Évolution de la température de l’air et des précipitations dans la région côtière syrienne (gouvernorat de Lattaquié) de 1970 à 2016

This study aims to analyze the changes in the annual and seasonal averages of air temperature and precipitation over Lattakia Governorate during the period 1970-2016. Annual and seasonal trends for temperature and precipitation were calculated by using the non-parametric Mann-Kendall test. The mean differences between the two periods 1970-2000 and 2001-2016, were assessed at the annual and seasonal scales by using the non-parametric Mann-Whitney U test. Furthermore, the occurrence of extreme high/low values were analyzed at the annual scale by using the normal distribution curve. The study found that the annual temperature averages significantly (p<0.05) increased by 0.22 ˚C/decade and 0.17 ˚C/decade, respectively at Lattakia and Hiffeh stations during the period 1970-2016. Summer exhibited strong and significant (at level 0.01) increasing trends by 0.39 ˚C/decade at Lattakia, and by 0.34 ˚C/decade at Hiffeh. Total spring precipitation significantly decreased by -6.5 mm/decade at Lattakia and by -12.1 mm/decade at Hiffeh. Probability of the occurrence of the value 20.2 ˚C or more as an extreme value increased by 40.8% at Lattakia station during the period 2001-2016. Este estudio tiene como objetivo analizar los cambios en los promedios anuales y estacionales de la temperatura del aire y las precipitaciones en la gobernación de Lattakia durante 1970-2016. Las tendencias anuales y estacionales para la temperatura y la precipitación se calcularon utilizando la prueba no paramétrica de Mann-Kendall. Las diferencias de medias entre los dos períodos (1970-2000) / (2001-2016) se evaluaron en los niveles anuales y estacionales mediante el uso de la prueba no paramétrica de Mann-Whitney U. Además, la aparición de valores extremadamente altos / bajos se analizó a nivel anual mediante el uso de la curva de distribución normal. El estudio encontró que los promedios anuales de temperatura aumentaron significativamente (p <0.05) en 0.22 ˚C / década y 0.17 ˚C \ década, en las estaciones de Lattakia y Hiffeh, respectivamente, durante 1970-2016. El verano reveló tendencias fuertes y significativas al alza (a nivel 0.01) en sus promedios de temperatura en 0.39 ˚C / década en Lattakia, y en 0.34 ˚C / década en Hiffeh. El promedio de precipitaciones de primavera disminuyó significativamente en -6.5 mm / década en Lattakia y en -12.1 mm / década en Hiffeh. La probabilidad de la aparición del valor de 20.2 ˚C o más como valor extremo aumentó en la estación de Lattakia durante 2001-2016 en un 40.8%.L’objectif de cette étude est d’analyser les changements dans les moyennes annuelles et saisonnières de la température de l’air et des précipitations sur la région du gouvernorat de Lattaquié entre 1970 et 2016. Les tendances annuelles et saisonnières de la température ont été calculées à l’aide du test non-paramétrique de Mann-Kendall. Les différences moyennes entre les périodes 1970-2000 et 2001-2016 ont été évaluées par année et saison en utilisant le test non-paramétrique de Mann-Whitney U. En ce qui concerne l’occurence de valeurs extrêmement élevées/ basses, celle-ci a été analysée sur une base annuelle en utilisant la courbe de distribution normale. L’étude a révélé que les températures moyennes annuelles (p<0,05) ont augmenté significativement de 0,22 ˚C / décennie et de 0,17 ˚C / décennie, dans les cas respectifs des stations de Lattakia et de Haffah durant la période 1970-2016. L’été a laissé voir une tendance marquée à la hausse (au niveau de 0,01) de ses moyennes de température : 0,39 ˚C / décennie à Lattaquié et 0,34 ˚C / décennie à Hiffeh. La moyenne des précipitations printanières a diminué de manière significative, soit de -6,5 mm / décennie à Lattakia et de -12,1 mm / décennie à Hiffeh. La probabilité d’apparition de la valeur de 20,2 ˚C ou plus comme valeur extrême a augmenté de 40,8% pour la station de Lattaquié pendant la période 2001-2016

Spatio-temporal analysis of maximum and minimum temperatures over Levant region (1987-2017)

Ponencia presentada en: XI Congreso de la Asociación Española de Climatología celebrado en Cartagena entre el 17 y el 19 de octubre de 2018.[ES]El objetivo de este estudio es analizar los cambios espaciales y temporales en los promedios anuales y estacionales de las temperaturas máxima y mínima en la región del Levante durante 1987-2017. Estos promedios se calcularon a partir de datos diarios para cada estación y para toda la región de Levante. Las tendencias espaciales y temporales para tres variables se calcularon utilizando la prueba no paramétrica de Mann-Kendall. Además, la diferencia de medias anuales y estacionales entre los dos períodos 1987-2000 y 2001-2011 se evaluó mediante el uso de la prueba U no paramétrica de Mann-Whitney. Durante 1987-2017, la región de Levante fue testigo de un calentamiento significativo en las temperaturas máximas y mínimas anuales de 0.33 y 0.30ºC/década, respectivamente. Además, la primavera mostró una tendencia al calentamiento muy fuerte y significativa en comparación con otras estaciones en 0.53ºC/década para la temperatura máxima y en 0.51ºC/década para la temperatura mínima. La temperatura máxima y mínima anual, de primavera y verano han aumentado significativamente en esta región durante 2001-2017 en comparación con el período 1987-2000. Las tendencias decrecientes mostraron un patrón muy aislado y aleatorio en comparación con las tendencias de calentamiento amplias, intensivas y coherentes en los promedios anuales y estacionales de la temperatura máxima y mínima. Las tasas de calentamiento en Jordania fueron generalmente las más altas.[EN]This study aims to analyze the spatial and temporal variability of the annual and seasonal maximum (Tmax) and minimum (Tmin) temperatures, along with the diurnal temperature range (DTR) over the entire Levant region for the period 1987-2017. The temporal trends for these three variables were calculated at the annual and seasonal scales by using the non-parametric Mann-Kendall test. Furthermore, the difference of the means between the two periods (1987-2000 and 2001-2017) were assessed by using the non-parametric Mann-Whitney U test. During 1987-2017, the Levant region suffered a significant warming for the annual maximum and minimum temperatures around 0.33 and 0.30ºC\decade, respectively. In addition, spring showed very strong and significant warming trend (around 0.53ºC/decade for Tmax and 0.51ºC/decade for Tmin) compared with the other seasons. The annual, spring and summer means of Tmax and Tmin have significantly increased over the Levant region during 2001-2017 compared with the period 1987-2000. Spatially, the decreasing trends showed very isolated and random patterns compared with the broad, intensive and coherent warming trends at annual and seasonal time scales. The warming over Jordan was generally the highest.This work has been financed by the projects P11-RNM-7941 (Junta de Andalucía), CGL2013-48539-R (MINECO-Spain, FEDER) and CGL2017-89836-R (MINECO-Spain, FEDER)

Extreme Rainfall Indices in Southern Levant and Related Large-Scale Atmospheric Circulation Patterns: A Spatial and Temporal Analysis

This study aims to provide a comprehensive spatio-temporal analysis of the annual and seasonal extreme rainfall indices over the southern Levant from 1970 to 2020. For this, temporal and spatial trends of 15 climate extreme indices based on daily precipitation at 66 stations distributed across Israel and Palestine territories were annually and seasonally analyzed through the nonparametric Mann–Kendall test and the Sen’s slope estimator. The annual averages for frequency-based extreme indices exhibited decreasing trends, significantly for the Consecutive Dry Days. In contrast, the percentiles- and intensity-based extreme indices showed increasing trends, significant for extremely wet days, Max 1- and 3-day precipitation amount indices. The study area had expanding periods of extreme dry spells for spring and correspondingly shortening extreme wet spells for spring, winter and the combined winter–spring. Moreover, most of spring indices showed negative trends. Conversely, most winter indices displayed positive trends. Regarding the influence of large-scale circulation patterns, the North Sea Caspian pattern, the Western Mediterranean Oscillation, and ENSO were the primary regulators of the winter, spring, and autumn extreme indices, respectively. These findings contribute to a better understanding of extreme rainfall variability in the Levant region and could be utilized in the management of water resources, drought monitoring, and flood control.FEDER/Junta de Andalucia-Consejeria de Transformacion Economica, Industria, Conocimiento y Universidades P20_00035Ministry of Science and Innovation through the FEDER funds from the Spanish Pluriregional Operational Program 2014-2020 (POPE), LifeWatch-ERIC action line LifeWatch-2019-10-UGR-0

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Changes in Air Temperature and Precipitation over the Syrian Coastal Region (Lattakia Governorate) from 1970 to 2016

This study aims to analyze the changes in the annual and seasonal averages of air temperature and precipitation over Lattakia Governorate during the period 1970-2016. Annual and seasonal trends for temperature and precipitation were calculated by using the non-parametric MannKendall test. The mean differences between the two periods 1970-2000 and 2001-2016, were assessed at the annual and seasonal scales by using the non-parametric Mann-Whitney U test. Furthermore, the occurrence of extreme high/low values were analyzed at the annual scale by using the normal distribution curve. The study found that the annual temperature averages significantly (p<0.05) increased by 0.22 ˚C/decade and 0.17 ˚C/decade, respectively at Lattakia and Hiffeh stations during the period 1970-2016. Summer exhibited strong and significant (at level 0.01) increasing trends by 0.39 ˚C/ decade at Lattakia, and by 0.34 ˚C/decade at Hiffeh. Total spring precipitation significantly decreased by -6.5 mm/decade at Lattakia and by -12.1 mm/decade at Hiffeh. Probability of the occurrence of the value 20.2 ˚C or more as an extreme value increased by 40.8% at Lattakia station during the period 2001-2016.L’objectif de cette étude est d’analyser les changements dans les moyennes annuelles et saisonnières de la température de l’air et des précipitations sur la région du gouvernorat de Lattaquié entre 1970 et 2016. Les tendances annuelles et saisonnières de la température ont été calculées à l’aide du test non-paramétrique de Mann-Kendall. Les différences moyennes entre les périodes 1970-2000 et 2001-2016 ont été évaluées par année et saison en utilisant le test non-paramétrique de Mann-Whitney U. En ce qui concerne l’occurence de valeurs extrêmement élevées/ basses, celle-ci a été analysée sur une base annuelle en utilisant la courbe de distribution normale. L’étude a révélé que les températures moyennes annuelles (p<0,05) ont augmenté significativement de 0,22 ˚C / décennie et de 0,17 ˚C / décennie, dans les cas respectifs des stations de Lattakia et de Haffah durant la période 1970-2016. L’été a laissé voir une tendance marquée à la hausse (au niveau de 0,01) de ses moyennes de température : 0,39 ˚C / décennie à Lattaquié et 0,34 ˚C / décennie à Hiffeh. La moyenne des précipitations printanières a diminué de manière significative, soit de -6,5 mm / décennie à Lattakia et de -12,1 mm / décennie à Hiffeh. La probabilité d’apparition de la valeur de 20,2 ˚C ou plus comme valeur extrême a augmenté de 40,8% pour la station de Lattaquié pendant la période 2001-2016.Este estudio tiene como objetivo analizar los cambios en los promedios anuales y estacionales de la temperatura del aire y las precipitaciones en la gobernación de Lattakia durante 1970-2016. Las tendencias anuales y estacionales para la temperatura y la precipitación se calcularon utilizando la prueba no paramétrica de Mann-Kendall. Las diferencias de medias entre los dos períodos (1970-2000) / (2001-2016) se evaluaron en los niveles anuales y estacionales mediante el uso de la prueba no paramétrica de Mann-Whitney U. Además, la aparición de valores extremadamente altos / bajos se analizó a nivel anual mediante el uso de la curva de distribución normal. El estudio encontró que los promedios anuales de temperatura aumentaron significativamente (p <0.05) en 0.22 ˚C / década y 0.17 ˚C \ década, en las estaciones de Lattakia y Hiffeh, respectivamente, durante 1970-2016. El verano reveló tendencias fuertes y significativas al alza (a nivel 0.01) en sus promedios de temperatura en 0.39 ˚C / década en Lattakia, y en 0.34 ˚C / década en Hiffeh. El promedio de precipitaciones de primavera disminuyó significativamente en -6.5 mm / década en Lattakia y en -12.1 mm / década en Hiffeh. La probabilidad de la aparición del valor de 20.2 ˚C o más como valor extremo aumentó en la estación de Lattakia durante 2001-2016 en un 40.8%

Extreme Rainfall Indices in Southern Levant and Related Large-Scale Atmospheric Circulation Patterns: A Spatial and Temporal Analysis

This study aims to provide a comprehensive spatio-temporal analysis of the annual and seasonal extreme rainfall indices over the southern Levant from 1970 to 2020. For this, temporal and spatial trends of 15 climate extreme indices based on daily precipitation at 66 stations distributed across Israel and Palestine territories were annually and seasonally analyzed through the nonparametric Mann&ndash;Kendall test and the Sen&rsquo;s slope estimator. The annual averages for frequency-based extreme indices exhibited decreasing trends, significantly for the Consecutive Dry Days. In contrast, the percentiles- and intensity-based extreme indices showed increasing trends, significant for extremely wet days, Max 1- and 3-day precipitation amount indices. The study area had expanding periods of extreme dry spells for spring and correspondingly shortening extreme wet spells for spring, winter and the combined winter&ndash;spring. Moreover, most of spring indices showed negative trends. Conversely, most winter indices displayed positive trends. Regarding the influence of large-scale circulation patterns, the North Sea Caspian pattern, the Western Mediterranean Oscillation, and ENSO were the primary regulators of the winter, spring, and autumn extreme indices, respectively. These findings contribute to a better understanding of extreme rainfall variability in the Levant region and could be utilized in the management of water resources, drought monitoring, and flood control

Wireless Sensor Networks for Smart Cities: Network Design, Implementation and Performance Evaluation

The advent of various wireless technologies has paved the way for the realization of new infrastructures and applications for smart cities. Wireless Sensor Networks (WSNs) are one of the most important among these technologies. WSNs are widely used in various applications in our daily lives. Due to their cost effectiveness and rapid deployment, WSNs can be used for securing smart cities by providing remote monitoring and sensing for many critical scenarios including hostile environments, battlefields, or areas subject to natural disasters such as earthquakes, volcano eruptions, and floods or to large-scale accidents such as nuclear plants explosions or chemical plumes. The purpose of this paper is to propose a new framework where WSNs are adopted for remote sensing and monitoring in smart city applications. We propose using Unmanned Aerial Vehicles to act as a data mule to offload the sensor nodes and transfer the monitoring data securely to the remote control center for further analysis and decision making. Furthermore, the paper provides insight about implementation challenges in the realization of the proposed framework. In addition, the paper provides an experimental evaluation of the proposed design in outdoor environments, in the presence of different types of obstacles, common to typical outdoor fields. The experimental evaluation revealed several inconsistencies between the performance metrics advertised in the hardware-specific data-sheets. In particular, we found mismatches between the advertised coverage distance and signal strength with our experimental measurements. Therefore, it is crucial that network designers and developers conduct field tests and device performance assessment before designing and implementing the WSN for application in a real field setting

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