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We review how the international modelling community, encompassing integrated assessment models, global and regional Earth system and climate models, and impact models, has worked together over the past few decades to advance understanding of Earth system change and its impacts on society and the environment and thereby support international climate policy. We go on to recommend a number of priority research areas for the coming decade, a timescale that encompasses a number of newly starting international modelling activities, as well as the IPCC Seventh Assessment Report (AR7) and the second UNFCCC Global Stocktake. Progress in these priority areas will significantly advance our understanding of Earth system change and its impacts, increasing the quality and utility of science support to climate policy. We emphasize the need for continued improvement in our understanding of, and ability to simulate, the coupled Earth system and the impacts of Earth system change. There is an urgent need to investigate plausible pathways and emission scenarios that realize the Paris climate targets – for example, pathways that overshoot 1.5 or 2 °C global warming, before returning to these levels at some later date. Earth system models need to be capable of thoroughly assessing such warming overshoots – in particular, the efficacy of mitigation measures, such as negative CO2 emissions, in reducing atmospheric CO2 and driving global cooling. An improved assessment of the long-term consequences of stabilizing climate at 1.5 or 2 °C above pre-industrial temperatures is also required. We recommend Earth system models run overshoot scenarios in CO2-emission mode to more fully represent coupled climate–carbon-cycle feedbacks and, wherever possible, interactively simulate other key Earth system phenomena at risk of rapid change during overshoot. Regional downscaling and impact models should use forcing data from these simulations, so impact and regional climate projections cover a more complete range of potential responses to a warming overshoot. An accurate simulation of the observed, historical record remains a fundamental requirement of models, as does accurate simulation of key metrics, such as the effective climate sensitivity and the transient climate response to cumulative carbon emissions. For adaptation, a key demand is improved guidance on potential changes in climate extremes and the modes of variability these extremes develop within. Such improvements will most likely be realized through a combination of increased model resolution, improvement of key model parameterizations, and enhanced representation of important Earth system processes, combined with targeted use of new artificial intelligence (AI) and machine learning (ML) techniques. We propose a deeper collaboration across such efforts over the coming decade. With respect to sampling future uncertainty, increased collaboration between approaches that emphasize large model ensembles and those focussed on statistical emulation is required. We recommend an increased focus on high-impact–low-likelihood (HILL) outcomes – in particular, the risk and consequences of exceeding critical tipping points during a warming overshoot and the potential impacts arising from this. For a comprehensive assessment of the impacts of Earth system change, including impacts arising directly as a result of climate mitigation actions, it is important that spatially detailed, disaggregated information used to generate future scenarios in integrated assessment models be available for use in impact models. Conversely, there is a need to develop methods that enable potential societal responses to projected Earth system change to be incorporated into scenario development. The new models, simulations, data, and scientific advances proposed in this article will not be possible without long-term development and maintenance of a robust, globally connected infrastructure ecosystem. This system must be easily accessible and useable by modelling communities across the world, allowing the global research community to be fully engaged in developing and delivering new scientific knowledge to support international climate policy.

Abstract Introduction Despite an improved understanding of its pathogenesis, dry eye disease (DED) remains relatively underestimated and its treatment challenging. A better alignment between the clinical evaluation and the patient self-assessment also requires capturing the whole patient experience of DED. This project aimed to unveil this experience through narrative medicine (NM). Methods The project involved 38 expert centres in Italy and one in San Marino, targeting adult patients with DED, their informal caregivers and their treating ophthalmologists. Written narratives and sociodemographic and quality of life (QoL)-related data were anonymously collected through the project’s webpage. Narratives were analysed through MAXQDA (VERBI Software, Berlin, Germany), NM classifications and content analysis. Results A total of 171 patients with DED, 37 informal caregivers and 81 ophthalmologists participated in the research. DED was defined as a disabling condition by 19% of patients and 35% of caregivers; 70% of patients reported that a therapeutic alliance is an integral part of DED treatment and 32% hope for more effective therapies. Forty-four per cent of patients assessed their own QoL as good; however, DED emerged as importantly impacting work performance and social events. DED physical, emotional and economic burden and the cruciality of a trusting care relationship represent the main themes that emerged across all narratives, while empathy and effective treatment are among the factors favouring coping with DED. Conclusion This project marked a pioneering initiative investigating the lived experience of patients with DED through NM, simultaneously involving all viewpoints involved in the care pathway. NM enabled the unveiling of factors favouring the ability to cope with DED and its associated QoL implications and provided valuable insights to improve the therapeutic alliance.

Abstract Background The association between septic shock, acute tubular necrosis, and central diabetes insipidus is infrequent: our recent clinical observation invited us to deepen its pathophysiological features. Methods We reported an unusual case report of a young, healthy man with a septic shock, severe dehydration with a hematocrit of 70.6% caused by gastrointestinal infection and refractory renal failure, and persistent polyuria. Results The patient presented severe dehydration, hypovolemic shock with a hematocrit of 70.6%, and acute renal failure. The subsequent laboratory exams demonstrated a gastrointestinal infection of Campylobacter Upsaliensis and Helicobacter pylori. The persistent renal failure and polyuria later 20 days made it mandatory for further investigations. A Magnetic brain Resonance excluded encephalic lesions but demonstrated a posterior pituitary lobe hypointense. Conclusions This cascade of pathological events seems originated from a septic shock: the consequent increase in hematocrit and blood viscosity, estimated double the normal, with severe hypotensive shock correlated, decelerated the microcirculatory blood flow, until a proper blood stasis in the venous system. These factors caused hypoxia and possible venous thromboses, electively affecting the pituitary hypothalamic nuclei and their axons in the post-hypophysis and its portal system.

PEO/TiP fibers were obtained using the Solution Blow Spinning (SBS) apparatus and heat treated to produce TiO2 fibers. The morphological and structural characteristics were assessed using SEM and X-ray diffraction. The fibers, with a thickness of 12 μm, showed a change in crystalline structure with heat treatment. At temperatures as low as 800 °C, only the anatase phase was identified, while at 900 °C, both anatase and rutile phases coexisted. The addition of TiP to the polymer matrix reduced the initial breakdown temperature, and the DSC curves showed exothermic peaks due to the amorphous phase transition to TiO2/anatase. The fibers' photocatalytic capacity was tested, revealing that TiO2-fibers in the anatase phase achieved 97% degradation of Rhodamine-B dye in 40 minutes. The study found that the biocide efficacy of TiO2-fibers depends on their heat treatment. Fibers with anatase/rutile or pure rutile phases did not show significant efficiency. However, fibers treated at 600°C with pure anatase phase were more effective in eliminating E. coli and total coliforms. Finally, we can state that the TiO2 fibers obtained in this work using the SBS technique can be used to produce filters to purify water contaminated by pathogens dangerous to human health or even to purify the air.

Background Respiratory diseases (RDs) cause millions of hospitalisations and deaths worldwide, resulting in economic and social impacts. Strategies for health promotion and disease prevention based on the epidemiological profile of the population may reduce hospital costs.Aim To characterise hospitalisations and deaths due to RDs in Brazilian adults above 20 years old between 2008 and 2021.Methods This ecological study used secondary data of hospitalisations and deaths due to RDs from the Hospital Information System of the Brazilian Unified Health System between 2008 and 2021. Data were grouped according to region, age group and sex. The period was divided into first (2008–2011), second (2012–2015) and third (2016–2019) quadrennia and one biennium (2020–2021), and all data were analysed using the GraphPad Prism; statistical significance was set at p

There is growing demand for seasonal forecast products for marine applications. The availability of consistent and sufficiently long observational records of ocean variables permits the assessment of the spatial distribution of the skill of ocean variables from seasonal forecasts. Here we use state-of-the-art temporal records of sea surface temperature (SST), sea surface height (SSH) and upper 300m ocean heat content (OHC) to quantify the distribution of skill, up to 2 seasons ahead, of two operational seasonal forecasting systems contributing to the seasonal multi-model of the Copernicus Climate Change Services (C3S). This study presents the spatial distribution of the skill of the seasonal forecast ensemble mean in terms of anomaly correlation and root mean square error and compares it to the persistence and climatological benchmarks. The comparative assessment of the skill among variables sheds light on sources/limits of predictability at seasonal time scales, as well as the nature of model errors. Beyond these standard verification metrics, we also evaluate the ability of the models to represent the observed long-term trends. Results show that long-term trends contribute to the skill of seasonal forecasts. Although the forecasts capture the long-term trends in general, some regional aspects remain challenging. Part of these errors can be attributed to specific aspects of the ocean initialization, but others, such as the overestimation of the warming in the Eastern Pacific are also influenced by model error. Skill gains can be obtained by improving the trend representation in future forecasting systems. In the meantime, a forecast calibration procedure that corrects the linear trends can produce substantial skill gains. The results show that calibrated seasonal forecasts beat both the climatological and persistence benchmark almost at every location for all initial dates and lead times. Results demonstrate the value of the seasonal forecasts for marine applications and highlight the importance of representing the decadal variability and trends in ocean heat content and sea level.

Background: Body image perception can significantly influence various aspects of adolescent lives. The study analyzed the relationship between body image satisfaction and sports participation in adolescents, examining various factors that contribute to body image concerns and their implications for sports engagement. Methods: A total of 237 schoolchildren were recruited from lower secondary Italian schools. Anthropometric characteristics were measured directly. Assessment of body image perception was performed using Body Silhouette Charts for preadolescent children. The Italian version of the International Physical Activity Questionnaire for Adolescents questionnaire was administered to assess physical activity (PA) levels at school and during leisure time in the last 7 days. Analysis of variance was used to test differences in PA levels, while multiple regression models were carried out to assess possible predictors of body dissatisfaction. Results: In total, 42.6% of children were not satisfied with their figure and 23.2% were very dissatisfied; among them, the vast majority would have liked to be thinner. The dissatisfaction and satisfaction were similar in boys and girls. The frequency of satisfaction with one’s body image was higher in children who practiced extracurricular sports compared to those who did not. The percentage of dissatisfaction with one’s body image was similar in the two groups, but the frequency of children being very dissatisfied was double in the group that does not practice extracurricular sport (31.2% vs. 17.7%). Body dissatisfaction increases with increasing body mass index in both genders but decreases in children involved in extracurricular sports. Conclusions: Encouraging teenagers to engage in regular physical activity should be a key component of therapies supporting positive body image. This study found a relationship between extracurricular sports and body image satisfaction, suggesting that physical activity protects teenagers’ body image satisfaction.

Skin lesions are frequently observed in children with rheumatic diseases, particularly in conditions such as IgA vasculitis (IgAV) and Kawasaki disease (KD). In paediatric vasculitis, the presence of skin lesions serves as an early indicator, emphasising the importance of timely diagnosis to prevent complications, such as cardiac or renal involvement. Conversely, autoinflammatory disorders like juvenile systemic lupus erythematosus (SLE) and juvenile dermatomyositis (DM) may manifest with cutaneous manifestations either at the onset of disease or during its progression. Identifying these skin lesions prior to the appearance of systemic symptoms offers an opportunity for early diagnosis and treatment, which has a positive influence on the outcomes. Additionally, it is noteworthy that specific rheumatological conditions, such as acute rheumatic fever (ARF) or oligoarticular or polyarticular forms of juvenile idiopathic arthritis (JIA), may exhibit occasional, but significant skin involvement, which is strongly correlated with an unfavourable prognosis. The assessment of skin is important in the holist approach to assessing patients for potentially systemic/multisystem disorder and helps distinguish discrete conditions.

Background: 68Ga-PSMA PET/CT is superior to standard-of-care imaging for detecting regional and distant metastatic recurrent prostate cancer. The objective of our study was to evaluate the performance of 68Ga-PSMAPET/CT in our patient population, using the new PSMA-RADS version 2.0. Methods: A total of 128 patients scanned with 68Ga-PSMA PET/CT for detection of recurrence after RP were analyzed with PSMA-RADS version 2.0. For the analysis of the detection rate, categories PSMA-RADS 3 to 5 were considered as “positive for malignancy” and 1–2 as “negative”. Results: According to PSMA-RADS v2.0, we classified patients as follows: 23 patients without PSMA-RADS because they were negative; PSMA-RADS 1: 10 patients; PSMA-RADS 2: 4 patients; PSMA-RADS 3A: 11 patients; PSMA-RADS 3B: 2 patients; PSMA-RADS 3C: 2 patients; PSMA-RADS 3D: 2 patients; PSMA-RADS 4: 13 patients; PSMA-RADS 5: 61 patients. Conclusions: The overall detection rate of 68Ga-PSMA PET/CT was 71%. By dividing the patients into fourgroups according to PSA level before examination, we obtained the following detection rates: PSA < 0.2 ng/mL 38%; 0.2 ≤ PSA < 0.5 ng/mL 57%; 0.5 ≤ PSA ≤ 1 ng/mL 77%; and PSA > 1 ng/mL 95%. Conclusion: Using PSMA-RADS version 2.0, we obtained detection rate values comparable with recent literature both in absolute terms and in relation to different PSA levels.

The COVID-19 pandemic and the resulting lockdown countermeasure may have significantly affected adolescents’ physical and mental health. This study aims to assess adolescents’ recollections of this period, also analyzing their current weight status along with factors they traced back to the epidemic phase and their current sports practice. A survey among 233 Italian adolescents aged 12.4 ± 0.9 years was conducted in October 2023. To achieve the research objectives, a new questionnaire was developed: the COVID-19 AdolesceNt/chilDren Lockdown Experience questionnaire (CANDLE). The new questionnaire was employed to gather data on the adolescents’ recollections of the lockdown situation they experienced. The stature and weight of participants were measured directly. The results indicated that middle schoolers remember both positive and negative experiences of the lockdown: the change perceived as the most positive was spending more time with family, while social detachment from peers represents the most negative aspect. According to multivariate regression analysis, certain behaviors they assumed during the lockdown, such as comfort food consumption in boys and sleeping disturbances in girls, in addition to their current sports practice, affected their actual Body Mass Index. This study supports the evidence that changes caused by the COVID-19 lockdown affected adolescents’ physical and mental health, albeit with sex differences.

Abstract Background There are several tools to assess functional and physical status in critical ill patients. These tools can guide rehabilitation strategies in Intensive care units (ICU). However, they are not standardized, and this can compromise their applicability. The aim of the study is to identify common contents between International Classification of Functioning, Disability and Health (ICF) and Medical Research Council sum score (MRC-ss), Functional Status Score for the ICU (FSS-ICU), and Physical Function in ICU Test-scored (PFIT-s). As well as to propose a new assessment approach based on the ICF to ICU patients. Methods Pilot cross-sectional study. ICU in-patients, both genders, aged between 50 and 75 years were assessed with MRC-ss, FSS-ICU, PFIT-s and the linking rules used were proposed by Cieza et al. The inter-rater agreement for the linking process was performed using the Kappa coefficient. Results The ICF categories identified in the tools covered a total of 14 items. Common contents were identified in 13 of the 14 and two were related to body functions, six to body structures and five to activities and participation. The inter-rater agreement was considered substantial for the linking of MRC-ss (k = 0.665) and PFIT-s (k = 0.749) to the ICF, and almost perfect for the FSS-ICU (k = 0.832). Conclusions This study synthesizes and categorizes commonly used tools and presents a new proposal based on the ICF to guide future studies. The proposed model combines the ICF with the contents of the most relevant instruments used in critical care.

Objectives: This experimental laboratory study aimed to compare the effect of four external irrigation protocols on bone tissue heating during guided implant drilling. Methods: Forty perforations were made in ten bovine rib specimens using customized surgical templates. Four experimental groups (n=10/group) were tested: Control group = 10-ml syringe with 25°C saline solution, Group 1 = 10-ml syringe with 10°C saline solution, Group 2 = combined external irrigation using a handpiece and a 10-ml syringe with 25°C saline solution, and Group 3 = combined external irrigation using a handpiece and a 10-ml syringe with 10°C saline solution. The temperature was measured at cervical and apical points using K-type thermocouples, a digital thermometer, and a video recorder. Data were analyzed by ANOVA and Pearson’s correlation coefficients (alpha=0.05). Results: The maximum temperature was 42°C (cervical) and 44°C (apical). No difference in temperature changes was found among groups, but the difference between bone specimens was statistically significant. Temperature and time were positively associated for most groups, mainly in the cervical region. Conclusions: All irrigation methods were equally effective in controlling the bone temperature in cervical and apical regions. However, longer drilling times caused a greater increase in temperature.

Abstract Marine heatwaves damage marine ecosystems and services, with effects identified mostly below the ocean surface. To create a truly user-relevant detection system, it is necessary to provide subsurface forecasts. Here, we demonstrate the feasibility of seasonal forecasting of subsurface marine heatwaves by using upper ocean heat content. We validate surface and subsurface events forecast by an operational dynamical seasonal forecasting system against satellite observations and an ocean reanalysis, respectively. We show that indicators of summer events (number of days, strongest intensity, and number of events) are predicted with greater skill than surface equivalents across much of the global ocean. We identify regions which do not display significant surface skill but could still benefit from accurate subsurface early warning tools (e.g., the mid-latitudes). The dynamical system used here outperforms a persistence model and is not widely influenced by warming trends, demonstrating the ability of the system to capture relevant subseasonal variability.

Abstract Cooling degree days provide a simple indicator to represent how temperature drives energy demand for cooling. We investigate, at country level, the changes in cooling degree days worldwide in a recent twenty-one-year period starting in 2000. A new database, jointly generated by CMCC and IEA based on ERA5 reanalysis’ global gridded data, is used for the analysis. In contrast to the existent literature, the factors of population-weighting and humidity are considered, which affect the magnitude and the spatial distribution of these changes. Annual tendencies show a general increase of cooling degree days over the different countries, fostering more energy consumption for cooling demand, as confirmed by some regional studies. We also focus on the temporal clustering, to measure if peaks occur evenly random or tend to cluster in shorter periods. We stress that including humidity is important both for general tendencies and clustering. India, Cambodia, Thailand and Vietnam represent the emerging countries where this effect is stronger.

This article presents a case study featuring a novel modification of the A-T flap, termed the "Sorting Hat" flap, employed in dermatologic surgery for facial reconstruction. In the treatment of an 89-year-old male's squamous cell carcinoma lesion on the forehead, the "Sorting Hat" flap, introduced as an innovative alternative, eliminates the need for Burrow triangles and relies on flap shape for inconspicuous scarring and favorable cosmetic outcomes.

Abstract The cartilaginous endplates (CEP) are key components of the intervertebral disc (IVD) necessary for sustaining the nutrition of the disc while distributing mechanical loads and preventing the disc from bulging into the adjacent vertebral body. The size, shape, and composition of the CEP are essential in maintaining its function, and degeneration of the CEP is considered a contributor to early IVD degeneration. In addition, the CEP is implicated in Modic changes, which are often associated with low back pain. This review aims to tackle the current knowledge of the CEP regarding its structure, composition, permeability, and mechanical role in a healthy disc, how they change with degeneration, and how they connect to IVD degeneration and low back pain. Additionally, the authors suggest a standardized naming convention regarding the CEP and bony endplate and suggest avoiding the term vertebral endplate. Currently, there is limited data on the CEP itself as reported data is often a combination of CEP and bony endplate, or the CEP is considered as articular cartilage. However, it is clear the CEP is a unique tissue type that differs from articular cartilage, bony endplate, and other IVD tissues. Thus, future research should investigate the CEP separately to fully understand its role in healthy and degenerated IVDs. Further, most IVD regeneration therapies in development failed to address, or even considered the CEP, despite its key role in nutrition and mechanical stability within the IVD. Thus, the CEP should be considered and potentially targeted for future sustainable treatments.

Decadal predictions present an emerging opportunity for various socio-economic sectors affected by climate variability. However, the development of associated climate services is still in an incipient stage. This study focuses on developing a prototype climate service for an end-user in the hydropower sector. The service aimed at predicting precipitation in three drainage basins (Guadalquivir, Ebro and Po) for the next ten years, and was developed in close collaboration with the user. In this paper we do not provide the real-time forecasts, but we focus on describing and evaluating the methods and the models used. Using a European multi-model ensemble, the predictive skill for precipitation is found to vary with the calendar season, the forecast range and the drainage basin considered, though it is generally low for the purposes of supporting such a climate service. To overcome this deficiency, a hybrid approach was developed making combined use of the good skill in predicting the North Atlantic Oscillation (NAO) and the observed dominant influence of the latter on the decadal variability of precipitation in the areas of interest. Implementing this hybrid approach, which combines predictive information from the dynamical models with statistical information from observations, brings significant skill improvements in all basins during the extended cold season (November-March) for the first 10 forecast years. The hybrid model outperforms the direct multi-model ensemble output, exhibiting statistically significant skill for all basins. Our results suggest that utilising large-scale predictors can significantly improve regional predictions, and provide usable information for the hydropower sector.

Venous leg ulcers are one of the most common nonhealing conditions and represent an important clinical problem. The application of pulsed radiofrequency electromagnetic fields (PRF-EMFs), already applied for pain, inflammation, and new tissue formation, can represent a promising approach for venous leg ulcer amelioration. This study aims to evaluate the effect of PRF-EMF exposure on the inflammatory, antioxidant, cell proliferation, and wound healing characteristics of human primary dermal fibroblasts collected from venous leg ulcer patients. The cells’ proliferative and migratory abilities were evaluated by means of a BrdU assay and scratch assay, respectively. The inflammatory response was investigated through TNFα, TGFβ, COX2, IL6, and IL1β gene expression analysis and PGE2 and IL1β production, while the antioxidant activity was tested by measuring GSH, GSSG, tGSH, and GR levels. This study emphasizes the ability of PRF-EMFs to modulate the TGFβ, COX2, IL6, IL1β, and TNFα gene expression in exposed ulcers. Moreover, it confirms the improvement of the proliferative index and wound healing ability presented by PRF-EMFs. In conclusion, exposure to PRF-EMFs can represent a strategy to help tissue repair, regulating mediators involved in the wound healing process.

Vaccination plays a pivotal role in the control of infectious disease outbreaks. Hesitancy/refusal of the vaccine by immigrants poses a serious threat to their and society’s health. We reviewed studies regarding COVID-19 vaccine uptake in Europe by first-generation immigrants. A systematic review (PROSPERO: CRD42023432142), conducted until 31 October 2023 using Web of Science, PubMed, and Scopus, identified 295 potential articles. Of these, 16 conducted on 2,009,820 immigrants in nine European countries met the eligibility criteria. Most studies were of medium/high quality according to the Newcastle–Ottawa Scale adapted for observational studies. Factors that affected the uptake or hesitancy/refusal to vaccinate, with particular regard to gender, age, and country of origin, were examined. The meta-analysis of eight studies revealed that the pooled estimated prevalence of COVID-19 vaccine uptake in first-generation immigrants was 71.3% (95% CI: 70.0–72.5%), corresponding to 13.3% less than the host country population (95% CI: 10.2–16.4%). Limitations of included studies and this review were deeply discussed, highlighting the need for further research on the effect of acculturation on second-generation immigrants. European governments need to ensure equal availability of COVID-19 and other health-saving vaccines to all immigrants in the future by overcoming cultural barriers, building trust in institutions, and improving communication.

The interest in gluteal augmentation using minimally invasive techniques has been increasing rapidly. Despite the fact that Aquafilling filler was described as biocompatible with human tissues, the number of associated complications has been rising. We present an exceptional case of a 35-year-old female patient, who suffered major long-term complications in association with Aquafilling filler injections in the gluteal region. The patient was referred to our center with signs of recurrent inflammation and severe pain focusing on the left lower extremity. A computed tomography (CT) scan showed multiple, communicating abscess formations all the way from the gluteal region to the lower leg. Therefore, an operative debridement was accomplished in the operating theater. Finally, this report emphasizes the severity of possible long-term complications when using Aquafilling filler especially in larger areas. Furthermore, the oncogenicity as well as toxicity of polyacrylamide, the core material of Aquafilling filler, remains uncertain, which is why further research is urgently required.

The nose is a vital organ and an important aesthetic unit, being placed in the middle of the face. It is also one of the most frequently site involved by skin cancer, and surgical reconstruction can be sometimes challenging. We present two cases of full thickness nasal ala defect, managed with turnover flap with and without earlobe cartilage graft.

Decadal climate predictions, obtained by constraining the initial condition of a dynamical model through a truthful estimate of the observed climate state, provide an accurate assessment of near-term climate change and are a useful tool to inform decision-makers on future climate-related risks. Here we present results from the CMIP6 (Coupled Model Intercomparison Project Phase 6) Decadal Climate Prediction Project (DCPP) decadal hindcasts produced with the operational CMCC (Euro-Mediterranean Center on Climate Change) decadal prediction system (DPS), based on the fully coupled CMCC-CM2-SR5 dynamical model. A 20-member suite of 10-year retrospective forecasts, initialized every year from 1960 to 2020, is performed using a full-field initialization strategy. The predictive skill for key variables is assessed and compared with the skill of an ensemble of non-initialized historical simulations so as to quantify the added value of the initialization. In particular, the CMCC DPS is able to skillfully reproduce past climate surface and subsurface temperature fluctuations over large parts of the globe. The North Atlantic Ocean is the region that benefits the most from initialization, with the largest skill enhancement occurring over the subpolar region compared to historical simulations. On the other hand, the predictive skill over the Pacific Ocean rapidly decays with forecast time, especially over the North Pacific. In terms of precipitation, the skill of the CMCC DPS is significantly higher than that of the historical simulations over a few specific regions, including the Sahel, northern Eurasia, and over western and central Europe. The Atlantic multidecadal variability is also skillfully predicted, and this likely contributes to the skill found over remote areas through downstream influence, circulation changes, and teleconnections. Considering the relatively small ensemble size, a remarkable prediction skill is also found for the North Atlantic Oscillation, with maximum correlations obtained in the 1–9 lead year range. Systematic errors also affect the forecast quality of the CMCC DPS, featuring a prominent cold bias over the Northern Hemisphere, which is not found in the historical runs, suggesting that, in some areas, the adopted full-field initialization strategy likely perturbs the equilibrium state of the model climate quite significantly. The encouraging results obtained in this study indicate that climate variability over land can be predictable over a multiyear range, and they demonstrate that the CMCC DPS is a valuable addition to the current generation of DPSs. This stresses the need to further explore the potential of the near-term predictions, further improving future decadal systems and initialization methods, with the aim to provide a reliable tool to inform decision-makers on how regional climate will evolve in the next decade.

Abstract Genesis Potential Indices (GPIs) link the occurrence of Tropical Cyclones (TCs) to large‐scale environmental conditions favorable for TC development. In the last few decades, they have been routinely used as a way to overcome the limitations of climate models (GCM), whose resolution is too coarse to produce realistic TCs. Recently, the first GCM ensemble with high enough horizontal resolution to realistically reproduce TCs was made available. Here, we address the questions of whether GPIs are still relevant in the era of TC‐permitting climate model ensembles, and whether they have sufficient predictive skills. The predictive skills of GPIs are assessed against the TCs directly simulated in a climate model ensemble. We found that GPIs have poor skill in two key metrics: inter‐annual variability and multi‐decadal trends. We discuss possible ways to improve the understanding of the predictive skill of GPIs and therefore enhance their applicability in the era of TC‐permitting GCMs.