Ten-year seasonal climate reforecasts over South America using the Eta Regional Climate Model.

Ten-year seasonal climate reforecasts over South America are obtained using the Eta Regional Climate Model at 40 km resolution, driven by the large-scale forcing from the global atmospheric model of the Center for Weather Forecasts and Climate Studies. The objective of this work is to evaluate these regional reforecasts. The dataset is comprised of four-month seasonal forecasts performed on a monthly basis between 2001 and 2010. An ensemble of five members is constructed from five slightly different initial conditions to partially reduce the uncertainty in the seasonal forecasts. The seasonal mean precipitation and 2-meter temperature forecasts are compared with the observations. The comparison shows that, in general, forecasted precipitation is underestimated in the central part of the continent in the austral summer, whereas the forecasted 2 meter temperature is underestimated in most parts of the continent and throughout the year. Skill scores show higher skill in the northern part of the continent and lower skill in the southern part of the continent, but mixed skill signs are seen in the central part of the continent. During the El Niño and La Niña seasons, the forecast skill scores clearly increase. The downscaling of the Eta model seasonal forecasts provides added value over the driver global model forecasts, especially during rainy periods.

Relationship between pulmonary hypertension and outcomes among patients with heart failure with reduced ejection fraction.

Objectives: To identify predictors of pulmonary hypertension (PHT) and the predictive value of PHT for rehospitalization among patients with heart failure with reduced ejection fraction (HFrEF). Methods: A retrospective study of 351 hospitalized patients with heart failure (HF). Patients 18 years and above with HFrEF secondary to non-ischemic cardiomyopathy were reviewed. Patients with coronary artery disease, preserved ejection fraction and other secondary causes of PHT apart from HF were excluded. PHT as a predictor of 30-day and six-month re-admission was assessed as well as important possible predictors of PHT. Cox regression analysis, multiple linear regression as well as other statistical tools were employed as deemed appropriate. Results: Thirty-seven (37) and 99 patients were re-hospitalized within 30 days and 6 months after discharge for decompensated HF, respectively. After Cox regression analysis, higher hemoglobin reduced the odds of rehospitalization for decompensated HF (p = 0.015) within 30 days after discharge while higher pulmonary artery systolic pressure (PASP) (p = 0.002) and blood urea nitrogen (BUN) (p = 0.041) increased the odds of rehospitalization within 6 months of discharge. The predictors of the PHT among patients with HFrEF after multiple linear regression were low BMI (p = 0.027), increasing age (p = 0.006) and increased left atrial diameter (LAD) on echocardiography (p = 0.0001). Conclusion: Patients with HFrEF have a high predisposition to developing PHT if at admission, they have low BMI, dilated left atrium or are older. Patients with one or more of these attributes may need more intensive therapy to reduce the risk of developing PHT and in turn reduce readmission rates.