Role of Tropical Atlantic SST Variability as a Modulator of El Nino Teleconnections

The present study suggests that the off-equatorial North Atlantic (NATL) SST warming plays a significant role in modulating El Nio teleconnection and its impact on the North Atlantic and European regions. The El Nio events accompanied by NATL SST warming exhibit south-north dipole pattern over the Western Europe to Atlantic, while the ENSO teleconnection pattern without NATL warming exhibits a Rossby wave-like pattern confined over the North Pacific and western Atlantic. Especially, the El Nio events with NATL warming show positive (negative) geopotential-height anomalies over the North Atlantic (Western Europe) which resemble the negative phase of the NAO. Consistently, it is shown using a simple statistical model that NATL SSTA in addition to the tropical Pacific SSTA leads to better prediction on regional climate variation over the North Atlantic and European regions. This role of NATL SST on ENSO teleconnection is also validated and discussed in a long term simulation of coupled global circulation model (CGCM)

Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700

Kuluttajabarometri maakunnittain 2000, 2. neljännes

Suomen virallinen tilasto (SVT

Use of failure-to-rescue to identify international variation in postoperative care in low-, middle- and high-income countries: a 7-day cohort study of elective surgery

This was an investigator-initiated study funded by Nestle Health Sciences through an unrestricted research grant and by a National Institute for Health Research (UK) Professorship held by R.P. The study was sponsored by Queen Mary University of London