Future heat extremes and impacts in a convection permitting climate ensemble over Germany

Heat extremes and associated impacts are considered the most pressing issue for German regional governments with respect to climate adaptation. We explore the potential of an unique high-resolution convection permitting (2.8 km), multi-GCM ensemble with COSMO-CLM regional simulations (1971&ndash;2100) over Germany regarding heat extremes and related impacts. We find an improved mean temperature beyond the effect of a better representation of orography on the convection permitting scale, with reduced bias particularly during summer. The projected increase in temperature and its variance favors the development of longer and hotter heat waves, especially in late summer and early autumn. In a 2&deg; (3&deg;) warmer world, a 26 % (100 %) increase in the Heat Wave Magnitude Index is anticipated. Human heat stress (UTCI &gt; 32&deg;C) and local-specific parameters tailored to climate adaptation, revealed a dependency on the major landscapes, resulting in significant higher heat exposure in flat regions as the Rhine Valley, accompanied by the strongest absolute increase. A non-linear, exponential increase is anticipated for parameters characterizing strong heat stress (UTCI &gt; 32&deg;C, tropical nights, very hot days). Providing local-specific and tailored climate information, we demonstrate the potential of convection permitting simulations to facilitate improved impact studies and narrow the gap between climate modelling and stakeholder requirements for climate adaptation.</p

Skill and added value of the MiKlip regional decadal prediction system for temperature over Europe

In recent years, several decadal prediction systems have been developed to provide multi-year predictions of the climate for the next 5–10 years. On the global scale, high decadal predictability has been identified for the North Atlantic sector, often extending over Europe. The first full regional hindcast ensemble, derived from dynamical downscaling, was produced within the German MiKlip project (‘decadal predictions’). The ensemble features annual starting dates from 1960 to 2017, with 10 decadal hindcasts per starting year. The global component of the prediction system uses the MPI-ESM-LR and the downscaling is performed with the regional climate model COSMO-CLM (CCLM). The present study focusses on a range of aspects dealing with the skill and added value of regional decadal temperature predictions over Europe. The results substantiate the added value of the regional hindcasts compared to the forcing global model as well as to un-initialized simulations. The results show that the hindcasts are skilful both for annual and seasonal means, and that the scores are comparable for different observational reference data sets. The predictive skill increases from earlier to more recent start-years. A recalibration of the simulation data generally improves the skill further, which can also be transferred to more user-relevant variables and extreme values like daily maximum temperatures and heating degree-days. These results provide evidence of the potential for the regional climate predictions to provide valuable climate information on the Abstract Formulae display:MathJax Logo? In recent years, several decadal prediction systems have been developed to provide multi-year predictions of the climate for the next 5–10 years. On the global scale, high decadal predictability has been identified for the North Atlantic sector, often extending over Europe. The first full regional hindcast ensemble, derived from dynamical downscaling, was produced within the German MiKlip project (‘decadal predictions’). The ensemble features annual starting dates from 1960 to 2017, with 10 decadal hindcasts per starting year. The global component of the prediction system uses the MPI-ESM-LR and the downscaling is performed with the regional climate model COSMO-CLM (CCLM). The present study focusses on a range of aspects dealing with the skill and added value of regional decadal temperature predictions over Europe. The results substantiate the added value of the regional hindcasts compared to the forcing global model as well as to un-initialized simulations. The results show that the hindcasts are skilful both for annual and seasonal means, and that the scores are comparable for different observational reference data sets. The predictive skill increases from earlier to more recent start-years. A recalibration of the simulation data generally improves the skill further, which can also be transferred to more user-relevant variables and extreme values like daily maximum temperatures and heating degree-days. These results provide evidence of the potential for the regional climate predictions to provide valuable climate information on the decadal time-scale to users

The regional MiKlip decadal prediction system for Europe: Hindcast skill for extremes and user‐oriented variables

Regional climate predictions for the next decade are gaining importance, as this period falls within the planning horizon of politics, economy, and society. The potential predictability of climate indices or extremes at the regional scale is of particular interest. The German MiKlip project (“mid‐term climate forecast”) developed the first regional decadal prediction system for Europe at 0.44° resolution, based on the regional model COSMO‐CLM using global MPI‐ESM simulations as boundary conditions. We analyse the skill of this regional system focussing on extremes and user‐oriented variables. The considered quantities are related to temperature extremes, heavy precipitation, wind impacts, and the agronomy sector. Variables related to temperature (e.g., frost days, heat wave days) show high predictive skill (anomaly correlation up to 0.9) with very little dependence on lead‐time, and the skill patterns are spatially robust. The skill patterns for precipitation‐related variables (e.g., heavy precipitation days) and wind‐based indices (like storm days) are less skilful and more heterogeneous, particularly for the latter. Quantities related to the agronomy sector (e.g., growing degree days) show high predictive skill, comparable to temperature. Overall, we provide evidence that decadal predictive skill can be generally found at the regional scale also for extremes and user‐oriented variables, demonstrating how the utility of decadal predictions can be substantially enhanced. This is a very promising first step towards impact‐related modelling at the regional scale and the development of individual user‐oriented products for stakeholders.The skill of the regional MiKlip decadal prediction system is analysed focussing on extremes and user‐oriented variables. Variables related to temperature extremes and the agronomy sector show high predictive skill with very little dependence on lead‐time. Skill patterns for precipitation‐related variables and wind‐based indices are less skilful and more heterogeneous, especially for the latter.The study was mainly funded by the Bundesministerium für Bildung und Forschung (BMBF) under project FONA MiKlip‐II http://dx.doi.org/10.13039/501100002347AXA Research Fund http://dx.doi.org/10.13039/50110000196

Health-status outcomes with invasive or conservative care in coronary disease

BACKGROUND In the ISCHEMIA trial, an invasive strategy with angiographic assessment and revascularization did not reduce clinical events among patients with stable ischemic heart disease and moderate or severe ischemia. A secondary objective of the trial was to assess angina-related health status among these patients. METHODS We assessed angina-related symptoms, function, and quality of life with the Seattle Angina Questionnaire (SAQ) at randomization, at months 1.5, 3, and 6, and every 6 months thereafter in participants who had been randomly assigned to an invasive treatment strategy (2295 participants) or a conservative strategy (2322). Mixed-effects cumulative probability models within a Bayesian framework were used to estimate differences between the treatment groups. The primary outcome of this health-status analysis was the SAQ summary score (scores range from 0 to 100, with higher scores indicating better health status). All analyses were performed in the overall population and according to baseline angina frequency. RESULTS At baseline, 35% of patients reported having no angina in the previous month. SAQ summary scores increased in both treatment groups, with increases at 3, 12, and 36 months that were 4.1 points (95% credible interval, 3.2 to 5.0), 4.2 points (95% credible interval, 3.3 to 5.1), and 2.9 points (95% credible interval, 2.2 to 3.7) higher with the invasive strategy than with the conservative strategy. Differences were larger among participants who had more frequent angina at baseline (8.5 vs. 0.1 points at 3 months and 5.3 vs. 1.2 points at 36 months among participants with daily or weekly angina as compared with no angina). CONCLUSIONS In the overall trial population with moderate or severe ischemia, which included 35% of participants without angina at baseline, patients randomly assigned to the invasive strategy had greater improvement in angina-related health status than those assigned to the conservative strategy. The modest mean differences favoring the invasive strategy in the overall group reflected minimal differences among asymptomatic patients and larger differences among patients who had had angina at baseline

Initial invasive or conservative strategy for stable coronary disease

BACKGROUND Among patients with stable coronary disease and moderate or severe ischemia, whether clinical outcomes are better in those who receive an invasive intervention plus medical therapy than in those who receive medical therapy alone is uncertain. METHODS We randomly assigned 5179 patients with moderate or severe ischemia to an initial invasive strategy (angiography and revascularization when feasible) and medical therapy or to an initial conservative strategy of medical therapy alone and angiography if medical therapy failed. The primary outcome was a composite of death from cardiovascular causes, myocardial infarction, or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest. A key secondary outcome was death from cardiovascular causes or myocardial infarction. RESULTS Over a median of 3.2 years, 318 primary outcome events occurred in the invasive-strategy group and 352 occurred in the conservative-strategy group. At 6 months, the cumulative event rate was 5.3% in the invasive-strategy group and 3.4% in the conservative-strategy group (difference, 1.9 percentage points; 95% confidence interval [CI], 0.8 to 3.0); at 5 years, the cumulative event rate was 16.4% and 18.2%, respectively (difference, 121.8 percentage points; 95% CI, 124.7 to 1.0). Results were similar with respect to the key secondary outcome. The incidence of the primary outcome was sensitive to the definition of myocardial infarction; a secondary analysis yielded more procedural myocardial infarctions of uncertain clinical importance. There were 145 deaths in the invasive-strategy group and 144 deaths in the conservative-strategy group (hazard ratio, 1.05; 95% CI, 0.83 to 1.32). CONCLUSIONS Among patients with stable coronary disease and moderate or severe ischemia, we did not find evidence that an initial invasive strategy, as compared with an initial conservative strategy, reduced the risk of ischemic cardiovascular events or death from any cause over a median of 3.2 years. The trial findings were sensitive to the definition of myocardial infarction that was used