Synoptic, thermodynamic and agroeconomic aspects of severe hail events in Cyprus

Hail is a hazardous weather element often accompanying a thunderstorm, as a result of either thermal instability or instability associated with baroclinic synoptic-scale systems (i.e. frontal depressions). Nevertheless, instability of any kind and thunderstorm activity does not always lead to the formation of hail of adequate size to reach the ground. The broader the knowledge concerning hail events the better the understanding of the underlying thermodynamic and dynamic mechanisms, as well as the physical processes associated with its formation. <br><br> In the present study, the severe hail events that were recorded in Cyprus during the ten-year period from 1996 until 2005 were examined, first by grouping them into two clusters, namely, the "thermal instability cluster" and the "frontal depression cluster". Subsequently, the spatial and temporal evolution of the synoptic, dynamic and thermodynamic characteristics of these hail events was studied in depth. Also, the impact of hailstorms on the local economy of the island is presented in terms of the compensations paid by the Agricultural Insurance Organization of the country

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background 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

Evaluation of appendicitis risk prediction models in adults with suspected appendicitis

Background Appendicitis is the most common general surgical emergency worldwide, but its diagnosis remains challenging. The aim of this study was to determine whether existing risk prediction models can reliably identify patients presenting to hospital in the UK with acute right iliac fossa (RIF) pain who are at low risk of appendicitis. Methods A systematic search was completed to identify all existing appendicitis risk prediction models. Models were validated using UK data from an international prospective cohort study that captured consecutive patients aged 16–45 years presenting to hospital with acute RIF in March to June 2017. The main outcome was best achievable model specificity (proportion of patients who did not have appendicitis correctly classified as low risk) whilst maintaining a failure rate below 5 per cent (proportion of patients identified as low risk who actually had appendicitis). Results Some 5345 patients across 154 UK hospitals were identified, of which two‐thirds (3613 of 5345, 67·6 per cent) were women. Women were more than twice as likely to undergo surgery with removal of a histologically normal appendix (272 of 964, 28·2 per cent) than men (120 of 993, 12·1 per cent) (relative risk 2·33, 95 per cent c.i. 1·92 to 2·84; P < 0·001). Of 15 validated risk prediction models, the Adult Appendicitis Score performed best (cut‐off score 8 or less, specificity 63·1 per cent, failure rate 3·7 per cent). The Appendicitis Inflammatory Response Score performed best for men (cut‐off score 2 or less, specificity 24·7 per cent, failure rate 2·4 per cent). Conclusion Women in the UK had a disproportionate risk of admission without surgical intervention and had high rates of normal appendicectomy. Risk prediction models to support shared decision‐making by identifying adults in the UK at low risk of appendicitis were identified

Seasonal effects on puberty and reproductive characteristics of female Chios sheep and Damascus goats born in autumn or in February

Ten Chios ewe lambs and 10 Damascus she-kids born in October–November and similar numbers born in February along with eight multiparous females from each species, were used to examine pubertal events and reproductive seasonality. Reproductive activity was monitored by determining serum progesterone concentrations once a week for 12 months. The mean date of onset of ovulation (puberty) in autumn-born Chios females (7 August) was earlier (p<0.05) than in February-born ones (11 September) though the onset of regular cyclicity was not significantly different between the two groups (30 August and 19 September, respectively). The age and live weight at puberty in autumn-born females was higher (p<0.01) than in February-born ones, the respective values being 43.3 weeks and 50.1 kg, versus 29.9 weeks and 42.0 kg. All animals, irrespective of time of birth, started ovulating after the summer equinox. Multiparous Chios ewes had reproductive cycles covering most time of the year with acyclic periods during spring and summer. In ewe lambs, about half of the animals ceased cycling during the second half of winter and in spring, while the rest continued cycling. The total number of cycles detected over the experimental period was lower (p<0.05) for February-born (n=9.4) compared with autumn-born females (n=13.7) and adult ewes (n=17.1). In Damascus she-kids born in autumn or in February, onset of puberty was at the same time in the following autumn, the respective mean date for the two groups being 1 November and 27 October. For autumn-born animals, age (48.4 weeks) and live weight (53.8 kg) at puberty were higher (p<0.01) than for those born in February (37.3 weeks, 42.9 kg). Reproductive cycles in adult goats started in the second half of September and continued until the end of March. Most young goats (75%) had their last seasonal cycle in February and the rest in March. The total number of cycles was higher (p<0.01) in adult (n=8.1) than in young goats born either in autumn (n=6.3) or in February (n=5.7). It is concluded that reproductive development and puberty in Chios female sheep are mostly under seasonal influences though age and body weight are also contributing factors. This breed has a long reproductive season with some animals cycling throughout the year. The Damascus female goat is strictly seasonal with distinct periods of reproductive cyclicity and inactivity. Puberty attainment of Damascus females born in autumn or in February is at the same time the following autumn

Initiation of the breeding season in ewe lambs and goat kids with melatonin implants

Sixty-eight female and 4 male lambs of the Chios breed born in autumn (September–October) and 48 female and 4 male kids of the Damascus breed also born in autumn (November), were used to evaluate the effect of melatonin implants (Regulin®) on the initiation of the breeding season. For each species and sex, half of the animals were either left untreated to serve as controls (C) or received ear implants (females one and males two implants) of melatonin (MEL) in May (spring). Each C and MEL group of females was kept separately and away from males for 5 weeks after implantation and then, C and MEL males were joined with the respective groups for 45 (sheep) and 35 days (goats). Animals not conceiving during the early June–July breeding season, were mated again in September (natural breeding season). The reproductive performance and the 60-day milk yield of animals giving birth during the two seasons were compared. Early in the season (mid November–December), significantly more MEL than C ewes and goats gave birth (75.5% versus 23.5%, p < 0.01; 70.8% versus 37.5%, p < 0.05, respectively). For both species, most of the other characteristics examined were significantly affected by season, but not by treatment. Females giving birth early in the season were approximately 80 days younger at parturition and recorded a lower body weight at mating than those giving birth in the natural February–March season. In the first mating period, the animals mated and conceived had similar body weights to those not mated. The natural, compared with the early June–July mating season, was associated in sheep with higher litter weight at birth (7.0 kg versus 5.8 kg, p < 0.05) and in sheep and goats with a higher number (p < 0.05) of offspring born live (1.78 versus 1.38; 2.0 versus 1.61, respectively) and weaned (1.74 versus 1.36; 1.82 versus 1.35, respectively). Total litter size at birth and 60-day milk yield after weaning, were not significantly different between the two seasons. It could be concluded that melatonin implants administered during the last month of spring in autumn-born female Chios sheep and Damascus goats, advanced the initiation of their breeding season by about 80 days when joined with young males also treated with melatonin implants. The overall reproductive performance and milk yield of animals breeding early, was satisfactory and comparable to that of animals breeding in the natural breeding season