Impacts of regional mixing on the temperature structure of the equatorial Pacific Ocean. Part 1: Vertically uniform vertical diffusion

AbstractWe investigate the sensitivity of numerical-model solutions to regional changes in vertical diffusion. Specifically, we vary the background diffusion coefficient, κb, within spatially distinct subregions of the tropical Pacific, assess the impacts of those changes, and diagnose the processes that account for them.Solutions respond to a diffusion anomaly, δκb, in three ways. Initially, there is a fast response (several months), due to the interaction of rapidly-propagating, barotropic and gravity waves with eddies and other mesoscale features. It is followed by a local response (roughly one year), the initial growth and spatial pattern of which can be explained by one-dimensional (vertical) diffusion. At this stage, temperature and salinity anomalies are generated that are either associated with a change in density (“dynamical” anomalies) or without one (“spiciness” anomalies). In a final adjustment stage, the dynamical and spiciness anomalies spread to remote regions by radiation of Rossby and Kelvin waves and by advection, respectively.In near-equilibrium solutions, dynamical anomalies are generally much larger in the latitude band of the forcing, but the impact of off-equatorial forcing by δκb on the equatorial temperature structure is still significant. Spiciness anomalies spread equatorward within the pycnocline, where they are carried to the equator as part of the subsurface branch of the Pacific Subtropical Cells, and spiciness also extends to the equator via western-boundary currents. Forcing near and at the equator generates strong dynamical anomalies, and sometimes additional spiciness anomalies, at pycnocline depths. The total response of the equatorial temperature structure to δκb in various regions depends on the strength and spatial pattern of the generation of each signal within the forcing region as well as on the processes of its spreading to the equator

Global disparities in surgeons’ workloads, academic engagement and rest periods: the on-calL shIft fOr geNEral SurgeonS (LIONESS) study

: The workload of general surgeons is multifaceted, encompassing not only surgical procedures but also a myriad of other responsibilities. From April to May 2023, we conducted a CHERRIES-compliant internet-based survey analyzing clinical practice, academic engagement, and post-on-call rest. The questionnaire featured six sections with 35 questions. Statistical analysis used Chi-square tests, ANOVA, and logistic regression (SPSS® v. 28). The survey received a total of 1.046 responses (65.4%). Over 78.0% of responders came from Europe, 65.1% came from a general surgery unit; 92.8% of European and 87.5% of North American respondents were involved in research, compared to 71.7% in Africa. Europe led in publishing research studies (6.6 ± 8.6 yearly). Teaching involvement was high in North America (100%) and Africa (91.7%). Surgeons reported an average of 6.7 ± 4.9 on-call shifts per month, with European and North American surgeons experiencing 6.5 ± 4.9 and 7.8 ± 4.1 on-calls monthly, respectively. African surgeons had the highest on-call frequency (8.7 ± 6.1). Post-on-call, only 35.1% of respondents received a day off. Europeans were most likely (40%) to have a day off, while African surgeons were least likely (6.7%). On the adjusted multivariable analysis HDI (Human Development Index) (aOR 1.993) hospital capacity > 400 beds (aOR 2.423), working in a specialty surgery unit (aOR 2.087), and making the on-call in-house (aOR 5.446), significantly predicted the likelihood of having a day off after an on-call shift. Our study revealed critical insights into the disparities in workload, access to research, and professional opportunities for surgeons across different continents, underscored by the HDI

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

The impact of the COVID-19 pandemic on Sexually Transmitted Infections surveillance data : incidence drop or artefact?

Altres ajuts: Fundacion Alfonso Martin Escudero and the Medical Research Council (grant numbers MR/K501256/1, MR/N013468/1).Background: Before the COVID-19 pandemic, Sexually transmitted infections (STIs) were increasing in Europe, and Spain and Catalonia were not an exception. Catalonia has been one of the regions with the highest number of COVID-19 confirmed cases in Spain. The objective of this study was to estimate the magnitude of the decline, due to the COVID-19 pandemic, in the number of STI confirmed cases in Catalonia during the lockdown and de-escalation phases. Methods: Interrupted time series analysis was performed to estimate the magnitude of decline in the number of STI reported confirmed cases - chlamydia, gonorrhoea, syphilis, and lymphogranuloma venereum- in Catalonia since lockdown with historical data, from March 13th to August 1st 2020, comparing the observed with the expected values. Results: We found that since the start of COVID-19 pandemic the number of STI reported cases was 51% less than expected, reaching an average of 56% during lockdown (50% and 45% during de-escalation and new normality) with a maximum decrease of 72% for chlamydia and minimum of 22% for syphilis. Our results indicate that fewer STIs were reported in females, people living in more deprived areas, people with no previous STI episodes during the last three years, and in the HIV negative. Conclusions: The STI notification sharp decline was maintained almost five months after lockdown started, well into the new normality. This fact can hardly be explained without significant underdiagnosis and underreporting. There is an urgent need to strengthen STI/HIV diagnostic programs and services, as well as surveillance, as the pandemic could be concealing the real size of the already described re-emergence of STIs in most of the European countries

Simulated changes in atmospheric dust in response to a Heinrich stadial

Heinrich stadials (HS), thought to be triggered by increased ice discharge in the high‐latitude North Atlantic at glacial periods, resulted in large freshwater forcing that weakened the Atlantic Meridional Overturning Circulation (AMOC). These events are strongly expressed in paleoclimate records throughout the Atlantic basin and much of the tropics. Compared to the Last Glacial Maximum, recent proxy data suggest HS were much drier and dustier in large parts of the tropics. We use a global climate model coupled to a prognostic dust model to examine the response of dust to changes in climate during HS. Despite some significant changes in regional precipitation patterns in response to the simulated shift in the Intertropical Convergence Zone, we find that changes in winds have a larger effect on dust mobilization and deposition patterns than soil moisture or vegetation changes associated with a weaker AMOC. Although Europe was colder and drier during HS, the annual mean glaciogenic dust emission rate is lower because a southward shift in the Northern Hemisphere jet stream leads to weaker winds and less dust mobilization. The proximity of the westerly wind anomaly associated with the jet stream shift increases gustiness and dust mobilization over northwestern Africa and shifts the African Easterly Jet southward resulting in less African dust transport and deposition over the North Tropical Atlantic. Drier conditions over the Sahel region of North Africa, however, do not lead to increased dust mobilization in our model. When we perturb Sahelian soil characteristics, our results are in better agreement with proxies. Key Points A shift in the AEJ reduces dust deposition over the North Atlantic during HS Wind changes have the largest effect on dust emission and depositio

Direct and semi-direct aerosol radiative effect on the Mediterranean climate variability using a coupled regional climate system model

A fully coupled regional climate system model (CNRM-RCSM4) has been used over the Mediterranean region to investigate the direct and semi-direct effects of aerosols, but also their role in the radiation–atmosphere–ocean interactions through multi-annual ensemble simulations (2003–2009) with and without aerosols and ocean–atmosphere coupling. Aerosols have been taken into account in CNRM-RCSM4 through realistic interannual monthly AOD climatologies. An evaluation of the model has been achieved, against various observations for meteorological parameters, and has shown the ability of CNRM-RCSM4 to reproduce the main patterns of the Mediterranean climate despite some biases in sea surface temperature (SST), radiation and cloud cover. The results concerning the aerosol radiative effects show a negative surface forcing on average because of the absorption and scattering of the incident radiation. The SW surface direct effect is on average −20.9 Wm−2 over the Mediterranean Sea, −14.7 Wm−2 over Europe and −19.7 Wm−2 over northern Africa. The LW surface direct effect is weaker as only dust aerosols contribute (+4.8 Wm−2 over northern Africa). This direct effect is partly counterbalanced by a positive semi-direct radiative effect over the Mediterranean Sea (+5.7 Wm−2 on average) and Europe (+5.0 Wm−2) due to changes in cloud cover and atmospheric circulation. The total aerosol effect is consequently negative at the surface and responsible for a decrease in land (on average −0.4 °C over Europe, and −0.5 °C over northern Africa) and sea surface temperature (on average −0.5 °C for the Mediterranean SST). In addition, the latent heat loss is shown to be weaker (−11.0 Wm−2) in the presence of aerosols, resulting in a decrease in specific humidity in the lower troposphere, and a reduction in cloud cover and precipitation. Simulations also indicate that dust aerosols warm the troposphere by absorbing solar radiation, and prevent radiation from reaching the surface, thus stabilizing the troposphere. The comparison with the model response in atmosphere-only simulations shows that these feedbacks are attenuated if SST cannot be modified by aerosols, highlighting the importance of using coupled regional models over the Mediterranean. Oceanic convection is also strengthened by aerosols, which tends to reinforce the Mediterranean thermohaline circulation. In parallel, two case studies are presented to illustrate positive feedbacks between dust aerosols and regional climate. First, the eastern Mediterranean was subject to high dust aerosol loads in June 2007 which reduce land and sea surface temperature, as well as air–sea humidity fluxes. Because of northern wind over the eastern Mediterranean, drier and cooler air has been consequently advected from the sea to the African continent, reinforcing the direct dust effect over land. On the contrary, during the western European heat wave in June 2006, dust aerosols have contributed to reinforcing an important ridge responsible for dry and warm air advection over western Europe, and thus to increasing lower troposphere (+0.8 °C) and surface temperature (+0.5 °C), namely about 15 % of this heat wave.ISSN:0930-7575ISSN:1432-089

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background: Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods: The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results: A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion: Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)

BJS commission on surgery and perioperative care post-COVID-19

Coronavirus disease 2019 (COVID-19) was declared a pandemic by the WHO on 11 March 2020 and global surgical practice was compromised. This Commission aimed to document and reflect on the changes seen in the surgical environment during the pandemic, by reviewing colleagues' experiences and published evidence