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Observations from Cloud–Aerosol Lidar and Infrared Pathfinder Satellite Observations (CALIPSO) and CloudSat satellites are used to evaluate clouds and precipitation in the ECHAM5 general circulation model. Active lidar and radar instruments on board CALIPSO and CloudSat allow the vertical distribution of clouds and their optical properties to be studied on a global scale. To evaluate the clouds modeled by ECHAM5 with CALIPSO and CloudSat, the lidar and radar satellite simulators of the Cloud Feedback Model Intercomparison Project’s Observation Simulator Package are used. Comparison of ECHAM5 with CALIPSO and CloudSat found large-scale features resolved by the model, such as the Hadley circulation, are captured well. The lidar simulator demonstrated ECHAM5 overestimates the amount of high-level clouds, particularly optically thin clouds. High-altitude clouds in ECHAM5 consistently produced greater lidar scattering ratios compared with CALIPSO. Consequently, the lidar signal in ECHAM5 frequently attenuated high in the atmosphere. The large scattering ratios were due to an underestimation of effective ice crystal radii in ECHAM5. Doubling the effective ice crystal radii improved the scattering ratios and frequency of attenuation. Additionally, doubling the effective ice crystal radii improved the detection of ECHAM5’s highest-level clouds by the radar simulator, in better agreement with CloudSat. ECHAM5 was also shown to significantly underestimate midlevel clouds and (sub)tropical low-level clouds. The low-level clouds produced were consistently perceived by the lidar simulator as too optically thick. The radar simulator demonstrated ECHAM5 overestimates the frequency of precipitation, yet underestimates its intensity compared with CloudSat observations. These findings imply compensating mechanisms inECHAM5 balance out the radiative imbalance caused by incorrect optical properties of clouds and consistently large hydrometeors in the atmosphere.

Objective: To review the literature and to identify practice gaps in the management of the hospitalized Parkinson's disease (PD) patient. Background(s): Patients with PD are admitted to hospitals at higher rates, and frequently have longer hospital stays than the general population. Little is known about outpatient interventions that might reduce the need for hospitalization and also reduce hospital-related complications. Method(s): A literature review was performed on PubMed about hospitalization and PD between 1970 and 2010. In addition, in press peer-reviewed papers or published abstracts known to the authors were included. Information was reviewed by a National Parkinson Foundation workgroup and a narrative review article was generated. Result(s): Motor disturbances in PD are believed to be a causal factor in the higher rates of admissions and complications. However, other conditions are commonly recorded as the primary reason for hospitalization including motor complications, reduced mobility, lack of compliance, inappropriate use of neuroleptics, falls, fractures, pneumonia, and other important medical problems. There are many relevant issues related to hospitalization in PD. Medications, dosages and specific dosage schedules are critical. Staff training regarding medications and medication management may help to avoid complications, particularly those related to reduced mobility, and aspiration pneumonia. Treatment of infections and a return to early mobility is also critical to management. Conclusion(s): Educational programs, recommendations, and guidelines are needed to better train interdisciplinary teams in the management of the PD patient. These initiatives have the potential for both cost savings and improved outcomes from a preventative and a hospital management standpoint. © 2010 Elsevier Ltd.

Item does not contain fulltext, OBJECTIVE: To review the literature and to identify practice gaps in the management of the hospitalized Parkinson's disease (PD) patient. BACKGROUND: Patients with PD are admitted to hospitals at higher rates, and frequently have longer hospital stays than the general population. Little is known about outpatient interventions that might reduce the need for hospitalization and also reduce hospital-related complications. METHODS: A literature review was performed on PubMed about hospitalization and PD between 1970 and 2010. In addition, in press peer-reviewed papers or published abstracts known to the authors were included. Information was reviewed by a National Parkinson Foundation workgroup and a narrative review article was generated. RESULTS: Motor disturbances in PD are believed to be a causal factor in the higher rates of admissions and complications. However, other conditions are commonly recorded as the primary reason for hospitalization including motor complications, reduced mobility, lack of compliance, inappropriate use of neuroleptics, falls, fractures, pneumonia, and other important medical problems. There are many relevant issues related to hospitalization in PD. Medications, dosages and specific dosage schedules are critical. Staff training regarding medications and medication management may help to avoid complications, particularly those related to reduced mobility, and aspiration pneumonia. Treatment of infections and a return to early mobility is also critical to management. CONCLUSIONS: Educational programs, recommendations, and guidelines are needed to better train interdisciplinary teams in the management of the PD patient. These initiatives have the potential for both cost savings and improved outcomes from a preventative and a hospital management standpoint.

Item does not contain fulltext, OBJECTIVES: To explore current practices and opinions regarding hospital management of Parkinson disease (PD) patients in specialized PD Centers. METHODS: Fifty-one out of 54 National Parkinson Foundation (NPF) Centers worldwide completed an online survey regarding hospitalization of PD patients. RESULTS: Many Centers were concerned about the quality of PD-specific care provided to their patients when hospitalized. Primary concerns were adherence to the outpatient medication schedule and poor understanding by hospital staff of medications that worsen PD. Few Centers had a policy with their primary hospital that notified them when their patients were admitted. Rather, notification of hospitalization came often from the patient or a family member. Several Centers (29%) reported not finding out about a hospitalization until a routine clinic visit after discharge. Quick access to outpatient PD care following discharge was a problem in many Centers. Elective surgery, fall/fracture, infection, and mental status changes, were identified as common reasons for hospitalization. CONCLUSIONS: There is a perceived need for PD specialists to be involved during hospitalization of their patients. Improvement in communication between hospitals and PD Centers is necessary so that hospital clinicians can take advantage of PD specialists' expertise. Education of hospital staff and clinicians regarding management of PD, complications of PD, and medications to avoid in PD is critical. Most importantly, outpatient access to PD specialists needs to be improved, which may prevent unnecessary hospitalizations in these patients.