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The predictor variables employed are area averages (over ~2.5 × 106 km2) of temperature and precipitation and propinquitous grid point values of mean sea level pressure and 700 mbar height, together with the zonal and meridional gradients of these two variables. Regression analyses are performed using monthly-mean data from Oregon, with separate analyses for each month. In independent verification, Spatial-mean explained variances range from 58 to 87% for temperature and from 39 to 76% for precipitation. Most of the variance explained arises from the area average of the variable which is the predictand: in other words, if the temperature, say, at point x is to be estimated, the best predictor is generally the area average temperature

I n Canada, alcohol use led to an estimated 5.8% of deaths in men and 0.6% of deaths in women in 2017. 1 Alcohol use also imposes a substantial burden on the Canadian health system; between 2014 and 2015, there were 77 000 hospital admissions entirely attributable to alcohol, exceeding the number of admissions for coronary artery disease. 2 A growing body of evidence from the United States, England and Australia has found that alcohol-related mortality and harms, such as hospital admissions or emergency department visits attributable to alcohol use, have increased over the past 2 decades. 3-5 In 2015, rates of hospital admissions attributable to alcohol in Canada were higher in men than in women and older adults. 2 Furthermore, mortality rates specifically attributable to alcohol-related liver disease have been increasing over time in Canada. 1 However, data are lacking on how population-level emergency department visits or hospital admissions attributable to alcohol use in Canada have changed over time and, importantly, whether any changes differ by factors such as age, sex and socioeconomic status. Although alcohol harms appear to be increasing in highincome countries, to our knowledge, only one study set in England has examined contemporary population-level changes in alcohol-related harms by age, sex and income. 4 Emerging data

Background:To enable coordinated palliative care delivery, all clinicians should have basic palliative care skill sets (‘generalist palliative care’). Specialists should have skills for managing complex and difficult cases (‘specialist palliative care’) and co-exist to support generalists through consultation care and transfer of care. Little information exists about the actual mixes of generalist and specialist palliative care.Aim:To describe the models of physician-based palliative care services delivered to patients in the last 12 months of life.Design:This is a population-based retrospective cohort study using linked health care administrative data.Setting/participants:Physicians providing palliative care services to a decedent cohort in Ontario, Canada. The decedent cohort consisted of all adults (18+ years) who died in Ontario, Canada between April 2011 and March 2015 (n = 361,951).Results:We describe four major models of palliative care services: (1) 53.0% of decedents received no physician-based palliative care, (2) 21.2% received only generalist palliative care, (3) 14.7% received consultation palliative care (i.e. care from both specialists and generalists), and (4) 11.1% received only specialist palliative care. Among physicians providing palliative care (n = 11,006), 95.3% had a generalist palliative care focus and 4.7% a specialist focus; 74.2% were trained as family physicians.Conclusion:We examined how often a coordinated palliative care model is delivered to a large decedent cohort and identified that few actually received consultation care. The majority of care, in both the palliative care generalist and specialist models, was delivered by family physicians. Further research should evaluate how different models of care impact patient outcomes and costs.