Особенности турбулентного теплообмена вблизи всторошенных участков морского льда

The studies of the features of turbulent heat exchange were carried out for the first time in domestic practice near ice ridge areas of sea ice using an unmanned aerial vehicle (UAV) as part of the expedition "Transarktika-2019" onboard the R/V “Akademik Tryoshnikov”. An original measuring complex designed in AARI, was used to assess the characteristics of the ice surface (ice ridges, flat areas of ice). This made it possible to obtain comparative estimates of the albedo and surface temperature of different morphometric structures of the sections of the ice field, where the expedition's ice camp was organized. Measurements of air temperature and wind velocity were carried in the atmospheric surface layer on flat snow-covered areas of sea ice out from the windward and leeward sides of the ridge in parallel with the UAV flights. As a result of the experiments, it was found that the ice ridges areas have a lower albedo and surface temperature compared to neighboring areas of flat sea ice on average. Turbulent heat fluxes from the windward side of the hummock ridge exceed similar values recorded from the leeward side under conditions of unstable stratification in the atmospheric surface layer and exceed the fluxes calculated for conditions of flat ice on the sections with absence of hummocks, on average. In total, the nature and intensity of turbulent heat conduction in the ice ridges area differs from the analogous values observed on the flat sea ice cover. It is possible that the assessment of heat conduction with the atmosphere requires a certain revision, against the background (within the conditions) of thin first-year ice increasing which is more prone to hummocking than multi-year ice.Исследуются особенности процессов турбулентного теплообмена вблизи всторошенных участков морского льда с помощью беспилотного летательного аппарата (БПЛА). Предшествующие исследования показали, что альбедо склонов торосов и турбулентный обмен вблизи гряд отличаются от условий, наблюдаемых на ровном льду. В задачи исследований входили измерения отраженной радиации над всторошенными участками, для последующего расчета альбедо, и проведение измерений скорости ветра и температуры воздуха вблизи подветренных и наветренных склонов для оценки турбулентных потоков явного тепла. Использовался БПЛА, с оригинальным измерительным комплексом, для изучения всторошенных поверхностей и соседних участков ровного льда, а также измерения характеристик приземного слоя атмосферы (температура воздуха/поверхности, скорость ветра) вблизи торосов. Эксперименты показали, что альбедо и температура поверхности торосов ниже, чем на прилегающих участках ровного льда, а турбулентные потоки явного тепла отличаются от аналогичных характеристик, полученных на ровном льду. В условиях увеличивающейся доли тонких однолетних льдов в Арктике, в большей степени подверженных торошению по сравнению с многолетними льдами, оценки теплообмена с атмосферой, возможно, требует определенного пересмотра

Условия питания и изменчивость ледников архипелага Северная Земля по результатам наблюдений 2014–2015 гг.

Glaciological investigations on the Severnaya Zemlya archipelago were resumed in 2013 when a new research station «Ice base Cape Baranova» had been organized by Arctic and Antarctic Research Institute in the North-West of the Island Bolshevik. In 2014–2015, the glaciological polygon named after Leonid Govorukha was established on glaciers Mushketov and Semenov-Tyan-Shanskiy. Two years of observations on the glaciers allowed us to estimate the mass balance of the Mushketov Glacier, which was positive in the 2013–2015. By the end of the melting periods, a superimposed ice was formed on the glacier with thickness of 4 cm in 2014 and 17 cm in 2015, on the average. A snow-firn mass with its vertical thickness exceeding 3 m had been found on the upper part of the Semenov-Tyan-Shansky Glacier. Based on analyses of summer air temperatures and precipitation at the meteorological station «The Golomyanny Island», we assumed that in 2013–2015 the mass balance was also positive on the other glaciers of the archipelago, located to the North of the studied glaciers on the Island of Bolshevik. Data of remote sensing of the catastrophic advancing of the outlet glacier from the Vavilov Ice Cap, obtained in 2013–2016, testify that for much longer period, i.e. during 25 years, conditions for the ice mass accumulation were favorable on the southern and eastern slopes of the Vavilov Ice Cap.Гляциологические исследования ААНИИ продолжены работами 2014–2015  гг. на ледниках о.  Большевик (архипелаг Северная Земля): Мушкетова высотой 560 м и Семенова-Тян-Шанского высотой 725 м. Работы на полигоне показали положительный баланс массы ледника Мушкетова, питающегося наложенным льдом, и наличие мощной (более 3 м) снежно-фирновой толщи в вершинной части ледника Семенова-Тян-Шанского. Данные метеостанции «Ледовая база «Мыс Баранова» и автоматической метеостанции на леднике Мушкетова позволили определить условия накопления льда. Катастрофическая подвижка на запад выводного ледника из ледникового купола Вавилова обусловлена более чем 25-летним периодом преобладания накопления льда, подлёдным рельефом и всплыванием ледника на глубине моря около 40 м

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p<0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p<0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

Conditions of the alimentation and the variability of glaciers of the Severnaya Zemlya Archipelago from observations of 2014–2015

Glaciological investigations on the Severnaya Zemlya archipelago were resumed in 2013 when a new research station «Ice base Cape Baranova» had been organized by Arctic and Antarctic Research Institute in the North-West of the Island Bolshevik. In 2014–2015, the glaciological polygon named after Leonid Govorukha was established on glaciers Mushketov and Semenov-Tyan-Shanskiy. Two years of observations on the glaciers allowed us to estimate the mass balance of the Mushketov Glacier, which was positive in the 2013–2015. By the end of the melting periods, a superimposed ice was formed on the glacier with thickness of 4 cm in 2014 and 17 cm in 2015, on the average. A snow-firn mass with its vertical thickness exceeding 3 m had been found on the upper part of the Semenov-Tyan-Shansky Glacier. Based on analyses of summer air temperatures and precipitation at the meteorological station «The Golomyanny Island», we assumed that in 2013–2015 the mass balance was also positive on the other glaciers of the archipelago, located to the North of the studied glaciers on the Island of Bolshevik. Data of remote sensing of the catastrophic advancing of the outlet glacier from the Vavilov Ice Cap, obtained in 2013–2016, testify that for much longer period, i.e. during 25 years, conditions for the ice mass accumulation were favorable on the southern and eastern slopes of the Vavilov Ice Cap

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

Background: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research