Extreme ocean warming events, known as marine heatwaves (MHWs), have been observed to perturb significantly marine ecosystems and fisheries around the world. Here, we propose a detection method for long-lasting and large-scale summer MHWs, using a local, climatological 99th percentile threshold, based on present-climate (1976–2005) daily SST. To assess their future evolution in the Mediterranean Sea we use, for the first time, a dedicated ensemble of fully-coupled Regional Climate System Models from the Med-CORDEX initiative and a multi-scenario approach. The models appear to simulate well MHW properties during historical period, despite biases in mean and extreme SST. In response to increasing greenhouse gas forcing, the events become stronger and more intense under RCP4.5 and RCP8.5 than RCP2.6. By 2100 and under RCP8.5, simulations project at least one long-lasting MHW every year, up to three months longer, about 4 times more intense and 42 times more severe than present-day events. They are expected to occur from June-October and to affect at peak the entire basin. Their evolution is found to occur mainly due to an increase in the mean SST, but increased daily SST variability also plays a noticeable role. Until the mid-21st century, MHW characteristics rise independently of the choice of the emission scenario, the influence of which becomes more evident by the end of the period. Further analysis reveals different climate change responses in certain configurations, more likely linked to their driving global climate model rather than to the individual model biases.

The Mediterranean has been identified as one of the most responsive regions to climate change. It has been conjectured that one of the effects of a warmer climate could be to make the Mediterranean Sea prone to the formation of hurricanes. Already in the present climate regime, however, a few of the numerous low pressure systems that form in the area develop a dynamical evolution similar to the one of tropical cyclones. Even if their spatial extent is generally smaller and the life cycle shorter compared to tropical cyclones, such storms produce severe damage on the highly populated coastal areas surrounding the Mediterranean Sea. This study, based on the analysis of individual realistically simulated storms in homogeneous long-term and high-resolution data from multiple climate change scenarios, shows that the projected effect of climate change on Mediterranean tropical-like cyclones is decreased frequency and a tendency toward a moderate increase of intensity.

Background and Purpose: The National Institutes of Health Stroke Scale (NIHSS) underestimates clinical severity in posterior circulation stroke and patients presenting with low NIHSS may be considered ineligible for reperfusion therapies. This study aimed to develop a modified version of the NIHSS, the Posterior NIHSS (POST-NIHSS), to improve NIHSS prognostic accuracy for posterior circulation stroke patients with mild-moderate symptoms. Methods: Clinical data of consecutive posterior circulation stroke patients with mild-moderate symptoms (NIHSS <10), who were conservatively managed, were retrospectively analyzed from the Basilar Artery Treatment and Management registry. Clinical features were assessed within 24 hours of symptom onset; dysphagia was assessed by a speech therapist within 48 hours of symptom onset. Random forest classification algorithm and constrained optimization were used to develop the POST-NIHSS in the derivation cohort. The POST-NIHSS was then validated in a prospective cohort. Poor outcome was defined as modified Rankin Scale score ≥3 at 3 months. Results: We included 202 patients (mean [SD] age 63 [14] years, median NIHSS 3 [interquartile range, 1–5]) in the derivation cohort and 65 patients (mean [SD] age 63 [16] years, median NIHSS 2 [interquartile range, 1–4]) in the validation cohort. In the derivation cohort, age, NIHSS, abnormal cough, dysphagia and gait/truncal ataxia were ranked as the most important predictors of functional outcome. POST-NIHSS was calculated by adding 5 points for abnormal cough, 4 points for dysphagia, and 3 points for gait/truncal ataxia to the baseline NIHSS. In receiver operating characteristic analysis adjusted for age, POST-NIHSS area under receiver operating characteristic curve was 0.80 (95% CI, 0.73–0.87) versus NIHSS area under receiver operating characteristic curve, 0.73 (95% CI, 0.64–0.83), P =0.03. In the validation cohort, POST-NIHSS area under receiver operating characteristic curve was 0.82 (95% CI, 0.69–0.94) versus NIHSS area under receiver operating characteristic curve 0.73 (95% CI, 0.58–0.87), P =0.04. Conclusions: POST-NIHSS showed higher prognostic accuracy than NIHSS and may be useful to identify posterior circulation stroke patients with NIHSS <10 at higher risk of poor outcome.