Hidrografia costeira de Aveiro a Finisterra

Mestrado em Meteorologia e Oceanografia FísicaO conhecimento adequado dos processos que ocorrem na plataforma continental é um pré requisito para um sistema operacional de observação costeira e previsão. O sistema hidrológico na área Norte da plataforma Oeste Ibérica não é ainda bem conhecido e os modelos existentes falham na sua descrição adequada, especialmente em condições extremas. Estudos recentes têm vindo a clarificar melhor o papel dos caudais fluviais e do vento no forçamento das correntes costeiras, contribuindo também para determinar as suas escalas espáciotemporais típicas. O principal objectivo deste trabalho consistiu na caracterização em termos hidrológicos da região da plataforma continental entre Aveiro e Finisterra em situação de Inverno. Para tal, nos Invernos de 2006 e 2007, efectuaram-se levantamentos de CTD, fundeou-se um ADCP para medir a corrente e a agitação marítima na plataforma interna e apoiou-se a discussão dos dados obtidos com informação meteorológica, caudais fluviais afectos à zona em estudo, maré e agitação marítima medida por uma bóia ondógrafo. Neste estudo sugere-se que o caudal fluvial, apesar de pouco elevado, é responsável pela indução da deriva de uma corrente costeira de superfície, capaz de promover um transporte efectivo para Norte de água, sedimentos e material biológico, provindos quer da plataforma quer das fontes estuarinas. Apesar da presença de flutuabilidade estuarina induzida, foi evidente que as alterações das estruturas hidrológicas responderam maioritariamente ao vento. Apenas se manifestou uma corrente para Norte durante o período de vento de Sul. A contribuição fluvial revelou-se demasiado fraca para contrariar este forçamento do vento. ABSTRACT: A proper understanding of the continental shelf process is a prerequisite for an operational system of coastal observations and forecast. The hydrologic system in the northern part of the west Iberian shelf is not yet well understood and the existing models fail to describe it adequately, especially in extreme conditions. Recent attempts have been done to better clarify the roles of buoyancy and wind in the coastal current forcing, as well as to disclose its typical space and time scales. The main purpose of this study was to characterize in hydrological terms the region of the continental shelf between Porto and Finisterre in a winter situation. With this propose, in the winters of 2006 and 2007, surveys of CTD were made, an ADCP was moored to measure currents and wave height, period and direction at the inner shelf. To discuss the data obtained, meteorological information, runoff at the studied area, tide and directional wave data measured at a wavescan buoy were collected. It is hypothesised in this study that river runoff, though not very high, is likely to induce a buoyancy driven coastal current capable of promoting an effective northward transport of water, sediments and biological material from both shelf and estuarine sources. Although the presence of estuarine induced buoyancy was evident in the hydrographic structures, their changes responded mainly to the wind. A northward current was present only during the period of southerlies, and buoyancy revealed to be too weak to counteract the wind reversal

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Numerical modelling of fish eggs dispersion at the Patos Lagoon estuary, Brazil

The Patos Lagoon estuary is the most important nursery ground for commercially relevant species of fish and crustaceans in the South of Brazil, maintaining fisheries that sustain 3500 fisher families throughout the Rio Grande do Sul State coastline. Around 80% of the interior estuarine area is very shallow (b2 m), and recruitment of fish eggs and larvae to the inner parts of the Patos Lagoon estuary is directly related to the circulation pattern in the area, which is controlled by local and non-local wind effects and freshwater discharge. The objective of this study is to investigate the processes controlling the transport of estuarine dependent fish eggs between the Atlantic Ocean and the Patos Lagoon estuary. An integrated numerical system based on a bi-dimensional hydrodynamic model and a Lagrangean transport model of passive particles is applied to a selection of scenarios representing the passage of weather fronts over the area. At this stage, fish eggs are represented as buoyant passive particles. Modelling results are compared against field data for the period under investigation (September/October 1999) and historical records. Short term results are analysed in terms of the meteorological conditions (wind direction, intensity and duration) controlling the transport of eggs to the inner parts of the estuary and the extension of their excursion. This experiment is the first attempt to couple biological and physical information to study fish eggs transport, and to enhance the current knowledge about recruitment of important fisheries resources in southern Brazil. © 2007 Elsevier B.V. All rights reserved

Characterisation of microbial attack on archaeological bone

As part of an EU funded project to investigate the factors influencing bone preservation in the archaeological record, more than 250 bones from 41 archaeological sites in five countries spanning four climatic regions were studied for diagenetic alteration. Sites were selected to cover a range of environmental conditions and archaeological contexts. Microscopic and physical (mercury intrusion porosimetry) analyses of these bones revealed that the majority (68%) had suffered microbial attack. Furthermore, significant differences were found between animal and human bone in both the state of preservation and the type of microbial attack present. These differences in preservation might result from differences in early taphonomy of the bones. © 2003 Elsevier Science Ltd. All rights reserved

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