Temporal and spatial assessment of four satellite rainfall estimates over French Guiana and North Brazil

Satellite precipitation products are a means of estimating rainfall, particularly in areas that are sparsely equipped with rain gauges. The Guiana Shield is a region vulnerable to high water episodes. Flood risk is enhanced by the concentration of population living along the main rivers. A good understanding of the regional hydro-climatic regime, as well as an accurate estimation of precipitation is therefore of great importance. Unfortunately, there are very few rain gauges available in the region. The objective of the study is then to compare satellite rainfall estimation products in order to complement the information available in situ and to perform a regional analysis of four operational precipitation estimates, by partitioning the whole area under study into a homogeneous hydro-climatic region. In this study, four satellite products have been tested, TRMM TMPA (Tropical Rainfall Measuring Mission Multisatellite Precipitation Analysis) V7 (Version 7) and RT (real time), CMORPH (Climate Prediction Center (CPC) MORPHing technique) and PERSIANN (Precipitation Estimation from Remotely-Sensed Information using Artificial Neural Network), for daily rain gauge data. Product performance is evaluated at daily and monthly scales based on various intensities and hydro-climatic regimes from 1 January 2001 to 30 December 2012 and using quantitative statistical criteria (coefficient correlation, bias, relative bias and root mean square error) and quantitative error metrics (probability of detection for rainy days and for no-rain days and the false alarm ratio). Over the entire study period, all products underestimate precipitation. The results obtained in terms of the hydro-climate show that for areas with intense convective precipitation, TMPA V7 shows a better performance than other products, especially in the estimation of extreme precipitation events. In regions along the Amazon, the use of PERSIANN is better. Finally, in the driest areas, TMPA V7 and PERSIANN show the same performance

The intensification of thermal extremes in west Africa

International audienceThis study aims in filling the gap in understanding the relationship between trend and extreme in diurnal and nocturnal temperatures (Tx and Tn) over the Gulf of Guinea area and the Sahel. Time-evolution and trend of Tx and Tn anomalies, extreme temperatures and heat waves are examined using regional and station-based indices over the 1900–2012 and 1950–2012 periods respectively. In investigating extreme temperature anomalies and heat waves, a percentile method is used. At the regional and local scales, rising trends in Tx and Tn anomalies, which appear more pronounced over the past 60 years, are identified over the two regions. The trends are characterized by an intensification of: i) nocturnal/Tn warming over the second half of the 20th century; and ii) diurnal/Tx warming over the post-1980s. This is the same scheme with extreme warm days and warm nights. Finally annual number of diurnal and nocturnal heat waves has increase over the Gulf of Guinea coastal regions over the second half of the 20th century, and even more substantially over the post-1980s period. Although this trend in extreme warm days and nights is always overestimated in the simulations, from the Coupled Model Intercomparison Project Phase 5 (CMIP5), those models display rising trends whatever the scenario, which are likely to be more and more pronounced over the two regions in the next 50 years

Are waiting times for hospital admissions affected by patients' choices and mobility?

Background Waiting times for elective care have been considered a serious problem in many health care systems. A topic of particular concern has been how administrative boundaries act as barriers to efficient patient flows. In Norway, a policy combining patient's choice of hospital and removal of restriction on referrals was introduced in 2001, thereby creating a nationwide competitive referral system for elective hospital treatment. The article aims to analyse if patient choice and an increased opportunity for geographical mobility has reduced waiting times for individual elective patients. Methods A survey conducted among Norwegian somatic patients in 2004 gave information about whether the choice of hospital was made by the individual patient or by others. Survey data was then merged with administrative data on which hospital that actually performed the treatment. The administrative data also gave individual waiting time for hospital admission. Demographics, socio-economic position, and medical need were controlled for to determine the effect of choice and mobility upon waiting time. Several statistical models, including one with instrument variables for choice and mobility, were run. Results Patients who had neither chosen hospital individually nor bypassed the local hospital for other reasons faced the longest waiting times. Next were patients who individually had chosen the local hospital, followed by patients who had not made an individual choice, but had bypassed the local hospital for other reasons. Patients who had made a choice to bypass the local hospitals waited on average 11 weeks less than the first group. Conclusion The analysis indicates that a policy combining increased opportunity for hospital choice with the removal of rules restricting referrals can reduce waiting times for individual elective patients. Results were robust over different model specifications

Integration of oncology and palliative care : a Lancet Oncology Commission

Full integration of oncology and palliative care relies on the specific knowledge and skills of two modes of care: the tumour-directed approach, the main focus of which is on treating the disease; and the host-directed approach, which focuses on the patient with the disease. This Commission addresses how to combine these two paradigms to achieve the best outcome of patient care. Randomised clinical trials on integration of oncology and palliative care point to health gains: improved survival and symptom control, less anxiety and depression, reduced use of futile chemotherapy at the end of life, improved family satisfaction and quality of life, and improved use of health-care resources. Early delivery of patient-directed care by specialist palliative care teams alongside tumour-directed treatment promotes patient-centred care. Systematic assessment and use of patient-reported outcomes and active patient involvement in the decisions about cancer care result in better symptom control, improved physical and mental health, and better use of health-care resources. The absence of international agreements on the content and standards of the organisation, education, and research of palliative care in oncology are major barriers to successful integration. Other barriers include the common misconception that palliative care is end-of-life care only, stigmatisation of death and dying, and insufficient infrastructure and funding. The absence of established priorities might also hinder integration more widely. This Commission proposes the use of standardised care pathways and multidisciplinary teams to promote integration of oncology and palliative care, and calls for changes at the system level to coordinate the activities of professionals, and for the development and implementation of new and improved education programmes, with the overall goal of improving patient care. Integration raises new research questions, all of which contribute to improved clinical care. When and how should palliative care be delivered? What is the optimal model for integrated care? What is the biological and clinical effect of living with advanced cancer for years after diagnosis? Successful integration must challenge the dualistic perspective of either the tumour or the host, and instead focus on a merged approach that places the patient's perspective at the centre. To succeed, integration must be anchored by management and policy makers at all levels of health care, followed by adequate resource allocation, a willingness to prioritise goals and needs, and sustained enthusiasm to help generate support for better integration. This integrated model must be reflected in international and national cancer plans, and be followed by developments of new care models, education and research programmes, all of which should be adapted to the specific cultural contexts within which they are situated. Patient-centred care should be an integrated part of oncology care independent of patient prognosis and treatment intention. To achieve this goal it must be based on changes in professional cultures and priorities in health care