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Severe local storm (SLS) activity is known to occur within specific thermodynamic and kinematic environments. These environments are commonly associated with key synoptic-scale features-including southerly Great Plains low-level jets, drylines, elevated mixed layers, and extratropical cyclones-that link the large-scale climate to SLS environments. This work analyzes spatiotemporal distributions of both extreme values of SLS environmental parameters and synoptic-scale features in the ERA5 reanalysis and in the Community Atmosphere Model, version 6 (CAM6), historical simulation during 1980-2014 over North America. Compared to radiosondes, ERA5 successfully reproduces SLS environments, with strong spatiotemporal correlations and low biases, especially over the Great Plains. Both ERA5 and CAM6 reproduce the climatology of SLS environments over the central United States as well as its strong seasonal and diurnal cycles. ERA5 and CAM6also reproduce the climatological occurrence of the synoptic-scale features, with the distribution pattern similar to that of SLS environments. Compared to ERA5, CAM6 exhibits a high bias in convective available potential energy over the eastern United States primarily due to a high bias in surface moisture and, to a lesser extent, storm-relative helicity due to enhanced low-level winds. Composite analysis indicates consistent synoptic anomaly patterns favorable for significant SLS environments over much of the eastern half of the United States in both ERA5 and CAM6, though the pattern differs for the southeastern United States. Overall, our results indicate that both ERA5 and CAM6 are capable of reproducing SLS environments as well as the synoptic-scale features and transient events that generate them. [ABSTRACT FROM AUTHOR]

Tropical cyclones (TCs) can subject an area to heavy precipitation for many hours, or even days, worsening the risk of flooding, which creates dangerous conditions for residents of the U.S. East and Gulf Coasts. To study the representation of TC-related precipitation over the eastern United States in current-generation global climate models, a novel analysis methodology is developed to track TCs and extract their associated precipitation using an estimate of their dynamical outer size. This methodology is applied to three variableresolution (VR) configurations of the Community Atmosphere Model, version 5 (CAM5), with highresolution domains over the North Atlantic and one low-resolution conventional configuration, as well as to a combination of reanalysis and observational precipitation data. Metrics and diagnostics such as TC counts, intensities, outer storm sizes, and annual mean total and extreme precipitation are compared between the CAM5 simulations and reanalysis/observations. The high-resolution VR configurations outperform the global low-resolution configuration for all variables in the North Atlantic. Realistic TC intensities are produced by the VR configurations. The total North Atlantic TC counts are lower than observations but better than reanalysis. [ABSTRACT FROM AUTHOR]

Decreasing climate models' grid spacing improves the representation of tropical cyclones at decadal time scales. In this study, a variable‐resolution (VR) version of the Community Atmosphere Model 5 (CAM5‐VR) is utilized to study North Atlantic tropical cyclone climatology in ensemble historical climate simulations and under two Representative Concentration Pathway (RCP) projections (RCP4.5 and RCP8.5). Basin‐wide tropical cyclone counts decrease in the RCP simulations, although landfalling storm counts do not show as straightforward of a pattern, especially when focusing on regional changes. Lifetime maximum intensity metrics suggest that tropical cyclones increase in strength in the RCP ensembles. However, despite increases in tropical cyclone‐related precipitation rates and the amount of precipitation produced per storm with warming, the annual average Rx5day from tropical cyclones over the eastern United States decreases due to less landfalling storms. This work is part of a continued effort to quantify how tropical cyclone‐induced hazards may change in future climates. Plain Language Summary: Landfalling tropical cyclones create dangerous conditions for residents of the eastern United States through heavy rainfall, strong winds, and storm surge. This work utilizes a global climate model to estimate how these hazards from such storms might change in the future by studying changes in the tropical cyclones' intensities, sizes, and rainfall accumulations. In these climate model simulations, the number of tropical cyclones in the North Atlantic decreases and so does the number of tropical cyclones that make landfall in the United States in the future climate projections. The average intensities of these storms increase. The rainfall intensities within the tropical cyclones also increase in the future climate projections, so that the amount of rainfall produced per storm increases. Based on our simulations, although the number of tropical cyclones that make landfall in the United States will decrease in the future, the amount of precipitation that each landfalling storm produces will increase. Key Points: North Atlantic tropical cyclone frequency decreases and median intensity increases in future CAM5 climate change projection simulationsDue to less tropical cyclone landfalls in the United States, tropical cyclone precipitation over land decreases in CAM5 in the futureHigher precipitation rates in future climate projections increase the amount of precipitation produced per hour of tropical cyclone impact [ABSTRACT FROM AUTHOR]

The article presents several issues in the U.S. It stresses that the integration of Magnet Status award by the American Nurses' Credentialing Center (ANCC) to hospitals that meet standards of the professional and nursing practice. Further, Magnet Recognition Program identifies and defines "Forces of Magnetism" as the characteristics displayed by health care organizations for the development and maintenance of professional practice environment for the recruitment and retention of nurses.

With passage of the Patient Protection and Affordable Care Act of 2010, payment incentives were created to improve the "value" of health care delivery. Because physicians and physician practices aim to deliver care that is both clinically effective and patient centered, it is important to understand the association between the patient experience and quality health outcomes. Surveys have become a tool with which to quantify the consumer experience. In addition, results of these surveys are playing an increasingly important role in determining hospital payment. Given that the patient experience is being used as a surrogate marker for quality and value of health care delivery, we will review the patient experience-related pay-for-performance programs and effect on emergency medicine, discuss the literature describing the association between quality and the patient-reported experience, and discuss future opportunities for emergency medicine., (Copyright © 2014 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.)

The Beacon Award for Critical Care Excellence recognizes individual critical care units that have met rigid criteria for excellence, exhibiting high-quality standards and exceptional care of patients and their families. Used as a framework for quality, the award criteria focus on structure, process, and outcomes that enable quality to emerge in the critical care environment. The journey toward meeting Beacon Award criteria can produce long-lasting changes that transform unit-based culture and lead to sustained excellence.

The virtual or remote intensive care unit is a redesigned model of care that uses state-of-the-art technology to leverage the expertise and knowledge of experienced caregivers over a large group of patients in multiple intensive care units. The registered nurse working in this environment, or eRN, is an expert clinician familiar with evidence-based clinical initiatives that need to occur at the bedside to optimize outcomes for patients. The eRN assists the bedside team by providing a second layer of quality and safety. As the use of this technology continues to grow, a new dimension for critical care nursing practice is emerging that has dramatic implications for the future.