The 11th edition of Harrison's Principles of Internal Medicine welcomes Anthony Fauci to its editorial staff, in addition to more than 85 new contributors. While the organization of the book is similar to previous editions, major emphasis has been placed on disorders that affect multiple organ systems. Important advances in genetics, immunology, and oncology are emphasized. Many chapters of the book have been rewritten and describe major advances in internal medicine. Subjects that received only a paragraph or two of attention in previous editions are now covered in entire chapters. Among the chapters that have been extensively revised are the chapters on infections in the compromised host, on skin rashes in infections, on many of the viral infections, including cytomegalovirus and Epstein-Barr virus, on sexually transmitted diseases, on diabetes mellitus, on disorders of bone and mineral metabolism, and on lymphadenopathy and splenomegaly. The major revisions in these chapters and many

Harrison's Principles of Internal Medicine

It has been widely debated whether recent extreme weather events are related to global warming. Now, from a review of the evidence so far, it is argued that certain events or an increase in their frequency can be linked with confidence to the human influence on climate.

/pdf/a-decade-of-weather-extremes-37qmrmwbjb.pdf

A decade of weather extremes

Endometriosis

[1] Arctic amplification (AA) – the observed enhanced warming in high northern latitudes relative to the northern hemisphere – is evident in lower-tropospheric temperatures and in 1000-to-500 hPa thicknesses. Daily fields of 500 hPa heights from the National Centers for Environmental Prediction Reanalysis are analyzed over N. America and the N. Atlantic to assess changes in north-south (Rossby) wave characteristics associated with AA and the relaxation of poleward thickness gradients. Two effects are identified that each contribute to a slower eastward progression of Rossby waves in the upper-level flow: 1) weakened zonal winds, and 2) increased wave amplitude. These effects are particularly evident in autumn and winter consistent with sea-ice loss, but are also apparent in summer, possibly related to earlier snow melt on high-latitude land. Slower progression of upper-level waves would cause associated weather patterns in mid-latitudes to be more persistent, which may lead to an increased probability of extreme weather events that result from prolonged conditions, such as drought, flooding, cold spells, and heat waves.

Climate phenomena and their relevance for future regional climate change

Two distinctly different forms of tropical Pacific Ocean warming are shown to have substantially different impacts on the frequency and tracks of North Atlantic tropical cyclones. The eastern Pacific warming (EPW) is identical to that of the conventional El Nino, whereas the central Pacific warming (CPW) has maximum temperature anomalies located near the dateline. In contrast to EPW events, CPW episodes are associated with a greater-than-average frequency and increasing landfall potential along the Gulf of Mexico coast and Central America. Differences are shown to be associated with the modulation of vertical wind shear in the main development region forced by differential teleconnection patterns emanating from the Pacific. The CPW is more predictable than the EPW, potentially increasing the predictability of cyclones on seasonal time scales.

https://science.sciencemag.org/content/sci/325/5936/77.full.pdf

Impact of Shifting Patterns of Pacific Ocean Warming on North Atlantic Tropical Cyclones

The seasonal prediction skill for the Northern Hemisphere winter is assessed using retrospective predictions (1982–2010) from the ECMWF System 4 (Sys4) and National Center for Environmental Prediction (NCEP) CFS version 2 (CFSv2) coupled atmosphere–ocean seasonal climate prediction systems. Sys4 shows a cold bias in the equatorial Pacific but a warm bias is found in the North Pacific and part of the North Atlantic. The CFSv2 has strong warm bias from the cold tongue region of the eastern Pacific to the equatorial central Pacific and cold bias in broad areas over the North Pacific and the North Atlantic. A cold bias in the Southern Hemisphere is common in both reforecasts. In addition, excessive precipitation is found in the equatorial Pacific, the equatorial Indian Ocean and the western Pacific in Sys4, and in the South Pacific, the southern Indian Ocean and the western Pacific in CFSv2. A dry bias is found for both modeling systems over South America and northern Australia. The mean prediction skill of 2 meter temperature (2mT) and precipitation anomalies are greater over the tropics than the extra-tropics and also greater over ocean than land. The prediction skill of tropical 2mT and precipitation is greater in strong El Nino Southern Oscillation (ENSO) winters than in weak ENSO winters. Both models predict the year-to-year ENSO variation quite accurately, although sea surface temperature trend bias in CFSv2 over the tropical Pacific results in lower prediction skill for the CFSv2 relative to the Sys4. Both models capture the main ENSO teleconnection pattern of strong anomalies over the tropics, the North Pacific and the North America. However, both models have difficulty in forecasting the year-to-year winter temperature variability over the US and northern Europe.

/pdf/seasonal-prediction-skill-of-ecmwf-system-4-and-ncep-cfsv2-3o8r9wf0x5.pdf

Seasonal prediction skill of ECMWF System 4 and NCEP CFSv2 retrospective forecast for the Northern Hemisphere Winter

[1] This study assesses the CMIP5 decadal hindcast/forecast simulations of seven state-of-the-art ocean-atmosphere coupled models. Each decadal prediction consists of simulations over a 10 year period each of which are initialized every five years from climate states of 1960/1961 to 2005/2006. Most of the models overestimate trends, whereby the models predict less warming or even cooling in the earlier decades compared to observations and too much warming in recent decades. All models show high prediction skill for surface temperature over the Indian, North Atlantic and western Pacific Oceans where the externally forced component and low-frequency climate variability is dominant. However, low prediction skill is found over the equatorial and North Pacific Ocean. The Atlantic Multidecadal Oscillation (AMO) index is predicted in most of the models with significant skill, while the Pacific Decadal Oscillation (PDO) index shows relatively low predictive skill. The multi-model ensemble has in general better-forecast quality than the single-model systems for global mean surface temperature, AMO and PDO.

/pdf/evaluation-of-short-term-climate-change-prediction-in-multi-3ujme37qiv.pdf

Evaluation of short-term climate change prediction in multi-model CMIP5 decadal hindcasts

Tropical Pacific Ocean warming has been separated into two modes based on the spatial distribution of the maximum sea surface temperature (SST) anomaly: an east Pacific warming (EPW) and a central Pacific warming (CPW). When combined with east Pacific cooling (EPC), these three regimes are shown to have different impacts on tropical cyclone (TC) activity over the North Pacific by differential modulation of both local thermodynamic factors and large-scale circulation patterns. In EPW years, the genesis and the track density of TCs tend to be enhanced over the southeastern part and suppressed in the northwestern part of the western Pacific by strong westerly wind shear. The extension of the monsoon trough and the weak wind shear over the central Pacific increases the likelihood of TC activity to the east of the climatological mean TC genesis location. In CPW years, the TC activity is shifted to the west and is extended through the northwestern part of the western Pacific. The westward shifting of C...

https://journals.ametsoc.org/doi/pdf/10.1175/2010JCLI3939.1

Modulation of North Pacific Tropical Cyclone Activity by Three Phases of ENSO

During July 2010, a series of monsoonal deluges over northern Pakistan resulted in catastrophic flooding, loss of life and property and an agricultural crisis that may last for years. Was the rainfall abnormal compared to previous years? Furthermore, could a high probability of flooding have been predicted? To address these questions, regional precipitation is analyzed using three dataset sets covering the 1981–2010 time period. It is concluded that the 2010 average May to August (MJJA) rainfall for year 2010 is somewhat greater in magnitude than previous years. However, the rainfall rate of the July deluges, especially in North Pakistan was exceptionally rare as deduced from limited data. The location of the deluges over the mountainous northern part of the country lead to the devastating floods. The European Centre for Medium Range Weather Forecasts (ECMWF) 15-day Ensemble Prediction System (EPS) is used to assess whether the rainfall over the flood affected region was predictable. A multi-year analysis shows that Pakistan rainfall is highly predictable out to 6–8 days including rainfall in the summer of 2010. We conclude that if these extended quantitative precipitation forecasts had been available in Pakistan, the high risk of flooding could have been foreseen. If these rainfall forecasts had been coupled to a hydrological model then the high risk of extensive and prolonged flooding could have anticipated and actions taken to mitigate their impact.

/pdf/were-the-2010-pakistan-floods-predictable-sbqiunjkw1.pdf

Hye-Mi Kim

Papers

Impact of Shifting Patterns of Pacific Ocean Warming on North Atlantic Tropical Cyclones

Seasonal prediction skill of ECMWF System 4 and NCEP CFSv2 retrospective forecast for the Northern Hemisphere Winter

Evaluation of short-term climate change prediction in multi-model CMIP5 decadal hindcasts

Modulation of North Pacific Tropical Cyclone Activity by Three Phases of ENSO

Were the 2010 Pakistan floods predictable