Summer heat waves over western Europe 1880-2003, their relationship to large-scale forcings and predictability

We investigate the large-scale forcing and teleconnections between atmospheric circulation (sea level pressure, SLP), sea surface temperatures (SSTs), precipitation and heat wave events over western Europe using a new dataset of 54 daily maximum temperature time series. Forty four of these time series have been homogenised at the daily timescale to ensure that the presence of inhomogeneities has been minimised. The daily data have been used to create a seasonal index of the number of heat waves. Using canonical correlation analysis (CCA), heat waves over western Europe are shown to be related to anomalous high pressure over Scandinavia and central western Europe. Other forcing factors such as Atlantic SSTs and European precipitation, the later as a proxy for soil moisture, a known factor in strengthening land-atmosphere feedback processes, are also important. The strength of the relationship between summer SLP anomalies and heat waves is improved (from 35%) to account for around 46% of its variability when summer Atlantic and Mediterranean SSTs and summer European precipitation anomalies are included as predictors. This indicates that these predictors are not completely collinear rather that they each have some contribution to accounting for summer heat wave variability. However, the simplicity and scale of the statistical analysis masks this complex interaction between variables. There is some useful predictive skill of summer heat waves using multiple lagged predictors. A CCA using preceding winter North Atlantic SSTs and preceding January to May Mediterranean total precipitation results in significant hindcast (1972-2003) Spearman rank correlation skill scores up to 0.55 with an average skill score over the domain equal to 0.28±0.28. In agreement with previous studies focused on mean summer temperature, there appears to be some predictability of heat wave events on the decadal scale from the Atlantic Multidecadal Oscillation (AMO), although the long-term global mean temperature is also well related to western European heat waves. Combining these results with the observed positive trends in summer continental European SLP, North Atlantic SSTs and indications of a decline in European summer precipitation then possibly these long-term changes are also related to increased heat wave occurrence and it is important that the physical processes controlling these changes be more fully understoo

Endotenon-Derived Type II Tendon Stem Cells Have Enhanced Proliferative and Tenogenic Potential

Funding This project received funding from the European Union’s Horizon 2020 Research and Innovation Program under the Marie Skłodowska-Curie grant agreement, No. 955685. This research also received funding support from the Engineering and Physical Sciences Research Council (EPSRC) Centre for Doctoral Training in Regenerative Medicine (EP/L015072/1).Peer reviewedPublisher PD

Climate change adaptation in European river basins

This paper contains an assessment and standardized comparative analysis of the current water management regimes in four case-studies in three European river basins: the Hungarian part of the Upper Tisza, the Ukrainian part of the Upper Tisza (also called Zacarpathian Tisza), Alentejo Region (including the Alqueva Reservoir) in the Lower Guadiana in Portugal, and Rivierenland in the Netherlands. The analysis comprises several regime elements considered to be important in adaptive and integrated water management: agency, awareness raising and education, type of governance and cooperation structures, information management and—exchange, policy development and—implementation, risk management, and finances and cost recovery. This comparative analysis has an explorative character intended to identify general patterns in adaptive and integrated water management and to determine its role in coping with the impacts of climate change on floods and droughts. The results show that there is a strong interdependence of the elements within a water management regime, and as such this interdependence is a stabilizing factor in current management regimes. For example, this research provides evidence that a lack of joint/participative knowledge is an important obstacle for cooperation, or vice versa. We argue that there is a two-way relationship between information management and collaboration. Moreover, this research suggests that bottom-up governance is not a straightforward solution to water management problems in large-scale, complex, multiple-use systems, such as river basins. Instead, all the regimes being analyzed are in a process of finding a balance between bottom-up and top–down governance. Finally, this research shows that in a basin where one type of extreme is dominant—like droughts in the Alentejo (Portugal) and floods in Rivierenland (Netherlands)—the potential impacts of other extremes are somehow ignored or not perceived with the urgency they might deserv

Wind gust estimation for Mid-European winter storms: towards a probabilistic view

Three wind gust estimation (WGE) methods implemented in the numerical weather prediction (NWP) model COSMO-CLM are evaluated with respect to their forecast quality using skill scores. Two methods estimate gusts locally from mean wind speed and the turbulence state of the atmosphere, while the third one considers the mixing-down of high momentum within the planetary boundary layer (WGE Brasseur). One hundred and fifty-eight windstorms from the last four decades are simulated and results are compared with gust observations at 37 stations in Germany. Skill scores reveal that the local WGE methods show an overall better behaviour, whilst WGE Brasseur performs less well except for mountain regions. The here introduced WGE turbulent kinetic energy (TKE) permits a probabilistic interpretation using statistical characteristics of gusts at observational sites for an assessment of uncertainty. The WGE TKE formulation has the advantage of a ‘native’ interpretation of wind gusts as result of local appearance of TKE. The inclusion of a probabilistic WGE TKE approach in NWP models has, thus, several advantages over other methods, as it has the potential for an estimation of uncertainties of gusts at observational sites

P499: APPLICABILITY OF 2022 CLASSIFICATIONS OF ACUTE MYELOID LEUKEMIA IN THE REAL-WORLD SETTING

Background: The increasing knowledge of molecular characterization in acute myeloid leukemia (AML) led to the necessity to fully evaluate the genetic profile also for clinical purposes. These efforts resulted in the release of 2022 new editions of AML classification and prognostication systems, including the 5th edition of The World Health Organization (WHO) classification, the International Consensus Classification (ICC), and the European LeukemiaNet (ELN) recommendations for AML prognosis. Aims: We aimed to provide a real-world application of the WHO 2022, ICC and ELN 2022 classifications in the real-world setting, to unravel differences and similarities, and to test their implementation in clinical AML diagnosis. We particularly focused on secondary AML, myelodysplasia (MDS) related. Methods: We selected a cohort of 1001 cases diagnosed with AML according to the WHO 2016 and the ELN 2017 classifications. Where available (44.9% of cases), information concerning a previous history of an antecedent MDS or MDS/Myeloproliferative neoplasm (MPN), as well as a previous exposure to cytotoxic therapies were considered for defining secondary AML (s-AML) and therapy-related AML (t-AML), respectively. Survival outcome was available for 84.4% patients. Results: The overall diagnostic changes between the WHO 2016, compared to WHO 2022 and ICC classifications were 22.8% and 23.7% respectively, with a 13.1% difference in patients’ distribution between ICC and WHO 2022. The “not otherwise specified” (NOS) by ICC and “defined by differentiation” by WHO 2022 categories shrank compared to WHO 2016 (24.1% and 26.8% respectively, vs 38.7%), particularly due to an expansion of MDS-related categories. The 92.7% and the 74.4% of RUNX1-mutated AML were re-classified respectively by the ICC into AML with MDS-related gene mutations and by WHO 2022 into the AML myelodysplasia related (MR) category, although the latter considers RUNX1 mutations lacking of sufficient unifying characteristics. Of 397 cases with a MDS-related AML according to ICC, 55.9% were definable by the presence of a MDS-related karyotype. More than 75.0% of s-AML and t-AML cases presented a MDS-related genetic profile according to both new 2022 diagnostic classifications. The overall re-stratification between ELN 2017 and 2022 accounted for 12.9% (4.0% favorable to intermediate and 8.1% intermediate to adverse risk). The majority of s-AML and t-AML (83.1%) fell into the ELN 2022 adverse risk group. Stratifying the 213 AML classified as favorable risk by ELN 2017, the difference in OS between ELN 2022-defined favorable and intermediate risk groups was statistically significant (p<0.01). We also focused on the heterogeneous group of patients with normal karyotype and adverse risk mutations according to the ELN 2022: the survival outcome was significantly inferior in patients with multiple versus single MDS-related gene mutations (p<0.05). Summary/Conclusion: The 2022 revisions of AML classification led to a significant improvement of diagnostic schemes. In the real-world setting, conventional cytogenetics, usually easily available and less expensive than molecular characterization, correctly stratified 56% of AML MDS-related, thereby maintaining a diriment diagnostic role. Although the secondary nature of AML (prior MDS or MDS/MPN and therapy-related) is now applied as “diagnostic qualifiers”, it maintains a predictive role for defining an adverse outcome according to the ELN 2022. Considering the similarities between WHO and ICC diagnostic schemes, a tentative to generate a unified model taking into account practical and socio-economic issues is desirable

Mediterranean cyclones and windstorms in a changing climate

Changes in the frequency and intensity of cyclones and associated windstorms affecting the Medi-terranean region simulated under enhanced Greenhouse Gas forcing conditions are investigated. The analysis is based on 7 climate model integrations performed with two coupled global models (ECHAM5 MPIOM and INGV CMCC), comparing the end of the twentieth century and at least the first half of the twenty-first century. As one of the models has a considerably enhanced resolution of the atmosphere and the ocean, it is also investigated whether the climate change signals are influenced by the model resolution. While the higher resolved simulation is closer to reanalysis climatology, both in terms of cyclones and windstorm distributions, there is no evidence for an influence of the resolution on the sign of the climate change signal. All model simulations show a reduction in the total number of cyclones crossing the Mediterranean region under climate change conditions. Exceptions are Morocco and the Levant region, where the models predict an increase in the number of cyclones. The reduction is especially strong for intense cyclones in terms of their Laplacian of pressure. The influence of the simulated positive shift in the NAO Index on the cyclone decrease is restricted to the Western Mediterranean region, where it explains 10–50 % of the simulated trend, depending on the individual simulation. With respect to windstorms, decreases are simulated over most of the Mediterranean basin. This overall reduction is due to a decrease in the number of events associated with local cyclones, while the number of events associated with cyclones outside of the Mediterranean region slightly increases. These systems are, however, less intense in terms of their integrated severity over the Mediterranean area, as they mostly affect the fringes of the region. In spite of the general reduction in total numbers, several cyclones and windstorms of intensity unknown under current climate conditions are identified for the scenario simulations. For these events, no common trend exists in the individual simulations. Thus, they may rather be attributed to long-term (e.g. decadal) variability than to the Greenhouse Gas forcing. Nevertheless, the result indicates that high-impact weather systems will remain an important risk in the Mediterranean Basin

Development of a wind gust model to estimate gust speeds and their return periods

Spatially dense observations of gust speeds are necessary for various applications, but their availability is limited in space and time. This work presents an approach to help to overcome this problem. The main objective is the generation of synthetic wind gust velocities. With this aim, theoretical wind and gust distributions are estimated from 10 yr of hourly observations collected at 123 synoptic weather stations provided by the German Weather Service. As pre-processing, an exposure correction is applied on measurements of the mean wind velocity to reduce the influence of local urban and topographic effects. The wind gust model is built as a transfer function between distribution parameters of wind and gust velocities. The aim of this procedure is to estimate the parameters of gusts at stations where only wind speed data is available. These parameters can be used to generate synthetic gusts, which can improve the accuracy of return periods at test sites with a lack of observations. The second objective is to determine return periods much longer than the nominal length of the original time series by considering extreme value statistics. Estimates for both local maximum return periods and average return periods for single historical events are provided. The comparison of maximum and average return periods shows that even storms with short average return periods may lead to local wind gusts with return periods of several decades. Despite uncertainties caused by the short length of the observational records, the method leads to consistent results, enabling a wide range of possible applications

Extreme energetic electron fluxes in low Earth orbit: Analysis of POES E > 30, E > 100 and E > 300 keV electrons

Energetic electrons are an important space weather hazard. Electrons with energies less than about 100 keV cause surface charging while higher energy electrons can penetrate materials and cause internal charging. In this study we conduct an extreme value analysis of the maximum 3-hourly flux of E> 30 keV, E> 100 keV and E> 300 keV electrons in low Earth orbit as a function of L∗, for geomagnetic field lines that map to the outer radiation belt, using data from the National Oceanic and Atmospheric Administration (NOAA) Polar Operational Environmental Satellites (POES) from July 1998 to June 2014. The 1 in 10 year flux of E> 30 keV electrons shows a general increasing trend with distance ranging from 1.8×107 cm−2s−1sr−1 at L∗ = 3.0 to 6.6×107 cm−2s−1sr−1 at L∗ = 8.0. The 1 in 10 year flux of E> 100 keV electrons peaks at L∗= 4.5 - 5.0 at 1.9×107 cm−2s−1sr−1 decreasing to minima of 7.1×106 and 8.7×106 cm−2s−1sr−1 at L∗ = 3.0 and 8.0 respectively. In contrast to the E> 30 keV electrons, the 1 in 10 year flux of E> 300 keV electrons shows a general decreasing trend with distance, ranging from 2.4×106 cm−2s−1sr−1 at L∗ = 3.0 to 1.2×105 cm−2s−1sr−1 at L∗= 8.0. Our analysis suggests that there is a limit to the E> 30 keV electrons with an upper bound in the range 5.1×107- 8.8×107 cm−2s−1sr−1. However, the results suggest that there is no upper bound for the E> 100 keV and E> 300 keV electrons

Health burden and economic impact of measles-related hospitalizations in Italy in 2002–2003

Background: A large measles outbreak occurred in Italy in 2002 - 2003. This study evaluates the health burden and economic impact of measles- related hospitalizations in Italy during the specified period. Methods: Hospital discharge abstract data for measles hospitalizations in Italy during 2002 - 2003 were analysed to obtain information regarding number and rates of measles hospitalizations by geographical area and age group, length of hospital stay, and complications. Hospitalization costs were estimated on the basis of Diagnosis- Related Groups. Results: A total of 5,154 hospitalizations were identified, 3,478 ( 67%) of which occurred in children < 15 years of age. Most hospitalizations occurred in southern Italy ( 71 %) and children below 1 year of age presented the greatest hospitalization rates ( 46.2/ 100,000 and 19.0/ 100,000, respectively in 2002 and 2003). Pneumonia was diagnosed in 594 cases ( 11.5%) and encephalitis in 138 cases ( 2.7%). Total hospital charges were approximately (sic) 8.8 million. Conclusion: The nationwide health burden associated with measles during the 2002 - 2003 outbreak was substantial and a high cost was incurred by the Italian National Health Service for the thousands of measles- related hospitalizations which occurred. By assuming that hospital costs represent 40 - 50% of the direct costs of measles cases, direct costs of measles for the two years combined were estimated to be between (sic)17.6 - 22.0 million, which equates to the vaccination of 1.5 - 1.9 million children ( 3 - 4 birth cohorts) with one dose of MMR. The high cost of measles and the severity of its complications fully justify the commitment required to reach measles elimination