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A recently launched project under the auspices of the World Climate Research Program’s (WCRP) Coordinated Regional Downscaling Experiments Flagship Pilot Studies program (CORDEX-FPS) is presented. This initiative aims to build first-of-its-kind ensemble climate experiments of convection permitting models to investigate present and future convective processes and related extremes over Europe and the Mediterranean. In this manuscript the rationale, scientific aims and approaches are presented along with some preliminary results from the testing phase of the project. Three test cases were selected in order to obtain a first look at the ensemble performance. The test cases covered a summertime extreme precipitation event over Austria, a fall Foehn event over the Swiss Alps and an intensively documented fall event along the Mediterranean coast. The test cases were run in both “weather-like” (WL, initialized just before the event in question) and “climate” (CM, initialized 1 month before the event) modes. Ensembles of 18–21 members, representing six different modeling systems with different physics and modelling chain options, was generated for the test cases (27 modeling teams have committed to perform the longer climate simulations). Results indicate that, when run in WL mode, the ensemble captures all three events quite well with ensemble correlation skill scores of 0.67, 0.82 and 0.91. They suggest that the more the event is driven by large-scale conditions, the closer the agreement between the ensemble members. Even in climate mode the large-scale driven events over the Swiss Alps and the Mediterranean coasts are still captured (ensemble correlation skill scores of 0.90 and 0.62, respectively), but the inter-model spread increases as expected. In the case over Mediterranean the effects of local-scale interactions between flow and orography and land–ocean contrasts are readily apparent. However, there is a much larger, though not surprising, increase in the spread for the Austrian event, which was weakly forced by the large-scale flow. Though the ensemble correlation skill score is still quite high (0.80). The preliminary results illustrate both the promise and the challenges that convection permitting modeling faces and make a strong argument for an ensemble-based approach to investigating high impact convective processes.

In the framework of the EURO-CORDEX initiative an ensemble of European-wide high-resolution regional climate simulations on a 0 . 11 ∘ ( ∼ 12.5 km ) grid has been generated. This study investigates whether the fine-gridded regional climate models are found to add value to the simulated mean and extreme daily and sub-daily precipitation compared to their coarser-gridded 0 . 44 ∘ ( ∼ 50 km ) counterparts. Therefore, pairs of fine- and coarse-gridded simulations of eight reanalysis-driven models are compared to fine-gridded observations in the Alps, Germany, Sweden, Norway, France, the Carpathians, and Spain. A clear result is that the 0 . 11 ∘ simulations are found to better reproduce mean and extreme precipitation for almost all regions and seasons, even on the scale of the coarser-gridded simulations (50 km). This is primarily caused by the improved representation of orography in the 0 . 11 ∘ simulations and therefore largest improvements can be found in regions with substantial orographic features. Improvements in reproducing precipitation in the summer season appear also due to the fact that in the fine-gridded simulations the larger scales of convection are captured by the resolved-scale dynamics . The 0 . 11 ∘ simulations reduce biases in large areas of the investigated regions, have an improved representation of spatial precipitation patterns, and precipitation distributions are improved for daily and in particular for 3 hourly precipitation sums in Switzerland. When the evaluation is conducted on the fine (12.5 km) grid, the added value of the 0 . 11 ∘ models becomes even more obvious.

Objective To assess the cancer risk in children and adolescents following exposure to low dose ionising radiation from diagnostic computed tomography (CT) scans.Design Population based, cohort, data linkage study in Australia.Cohort members 10.9 million people identified from Australian Medicare records, aged 0-19 years on 1 January 1985 or born between 1 January 1985 and 31 December 2005; all exposures to CT scans funded by Medicare during 1985-2005 were identified for this cohort. Cancers diagnosed in cohort members up to 31 December 2007 were obtained through linkage to national cancer records.Main outcome Cancer incidence rates in individuals exposed to a CT scan more than one year before any cancer diagnosis, compared with cancer incidence rates in unexposed individuals.Results 60 674 cancers were recorded, including 3150 in 680 211 people exposed to a CT scan at least one year before any cancer diagnosis. The mean duration of follow-up after exposure was 9.5 years. Overall cancer incidence was 24% greater for exposed than for unexposed people, after accounting for age, sex, and year of birth (incidence rate ratio (IRR) 1.24 (95% confidence interval 1.20 to 1.29); P<0.001). We saw a dose-response relation, and the IRR increased by 0.16 (0.13 to 0.19) for each additional CT scan. The IRR was greater after exposure at younger ages (P<0.001 for trend). At 1-4, 5-9, 10-14, and 15 or more years since first exposure, IRRs were 1.35 (1.25 to 1.45), 1.25 (1.17 to 1.34), 1.14 (1.06 to 1.22), and 1.24 (1.14 to 1.34), respectively. The IRR increased significantly for many types of solid cancer (digestive organs, melanoma, soft tissue, female genital, urinary tract, brain, and thyroid); leukaemia, myelodysplasia, and some other lymphoid cancers. There was an excess of 608 cancers in people exposed to CT scans (147 brain, 356 other solid, 48 leukaemia or myelodysplasia, and 57 other lymphoid). The absolute excess incidence rate for all cancers combined was 9.38 per 100 000 person years at risk, as of 31 December 2007. The average effective radiation dose per scan was estimated as 4.5 mSv.Conclusions The increased incidence of cancer after CT scan exposure in this cohort was mostly due to irradiation. Because the cancer excess was still continuing at the end of follow-up, the eventual lifetime risk from CT scans cannot yet be determined. Radiation doses from contemporary CT scans are likely to be lower than those in 1985-2005, but some increase in cancer risk is still likely from current scans. Future CT scans should be limited to situations where there is a definite clinical indication, with every scan optimised to provide a diagnostic CT image at the lowest possible radiation dose.

As global temperatures continue to rise, the impact of heatwaves becomes increasingly striking. The increasing frequency and intensity of these events underscore the critical need to understand regional‐scale mechanisms and feedback, exacerbating or mitigating heatwave magnitude. Here, we use an ensemble of convection‐permitting regional climate models (CPRCMs) to elucidate future heatwave changes at fine spatial scales. We explore whether the recently highlighted drier/warmer signal introduced by CPRCMs improves summer temperature extremes representation and if it modulates future heatwave changes compared to convection‐parameterizing regional climate models (RCMs). In historical runs, CPRCMs show a more realistic representation of summer maximum temperature especially on a ground‐station‐based evaluation. CPRCMs project substantially drier conditions than RCMs. This is associated with a modulation of heatwave temperature changes which show diversified spatial patterns, magnitudes, and signs. CPRCMs ensemble shows an overall reduction in heatwave metrics future changes inter‐model spread compared to the RCMs ensemble. Plain Language Summary Heatwaves are progressively having a bigger impact on communities and ecosystems. The growing frequency and intensity of these events highlight the need to understand regional mechanisms and feedback that can either worsen or mitigate increasing heatwave trends. We use an ensemble of very high‐resolution regional climate models (CPRCMs, ∼3 km) to explore changes in heatwaves at fine spatial scales. We investigate if the drier and warmer conditions characterizing CPRCMs improve the accuracy of summer temperature extremes and how they affect future heatwave patterns compared to lower‐resolution regional climate models (RCMs). In historical simulations, CPRCMs provide a more accurate representation of summer maximum temperatures, especially on a station‐based evaluation. CPRCMs predict drier conditions than RCMs. This dryness affects heatwave temperature changes according to varied spatial patterns, magnitudes, and trends. Overall, the CPRCMs ensemble shows less uncertainty in predicted heatwave changes compared to the RCMs ensemble. Key Points CPRCMs improve summer season maximum temperature representation, especially on a ground‐station‐based evaluation CPRCMs amplify heatwave maximum temperature changes over the Alps and the northern GAR, combined with the strongest projected drying CPRCMs ensemble reduces heatwave metrics change signal inter‐model spread except for the dry spell length

In the current work we present six hindcast WRF (Weather Research and Forecasting model) simulations for the EURO-CORDEX (European Coordinated Regional Climate Downscaling Experiment) domain with different configurations in microphysics, convection and radiation for the time period 1990–2008. All regional model simulations are forced by the ERA-Interim reanalysis and have the same spatial resolution (0.44°). These simulations are evaluated for surface temperature, precipitation, short- and longwave downward radiation at the surface and total cloud cover. The analysis of the WRF ensemble indicates systematic temperature and precipitation biases, which are linked to different physical mechanisms in the summer and winter seasons. Overestimation of total cloud cover and underestimation of downward shortwave radiation at the surface, mostly linked to the Grell–Devenyi convection and CAM (Community Atmosphere Model) radiation schemes, intensifies the negative bias in summer temperatures over northern Europe (max −2.5 °C). Conversely, a strong positive bias in downward shortwave radiation in summer over central (40–60%) and southern Europe mitigates the systematic cold bias over these regions, signifying a typical case of error compensation. Maximum winter cold biases are over northeastern Europe (−2.8 °C); this location suggests that land–atmosphere rather than cloud–radiation interactions are to blame. Precipitation is overestimated in summer by all model configurations, especially the higher quantiles which are associated with summertime deep cumulus convection. The largest precipitation biases are produced by the Kain–Fritsch convection scheme over the Mediterranean. Precipitation biases in winter are lower than those for summer in all model configurations (15–30%). The results of this study indicate the importance of evaluating not only the basic climatic parameters of interest for climate change applications (temperature and precipitation), but also other components of the energy and water cycle, in order to identify the sources of systematic biases, possible compensatory or masking mechanisms and suggest pathways for model improvement.

Daily precipitation statistics as simulated by the ERA-Interim-driven EURO-CORDEX regional climate model (RCM) ensemble are evaluated over two distinct regions of the European continent, namely the European Alps and Spain. The potential added value of the high-resolution 12 km experiments with respect to their 50 km resolution counterparts is investigated. The statistics considered consist of wet-day intensity and precipitation frequency as a measure of mean precipitation, and three precipitation-derived indicators (90th percentile on wet days—90pWET, contribution of the very wet days to total precipitation—R95pTOT and number of consecutive dry days—CDD). As reference for model evaluation high resolution gridded observational data over continental Spain (Spain011/044) and the Alpine region (EURO4M-APGD) are used. The assessment and comparison of the two resolutions is accomplished not only on their original horizontal grids (approximately 12 and 50 km), but the high-resolution RCMs are additionally regridded onto the coarse 50 km grid by grid cell aggregation for the direct comparison with the low resolution simulations. The direct application of RCMs e.g. in many impact modelling studies is hampered by model biases. Therefore bias correction (BC) techniques are needed at both resolutions to ensure a better agreement between models and observations. In this work, the added value of the high resolution (before and after the bias correction) is assessed and the suitability of these BC methods is also discussed. Three basic BC methods are applied to isolate the effect of biases in mean precipitation, wet-day intensity and wet-day frequency on the derived indicators. Daily precipitation percentiles are strongly affected by biases in the wet-day intensity, whereas the dry spells are better represented when the simulated precipitation frequency is adjusted to the observed one. This confirms that there is no single optimal way to correct for RCM biases, since correcting some distributional features typically leads to an improvement of some aspects but to a deterioration of others. Regarding mean seasonal biases before the BC, we find only limited evidence for an added value of the higher resolution in the precipitation intensity and frequency or in the derived indicators. Thereby, evaluation results considerably depend on the RCM, season and indicator considered. High resolution simulations better reproduce the indicators’ spatial patterns, especially in terms of spatial correlation. However, this improvement is not statistically significant after applying specific BC methods.

Recent studies using convection-permitting (CP) climate simulations have demonstrated a step-change in the representation of heavy rainfall and rainfall characteristics (frequency-intensity) compared to coarser resolution Global and Regional climate models. The goal of this study is to better understand what explains the weaker frequency of precipitation in the CP ensemble by assessing the triggering process of precipitation in the different ensembles of regional climate simulations available over Europe. We focus on the statistical relationship between tropospheric temperature, humidity and precipitation to understand how the frequency of precipitation over Europe and the Mediterranean is impacted by model resolution and the representation of convection (parameterized vs. explicit). We employ a multi-model data-set with three different resolutions (0.44°, 0.11° and 0.0275°) produced in the context of the MED-CORDEX, EURO-CORDEX and the CORDEX Flagship Pilot Study \"Convective Phenomena over Europe and the Mediterranean\" (FPSCONV). The multi-variate approach is applied to all model ensembles, and to several surface stations where the integrated water vapor (IWV) is derived from Global Positioning System (GPS) measurements. The results show that all model ensembles capture the temperature dependence of the critical value of IWV (IWVcv), above which an increase in precipitation frequency occurs, but the differences between the models in terms of the value of IWVcv, and the probability of its being exceeded, can be large at higher temperatures. The lower frequency of precipitation in convection-permitting simulations is not only explained by higher temperatures but also by a higher IWVcv necessary to trigger precipitation at similar temperatures, and a lower probability to exceed this critical value. The spread between models in simulating IWVcv and the probability of exceeding IWVcv is reduced over land in the ensemble of models with explicit convection, especially at high temperatures, when the convective fraction of total precipitation becomes more important and the influence of the representation of entrainment in models thus becomes more important. Over lowlands, both model resolution and convection representation affect precipitation triggering while over mountainous areas, resolution has the highest impact due to orography-induced triggering processes. Over the sea, since lifting is produced by large-scale convergence, the probability to exceed IWVcv does not depend on temperature, and the model resolution does not have a clear impact on the results.

Heatwaves (HWs) are high-impact phenomena stressing both societies and ecosystems. Their intensity and frequency are expected to increase in a warmer climate over many regions of the world. While these impacts can be wide-ranging, they are potentially influenced by local to regional features such as topography, land cover, and urbanization. Here, we leverage recent advances in the very high-resolution modelling required to elucidate the impacts of heatwaves at these fine scales. Further, we aim to understand how the new generation of km-scale regional climate models (RCMs) modulates the representation of heatwaves over a well-known climate change hot spot. We analyze an ensemble of 15 convection-permitting regional climate model (CPRCM, ~ 2–4 km grid spacing) simulations and their driving, convection-parameterized regional climate model (RCM, ~ 12–15 km grid spacing) simulations from the CORDEX Flagship Pilot Study on Convection. The focus is on the evaluation experiments (2000–2009) and three subdomains with a range of climatic characteristics. During HWs, and generally in the summer season, CPRCMs exhibit warmer and drier conditions than their driving RCMs. Higher maximum temperatures arise due to an altered heat flux partitioning, with daily peaks up to ~ 150 W/m 2 larger latent heat in RCMs compared to the CPRCMs. This is driven by a 5–25% lower soil moisture content in the CPRCMs, which is in turn related to longer dry spell length (up to double). It is challenging to ascertain whether these differences represent an improvement. However, a point-scale distribution-based maximum temperature evaluation, suggests that this CPRCMs warmer/drier tendency is likely more realistic compared to the RCMs, with ~ 70% of reference sites indicating an added value compared to the driving RCMs, increasing to 95% when only the distribution right tail is considered. Conversely, a CPRCMs slight detrimental effect is found according to the upscaled grid-to-grid approach over flat areas. Certainly, CPRCMs enhance dry conditions, with knock-on implications for summer season temperature overestimation. Whether this improved physical representation of HWs also has implications for future changes is under investigation.

ObjectivesThis study aimed to examine how patients perceive shared decision-making regarding CT scan referral and use of the five Choosing Wisely questions with their general practitioner (GP).DesignThis is a qualitative exploratory study using semistructured interviews.SettingThis study was conducted in a large metropolitan public healthcare organisation in urban Australia.ParticipantsFollowing purposive sampling, 20 patients and 2 carers participated. Patient participants aged 18 years or older were eligible if they were attending the healthcare organisation for a CT scan and referred by their GP. Carers/family were eligible to participate when they were in the role of an unpaid carer and were aged 18 years or older. Participants were required to speak English sufficiently to provide informed consent. Participants with cognitive impairment were excluded.FindingsEighteen interviews were conducted with the patient only. Two interviews were conducted with the patient and the patient’s carer. Fourteen participants were female. Five themes resulted from the thematic analysis: (1) needing to know, (2) questioning doctors is not necessary, (3) discussing scans is not required, (4) uncertainty about questioning and (5) valuing the Choosing Wisely questions. Participants reported that they presented to their GP with a health problem that they needed to understand and address. Participants accepted their GPs decision to prescribe a CT scan to identify the nature of their problem. They reported ambivalence about engaging in shared decision-making with their doctor, although many participants reported valuing the Choosing Wisely questions.ConclusionsShared decision-making is an important principle underpinning Choosing Wisely. Practice implementation requires understanding patients’ motivations to engage in shared decision-making with a focus on attitudes, beliefs, knowledge and emotions. Systems-level support and education for healthcare practitioners in effective communication is important. However, this needs to emphasise communication with patients who have varying degrees of motivation to engage in shared decision-making and Choosing Wisely.

The advancement of computational resources has allowed researchers to run convection-permitting regional climate model (CPRCM) simulations. A pioneering effort promoting a multimodel ensemble of such simulations is the CORDEX Flagship Pilot Studies (FPS) on “Convective Phenomena over Europe and the Mediterranean” over an extended Alps region. In this study, the Distribution Added Value metric is used to determine the improvement of the representation of all available FPS hindcast simulations for the daily mean near-surface wind speed. The analysis is performed on normalized empirical probability distributions and considers station observation data as the reference. The use of a normalized metric allows for spatial comparison among the different regions (coast and inland), altitudes and seasons. This approach permits a direct assessment of the added value between the CPRCM simulations against their global driving reanalysis (ERA-Interim) and respective coarser resolution regional model counterparts. In general, the results show that CPRCMs add value to their global driving reanalysis or forcing regional model, due to better-resolved topography or through better representation of ocean-land contrasts. However, the nature and magnitude of the improvement in the wind speed representation vary depending on the model, the season, the altitude, or the region. Among seasons, the improvement is usually larger in summer than winter. CPRCMs generally display gains at low and medium-range altitudes. In addition, despite some shortcomings in comparison to ERA-Interim, which can be attributed to the assimilation of wind observations on the coast, the CPRCMs outperform the coarser regional climate models, both along the coast and inland.