Simulating the seeder–feeder impacts on cloud ice and precipitation over the Alps

The ice phase impacts many cloud properties as well as cloud lifetime. Ice particles that sediment into a lower cloud from an upper cloud (external seeder–feeder process) or into the mixed-phase region of a deep cloud from cirrus levels (internal seeder–feeder process) can influence the ice phase of the lower cloud, amplify cloud glaciation and enhance surface precipitation. Recently, numerical weather prediction modeling studies have aimed at representing the ice crystal number concentration in mixed-phase clouds more accurately by including secondary ice formation processes. The increase in the ice crystal number concentration can impact the number of ice particles that sediment into the lower cloud and alter its composition and precipitation formation. In the Swiss Alps, the orography permits the formation of orographic clouds, making it ideal for studying the occurrence of multi-layered clouds and the seeder–feeder process. We present results from a case study on 18 May 2016, showing the occurrence frequency of multi-layered clouds and the seeder–feeder process. About half of all observed clouds were categorized as multi-layered, and the external seeder–feeder process occurred in 10 % of these clouds. Between cloud layers, ≈60 % of the ice particle mass was lost due to sublimation or melting. The external seeder–feeder process was found to be more important than the internal seeder–feeder process with regard to the impact on precipitation. In the case where the external seeder–feeder process was inhibited, the average surface precipitation and riming rate over the domain were both reduced by 8.5 % and 3.9 %, respectively. When ice–graupel collisions were allowed, further large reductions were seen in the liquid water fraction and riming rate. Inhibiting the internal seeder–feeder process enhanced the liquid water fraction by 6 % compared to a reduction of 5.8 % in the cloud condensate, therefore pointing towards the de-amplification in cloud glaciation and a reduction in surface precipitation. Adding to the observational evidence of frequent seeder–feeder situations, at least over Switzerland, our study highlights the extensive influence of sedimenting ice particles on the properties of feeder clouds as well as on precipitation formation.</p

Global economic burden of unmet surgical need for appendicitis

Background: There is a substantial gap in provision of adequate surgical care in many low-and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods: Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results: Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion: For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

Evaluation of climate model aerosol seasonal and spatial variability over Africa using AERONET

The sensitivity of climate models to the characterization of African aerosol particles is poorly understood. Africa is a major source of dust and biomass burning aerosols and this represents an important research gap in understanding the impact of aerosols on radiative forcing of the climate system. Here we evaluate the current representation of aerosol particles in the Conformal Cubic Atmospheric Model (CCAM) with ground-based remote retrievals across Africa, and additionally provide an analysis of observed aerosol optical depth at 550 nm (AOD550 nm) and Ångström exponent data from 34 Aerosol Robotic Network (AERONET) sites. Analysis of the 34 long-term AERONET sites confirms the importance of dust and biomass burning emissions to the seasonal cycle and magnitude of AOD550 nm across the continent and the transport of these emissions to regions outside of the continent. In general, CCAM captures the seasonality of the AERONET data across the continent. The magnitude of modeled and observed multiyear monthly average AOD550 nm overlap within ±1 standard deviation of each other for at least 7 months at all sites except the Réunion St Denis Island site (Réunion St. Denis). The timing of modeled peak AOD550 nm in southern Africa occurs 1 month prior to the observed peak, which does not align with the timing of maximum fire counts in the region. For the western and northern African sites, it is evident that CCAM currently overestimates dust in some regions while others (e.g., the Arabian Peninsula) are better characterized. This may be due to overestimated dust lifetime, or that the characterization of the soil for these areas needs to be updated with local information. The CCAM simulated AOD550 nm for the global domain is within the spread of previously published results from CMIP5 and AeroCom experiments for black carbon, organic carbon, and sulfate aerosols. The model's performance provides confidence for using the model to estimate large-scale regional impacts of African aerosols on radiative forcing, but local feedbacks between dust aerosols and climate over northern Africa and the Mediterranean may be overestimated

The Green Chemistry Initiative’s contributions to education at the University of Toronto and beyond

The Green Chemistry Initiative (GCI) is a student-led group founded in 2012 with the primary mission of promoting green chemistry education at the University of Toronto. In order to achieve this, the GCI’s activities have included undergraduate curriculum development, arrangement of an external speaker seminar series, and organization of an annual three-day symposium along with biweekly trivia challenges. To broaden education beyond the Department of Chemistry, a successful YouTube video campaign articulating the Twelve Principles of Green Chemistry in an accessible manner has also been undertaken (acquiring over 40,000 views), in addition to monthly blog posts and conference/outreach presentations. Descriptions of these activities are discussed in this paper, along with the resulting impact they have had. Through such efforts, undergraduate and graduate students are showing a growing understanding of the relevance of green chemistry in today’s world, with the GCI serving as a platform for similar groups to build upon across Canada