In 1989, the need for reliable gridded land surface precipitation data sets, in view of the large uncertainties in the assessment of the global energy and water cycle, has led to the establishment of ...the Global Precipitation Climatology Centre (GPCC) at Deutscher Wetterdienst on invitation of the WMO. The GPCC has calculated a precipitation climatology for the global land areas for the target period 1951–2000 by objective analysis of climatological normals of about 67,200 rain gauge stations from its data base. GPCC's new precipitation climatology is compared to several other station-based precipitation climatologies as well as to precipitation climatologies derived from the GPCP V2.2 data set and from ECMWF's model reanalyses ERA-40 and ERA-Interim. Finally, how GPCC's best estimate for terrestrial mean precipitation derived from the precipitation climatology of 786 mm per year (equivalent to a water transport of 117,000 km³) is fitting into the global water cycle context is discussed.
The 2015 release of the precipitation climatology from the Global Precipitation Climatology Centre (GPCC) for 1951–2000, based on climatological normals of about 75,100 rain gauges, allows for ...quantification of mean land surface precipitation as part of the global water cycle. In GPCC’s 2011-release, a bulk climatological correction was applied to compensate for gauge undercatch. In this paper we derive an improved correction approach based on the synoptic weather reports for the period 1982–2015. The compared results show that the climatological approach tends to overestimate the correction for Central and Eastern Europe, especially in the northern winter, and in other regions throughout the year. Applying the mean weather-dependent correction to the GPCC’s uncorrected precipitation climatology for 1951–2000 gives a value of 854.7 mm of precipitation per year (excluding Antarctica) or 790 mm for the global land surface. The warming of nearly 1 K relative to pre-industrial temperatures is expected to be accompanied by a 2%–3% increase in global (land and ocean) precipitation. However, a comparison of climatology for 30-year reference periods from 1931–1960 up to 1981–2010 reveals no significant trend for land surface precipitation. This may be caused by the large variability of precipitation, the varying data coverage over time and other issues related to the sampling of rain-gauge networks. The GPCC continues to enlarge and further improve the quality of its database, and will generate precipitation analyses with homogeneous data coverage over time. Another way to reduce the sampling issues is the combination of rain gauge-based analyses with remote sensing (i.e., satellite or radar) datasets.
Suboptimal patient adherence to pharmacological therapy of type 2 diabetes may be due in part to pill burden. One way to reduce pill burden in patients who need multiple medications is to use ...fixed-dose combinations. Our study aimed to compare the effects of fixed-dose combination versus loose-dose combination therapy on medication adherence and persistence, health care utilization, therapeutic safety, morbidities, and treatment modification in patients with type 2 diabetes over three years.
Using administrative data, we conducted a retrospective controlled cohort study comparing type 2 diabetes patients who switched from monotherapy to either a fixed-dose combination or a loose-dose combination. Adherence was assessed as the primary endpoint and calculated as the proportion of days covered with medication. After using entropy balancing to eliminate differences in observable baseline characteristics between the two groups, we applied difference-in-difference estimators for each outcome to account for time-invariant unobservable heterogeneity.
Of the 990 type 2 diabetes patients included in our analysis, 756 were taking a fixed-dose combination and 234 were taking a loose-dose combination. We observed a statistically significantly higher change in adherence (year one: 0.22, p<0.001, year two: 0.25, p<0.001, and year three: 0.29, p<0.001) as well as higher persistence and a smaller change in the number of drug prescriptions in each of the three years in the fixed-dose combination group compared to the loose-dose combination group. The differences were most pronounced in patients who were poorly adherent, had a high pill burden, or did not have a severe concomitant disease.
Our results indicate that taking a fixed-dose combination can lead to a significant improvement in adherence to pharmacological therapy of type 2 diabetes compared to a loose-dose combination. In particular, these findings suggest that reducing pill burden may improve disease management among patients with more complex medication demand and patients who have demonstrated poor medication adherence.
The new Version 2.3 of the GPCP Monthly analysis is described in terms of changes made to improve the homogeneity of the product, especially after 2002. These changes include corrections to cross ...calibration of satellite data inputs and updates to the gauge analysis. Over ocean, changes starting in 2003 result in an overall precipitation increase of 1.8% after 2009. Updating the gauge analysis to its final, high quality version increases the global land total by 1.8% for the post-2002 period. These changes correct a small, incorrect dip in the estimated global precipitation over the last decade in the earlier Version 2.2. The GPCP analysis is also used to describe global precipitation for 2017. The general La Nina pattern for 2017 is noted and the evolution from the early 2016 El Nino pattern is described. The 2017 global value is one of the highest for the 19792017 period, exceeded only by 2016 and 1998 (both El Nino years) and reinforces the small positive trend. Results for 2017 also reinforce significant trends in precipitation intensity (on a monthly scale) in the tropics. These results for 2017 indicate the value of the GPCP analysis for climate monitoring in addition to research.
We present a new global land-based daily precipitation dataset from 1950 using an interpolated network of in situ data called Rainfall Estimates on a Gridded Network – REGEN. We merged multiple ...archives of in situ data including two of the largest archives, the Global Historical Climatology Network – Daily (GHCN-Daily) hosted by National Centres of Environmental Information (NCEI), USA, and one hosted by the Global Precipitation Climatology Centre (GPCC) operated by Deutscher Wetterdienst (DWD). This resulted in an unprecedented station density compared to existing datasets. The station time series were quality-controlled using strict criteria and flagged values were removed. Remaining values were interpolated to create area-average estimates of daily precipitation for global land areas on a 1∘ × 1∘ latitude–longitude resolution. Besides the daily precipitation amounts, fields of standard deviation, kriging error and number of stations are also provided. We also provide a quality mask based on these uncertainty measures. For those interested in a dataset with lower station network variability we also provide a related dataset based on a network of long-term stations which interpolates stations with a record length of at least 40 years. The REGEN datasets are expected to contribute to the advancement of hydrological science and practice by facilitating studies aiming to understand changes and variability in several aspects of daily precipitation distributions, extremes and measures of hydrological intensity. Here we document the development of the dataset and guidelines for best practices for users with regards to the two datasets.
Granulomatosis with Polyangiitis (GPA) is a small vessel vasculitis typically associated with release of neutrophil extracellular traps (NETs) by activated neutrophils. In this study, we further ...aimed to investigate the contributions of neutrophils and NETs to the complex disease pathogenesis. We characterized the phenotype of neutrophils and their capacity to induce NETs. In addition, the level of circulating NETs, determined by neutrophil elastase/DNA complexes, and the capacity of patient sera to degrade NETs were investigated from blood samples of 12 GPA patients, 21 patients with systemic lupus erythematosus (SLE) and 21 healthy donors (HD). We found that GPA patients had significantly increased levels of low-density granulocytes (LDGs) compared to HD, which displayed an activated and more immature phenotype. While the propensity of normal-density granulocytes to release NETs and the levels of circulating NETs were not significantly different from HD, patient sera from GPA patients degraded NETs less effectively, which weakly correlated with markers of disease activity. In conclusion, increased levels of immature and activated LDGs and altered degradation of circulating NETs may contribute to pathogenesis of GPA, potentially by providing a source of autoantigens that trigger or further enhance autoimmune responses.
Biases in climatological and extreme precipitation estimates are assessed for 11 global observational datasets constructed with merged satellite measurements and/or rain gauge networks. Specifically, ...the biases in extreme precipitation are contrasted with mean-state biases. Extreme precipitation is defined by a 99th percentile threshold (R99p) on a daily, 1° × 1° grid for 50 °S-50 °N. The spatial pattern of extreme precipitation lacks distinct features such as the ITCZ that is evident in the global climatological map, and the climatology and extremes share little in common in terms of the spatial characteristics of inter-product biases. The time series also exhibit a larger spread in the extremes than in the climatology. Further, when analysed from 2001 to 2013, they show relatively consistent decadal stability in the climatology over ocean while the dispersion is larger for the extremes over ocean. This contrast is not observed over land. Overall, the results suggest that the inter-product biases apparent in the climatology are a poor predictor of the extreme-precipitation biases even in a qualitative sense.
ObjectiveTo examine the impact of nurse staffing on patient-perceived quality of nursing care. We differentiate nurse staffing levels and nursing skill mix as two facets of nurse staffing and use a ...multidimensional instrument for patient-perceived quality of nursing care. We investigate non-linear and interaction effects.SettingThe study setting was 3458 hospital units in 1017 hospitals in Germany.ParticipantsWe contacted 212 554 patients discharged from non-paediatric, non-intensive and non-psychiatric hospital units who stayed at least two nights in the hospital between January and October 2019. Of those, 30 174 responded, yielding a response rate of 14.2%. Our sample included only those patients. After excluding extreme values for our nurse staffing variables and removing observations with missing values, our final sample comprised 28 136 patients ranging from 18 to 97 years of age (average: 61.12 years) who had been discharged from 3458 distinct hospital units in 1017 hospitals.Primary and secondary outcome measuresPatient-perceived quality of nursing care (general nursing care, guidance provided by nurses, and patient loyalty to the hospital).ResultsFor all three dimensions of patient-perceived quality of nursing care, we found that they significantly decreased as (1) nurse staffing levels decreased (with decreasing marginal effects) and (2) the proportion of assistant nurses in a hospital unit increased. The association between nurse staffing levels and quality of nursing care was more pronounced among patients who were less clinically complex, were admitted to smaller hospitals or were admitted to medical units.ConclusionsOur results indicate that, in addition to nurse staffing levels, nursing skill mix is crucial for providing the best possible quality of nursing care from the patient perspective and both should be considered when designing policies such as minimum staffing regulations to improve the quality of nursing care in hospitals.
Seasonal influenza contributes substantially to the burden of communicable diseases in Europe, especially among paediatric populations and the elderly. The aim of the present study was to estimate ...the incidence of seasonal influenza in Germany, the probabilities of related complications and the economic burden of influenza per case and on a population level for different age groups.
Claims data from 2012 to 2014 from > 8 million insured of a large German sick-ness fund were analysed. A matched case control study was used on a sub-sample of 100,000 influenza cases to calculate complication rates for ear infections/acute otitis media (AOM) and community-acquired pneumonia (CAP) as well as resource use and costs for seven age groups.
Incidence of seasonal influenza varies between the years and is highest among infants and children 2 to 5 years of age. AOM is more likely in the younger age groups with up to 14% more patients in the influenza group than in the control group. CAP is more frequently observed in the younger age groups and in influenza patients 60 years and older. The manifestation of one influenza complication (AOM or CAP) significantly in-creases the occurrence of a second complication (AOM or CAP). The economic burden per case is highest in infants (€251.91) and persons over 60 years of age (€131.59).
The burden of influenza is highest among infants and young children, which is also reflected in the economic burden. Influenza related costs per case are nearly double for infants compared to persons over 60 years of age.
Diffuse myofiber necrosis in the context of inflammatory myopathy is the hallmark of immune‐mediated necrotizing myopathy (IMNM). We have previously shown that skeletal muscle fibers of IMNM patients ...may display nonrimmed vacuoles and sarcoplasmic irregularities. The dysfunctional chaperone activity has been linked to the defective assembly of skeletal muscle proteins and their degradation via lysosomes, autophagy and the proteasomal machinery. This study was undertaken to highlight a chaperone‐assisted selective autophagy (CASA) pathway, functionally involved in protein homeostasis, cell stress and the immune response in skeletal muscle of IMNM patients. Skeletal muscle biopsies from 54 IMNM patients were analyzed by immunostaining, as well as by qPCR. Eight biopsies of sIBM patients served as pathological controls, and eight biopsies of nondisease control subjects were included. Alteration of autophagy was detectable in all IMNM biopsy samples highlighted via a diffuse sarcoplasmic staining pattern by p62 and LC3 independent of vacuoles. This pattern was at variance with the coarse focal staining pattern mostly confined to rimmed vacuoles in sIBM. Colocalization of p62 with the chaperone proteins HSP70 and αB‐crystalline points to the specific targeting of misfolded proteins to the CASA machinery. Bcl2‐associated athanogene 3 (BAG3) positivity of these fibers emphasizes the selectivity of autophagy processes and these fibers also express MHC class I sarcolemma. Expression of genes involved in autophagy and endoplasmic reticulum (ER) stress pathways studied here is significantly upregulated in IMNM. We highlight that vacuoles without sarcolemmal features may arise in IMNM muscle biopsies, and they must not be confounded with sIBM‐specific vacuoles. Further, we show the activation of selective autophagy and emphasize the role of chaperones in this context. CASA occurs in IMNM muscle, and specific molecular pathways of autophagy differ from the ones in sIBM, with p62 as a unique identifier of this process.
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