How much can we save? Impact of different emission scenarios on future snow cover in the Alps

This study focuses on an assessment of the future snow depth for two larger Alpine catchments. Automatic weather station data from two diverse regions in the Swiss Alps have been used as input for the Alpine3D surface process model to compute the snow cover at a 200m horizontal resolution for the reference period (1999-2012). Future temperature and precipitation changes have been computed from 20 downscaled GCM-RCM chains for three different emission scenarios, including one intervention scenario (2 degrees C target) and for three future time periods (2020-2049, 20452074, 2070-2099). By applying simple daily change values to measured time series of temperature and precipitation, small-scale climate scenarios have been calculated for the median estimate and extreme changes. The projections reveal a decrease in snow depth for all elevations, time periods and emission scenarios. The non-intervention scenarios demonstrate a decrease of about 50% even for elevations above 3000 m. The most affected elevation zone for climate change is located below 1200 m, where the simulations show almost no snow towards the end of the century. Depending on the emission scenario and elevation zone the winter season starts half a month to 1 month later and ends 1 to 3 months earlier in this last scenario period. The resulting snow cover changes may be roughly equivalent to an elevation shift of 500-800 or 700-1000m for the two non-intervention emission scenarios. At the end of the century the number of snow days may be more than halved at an elevation of around 1500m and only 0-2 snow days are predicted in the lowlands. The results for the intervention scenario reveal no differences for the first scenario period but clearly demonstrate a stabilization there-after, comprising much lower snow cover reductions towards the end of the century (ca. 30% instead of 70 %)

Top ten tips palliative care clinicians should know about prognostication in children

Pediatric palliative care (PPC) is different from palliative care (PC) for adults. However, conceptualizing PPC remains cumbersome due to the high heterogeneity of often rare diseases, the high diversity of disease trajectories, and the particular difficulty to predict the future of an individual, severely ill child. This article aims to provide an overview and critical reflection of different aspects of prognostication in children with PC needs. This includes different diseases from neurology to oncology, from the unborn baby to the young adult, new approaches in treatment, advance care planning, and, most important, communication with the affected child as well as parents

Top ten tips palliative care clinicians should know about cachexia

Cachexia is a multifactorial syndrome that is common in cancer and chronic disease. It is often underdiagnosed and therefore goes untreated or undertreated. Cachexia causes suffering across biopsychosocial domains and affects patients and their loved ones. In this article, a group of clinicians and researchers across cancer care, nutrition, and exercise offers tips about assessment, classification, and management of cachexia, with attention to its stage. The required multimodal management of cachexia mirrors well the interprofessional collaboration that is the mainstay of interdisciplinary palliative care and attention to screening, diagnosis, and management of cachexia is critical to maximize patients' quality of life

Physical Activity and Exercise for the Prevention and Management of Mild Cognitive Impairment and Dementia: A Collaborative International Guideline

Background: Physical activity and exercise have been suggested as effective interventions for the prevention and management of mild cognitive impairment (MCI) and dementia, but there are no international guidelines. Objectives: To create a set of evidence- and expert consensus-based prevention and management recommendations regarding physical activity (any bodily movement produced by skeletal muscles that results in energy expenditure) and exercise (a subset of physical activity that is planned, structured, repetitive), applicable to a range of individuals from healthy older adults to those with MCI/dementia.  Methods: Guideline content was developed with input from several scientific and lay representatives’ societies. A systematic search across multidisciplinary databases was carried out until October 2021. Recommendations for prevention and management were developed according to the GRADE and complemented by consensus statements from the expert panels. Recommendations: Physical activity may be considered for the primary prevention of dementia. In people with MCI there is continued uncertainty about the role of physical activity in slowing the conversion to dementia. Mind-body interventions have the greatest supporting evidence. In people with moderate dementia, exercise may be used for maintaining disability and cognition. All these recommendations were based on a very low/low certainty of evidence. Conclusions:  Although the scientific evidence on the beneficial role of physical activity and exercise in preserving cognitive functions in subjects with normal cognition, MCI or dementia is inconclusive, this panel, composed of scientific societies and other stakeholders, recommends their implementation based on their beneficial effects on almost all facets of health. </p