Description and Demonstration of the Coupled Community Earth System Model v2 - Community Ice Sheet Model v2 (CESM2-CISM2).

Earth system/ice-sheet coupling is an area of recent, major Earth System Model (ESM) development. This work occurs at the intersection of glaciology and climate science and is motivated by a need for robust projections of sea-level rise. The Community Ice Sheet Model version 2 (CISM2) is the newest component model of the Community Earth System Model version 2 (CESM2). This study describes the coupling and novel capabilities of the model, including: (1) an advanced energy-balance-based surface mass balance calculation in the land component with downscaling via elevation classes; (2) a closed freshwater budget from ice sheet to the ocean from surface runoff, basal melting, and ice discharge; (3) dynamic land surface types; and (4) dynamic atmospheric topography. The Earth system/ice-sheet coupling is demonstrated in a simulation with an evolving Greenland Ice Sheet (GrIS) under an idealized high CO2 scenario. The model simulates a large expansion of ablation areas (where surface ablation exceeds snow accumulation) and a large increase in surface runoff. This results in an elevated freshwater flux to the ocean, as well as thinning of the ice sheet and area retreat. These GrIS changes result in reduced Greenland surface albedo, changes in the sign and magnitude of sensible and latent heat fluxes, and modified surface roughness and overall ice sheet topography. Representation of these couplings between climate and ice sheets is key for the simulation of ice and climate interactions.

An Efficient Ice Sheet/Earth System Model Spin-up Procedure for CESM2-CISM2: Description, Evaluation, and Broader Applicability.

Spinning up a highly complex, coupled Earth system model (ESM) is a time consuming and computationally demanding exercise. For models with interactive ice sheet components, this becomes a major challenge, as ice sheets are sensitive to bidirectional feedback processes and equilibrate over glacial timescales of up to many millennia. This work describes and demonstrates a computationally tractable, iterative procedure for spinning up a contemporary, highly complex ESM that includes an interactive ice sheet component. The procedure alternates between a computationally expensive coupled configuration and a computationally cheaper configuration where the atmospheric component is replaced by a data model. By periodically regenerating atmospheric forcing consistent with the coupled system, the data atmosphere remains adequately constrained to ensure that the broader model state evolves realistically. The applicability of the method is demonstrated by spinning up the preindustrial climate in the Community Earth System Model Version 2 (CESM2), coupled to the Community Ice Sheet Model Version 2 (CISM2) over Greenland. The equilibrium climate state is similar to the control climate from a coupled simulation with a prescribed Greenland ice sheet, indicating that the iterative procedure is consistent with a traditional spin-up approach without interactive ice sheets. These results suggest that the iterative method presented here provides a faster and computationally cheaper method for spinning up a highly complex ESM, with or without interactive ice sheet components. The method described here has been used to develop the climate/ice sheet initial conditions for transient, ice sheet-enabled simulations with CESM2-CISM2 in the Coupled Model Intercomparison Project Phase 6 (CMIP6).

Communication with pharmacy technicians: how to reduce stress and improve pharmacy operations.

Analysis of interviews with certified pharmacy technicians revealed that they experience work-related stressors related to the need for accuracy, workload expansion, and customer interaction. Three types of supportive communication (i.e., instrumental , emotional, informational) are discussed as methods to reduce the negative impact of these stressors on pharmacy operations.

Recommendations for overcoming barriers to medication therapy management implementation, part 1: review of literature.

As a required service of the Medicare Modernization Act of 2003, medication therapy management services must be offered by all Part D prescription drug plan sponsors in order to improve overall knowledge of medication usage for targeted patients. Those targeted patients include patients who have multiple chronic diseases, have been prescribed several covered Part D medications, and are paying at least $4,000 in out-of-pocket expenses for their medication each year. This article serves as a literature review of medication therapy management services and serves as an introduction to a study conducted by the authors concerning some of the barriers and recommendations to overcome such barriers encountered by Indiana pharmacists.

Medication therapy management implementation, part 2: study methodologies, barriers, and recommendations to overcome barriers.

As a required service of the Medicare Modernization Act of 2003, medication therapy management services must be offered by all Part D prescription drug-plan sponsors in order to improve overall knowledge of medication usage for targeted patients. Those targeted patients include patients who have multiple chronic diseases, have been prescribed several covered Part D medications, and are paying at least $4,000 in medication each year. This article presents the methodolgy used by authors to conduct a study of Indiana pharmacists to determine pharmacists' attitudes and practices surrounding medication therapy management services. This article also discusses some of the barriers and recommendations to overcome such barriers encountered by Indiana pharmacists.

Medication therapy management implementation, part 3: barriers and recommendations to overcome barriers.

As a required service of the Medicare Modernization Act of 2003, medication therapy management services must be offered by all Part D prescription drug-plan sponsors in order to improve overall knowledge of medication usage for targeted patients. Those targeted patients include patients who have multiple chronic diseases, have been prescribed several covered Part D medications, and are paying at least $4,000 for their medication each year. This article discusses some of the barriers and recommendations to overcome such barriers encountered by Indiana pharmacists.