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The retreat of Arctic sea ice is frequently considered to be a possible driver of changes in climate extremes in the Arctic and possibly down to mid-latitudes. However, it remains unclear how the atmosphere will respond to a near-total retreat of summer Arctic sea ice, a reality that might occur in the foreseeable future. This study explores this question by conducting sensitivity experiments with two global coupled climate models run at two different horizontal resolutions to investigate the change in temperature and precipitation extremes during summer over peripheral Arctic regions following a sudden reduction in summer Arctic sea ice cover. An increase in frequency and persistence of maximum surface air temperature is found in all peripheral Arctic regions during the summer, when sea ice loss occurs. For each 1×106 km2 of Arctic sea ice extent reduction, the absolute frequency of days exceeding the surface air temperature of the climatological 90th percentile increases by ∼ 4 % over the Svalbard area, and the duration of warm spells increases by ∼ 1 d per month over the same region. Furthermore, we find that the 10th percentile of surface daily air temperature increases more than the 90th percentile, leading to a weakened diurnal cycle of surface air temperature. Finally, an increase in extreme precipitation, which is less robust than the increase in extreme temperatures, is found in all regions in summer. These findings suggest that a sudden retreat of summer Arctic sea ice clearly impacts the extremes in maximum surface air temperature and precipitation over the peripheral Arctic regions with the largest influence over inhabited islands such as Svalbard or northern Canada. Nonetheless, even with a large sea ice reduction in regions close to the North Pole, the local precipitation response is relatively small compared to internal climate variability.

Objectives To understand healthcare professionals’ experiences and perceptions of nurses’ potential or ideal roles in pharmaceutical care (PC). Design Qualitative study conducted through semi-structured in-depth interviews. Setting Between December 2018 and October 2019, interviews were conducted with healthcare professionals of 14 European countries in four healthcare settings: hospitals, community care, mental health and long-term residential care. Participants In each country, pharmacists, physicians and nurses in each of the four settings were interviewed. Participants were selected on the basis that they were key informants with broad knowledge and experience of PC. Data collection and analysis All interviews were conducted face to face. Each country conducted an initial thematic analysis. Consensus was reached through a face-to-face discussion of all 14 national leads. Results 340 interviews were completed. Several tasks were described within four potential nursing responsibilities, that came up as the analysis themes, being: 1) monitoring therapeutic/adverse effects of medicines, 2) monitoring medicines adherence, 3) decision making on medicines, including prescribing 4) providing patient education/information. Nurses’ autonomy varied across Europe, from none to limited to a few tasks and emergencies to a broad range of tasks and responsibilities. Intended level of autonomy depended on medicine types and level of education. Some changes are needed before nursing roles can be optimised and implemented in practice. Lack of time, shortage of nurses, absence of legal frameworks and limited education and knowledge are main threats to European nurses actualising their ideal role in PC. Conclusions European nurses have an active role in PC. Respondents reported positive impacts on care quality and patient outcomes when nurses assumed PC responsibilities. Healthcare professionals expect nurses to report observations and assessments. This key patient information shoul

Clear role descriptions promote the quality of interprofessional collaboration. Currently, it is unclear to what extent healthcare professionals consider pharmaceutical care (PC) activities to be nurses’ responsibility in order to obtain best care quality. This study aimed to create and evaluate a framework describing potential nursing tasks in PC and to investigate nurses’ level of responsibility. A framework of PC tasks and contextual factors was developed based on literature review and previous DeMoPhaC project results. Tasks and context were cross-sectionally evaluated using an online survey in 14 European countries. A total of 923 nurses, 240 physicians and 199 pharmacists responded. The majority would consider nurses responsible for tasks within: medication self-management (86–97%), patient education (85–96%), medication safety (83–95%), monitoring adherence (82–97%), care coordination (82–95%), and drug monitoring (78–96%). The most prevalent level of responsibility was ‘with shared responsibility’. Prescription management tasks were considered to be nurses’ responsibility by 48–81% of the professionals. All contextual factors were indicated as being relevant for nurses’ role in PC by at least 74% of the participants. No task nor contextual factor was removed from the framework after evaluation. This framework can be used to enable healthcare professionals to openly discuss allocation of specific (shared) responsibilities and tasks.

Objectives Safe pharmaceutical care (PC) requires an interprofessional team approach, involving physicians, nurses and pharmacists. Nurses’ roles however, are not always explicit and clear, complicating interprofessional collaboration. The aim of this study is to describe nurses’ practice and interprofessional collaboration in PC, from the viewpoint of nurses, physicians and pharmacists. Design A cross-sectional survey. Setting The study was conducted in 17 European countries, each with their own health systems. Participants Pharmacists, physicians and nurses with an active role in PC were surveyed. Main outcome measures Nurses’ involvement in PC, experiences of interprofessional collaboration and communication and views on nurses’ competences. Results A total of 4888 nurses, 974 physicians and 857 pharmacists from 17 European countries responded. Providing patient education and information (PEI), monitoring medicines adherence (MMA), monitoring adverse/therapeutic effects (ME) and prescribing medicines were considered integral to nursing practice by 78%, 73%, 69% and 15% of nurses, respectively. Most respondents were convinced that quality of PC would be improved by increasing nurses’ involvement in ME (95%), MMA (95%), PEI (91%) and prescribing (53%). Mean scores for the reported quality of collaboration between nurses and physicians, collaboration between nurses and pharmacists and interprofessional communication were respectively <7/10, ≤4/10, <6/10 for all four aspects of PC. Conclusions ME, MMA, PEI and prescribing are part of nurses’ activities, and most healthcare professionals felt their involvement should be extended. Collaboration between nurses and physicians on PC is limited and between nurses and pharmacists even more.

This study investigates how teleconnections linking tropical rainfall anomalies and wintertime circulation in the northern extra-tropics are represented in historical simulations for the period 1950–2010 run by partners of the EU-funded PRIMAVERA project, following the HighResMIP protocol of CMIP6. The analysis focusses on teleconnections from the western/central Indian Ocean in mid-winter and from the NINO4 region in both the early and the late part of winter; this choice is justified by a substantial change in the relationship between ENSO and the North Atlantic Oscillation (NAO) in the two parts of the season. Model results for both coupled integrations and runs with prescribed sea-surface temperature (SST) are validated against data from the latest ECMWF 20th-century re-analysis, CERA20C. Simulations from six modelling groups are considered, comparing the impact of increasing atmospheric resolution in runs with prescribed SST, and of moving from uncoupled to coupled simulations in the high-resolution version of each model. Single runs were available for each model configurations at the time of writing, with one centre (ECMWF) also providing a 6-member ensemble. Results from this ensemble are compared with those of a 6-member multi-model ensemble (MME) formed by including one simulation from each model. Using only a single historical simulation from each model configuration, it is difficult to detect a consistent change in the fidelity of model-generated teleconnections when either atmospheric resolution is increased or ocean coupling is introduced. However, when simulations from six different models are pooled together in the MME, some improvements in teleconnection patterns can be seen when moving from uncoupled to coupled simulations. For the ECMWF ensemble, improvements in the coupled simulations are only apparent for the late-winter NINO4 teleconnection. While the Indian Ocean teleconnection and the late-winter NINO4 teleconnection appear equally robust in t, The simulations and diagnostics described in this paper have been funded by the European Union Horizon 2020 PRIMAVERA project, grant agreement no. 641727. Model output from the PRIMAVERA simulations can be accessed from the archive of the Centre for Environmental Data Analysis (CEDA). Re-analysis data from CERA20C is available from the European Centre for Medium-Range Weather Forecasts (ECMWF)., Peer Reviewed, Postprint (published version)