How to provide actionable information on weather and climate impacts?–A summary of strategic, methodological, and technical perspectives

Climate change will result in more intense and more frequent weather and climate events that will continue to cause fatalities, economic damages and other adverse societal impacts worldwide. To mitigate these consequences and to support better informed decisions and improved actions and responses, many National Meteorological and Hydrological Services (NMHSs) are discussing how to provide services on weather and climate impacts as part of their operational routines. The authors outline how a risk framework can support the development of these services by NMHSs. In addition to the hazard information, a risk perspective considers the propensity for a given hazard to inflict adverse consequences on society and environment, and attempts to quantify the uncertainties involved. The relevant strategic, methodological and technical steps are summarized and recommendations for the development of impact-related services are provided. Specifically, we propose that NMHSs adopt an integrated risk framework that incorporates a hazard-exposure-vulnerability model into operational services. Such a framework integrates all existing forecast and impact services, including the underlying impact models, and allows for flexible future extensions driven by the evolving collaboration with partners, stakeholders and users. Thereby, this paper attempts to unify existing work streams on impact-related services from different spatial and temporal scales (weather, climate) and disciplines (hydrology, meteorology, economics, social sciences) and to propose a harmonized approach that can create synergies within and across NMHSs to further develop and enhance risk-based services

How to provide actionable information on weather and climate impacts?-A summary of strategic, methodological, and technical perspectives

Climate change will result in more intense and more frequent weather and climate events that will continue to cause fatalities, economic damages and other adverse societal impacts worldwide. To mitigate these consequences and to support better informed decisions and improved actions and responses, many National Meteorological and Hydrological Services (NMHSs) are discussing how to provide services on weather and climate impacts as part of their operational routines. The authors outline how a risk framework can support the development of these services by NMHSs. In addition to the hazard information, a risk perspective considers the propensity for a given hazard to inflict adverse consequences on society and environment, and attempts to quantify the uncertainties involved. The relevant strategic, methodological and technical steps are summarized and recommendations for the development of impact-related services are provided. Specifically, we propose that NMHSs adopt an integrated risk framework that incorporates a hazard-exposure-vulnerability model into operational services. Such a framework integrates all existing forecast and impact services, including the underlying impact models, and allows for flexible future extensions driven by the evolving collaboration with partners, stakeholders and users. Thereby, this paper attempts to unify existing work streams on impact-related services from different spatial and temporal scales (weather, climate) and disciplines (hydrology, meteorology, economics, social sciences) and to propose a harmonized approach that can create synergies within and across NMHSs to further develop and enhance risk-based services.ISSN:2624-955

Telemedicine Versus Standard Follow-Up Care for Diabetes-Related Foot Ulcers: Protocol for a Cluster Randomized Controlled Noninferiority Trial (DiaFOTo)

Background: This paper presents the protocol for an ongoing study to evaluate a telemedicine follow-up intervention for patients with diabetes-related foot ulcers. Diabetes-related foot ulcers represent challenges for patients and the health services. The large increase in the prevalence of diabetes, combined with the aging population, means that the absolute number of patients with diabetes-related foot ulcers is likely to continue to increase. Health care services therefore need to provide close clinical follow-up care for people with diabetes both in primary and specialist care. Information and communication technologies may enable more integrated treatment and care pathways across organizational boundaries. However, we lack knowledge about the effect of telemedicine follow-up and how such services can be optimally organized. Objective: To present the design and methods of a study evaluating a telemedicine follow-up intervention for patients with diabetes-related foot ulcers. Methods: The study is designed as a cluster randomized controlled trial (noninferiority trial) involving municipalities or municipality districts (clusters) belonging to one clinical site in Western Norway. The study includes patients with type 1 and type 2 diabetes presenting with a new foot ulcer at the initial visit to the clinic. Patients in the intervention group receive telemedicine follow-up care in the community. The key ingredient in the intervention is the close integration between health care levels. The intervention is facilitated by the use of an interactive wound platform consisting of a Web-based ulcer record combined with a mobile phone, enabling counseling and communication between nurses in the community and specialist health care. Patients in the control group receive standard hospital outpatient care. The primary endpoint in the trial is healing time; secondary outcomes include amputation and death, patient-reported outcome measures, and follow-up data on the recurrence of foot ulcers. In addition, qualitative substudies are being performed to provide a more comprehensive evaluation of the ongoing processes during the trial with the patients in the intervention and control groups and those health care professionals either working in primary care or in specialist care delivering the intervention. Results: The project has been funded. The inclusion of patients started in September 2012. Because recruitment goals were not met in the initial period, two more clinical sites have been included to meet sample size requirements. Patient recruitment will continue until June 2016. Data collection in the qualitative substudies has been completed. Conclusions: This telemedicine trial operates in a novel setting and targets patients with diabetes-related foot ulcers during a 12-month follow-up period. The trial addresses whether integrated care using telemedicine between primary and specialist health care can be an equivalent alternative to standard outpatient care

Association of polygenic risk scores, traumatic life events and coping strategies with war-related PTSD diagnosis and symptom severity in the South Eastern Europe (SEE)-PTSD cohort

Objectives Posttraumatic stress disorder (PTSD) is triggered by extremely stressful environmental events and characterized by high emotional distress, re-experiencing of trauma, avoidance and hypervigilance. The present study uses polygenic risk scores (PRS) derived from the UK Biobank (UKBB) mega-cohort analysis as part of the PGC PTSD GWAS effort to determine the heritable basis of PTSD in the South Eastern Europe (SEE)-PTSD cohort. We further analyzed the relation between PRS and additional disease-related variables, such as number and intensity of life events, coping, sex and age at war on PTSD and CAPS as outcome variables. Methods Association of PRS, number and intensity of life events, coping, sex and age on PTSD were calculated using logistic regression in a total of 321 subjects with current and remitted PTSD and 337 controls previously subjected to traumatic events but not having PTSD. In addition, PRS and other disease-related variables were tested for association with PTSD symptom severity, measured by the Clinician Administrated PTSD Scale (CAPS) by liner regression. To assess the relationship between the main outcomes PTSD diagnosis and symptom severity, each of the examined variables was adjusted for all other PTSD related variables. Results The categorical analysis showed significant polygenic risk in patients with remitted PTSD and the total sample, whereas no effects were found on symptom severity. Intensity of life events as well as the individual coping style were significantly associated with PTSD diagnosis in both current and remitted cases. The dimensional analyses showed as association of war-related frequency of trauma with symptom severity, whereas the intensity of trauma yielded significant results independently of trauma timing in current PTSD. Conclusions The present PRS application in the SEE-PTSD cohort confirms modest but significant polygenic risk for PTSD diagnosis. Environmental factors, mainly the intensity of traumatic life events and negative coping strategies, yielded associations with PTSD both categorically and dimensionally with more significant p-values. This suggests that, at least in the present cohort of war-related trauma, the association of environmental factors and current individual coping strategies with PTSD psychopathology was stronger than the polygenic risk