Heat extremes in Western Europe increasing faster than simulated due to atmospheric circulation trends.

Over the last 70 years, extreme heat has been increasing at a disproportionate rate in Western Europe, compared to climate model simulations. This mismatch is not well understood. Here, we show that a substantial fraction (0.8 °C [0.2°-1.4 °C] of 3.4 °C per global warming degree) of the heat extremes trend is induced by atmospheric circulation changes, through more frequent southerly flows over Western Europe. In the 170 available simulations from 32 different models that we analyzed, including 3 large model ensembles, none have a circulation-induced heat trend as large as observed. This can be due to underestimated circulation response to external forcing, or to a systematic underestimation of low-frequency variability, or both. The former implies that future projections are too conservative, the latter that we are left with deep uncertainty regarding the pace of future summer heat in Europe. This calls for caution when interpreting climate projections of heat extremes over Western Europe, in view of adaptation to heat waves.

Èquipe, community, traditional values, and reproductive rights.

Gender stereotypes still surround women's reproductive health for several reasons. Moreover, in the last 20 years, women's access to essential reproductive healthcare is becoming an issue contributing to inequality and exacerbating different kinds of violence (cultural and structural). The patriarchal system, intimate partner violence, and traditional cultural and conservative values have a huge impact on women's access to contraceptive information, services, and induced abortion. Gender-based human rights violation has a higher impact on those women who are part of a minority or suffer a marginalized social or economic condition. In the present article, the behavior of migrant women's networks is examined as a case study when they come into contact with the health and care sector with the aim to highlight how, in the context of childbirth, they can suffer discriminatory and violent treatment by the community and groups that defend conservative and traditional values due to the exercise of reproductive rights. The investigated context was the Careggi Hospital in Florence, Italy, but in further investigation, the research will take place in different medium-sized cities such as Terni and Perugia. The chosen methodology was that of second-level sources and qualitative interviews with the health personnel who usually deals with these women (two focus groups involving 11 persons of the hospital équipe). This article has two aims: (1) to present the conflict between community behavior and the right to reproductive health and (2) to discuss aspects of IPV as degrading or violent treatment due to the exercise of reproductive rights. The main finding underlined the importance of considering the link between rights, identity, culture, and relationships with the community.

The effectiveness of a nursing discharge programme to improve medication adherence and patient satisfaction in the psychiatric intensive care unit.

AIMS AND OBJECTIVES: To observe the extent to which a nursing discharge plan is effective in promoting therapeutic adherence and improving patient satisfaction with their treatment based on information interventions provided by nursing staff, direct hospital medication distribution and follow-up telephone calls. BACKGROUND: Patient adherence is a fundamental requirement for the treatment of chronic diseases. Among psychiatric patients, adherence to the prescribed course of treatment allows patients to keep the symptoms of their disease under control, allowing for improvements in the management of their condition, minimising the risks of relapse and reducing the number of hospitalisations. DESIGN: This study uses a prospective correlational design. METHODS: The Morisky Medication Adherence Scale, the Satisfaction with Information about Medicine Scale and the General Satisfaction Questionnaire were used. RESULTS: Of the 135 patients enrolled in the study, 57% of the sample was female, and, on average, patients were aged 33 years. About 72.9% were unmarried, and 88.1% were educated at less than high school level. This study showed that patients who received more information on their health status and on what would be done for them after their hospitalisation had a higher adherence to treatment. In addition, patients who were more satisfied with the nursing care provided had a higher rate of adherence to their treatment plan. CONCLUSIONS: The interpersonal and educational nursing intervention improves adherence to a treatment plan by allowing patients to express themselves not only as individuals who rely on health care but also as protagonists able to effectively manage their disease and to empower themselves by acquiring disease management skills. RELEVANCE TO CLINICAL PRACTICE: A patient-nurse communication programme could help to analyse the individual patient circumstances that might become barriers to adherence and to apply nursing interventions that promote better patient adherence.

Fixed points, stable manifolds, weather regimes, and their predictability.

In a simple, one-layer atmospheric model, we study the links between low-frequency variability and the model's fixed points in phase space. The model dynamics is characterized by the coexistence of multiple "weather regimes." To investigate the transitions from one regime to another, we focus on the identification of stable manifolds associated with fixed points. We show that these manifolds act as separatrices between regimes. We track each manifold by making use of two local predictability measures arising from the meteorological applications of nonlinear dynamics, namely, "bred vectors" and singular vectors. These results are then verified in the framework of ensemble forecasts issued from "clouds" (ensembles) of initial states. The divergence of the trajectories allows us to establish the connections between zones of low predictability, the geometry of the stable manifolds, and transitions between regimes.