Patient satisfaction with healthcare provision services and the factors influencing it are be-coming the main focus of many scientific studies. Assuring the quality of the provided services is essential for the fulfillment of patients’ expectations and needs. Thus, this systematic review seeks to find the determinants of patient satisfaction in a global setting. We perform an analysis to evaluate the collected literature and to fulfill the literature gap of bibliometric analysis within this theme. This review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) approach. We conducted our database search in Scopus, Web of Science, and PubMed in June 2022. Studies from 2000–2021 that followed the inclusion and exclusion criteria and that were written in English were included in the sample. We ended up with 157 articles to review. A co-citation and bibliographic coupling analysis were employed to find the most relevant sources, authors, and documents. We divided the factors influencing patient satisfaction into criteria and explanatory variables. Medical care, communication with the patient, and patient’s age are among the most critical factors for researchers. The bibliometric analysis revealed the countries, institutions, documents, authors, and sources most productive and significant in patient satisfaction.

The Mediterranean region is characterized by the frequent occurrence of summer wildfires, representing an environmental and socioeconomic burden. Some Mediterranean countries (or provinces) are particularly prone to large fires, namely Portugal, Galicia (Spain), Greece, and southern France. Additionally, the Mediterranean basin corresponds to a major hotspot of climate change, and anthropogenic warming is expected to increase the total burned area due to fires in Mediterranean Europe. Here, we propose to classify summer large fires for fifty-four provinces of the Iberian Peninsula according to their local-scale weather conditions and fire danger weather conditions. A composite analysis was used to investigate the impact of local and regional climate drivers at different timescales, and to identify distinct climatologies associated with the occurrence of large fires. Cluster analysis was also used to identify a limited set of fire weather types, each characterized by a combination of meteorological conditions. For each of the provinces, two significant fire weather types were identified—one dominated by high positive temperature anomalies and negative humidity anomalies, and the other by intense zonal wind anomalies with two distinct subtypes in the Iberian Peninsula., allowing for the identification of three distinct regions.

Abstract. Climate change has the potential to increase surface ozone (O3) concentrations, known as the “ozone–climate penalty”, through changes to atmospheric chemistry, transport and dry deposition. In the tropics, the response of surface O3 to changing climate is relatively understudied but has important consequences for air pollution and human and ecosystem health. In this study, we evaluate the change in surface O3 due to climate change over South America and Africa using three state-of-the-art Earth system models that follow the Shared Socioeconomic Pathway 3-7.0 emission scenario from CMIP6. In order to quantify changes due to climate change alone, we evaluate the difference between simulations including climate change and simulations with a fixed present-day climate. We find that by 2100, models predict an ozone–climate penalty in areas where O3 is already predicted to be high due to the impacts of precursor emissions, namely urban and biomass burning areas, although on average, models predict a decrease in surface O3 due to climate change. We identify a small but robust positive trend in annual mean surface O3 over polluted areas. Additionally, during biomass burning seasons, seasonal mean O3 concentrations increase by 15 ppb (model range 12 to 18 ppb) in areas with substantial biomass burning such as the arc of deforestation in the Amazon. The ozone–climate penalty in polluted areas is shown to be driven by an increased rate of O3 chemical production, which is strongly influenced by NOx concentrations and is therefore specific to the emission pathway chosen. Multiple linear regression finds the change in NOx concentration to be a strong predictor of the change in O3 production, whereas increased isoprene emission rate is positively correlated with increased O3 destruction, suggesting NOx-limited conditions over the majority of tropical Africa and South America. However, models disagree on the role of climate change in remote, low-NOx regions, partly because of significant differences in NOx concentrations produced by each model. We also find that the magnitude and location of the ozone–climate penalty in the Congo Basin has greater inter-model variation than that in the Amazon, so further model development and validation are needed to constrain the response in central Africa. We conclude that if the climate were to change according to the emission scenario used here, models predict that forested areas in biomass burning locations and urban populations will be at increasing risk of high O3 exposure, irrespective of any direct impacts on O3 via the prescribed emission scenario.

The increase in frequency, severity, and duration of droughts poses as a serious issue to the management of forests in the Iberian Peninsula, with particular emphasis on the decline of forest growth and forest dieback. Hence, the adoption of adaptation and mitigation measures in forest ecosystems that are more vulnerable to drought is a pressing matter that needs to be addressed in the near future.This work aims at identifying the regions in the Iberian Peninsula where forest exhibit high vulnerability to drought conditions. To accomplish that, a vulnerability map is produced by considering three pillar components: exposure, sensitivity, and adaptive capacity to drought. Exposure is estimated based on the multi-scalar drought index Standardized Precipitation-Evapotranspiration Index (SPEI) and aridity, while the remotely sensed Vegetation Health Index (VHI) and mean forested cover are used to assess the regions’ sensitivity to drought. Finally, elevation, water table depth, fire radiative energy, and annual solar irradiation are compiled as indicators to assess adaptive capacity. Principal component analysis was then applied to the three pillar components to identify the areas more vulnerable to drought. This approach allows for the identification of forested areas vulnerable to drought in terms of vulnerability classes automatically determined.Forests presented very high vulnerability in eastern Spain, and central Portugal. Within the most vulnerable vegetation communities, mosaic tree and shrub types revealed to be extremely vulnerable to droughts in the Iberian Peninsula, followed by needle-leaved forests (in Central Portugal, and Northeast Iberia). This work highlights the regions and primary vegetation communities to which the effort of adapting and mitigating drought consequences should be utterly enforced by the responsible authorities.

Patient satisfaction and the factors influencing it are becoming a significant concern for health organizations and patients around the world. This study evaluates patients' satisfaction regarding the inpatient service while tackling the existent literature gap on which method best suits the patient satisfaction analysis. We perform a methodological comparison (using factor analysis, structural equation modeling, ordinal logistic regression (OLR), and multicriteria satisfaction analysis (MUSA)) to contrast the different results from different methodologies. After implementing the methods, we concluded that, out of the eleven analyzed factors, seven influence satisfaction: accommodations, auxiliary staff, exams and treatments, medical staff, food quality, volunteering staff, and obtained information. Three were consistent for structural equation modeling and OLR: accommodations, exams and treatments, and health services. The outputs of MUSA were not compatible with the other methods. However, we concluded that the MUSA method is a good option when dealing with patient satisfaction studies since it provides insightful outputs that facilitate managers' decision making and improve the provider's performance efficiency.

Abstract. Climate change has the potential to increase surface ozone (O3) concentrations, known as the ‘ozone–climate penalty’, through changes to atmospheric chemistry, transport and dry deposition. In the tropics, the response of surface O3 to changing climate is relatively understudied, but has important consequences for air pollution, human and ecosystem health. In this study, we evaluate the change in surface O3 due to climate change over South America and Africa using 3 state-of-the-art Earth system models that follow the Shared Socioeconomic Pathway 3 7.0 emissions scenario from CMIP6. To quantify the changes driven by climate change alone, we evaluate the difference between end of the century predictions for simulations which include climate change and simulations with the same emissions scenario but with a fixed present-day climate. We find that by 2100, models predict an ozone–climate penalty in areas where O3 is already predicted to be high due to the impacts of precursor emissions, namely urban and biomass burning areas, although on average models predict a decrease in surface O3 due to climate change. We identify a small but robust positive trend in annual mean surface O3 over polluted areas. Additionally, during biomass burning seasons, seasonal mean O3 concentrations increase by 15 ppb (model range 12 to 18 ppb) in areas with substantial biomass burning such as the arc of deforestation in the Amazon. The ozone–climate penalty in polluted areas is shown to be driven by an increased rate of O3 chemical production, which is strongly influenced by NOx concentrations and is therefore specific to the emissions pathway chosen. Multiple linear regression finds the change in NOx concentration to be a strong predictor of the change in O3 production whereas increased isoprene emission rate is positively correlated with increased O3 destruction, suggesting NOx-limited conditions over the majority of tropical Africa and South America. However, models disagree on the role of climate change in remote, low-NOx regions, partly because of significant differences in NOx concentrations produced by each model. We also find that the magnitude and location of the ozone–climate penalty in the Congo basin has greater inter-model variation than in the Amazon, so further model development and validation is needed to constrain the response in central Africa. We conclude that if the climate were to change according to the emissions scenario used here, models predict that forested areas in biomass burning locations and urban populations will be at increasing risk of high O3 exposure.

No abstract

The IMPECAF is a research project that started at the end of 2018 and aims to deepen the knowledge on weather extremes, particularly droughts and heat waves, which affect agricultural and forest ecosystems of the Iberian Peninsula. Despite these events presenting different temporal scales, their simultaneous occurrence can intensify the observed impacts. In addition, these impacts may extend over large areas affecting different ecosystems. This project aims at transferring knowledge on fundamental research in meteorology for the agricultural and forestry sectors, and it is expected that the results may be an input in the decision-making process of farmers. To achieve this aim, appropriate measures will be developed to mitigate the impact of these extreme weather events in the forestry and agricultural sectors. This will be followed by an approach that ensures the involvement of stakeholders since the beginning of the project and even after its conclusion.