No abstract

A dense rain-gauge network within continental Ecuador was used to evaluate the quality of various products of rainfall data over the Pacific slope and coast of Ecuador (EPSC). A cokriging interpolation method is applied to the rain-gauge data yielding a gridded product at 5-km resolution covering the period 1965-2015. This product is compared with the Global Precipitation Climatology Centre (GPCC) dataset, the Climatic Research Unit-University of East Anglia (CRU) dataset, the Tropical Rainfall Measuring Mission (TRMM/TMPA 3B43 Version 7) dataset and the ERA-Interim Reanalysis. The analysis reveals that TRMM data show the most realistic features. The relative bias index (Rbias) indicates that TRMM data is closer to the observations, mainly over lowlands (mean Rbias of 7%) but have more limitations in reproducing the rainfall variability over the Andes (mean Rbias of −28%). The average RMSE and Rbias of 68.7 and −2.8% of TRMM are comparable with the GPCC (69.8 and 5.7%) and CRU (102.3 and −2.3%) products. This study also focuses on the rainfall inter-annual variability over the study region which experiences floods that have caused high economic losses during extreme El Niño events. Finally, our analysis evaluates the ability of TRMM data to reproduce rainfall events during El Niño years over the study area and the large basins of Esmeraldas and Guayas rivers. The results show that TRMM estimates report reasonable levels of heavy rainfall detection (for the extreme 1998 El Niño event) over the EPSC and specifically towards the center-south of the EPSC (Guayas basin) but present underestimations for the moderate El Niño of 2002-2003 event and the weak 2009-2010 event. Generally, the rainfall seasonal features, quantity and long-term climatology patterns are relatively well estimated by TRMM.

Duran is a coastal city located in the Guayas Estuary region in which 24% of urban sectors suffers from the effects of chronic flooding. This study seeks to assess the causes of Duran’s vulnerability by considering exposure, population sensitivity and adaptive capacity to establish alternatives to reduce its vulnerability to flooding. An operational framework is proposed based on the vulnerability definition of the Intergovernmental Panel on Climate Change (IPCC) and applying a census-based Index of Vulnerability, a geographic information system and local knowledge of urban development. A Principal Component and equal weighting analysis were applied as well as a spatial clustering to explore the spatial vulnerability across the city. A total of 34% of the city area is mapped as having high and very high vulnerability, mostly occupied by informal settlements (e.g., 288 hectares). Underlying factors were poor quality housing, lack of city services and low adaptive capacity of the community. However, some government housing programs (e.g., El Recreo), with better housing and adaptive capacity were also highly vulnerable. Limited urban planning governance has led to the overloading of storm water and drainage infrastructure which cause chronic flooding. Understanding the underlying causes of vulnerability is critical in order develop integrated strategies that increase city resilience to climate change.

Banana production is very important for the Ecuadorian national income, but it is also a potential source of river pollution in the country. Current research is focusing on the use of GIS to perform pesticide assessment of a river basin that includes banana as its main agricultural activity. The Agricultural Non Point Source Model (AGNPS) is being used to perform pesticide assessment in the basin. The model structure and type of needed data was identified. By applying GIS methodology, a complete set of cartographical information was obtained to supply input data to the pesticide model. In addition, ready-to-print maps were useful by-products for farmers.

Type 2 diabetes (T2D) progresses over time, and to achieve and maintain adequate glucose control, many people eventually require injectable therapies such as insulin. However, there can be significant barriers to the initiation of these medications, both from people living with T2D and from healthcare practitioners (HCPs). Misconceptions and misinformation relating to the potential risks and benefits of injectable therapies are common and can contribute to negative perceptions regarding their use. Additionally, HCPs are often unaware of the emotional burden associated with T2D. In particular, diabetes distress is a key contributory factor that needs to be addressed to alleviate fears before diabetes education can be successful. The onus is often on the HCP to initiate effective, individualized communication with each patient and make that person feel an active and equal participant in the management of their T2D. Shared decision-making has been demonstrated to improve understanding of the pathophysiology and treatment options, to increase risk awareness, adherence, and persistence, and to improve self-management behaviors (e.g., exercise, self-care) and patient satisfaction. While therapeutic inertia can result from both patient and HCP, HCPs need to bear the responsibility for escalating therapy when necessary. A proactive approach by the HCP, combined with shared decision-making and a patient-centric approach, are important for optimal T2D management; therefore, an open and effective relationship between the HCP and the person living with T2D is essential. This article is written by a person with T2D, a nurse practitioner/Certified Diabetes Care and Education Specialist, and a clinical endocrinologist, with the goal of providing a holistic view of the management experience, exploring patient needs and expectations, recognizing and avoiding HCP and patient barriers, and providing practical advice to HCPs to empower patients who would benefit from injectable therapy. Infographic and video abstract available for this article. Supplementary Information The online version contains supplementary material available at 10.1007/s13300-022-01330-z.