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Background: In end-of-life care hygiene, measures concerning multidrug-resistant bacterial microorganisms may contradict the palliative care approach of social inclusion and be burdensome for patients. Objectives: To integrate patients’ perspectives on handling multidrug-resistant bacterial microorganisms at their end of life, their quality of life, the impact of positive multidrug-resistant bacterial microorganisms’ diagnosis, protection and isolation measures on their well-being and patients’ wishes and needs regarding their care. Design: A mixed-methods convergent parallel design embedded quantitative data on the patients’ multidrug-resistant bacterial microorganisms’ trajectory and quality of life assessed by the Schedule for the Evaluation of Individual Quality of Life in qualitative data collection via interviews and focus groups. Data analysis was performed according to Grounded Theory and qualitative and quantitative results were interrelated. Setting/participants: Between March 2014 and September 2015 at two hospitals adult patients diagnosed with multidrug-resistant bacterial microorganisms and treated in a palliative care department or a geriatric ward were included in the sample group. Results: Patients in end-of-life and geriatric care reported emotional and social impact through multidrug-resistant bacterial microorganisms’ diagnosis itself, hygiene measures and lack of information. This impact affects aspects relevant to the patients’ quality of life. Patients’ wishes for comprehensive communication/information and reduction of social strain were identified from the focus group discussion. Conclusion: Patients would benefit from comprehensible information on multidrug-resistant bacterial microorganisms. Strategies minimizing social exclusion and emotional impact of multidrug-resistant bacterial microorganisms’ diagnosis in end-of-life care are needed as well as adaption or supplementation of standard multidrug-resistant bacterial microorganisms’ policies of hospitals.

Current climate and forecast models treat clouds as plane-uniform, ignoring subgrid-scale variations of cloud water content in radiative transfer calculations. The plane-uniform assumption is relaxed in a new cloud-radiation parameterization that considers cloud inhomogeneities and heterogeneities associated with convective and stratiform cloudiness. Convective cloudiness is diagnosed from the assumption that the ensemble of convective clouds within a model grid column is in a quasi-steady state. Global forecast experiments with the new parameterization show that the introduction of cloud inhomogeneities and heterogeneities leads to substantially increased and more realistic net downward shortwave radiative fluxes at the top of the atmosphere; over the tropical and subtropical oceans (30°S–30°N) the increase by inhomogeneities and heterogeneities is on average 9 and 7 W m−2, respectively.

A prognostic scheme for stratiform and convective clouds is developed for large-scale models. The time evolution of clouds is defined through the large-scale budget equations for cloud water content and cloud air (which is converted into a prognostic equation for fractional cloud cover). The scheme considers the formation of clouds in connection with large-scale ascent diabatic cooling, boundary-layer turbulence, and horizontal transport of cloud water from convective updrafts. Clouds dissipate through adiabatic and diabatic heating, turbulent mixing of cloud air with unsaturated environmental air, and depletion of cloud water by precipitation. The scheme differs from conventional schemes in its approach, which is fully prognostic and model consistent, and in the larger degree of complexity as the formation of anvil and circus clouds originating by cumulus updrafts and boundary-layer clouds is included. The scheme has been tested in the European Centre for Medium-Range Weather Forecasts (ECMWF) g...

The HIRS instrument on the NOAA polar orbiting satellites is used to obtain coverage of outward-going longwave radiation across the global tropics and subtropics four times a day. Fractional coverage of cold cloud is obtained from this, which is then interpreted as rainfall rates. This information is introduced into the ECMWF data assimilation system as diabatic heating through the nonlinear normal-mode initialization scheme. Substantial impact on the analyses is found.

This paper describes the impact on the tropical simulation in the ECMWF model of various changes to the treatment of physical processes, with particular emphasis on the onset of the Asian summer monsoon. A series of 10-day forecasts were carried out, each integration starting from 1200 UTC 11 June 1979 and covering the rapid intensification of the monsoon over the Arabian Sea and Southern India. The changes to the physical processes involved modifications to the radiation and Kuo penetrative convective schemes and the introduction of a shallow convection scheme. The changes to the treatment of convection, particularly the introduction of the shallow convection scheme, are found to have a large impact on the tropical circulation and precipitation. In addition to an overall beneficial effect on the simulated large-scale flow (e.g., tradewind boundary layer structure, tradewinds, ITCZ) there is a significant improvement of the monsoon simulation. It is found that only when the radiation changes are ...

We present the results of a series of forecasts on seven weather situations from February 1976 using two models which differ only in their physical parameterizations. One set of parameterizations was developed at the Geophysical Fluid Dynamics Laboratory (GFDL) some years ago, the other more recently at the European Centre for Medium Range Forcasts (ECMWF). The resolution of the model (N48, 15 levels) was that which ECMWF has used in the first phase of operations, which began in August 1979. The particular aim of the experiments was to study the importance of the differences in the parameterization schemes for the model; in addition, we obtained a general view of the forecast results that might be available in the first phase of operations. Both sets of parameterizations gave similar results in terms of forecast quality. When measured by the standard objective methods, the range of predictability was 5–6 days. A study of the systematic errors in the forecasts showed that these were mainly associa...