Southwest monsoon onset dates over Malaysia and associated climatological characteristics

In Malaysia precipitation prevails throughout the year. However, the southwest monsoon (late May to September) is characterised with low precipitation, less cloud, high outgoing long-wave radiation (OLR) and often featured by dry epochs. Therefore, onset of the monsoon here is best determined by considering multiple onset parameters such as wind, OLR, rainfall and relative humidity. We used modified Malaysian Meteorological Department wind shear index based on major convection centres during the monsoon onset. The 850 hPa winds were chosen to investigate the onsets of the monsoon in view of the marked orographic and mesoscale processes. The next criterion was the presence of sustained westerlies averaged between 850 hPa and 600 hPa from all the available radiosonde stations data over Malaysia for at least 5 days. As the strongest convective activity in the tropics is represented by OLR of less than 220 W m-2, the third criterion was to check whether the value of OLR was greater than 220 W m-2 over the region. The mean date of the summer monsoon onset over Malaysia is found to be 19 May, with a standard deviation of 8 days. Further, climatological composites show that there is a gradual change from easterlies to westerlies from the surface up to 500 hPa in Malaysian stations both in Peninsular Malaysia and East Malaysia during May. OLR and rainfall analysis reveal that, the southwest monsoon daily rainfall over Malaysia is less than 10 mm and OLR is greater than 220 W m-2. Additionally, monsoon onset tends to be late during the El Niño years and earlier during the La Niña years

Evaluation of prognostic risk models for postoperative pulmonary complications in adult patients undergoing major abdominal surgery: a systematic review and international external validation cohort study

Background Stratifying risk of postoperative pulmonary complications after major abdominal surgery allows clinicians to modify risk through targeted interventions and enhanced monitoring. In this study, we aimed to identify and validate prognostic models against a new consensus definition of postoperative pulmonary complications. Methods We did a systematic review and international external validation cohort study. The systematic review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE and Embase on March 1, 2020, for articles published in English that reported on risk prediction models for postoperative pulmonary complications following abdominal surgery. External validation of existing models was done within a prospective international cohort study of adult patients (≥18 years) undergoing major abdominal surgery. Data were collected between Jan 1, 2019, and April 30, 2019, in the UK, Ireland, and Australia. Discriminative ability and prognostic accuracy summary statistics were compared between models for the 30-day postoperative pulmonary complication rate as defined by the Standardised Endpoints in Perioperative Medicine Core Outcome Measures in Perioperative and Anaesthetic Care (StEP-COMPAC). Model performance was compared using the area under the receiver operating characteristic curve (AUROCC). Findings In total, we identified 2903 records from our literature search; of which, 2514 (86·6%) unique records were screened, 121 (4·8%) of 2514 full texts were assessed for eligibility, and 29 unique prognostic models were identified. Nine (31·0%) of 29 models had score development reported only, 19 (65·5%) had undergone internal validation, and only four (13·8%) had been externally validated. Data to validate six eligible models were collected in the international external validation cohort study. Data from 11 591 patients were available, with an overall postoperative pulmonary complication rate of 7·8% (n=903). None of the six models showed good discrimination (defined as AUROCC ≥0·70) for identifying postoperative pulmonary complications, with the Assess Respiratory Risk in Surgical Patients in Catalonia score showing the best discrimination (AUROCC 0·700 [95% CI 0·683–0·717]). Interpretation In the pre-COVID-19 pandemic data, variability in the risk of pulmonary complications (StEP-COMPAC definition) following major abdominal surgery was poorly described by existing prognostication tools. To improve surgical safety during the COVID-19 pandemic recovery and beyond, novel risk stratification tools are required. Funding British Journal of Surgery Society