Assessing the accuracy of a computerized decision support system for digoxin dosing in primary care: an observational study

Background: This study was carried out as part of a European Union funded project (PharmDIS-e+), to develop and evaluate software aimed at assisting physicians with drug dosing. A drug that causes particular problems with drug dosing in primary care is digoxin because of its narrow therapeutic range and low therapeutic index. Objectives: To determine (i) accuracy of the PharmDIS-e+ software for predicting serum digoxin levels in patients who are taking this drug regularly; (ii) whether there are statistically significant differences between predicted digoxin levels and those measured by a laboratory and (iii) whether there are differences between doses prescribed by general practitioners and those suggested by the program. Methods: We needed 45 patients to have 95% Power to reject the null hypothesis that the mean serum digoxin concentration was within 10% of the mean predicted digoxin concentration. Patients were recruited from two general practices and had been taking digoxin for at least 4 months. Exclusion criteria were dementia, low adherence to digoxin and use of other medications known to interact to a clinically important extent with digoxin. Results: Forty-five patients were recruited. There was a correlation of 0·65 between measured and predicted digoxin concentrations (P < 0·001). The mean difference was 0·12 μg/L (SD 0·26; 95% CI 0·04, 0·19, P = 0·005). Forty-seven per cent of the patients were prescribed the same dose as recommended by the software, 44% were prescribed a higher dose and 9% a lower dose than recommended. Conclusion: PharmDIS-e+ software was able to predict serum digoxin levels with acceptable accuracy in most patients.

The precipitation climate of Central Asia: intercomparison of observational and numerical data sources in a remote semiarid region

In this study, we systematically compare a wide range of observational and numerical precipitation datasets for Central Asia. Data considered include two re-analyses, three datasets based on direct observations, and the output of a regional climate model simulation driven by a global re-analysis. These are validated and intercompared with respect to their ability to represent the Central Asian precipitation climate. In each of the datasets, we consider the mean spatial distribution and the seasonal cycle of precipitation, the amplitude of interannual variability, the representation of individual yearly anomalies, the precipitation sensitivity (i.e. the response to wet and dry conditions), and the temporal homogeneity of precipitation. Additionally, we carried out part of these analyses for datasets available in real time. The mutual agreement between the observations is used as an indication of how far these data can be used for validating precipitation data from other sources. In particular, we show that the observations usually agree qualitatively on anomalies in individual years while it is not always possible to use them for the quantitative validation of the amplitude of interannual variability. The regional climate model is capable of improving the spatial distribution of precipitation. At the same time, it strongly underestimates summer precipitation and its variability, while interannual variations are well represented during the other seasons, in particular in the Central Asian mountains during winter and spring

Observational tracking of the 2D structure of coronal mass ejections between the sun and 1 AU

The Solar TErrestrial RElations Observatory (STEREO) provides high cadence and high resolution images of the structure and morphology of coronal mass ejections (CMEs) in the inner heliosphere. CME directions and propagation speeds have often been estimated through the use of time-elongation maps obtained from the STEREO Heliospheric Imager (HI) data. Many of these CMEs have been identified by citizen scientists working within the SolarStormWatch project ( www.solarstormwatch.com ) as they work towards providing robust real-time identification of Earth-directed CMEs. The wide field of view of HI allows scientists to directly observe the two-dimensional (2D) structures, while the relative simplicity of time-elongation analysis means that it can be easily applied to many such events, thereby enabling a much deeper understanding of how CMEs evolve between the Sun and the Earth. For events with certain orientations, both the rear and front edges of the CME can be monitored at varying heliocentric distances (R) between the Sun and 1 AU. Here we take four example events with measurable position angle widths and identified by the citizen scientists. These events were chosen for the clarity of their structure within the HI cameras and their long track lengths in the time-elongation maps. We show a linear dependency with R for the growth of the radial width (W) and the 2D aspect ratio (χ) of these CMEs, which are measured out to ≈ 0.7 AU. We estimated the radial width from a linear best fit for the average of the four CMEs. We obtained the relationships W=0.14R+0.04 for the width and χ=2.5R+0.86 for the aspect ratio (W and R in units of AU).

Exploring the interplay between natural decadal variability and anthropogenic climate change in summer rainfall over China. Part I: Observational evidence

Summer rainfall over China has experienced substantial variability on longer time scales during the last century, and the question remains whether this is due to natural, internal variability or is part of the emerging signal of anthropogenic climate change. Using the best available observations over China, the decadal variability and recent trends in summer rainfall are investigated with the emphasis on changes in the seasonal evolution and on the temporal characteristics of daily rainfall. The possible relationships with global warming are reassessed. Substantial decadal variability in summer rainfall has been confirmed during the period 1958–2008; this is not unique to this period but is also seen in the earlier decades of the twentieth century. Two dominant patterns of decadal variability have been identified that contribute substantially to the recent trend of southern flooding and northern drought. Natural decadal variability appears to dominate in general but in the cases of rainfall intensity and the frequency of rainfall days, particularly light rain days, then the dominant EOFs have a rather different character, being of one sign over most of China, and having principal components (PCs) that appear more trendlike. The increasing intensity of rainfall throughout China and the decrease in light rainfall days, particularly in the north, could at least partially be of anthropogenic origin, both global and regional, linked to increased greenhouse gases and increased aerosols.

Observational challenges in evaluating climate models

Activities like the Coupled Model Intercomparison Project (CMIP) have revolutionized climate modelling in terms of our ability to compare models and to process information about climate projections and their uncertainties. The evaluation of models against observations is now considered a key component of multi-model studies. While there are a number of outstanding scientific issues surrounding model evaluation, notably the open question of how to link model performance to future projections, here we highlight a specific but growing problem in model evaluation - that of uncertainties in the observational data that are used to evaluate the models. We highlight the problem using an example obtained from studies of the South Asian Monsoon but we believe the problem is a generic one which arises in many different areas of climate model evaluation and which requires some attention by the community.

Dynamical and observational constraints on tropical Pacific sea surface temperatures at the last glacial maximum

Asynchronously coupled atmosphere and ocean general circulation model simulations are used to examine the consequences of changes in the west/east sea-surface temperature (SST) gradient across the equatorial Pacific at the last glacial maximum (LGM). Simulations forced by the CLIMAP SST for the LGM, where the west/east SST gradient across the Pacific is reduced compared to present, produce a reduction in the strength of the trade winds and a decrease in the west/east slope of the equatorial thermocline that is incompatible with thermocline depths newly inferred from foraminiferal assemblages. Stronger-than-present trade winds, and a more realistic simulation of the thermocline slope, are produced when eastern Pacific SSTs are 2°C cooler than western Pacific SSTs. Our study highlights the importance of spatial heterogeneity in tropical SSTs in determining key features of the glacial climate.

Seasonal intercomparison of observational rainfall datasets over India during the southwest monsoon season

The Indian monsoon is an important component of Earth's climate system, accurate forecasting of its mean rainfall being essential for regional food and water security. Accurate measurement of the rainfall is essential for various water-related applications, the evaluation of numerical models and detection and attribution of trends, but a variety of different gridded rainfall datasets are available for these purposes. In this study, six gridded rainfall datasets are compared against the India Meteorological Department (IMD) gridded rainfall dataset, chosen as the most representative of the observed system due to its high gauge density. The datasets comprise those based solely on rain gauge observations and those merging rain gauge data with satellite-derived products. Various skill scores and subjective comparisons are carried out for the Indian region during the south-west monsoon season (June to September). Relative biases and skill metrics are documented at all-India and sub-regional scales. In the gauge-based (land-only) category, Asian Precipitation-Highly-Resolved Observational Data Integration Towards Evaluation of water resources (APHRODITE) and Global Precipitation Climatology Center (GPCC) datasets perform better relative to the others in terms of a variety of skill metrics. In the merged category, the Global Precipitation Climatology Project (GPCP) dataset is shown to perform better than the Climate Prediction Center Merged Analysis of Precipitation (CMAP) for the Indian monsoon in terms of various metrics, when compared with the IMD gridded data. Most of the datasets have difficulty in representing rainfall over orographic regions including the Western Ghats mountains, in north-east India and the Himalayan foothills. The wide range of skill scores seen among the datasets and even the change of sign of bias found in some years are causes of concern. This uncertainty between datasets is largest in north-east India. These results will help those studying the Indian monsoon region to select an appropriate dataset depending on their application and focus of research.

Observational and energetics constraints on the non-conservation of potential/Conservative Temperature and implications for ocean modelling

This paper seeks to elucidate the fundamental differences between the nonconservation of potential temperature and that of Conservative Temperature, in order to better understand the relative merits of each quantity for use as the heat variable in numerical ocean models. The main result is that potential temperature is found to behave similarly to entropy, in the sense that its nonconservation primarily reflects production/destruction by surface heat and freshwater fluxes; in contrast, the nonconservation of Conservative Temperature is found to reflect primarily the overall compressible work of expansion/contraction. This paper then shows how this can be exploited to constrain the nonconservation of potential temperature and entropy from observed surface heat fluxes, and the nonconservation of Conservative Temperature from published estimates of the mechanical energy budgets of ocean numerical models. Finally, the paper shows how to modify the evolution equation for potential temperature so that it is exactly equivalent to using an exactly conservative evolution equation for Conservative Temperature, as was recently recommended by IOC et al. (2010). This result should in principle allow ocean modellers to test the equivalence between the two formulations, and to indirectly investigate to what extent the budget of derived nonconservative quantities such as buoyancy and entropy can be expected to be accurately represented in ocean models.

Easterly wave disturbances over Northeast Brazil: an observational analysis

This paper aims to identify the circulation associated with Easterly Wave Disturbances (EWDs) that propagate toward the Eastern Northeast Brazil (ENEB) and their impact on the rainfall over ENEB during 2006 and 2007 rainy seasons (April–July). The EWDs identification and trajectory are analyzed using an automatic tracking technique (TracKH). The EWDs circulation patterns and their main features were obtained using the composite technique. To evaluate the TracKH efficiency, a validation was done by comparing the EWDs number tracked against observed cases obtained from an observational analysis. The mean characteristics of EWDs are 5.5-day period, propagation speed of ~9.5 m·s−1, and a 4500 km wavelength. A synoptic analysis shows that between days −2 d and 0 d, the low level winds presented cyclonic relative vorticity and convergence anomalies both in 2006 and 2007. The EWDs signals are strongest at low levels. The EWDs propagation is associated with relative humidity and precipitation positive anomalies and OLR and omega negative anomalies. The EWDs tracks are seen over all ENEB and their lysis occurs between the ENEB and marginally inside the continent. The tracking captured 71% of EWDs in all periods, indicating that an objective analysis is a promising method for EWDs detection.

Observational constraints on atmospheric and oceanic cross-equatorial heat transports: revisiting the precipitation asymmetry problem in climate models

Satellite based top-of-atmosphere (TOA) and surface radiation budget observations are combined with mass corrected vertically integrated atmospheric energy divergence and tendency from reanalysis to infer the regional distribution of the TOA, atmospheric and surface energy budget terms over the globe. Hemispheric contrasts in the energy budget terms are used to determine the radiative and combined sensible and latent heat contributions to the cross-equatorial heat transports in the atmosphere (AHT_EQ) and ocean (OHT_EQ). The contrast in net atmospheric radiation implies an AHT_EQ from the northern hemisphere (NH) to the southern hemisphere (SH) (0.75 PW), while the hemispheric difference in sensible and latent heat implies an AHT_EQ in the opposite direction (0.51 PW), resulting in a net NH to SH AHT_EQ (0.24 PW). At the surface, the hemispheric contrast in the radiative component (0.95 PW) dominates, implying a 0.44 PW SH to NH OHT_EQ. Coupled model intercomparison project phase 5 (CMIP5) models with excessive net downward surface radiation and surface-to-atmosphere sensible and latent heat transport in the SH relative to the NH exhibit anomalous northward AHT_EQ and overestimate SH tropical precipitation. The hemispheric bias in net surface radiative flux is due to too much longwave surface radiative cooling in the NH tropics in both clear and all-sky conditions and excessive shortwave surface radiation in the SH subtropics and extratropics due to an underestimation in reflection by clouds.

Impact of a Fram Strait cyclone on ice edge, drift, divergence, and concentration: Possibilities and limits of an observational analysis

This study aims at the determination of a Fram Strait cyclone track and of the cyclone’s impact on ice edge, drift, divergence, and concentration. A 24 h period on 13–14 March 2002 framed by two RADARSAT images is analyzed. Data are included from autonomous ice buoys, a research vessel, Special Sensor Microwave Imager (SSM/I) and QuikSCAT satellite, and the operational European Centre for Medium-Range Weather Forecasts (ECMWF) model. During this 24 h period the cyclone moved northward along the western ice edge in the Fram Strait, crossed the northern ice edge, made a left-turn loop with 150 km diameter over the sea ice, and returned to the northern ice edge. The ECMWF analysis places the cyclone track 100 km too far west over the sea ice, a deviation which is too large for representative sea ice simulations. On the east side of the northward moving cyclone, the ice edge was pushed northward by 55 km because of strong winds. On the rear side, the ice edge advanced toward the open water but by a smaller distance because of weaker winds there. The ice drift pattern as calculated from the ice buoys and the two RADARSAT images is cyclonically curved around the center of the cyclone loop. Ice drift divergence shows a spatial pattern with divergence in the loop center and a zone of convergence around. Ice concentration changes as retrieved from SSM/I data follow the divergence pattern such that sea ice concentration increased in areas of divergence and decreased in areas of convergence.

Observational evidence for a negative shortwave cloud feedback in middle to high latitudes

Exploiting the observed robust relationships between temperature and optical depth in extratropical clouds, we calculate the shortwave cloud feedback from historical data, by regressing observed and modeled cloud property histograms onto local temperature in middle to high southern latitudes. In this region, all CMIP5 models and observational data sets predict a negative cloud feedback, mainly driven by optical thickening. Between 45° and 60°S, the mean observed shortwave feedback (−0.91 ± 0.82 W m−2 K−1, relative to local rather than global mean warming) is very close to the multimodel mean feedback in RCP8.5 (−0.98 W m−2 K−1), despite differences in the meridional structure. In models, historical temperature-cloud property relationships reliably predict the forced RCP8.5 response. Because simple theory predicts this optical thickening with warming, and cloud amount changes are relatively small, we conclude that the shortwave cloud feedback is very likely negative in the real world at middle to high latitudes.