Epoch-Based Height Reference System for Sea Level Rise Impact Assessment on the Coast of Peninsular Malaysia

The Peninsular Malaysia Geodetic Vertical Datum 2000 (PMGVD2000) inherited several deficiencies due to offsets between local datums used, levelling error propagations, land subsidence, sea level rise, and sea level slopes along the southern half of the Malacca Strait on the west coast and the South China Sea in the east coast of the Peninsular relative to the Port Klang (PTK) datum point. To cater for a more reliable elevation-based assessment of both sea level rise and coastal flooding exposure, a new epoch-based height reference system PMGVD2022 has been developed. We have undertaken the processing of more than 30 years of sea level data from twelve tide gauge (TG) stations along the Peninsular Malaysia coast for the determination of the relative mean sea level (RMSL) at epoch 2022.0 with their respective trends and incorporates the quantification of the local vertical land motion (VLM) impact. PMGVD2022 is based on a new gravimetric geoid (PMGeoid2022) fitted to the RMSL at PTK. The orthometric height is realised through the GNSS levelling concept H = hGNSS–Nfit_PTK–NRMDT, where NRMDT is a constant offset due to the relative mean dynamic ocean topography (RMDT) between the fitted geoid at PTK and the local MSL datums along the Peninsular Malaysia coast. PMGVD2022 will become a single height reference system with absolute accuracies of better than ±3 cm and ±10 cm across most of the land/coastal area and the continental shelf of Peninsular Malaysia, respectively

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