Was the cold European winter 2009-2010 modified by anthropogenic climate change? An attribution study

An attribution study has been performed to investigate the degree to which the unusually cold European winter 2009-2010 was modified by anthropogenic climate change. Two different methods have been included for the attribution: one based on a large HadGEM3-A ensemble and one based on a statistical surrogate method. Both methods are evaluated by comparing simulated winter temperature means, trends, standard deviations, skewness, return periods, and 5 % quantiles with observations. While the surrogate method performs well, HadGEM3-A in general underestimates the trend in winter by a factor of 2/3. It has a mean cold bias dominated by the mountainous regions and also underestimates the cold 5 % quantile in many regions of Europe. Both methods show that the probability of experiencing a winter as cold as 2009-2010 has been reduced by approximately a factor of two due to anthropogenic changes. The method based on HadGEM3-A ensembles gives somewhat larger changes than the surrogate method because of differences in the definition of the unperturbed climate. The results are based on two diagnostics: the coldest day in winter and the largest continuous area with temperatures colder than twice the local standard deviation. The results are not sensitive to the choice of bias correction except in the mountainous regions. Previous results regarding the behavior of the measures of the changed probability have been extended. The counter-intuitive behavior for heavy-tailed distributions is found to hold for a range of measures and for events that become more rare in a changed climate

Evaluation of the HadGEM3-A simulations in view of detection and attribution of human influence on extreme events in Europe

A detailed analysis is carried out to assess the HadGEM3-A global atmospheric model skill in simulating extreme temperatures, precipitation and storm surges in Europe in the view of their attribution to human influence. The analysis is performed based on an ensemble of 15 atmospheric simulations forced with observed Sea Surface Temperature of the 54 year period 1960-2013. These simulations, together with dual simulations without human influence in the forcing, are intended to be used in weather and climate event attribution. The analysis investigates the main processes leading to extreme events, including atmospheric circulation patterns, their links with temperature extremes, land-atmosphere and troposphere-stratosphere interactions. It also compares observed and simulated variability, trends and generalized extreme value theory parameters for temperature and precipitation. One of the most striking findings is the ability of the model to capture North Atlantic atmospheric weather regimes as obtained from a cluster analysis of sea level pressure fields. The model also reproduces the main observed weather patterns responsible for temperature and precipitation extreme events. However, biases are found in many physical processes. Slightly excessive drying may be the cause of an overestimated summer interannual variability and too intense heat waves, especially in central/northern Europe. However, this does not seem to hinder proper simulation of summer temperature trends. Cold extremes appear well simulated, as well as the underlying blocking frequency and stratosphere-troposphere interactions. Extreme precipitation amounts are overestimated and too variable. The atmospheric conditions leading to storm surges were also examined in the Baltics region. There, simulated weather conditions appear not to be leading to strong enough storm surges, but winds were found in very good agreement with reanalyses. The performance in reproducing atmospheric weather patterns indicates that biases mainly originate from local and regional physical processes. This makes local bias adjustment meaningful for climate change attribution

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

The serotonin receptor type 3 in chronic and experimental human muscle pain

The main aim of this thesis was to gain a better understanding of the influence of serotonin on chronic craniofacial muscle pain. The thesis comprised a basic science part and a human experimental part. The aim for the basic science part was to investigate if the expression of 5-HT3 receptors in muscle tissue differ between myalgic and healthy muscles and if sex or muscle site influence this expression. The aim for the human experimental part was to investigate if the specific 5-HT3 antagonist granisetron influences pain variables in patients with chronic craniofacial myalgia and experimental pain induced by hypertonic saline, as well as the mechanical pain threshold of healthy muscles. A second aim was to investigate if any effect by granisetron was influenced by sex, muscle site or route of administration, i.e. local or systemic. In the basic science part, patients with chronic local myalgia of the masseter muscle and age- and sexmatched healthy controls were examined clinically according to the Research Diagnostic Criteria for Temporomandibular Disorders. Traditional biopsies were taken intra-orally with a 4-mm Bergström needle from the most painful part of the masseter muscle in patients, and from a standardized point in the healthy controls. In order to compare if there were any differences in receptor expression due to sex or between muscles a microbiopsy technique was used to obtain masseter muscle and tibialis anterior muscle biopsies in healthy age-matched men and women. The patients were found to have a significantly higher amount of co-expressed 5-HT3A receptors and NaV1.8 sodium channels in the connective tissue compared to their healthy controls. This novel finding makes it presumable that in myalgic muscles proliferation of nociceptive nerve fibers occurs in the connective tissue surrounding the myocytes. Further, in healthy subjects, the co-expression of 5-HT3A receptors and NaV1.8 sodium channels in the masseter muscle was higher in women than in men. The tibialis anterior muscle expressed more 5-HT3A receptors than the masseter muscle. However, since these fibers did not co-express NaV1.8 sodium channels extensively, they are presumed being motor neurons. The first experimental part, investigating the effect of granisetron on the mechanical pain threshold, comprised both healthy men and age-matched women. Granisetron was administrated in a randomized, placebo-controlled and double-blind manner both systemically and locally by intramuscular injection. Sugar pills and isotonic saline served as placebo. The pressure pain threshold (PPT) was examined over the masseter, temporalis anterior, trapezius and tibialis anterior muscles before and after drug administration. The PPT of the masseter muscle increased significantly after local administration of granisetron and for all muscles combined after systemic administration. However, the increase of PPT was only significant over the trapezius and tibialis anterior muscles. Further, the PPT at baseline was significantly higher in the men and the increase of PPT after administration of granisetron was also only significant in the men. This blockage of the 5-HT3 receptors with granisetron seems to inhibit serotonin to excite and sensitize nociceptors, leading to a reduced sensitivity to mechanical stimuli. The second experimental part used a randomized, placebo-controlled and double-blind methodology to investigate how granisetron influences masseter muscle pain variables both in patients with chronic local myalgia, and in an experimental pain situation including sex- and age-matched healthy individuals. In the experimental pain situation injections with hypertonic saline were used to induce pain, followed by injections of granisetron or placebo as pre-treatment before a second pain induction with hypertonic saline. Granisetron significantly reduced both clinical and experimentally induced pain variables. The painful area was greater in the healthy women compared to the men before pre-treatment with granisetron. However, after pre-treatment with granisetron there were no significant sex differences in any pain variable. These findings indicate that 5-HT3 receptors play a significant role in pain transmission and pain modulation in human muscles, since granisetron diminishes experimentally hypertonic saline-induced pain and chronic myalgia of the masseter muscle. Conclusively, our novel findings that the 5-HT3 receptor is up-regulated in painful craniofacial muscles and that blocking of this receptor decreases clinical and experimental human muscle pain indicate that the 5-HT3 receptor has an important role in peripheral pain transmission in localized chronic muscle pain

Literacy as part of professional knowing in a Swedish dental education

BACKGROUND: Academic reading and writing are seen as self-evident literacy competences in most contemporary higher educations, however, whether students also are introduced to professional literacy of relevance for dentistry during their education is a question. The purpose of this study is to analyze one of the Swedish dental programmes, with respect to its design, in relation to possible content of relevance for academic and professional literacy. Secondarily, to identify and analyze Swedish dental students' writing in an academic setting, i.e. what these students are expected to read and write, and how they write. METHODS: Data, for this ethnographically inspired case-study, was produced by observations and audio-recordings of lectures, copies of teachers' handouts and of volunteering students' notes, and a multiple-choice-test. Data-analysis was made in five steps, starting with macro-level data, i.e. curriculum and syllabuses, followed by the syllabuses for the two observed modules, the teacher-provided material, analysis of the students' notes, while in the fifth and final step, the results from the previous steps were compared, to find patterns of what students were expected to read and write, and what in the teacher-provided multimodal material that was emphasized in teachers' talk. RESULTS: This study showed that students were engaged in several types of literacy events, such as reading, finding and watching videos on their learning platform, writing, and following instructions. The study also showed that there is a recurrent academic content comprised of anatomy, physiology and pathology, while the professional content comprised of patient communication and anamnesis. Further, an integrated content was found and was initiated in teacher-constructed PowerPoints and by student-questions. Note-taking patterns varied between individual students, but the general pattern for this group of students were the use of complementary notes. This type of note-taking was used to make available further descriptions of the teacher-constructed text in PowerPoints, but also an independent text describing pictures shown on teachers' PowerPoints or the blackboard. CONCLUSION: Findings from the present study reveal that students either copy text from teachers' PowerPoint-slides, re-formulate text from teachers' PowerPoint-slides, or write complementing text to teachers' PowerPoint-slides. Further, the students individually choses type of note-taking based on situation. The study also revealed that the academic literacy - in the two modules during the fifth and sixth semesters of a dental education analyzed - mainly has a professional basis for reading, writing, and communication purposes. The study also showed that academic and professional literacy are closely connected through recurrent integration

Early steps towards professional clinical note-taking in a Swedish study programme in dentistry

Background: Higher education tends to focus on academic writing only, instead of emphasizing that professional texts are also used as a basis for communication in contexts with a variety of participators. When it comes to clinical notes, research is scarce and focused on technology and informatics. Therefore, the aim was to explore dental students' clinical notes, and specifically which aspects of the clinical notes characterizes clinical notes that are not sufficient enough for professional purposes. Methods: The object of analysis was the student's written completion of a teacher constructed protocol regarding oral mucosa, the dental apparatus including pathology on tooth level, oral hygiene, and a validated international clinical examination protocol of the temporomandibular region. The study was framed within the New Literacy Studies approach, and the clinical notes were analyzed using thematic analysis. Results: Within the clinical notes three themes were identified; a) familiar content; b) familiar content in new context; and c) new content. The forms of notes could refer to either categorizational clinical notes or descriptive clinical notes. Most students were able to write acceptable clinical notes when the content was familiar, but as soon as the familiar content was in a new context the students had difficulties to write acceptable notes. When it comes to descriptive notes students suffered difficulties to write acceptable notes both when it came to familiar content, or familiar content in a new context. Conclusions: Taken together, the results indicate that students have difficulties writing acceptable notes when they are novices to the content or context, making their notes either insufficient, too short or even wrong for professional purposes. With this in mind, this study suggests that there is a need to strengthen the demands on sufficient professional quality in clinical notes and focus on clinical notes already in the early stages of the different medical educations

Operational attribution of weather and climate extremes: what next?

The science of event attribution has developed considerably in recent years. There is now a growing interest in making this science operational. This perspective considers the challenges involved in doing this and suggests some priorities for further developments. It concludes that there is a requirement to deepen understanding of user needs for operational attribution, that further research will be needed to enable attribution of a wider variety of extreme events and their impacts, that there will have to be a greater underpinning of operational capability for such activities to be achievable, and that improved strategies for communicating results are needed for successful uptake by users