Increasing frequency in off-season tropical cyclones and its relation to climate variability and change

This article analyzes the relationship between off-season tropical cyclone (TC) frequency and climate variability and change for the Pacific Ocean and Atlantic Ocean basins. TC track data were used to extract the off-season storms for the 1900–2019 period. TC counts were aggregated by decade, and the number of storms for the first 6 decades (presatellite era) was adjusted. Mann–Kendall nonparametric tests were used to identify trends in decadal TC counts and multiple linear regression (MLR) models were used to test if climatic variability or climate change factors explained the trends in off-season storms. MLR stepwise procedures were implemented to identify the climate variability and change factors that explained most of the variability in off-season TC frequency. A total of 713 TCs were identified as occurring earlier or later than their peak seasons, most during the month of May and in the West Pacific and South Pacific basins. The East Pacific (EP), North Atlantic (NA) and West Pacific (WP) basins exhibit significant increasing trends in decadal off-season TC frequency. MLR results show that trends in sea surface temperature, global mean surface temperature and cloud cover explain most of the increasing trend in decadal off-season TC counts in the EP, NA and WP basins. Stepwise MLR results also identified climate change variables as the dominant forces behind increasing trends in off-season TC decadal counts, yet they also showed that climate variability factors like El Niño–Southern Oscillation, the Atlantic Multidecadal Oscillation and the Interdecadal Pacific Oscillation also account for a portion of the variability.</p

Diurnal Variation of Rainfall in a Tropical Coastal Region with Complex Orography

We examined the diurnal cycle of the rainfall in a coastal tropical mountainous region in central Veracruz State, Mexico (18&deg;&ndash;21&deg; N, 95.5&deg;&ndash;98.5&deg; W), featuring a striking topographic gradient running from sea level at the Gulf of Mexico coast to 5000 m above sea level (m.a.s.l.) in less than 100 km horizontal distance. During the summer, this unique location leads to regular the interaction between the easterly moisture inflow and the mountainous barrier. Over the complex terrain, forced ascent leads the occurrence of maximum rainfall during the afternoon (16&ndash;19 local time, LT &asymp; 1&frac12; hours ahead of solar time in summer), first along the slope and later over the coast. Along the coastal plain, the precipitation continues until the early morning consistent with there being convergence between land breezes and the trade winds. Observations obtained during a measurement campaign from 28 June to 3 July 2015, indicate that during the early evening downslope winds move against easterly flow, likely due to katabatic outflows previously observed over the region. These features are confirmed using spatial (0.88&deg;) and temporal (30 min) resolution CMORPH rainfall estimates, since we observed evening episodes initiating along the slope during the afternoon (14&ndash;17 LT) moving later towards the coast

El concepto de Temperatura Efectiva aplicado a las tarifas eléctricas domésticas en el oriente de México

La legislación mexicana establece que las tarifas eléctricas domésticas se asignan en función de la temperatura media mensual durante el semestre más cálido. En este artículo se presenta un procedimiento que estima las temperaturas medias mensuales del verano a partir de la altitud, de modo que se pueda asignar la tarifa a cualquier sitio aun careciendo de una estación climatológica en su vecindad. Además, ante la necesidad de establecer las tarifas en función de una temperatura representativa de la sensación térmica, como es la llamada Temperatura Efectiva, se incluye una corrección adicional que debería incluirse para tomar en cuenta este criterio. Finalmente, se incluye una estimación de los impactos de esta propuesta para las finanzas de la Comisión Federal de Electricidad

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