths in autumn and spring are also noteworthy, giving evidence for an extension of the dry season from summer to spring and autumn. Although no coupling analysis is undertaken, these changes are qualitatively related to modifications in the large-scale circulation over the Euro-Atlantic area, more specifically to shifts in the position of the Azores High and associated changes in the large-scale pressure gradient over the area.