Incorporating EarthCARE observations into a multi-lidar cloud climate record: the ATLID (Atmospheric Lidar) cloud climate product

Despite significant advances in atmospheric measurements and modeling, clouds' response to human-induced climate warming remains the largest source of uncertainty in model predictions of climate. The launch of the Cloud-Aerosol Lidar and Infrared Pathfinder Satellite Observation (CALIPSO) satellite in 2006 started the era of long-term spaceborne optical active sounding of Earth's atmosphere, which continued with the CATS (Cloud-Aerosol Transport System) lidar on board the International Space Station (ISS) in 2015 and the Atmospheric Laser Doppler Instrument (ALADIN) lidar on board Aeolus in 2018. The next important step is the Atmospheric Lidar (ATLID) instrument from the EarthCARE (Earth Clouds, Aerosols and Radiation Explorer) mission, expected to launch in 2024. In this article, we define the ATLID Climate Product, Short-Term (CLIMP-ST) and ATLID Climate Product, Long-Term (CLIMP-LT). The purpose of CLIMP-ST is to help evaluate the description of cloud processes in climate models, beyond what is already done with existing space lidar observations, thanks to ATLID's new capabilities. The CLIMP-LT product will merge the ATLID cloud observations with previous space lidar observations to build a long-term cloud lidar record useful to evaluate the cloud climate variability predicted by climate models. We start with comparing the cloud detection capabilities of ATLID and CALIOP (Cloud-Aerosol Lidar with Orthogonal Polarization) in day- and nighttime, on a profile-to-profile basis in analyzing virtual ATLID (355 nm) and CALIOP (532 nm) measurements over synthetic cirrus and stratocumulus cloud scenes. We show that solar background noise affects the cloud detectability in daytime conditions differently for ATLID and CALIPSO. We found that the simulated daytime ATLID measurements have lower noise than the simulated daytime CALIOP measurements. This allows for lowering the cloud detection thresholds for ATLID compared to CALIOP and enables ATLID to better detect optically thinner clouds than CALIOP in daytime at high horizontal resolution without false cloud detection. These lower threshold values will be used to build the CLIMP-ST (Short-Term, related only to the ATLID observational period) product. This product should provide the ability to evaluate optically thin clouds like cirrus in climate models compared to the current existing capability. We also found that ATLID and CALIPSO may detect similar clouds if we convert ATLID 355 nm profiles to 532 nm profiles and apply the same cloud detection thresholds as the ones used in GOCCP (GCM-Oriented CALIPSO Cloud Product; general circulation model). Therefore, this approach will be used to build the CLIMP-LT product. The CLIMP-LT data will be merged with the GOCCP data to get a long-term (2006–2030s) cloud climate record. Finally, we investigate the detectability of cloud changes induced by human-caused climate warming within a virtual long-term cloud monthly gridded lidar dataset over the 2008–2034 period that we obtained from two ocean–atmosphere coupled climate models coupled with a lidar simulator. We found that a long-term trend of opaque cloud cover should emerge from short-term natural climate variability after 4 years (possible lifetime) to 7 years (best-case scenario) for ATLID merged with CALIPSO measurements according to predictions from the considered climate models. We conclude that a long-term lidar cloud record built from the merging of the actual ATLID-LT data with CALIPSO-GOCCP data will be a useful tool for monitoring cloud changes and evaluating the realism of the cloud changes predicted by climate models.</p

Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study.

BACKGROUND: Appendicitis is the most common abdominal surgical emergency worldwide. Differences between high- and low-income settings in the availability of laparoscopic appendectomy, alternative management choices, and outcomes are poorly described. The aim was to identify variation in surgical management and outcomes of appendicitis within low-, middle-, and high-Human Development Index (HDI) countries worldwide. METHODS: This is a multicenter, international prospective cohort study. Consecutive sampling of patients undergoing emergency appendectomy over 6 months was conducted. Follow-up lasted 30 days. RESULTS: 4546 patients from 52 countries underwent appendectomy (2499 high-, 1540 middle-, and 507 low-HDI groups). Surgical site infection (SSI) rates were higher in low-HDI (OR 2.57, 95% CI 1.33-4.99, p = 0.005) but not middle-HDI countries (OR 1.38, 95% CI 0.76-2.52, p = 0.291), compared with high-HDI countries after adjustment. A laparoscopic approach was common in high-HDI countries (1693/2499, 67.7%), but infrequent in low-HDI (41/507, 8.1%) and middle-HDI (132/1540, 8.6%) groups. After accounting for case-mix, laparoscopy was still associated with fewer overall complications (OR 0.55, 95% CI 0.42-0.71, p < 0.001) and SSIs (OR 0.22, 95% CI 0.14-0.33, p < 0.001). In propensity-score matched groups within low-/middle-HDI countries, laparoscopy was still associated with fewer overall complications (OR 0.23 95% CI 0.11-0.44) and SSI (OR 0.21 95% CI 0.09-0.45). CONCLUSION: A laparoscopic approach is associated with better outcomes and availability appears to differ by country HDI. Despite the profound clinical, operational, and financial barriers to its widespread introduction, laparoscopy could significantly improve outcomes for patients in low-resource environments. TRIAL REGISTRATION: NCT02179112

Prognostic model to predict postoperative acute kidney injury in patients undergoing major gastrointestinal surgery based on a national prospective observational cohort study.

Background: Acute illness, existing co-morbidities and surgical stress response can all contribute to postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. The aim of this study was prospectively to develop a pragmatic prognostic model to stratify patients according to risk of developing AKI after major gastrointestinal surgery. Methods: This prospective multicentre cohort study included consecutive adults undergoing elective or emergency gastrointestinal resection, liver resection or stoma reversal in 2-week blocks over a continuous 3-month period. The primary outcome was the rate of AKI within 7 days of surgery. Bootstrap stability was used to select clinically plausible risk factors into the model. Internal model validation was carried out by bootstrap validation. Results: A total of 4544 patients were included across 173 centres in the UK and Ireland. The overall rate of AKI was 14·2 per cent (646 of 4544) and the 30-day mortality rate was 1·8 per cent (84 of 4544). Stage 1 AKI was significantly associated with 30-day mortality (unadjusted odds ratio 7·61, 95 per cent c.i. 4·49 to 12·90; P < 0·001), with increasing odds of death with each AKI stage. Six variables were selected for inclusion in the prognostic model: age, sex, ASA grade, preoperative estimated glomerular filtration rate, planned open surgery and preoperative use of either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker. Internal validation demonstrated good model discrimination (c-statistic 0·65). Discussion: Following major gastrointestinal surgery, AKI occurred in one in seven patients. This preoperative prognostic model identified patients at high risk of postoperative AKI. Validation in an independent data set is required to ensure generalizability

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

The I3RC - Bringing Together the Most Advanced Radiative Transfer Tools for Cloudy Atmospheres

The interaction of clouds with solar and terrestrial radiation is one of the most important topics of climate research. In recent years it has been recognized that only a full three-dimensional (3D) treatment of this interaction can provide answers to many climate and remote sensing problems, leading to the worldwide development of numerous 3D radiative transfer (RT) codes. The international Intercomparison of 3D Radiation Codes (I3RC), described in this paper, sprung from the natural need to compare the performance of these 3D RT codes used in a variety of current scientific work in the atmospheric sciences. I3RC supports intercomparison and development of both exact and approximate 3D methods in its effort to 1) understand and document the errors/limits of 3D algorithms and their sources; 2) provide “baseline” cases for future code development for 3D radiation; 3) promote sharing and production of 3D radiative tools; 4) derive guidelines for 3D radiative tool selection; and 5) improve atmospheric science education in 3D RT. Results from the two completed phases of I3RC have been presented in two workshops and are expected to guide improvements in both remote sensing and radiative energy budget calculations in cloudy atmospheres

Vertical distribution of microphysical properties of Arctic springtime low-level mixed-phase clouds over the Greenland and Norwegian seas

This study aims to characterize the microphysical and optical properties of ice crystals and supercooled liquid droplets within low-level Arctic mixed-phase clouds (MPCs). We compiled and analyzed cloud in situ measurements from four airborne spring campaigns (representing 18 flights and 71 vertical profiles in MPCs) over the Greenland and Norwegian seas mainly in the vicinity of the Svalbard archipelago. Cloud phase discrimination and representative vertical profiles of the number, size, mass and shape of ice crystals and liquid droplets are established. The results show that the liquid phase dominates the upper part of the MPCs. High concentrations (120 cm−3 on average) of small droplets (mean values of 15 µm), with an averaged liquid water content (LWC) of 0.2 g m−3 are measured at cloud top. The ice phase dominates the microphysical properties in the lower part of the cloud and beneath it in the precipitation region (mean values of 100 µm, 3 L−1 and 0.025 g m−3 for diameter, particle concentration and ice water content (IWC), respectively). The analysis of the ice crystal morphology shows that the majority of ice particles are irregularly shaped or rimed particles; the prevailing regular habits found are stellars and plates. We hypothesize that riming and diffusional growth processes, including the Wegener–Bergeron–Findeisen (WBF) mechanism, are the main growth mechanisms involved in the observed MPCs. The impact of larger-scale meteorological conditions on the vertical profiles of MPC properties was also investigated. Large values of LWC and high concentration of smaller droplets are possibly linked to polluted situations and air mass origins from the south, which can lead to very low values of ice crystal size and IWC. On the contrary, clean situations with low temperatures exhibit larger values of ice crystal size and IWC. Several parameterizations relevant for remote sensing or modeling studies are also determined, such as IWC (and LWC) – extinction relationship, ice and liquid integrated water paths, ice concentration and liquid water fraction according to temperature

Effects of cirrus heterogeneity on lidar CALIOP/CALIPSO data

International audienc