Crustal and upper mantle structure of the interior Arabian platform

The crustal and upper-mantle velocity structure of the interior Arabian platform is derived using the spectral analysis of long-period P-wave amplitude ratios. The ratio of the vertical to the horizontal component is utilized to obtain crustal transfer functions using the Thomson- Haskell matrix formulation for horizontally layered crustal models.20 earthquakes recorded at the long-period station RYD between azimuths N20'W and ti 150-E were selected for the analysis based on the following criteria: focal depths in the range 5 to 215 km, body-wave magnitudes greater than 5.0, and epicentral distances in the range 7' to 97'. V A careful quality check of the data left us with six events, out of 29, that had short epicentral distances (<20~) to be analysed. The selection criterion for the final model in the forward modelling process was based on the correlation coefficient between observed and theoretical transfer function. The model suggested that the crust consists of five distinct lavers. The upper crustal laver has a P-wave velocity of about 5.6 km s-t and is about 3 km thick. The second layer has a velocity of about 6.3 km s-i and is 10 km thick. The third laver has a velocity of 6.6km s-t and is 8 km thick. The fourth layer has a velocity of 6.9 km s-t and is 15 km thick. The lower layer has a velocity of about 7.6 km s-' and is 10 km thick. For the Mohorovicic discontinuity, a velocity of 8.3 km s-i for the upper mantle and 46 km depth are indicated

Investigating the P wave velocity structure beneath Harrat Lunayyir, northwestern Saudi Arabia, using double-difference tomography and earthquakes from the 2009 seismic swarm

In 2009, a swarm of more than 30,000 earthquakes occurred beneath the Harrat Lunayyir lava field in northwest Saudi Arabia. This event was just one of several seismic swarms to occur in this region over the past decade. Surface deformation associated with the seismicity, modeled in previous studies using Interferometric Synthetic Aperture Radar (InSAR) data, is best attributed to the intrusion of a 10 km long dyke. However, little is known about the velocity structure beneath Harrat Lunayyir, making assessment of future seismic and volcanic hazards difficult. In this study, we use local double-difference tomography to generate a P wave velocity model beneath Harrat Lunayyir and to more precisely locate earthquakes from the 2009 seismic swarm. A pronounced fast velocity anomaly, centered at ∼15 km depth with a shallower extension to the N-NW, is interpreted as an area of repeated magmatic intrusion. The crust surrounding the fast intrusion is slower than that suggested by broader-scale models for the Arabian Shield. The largest magnitude events occurred early in the swarm, concentrated at shallow depths (∼2-8 km) beneath northern Harrat Lunayyir, and these events are associated with the dyke intrusion. Later, deep earthquakes (∼15 km) beneath the southern end of the study region as well as a group of intermediate-depth events connecting the shallow and deep regions of seismicity occurred. These later events likely represent responses to the local stress conditions following the intrusion. Our results are unique since harrat magma systems are rarely imaged, and our observations, coupled with the seismic history in this region, suggest that future volcanic intrusions beneath Harrat Lunayyir are likely. Key PointsFast velocities beneath Harrat Lunayyir are interpreted as magmatic intrusionsCrustal velocities are slower than those suggested by broader-scale modelsEarthquakes from the 2009 swarm delineate the orientation of dyke intrusion © 2013. American Geophysical Union. All Rights Reserved

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