Abstract: The Clavien–Dindo classification is perhaps the most widely used approach for reporting postoperative complications in clinical trials. This system classifies complication severity by the treatment provided. However, it is unclear whether the Clavien–Dindo system can be used internationally in studies across differing healthcare systems in high- (HICs) and low- and middle-income countries (LMICs). Methods This was a secondary analysis of the International Surgical Outcomes Study (ISOS), a prospective observational cohort study of elective surgery in adults. Data collection occurred over a 7-day period. Severity of complications was graded using Clavien–Dindo and the simpler ISOS grading (mild, moderate or severe, based on guided investigator judgement). Severity grading was compared using the intraclass correlation coefficient (ICC). Data are presented as frequencies and ICC values (with 95 per cent c.i.). The analysis was stratified by income status of the country, comparing HICs with LMICs. Results A total of 44 814 patients were recruited from 474 hospitals in 27 countries (19 HICs and 8 LMICs). Some 7508 patients (16·8 per cent) experienced at least one postoperative complication, equivalent to 11 664 complications in total. Using the ISOS classification, 5504 of 11 664 complications (47·2 per cent) were graded as mild, 4244 (36·4 per cent) as moderate and 1916 (16·4 per cent) as severe. Using Clavien–Dindo, 6781 of 11 664 complications (58·1 per cent) were graded as I or II, 1740 (14·9 per cent) as III, 2408 (20·6 per cent) as IV and 735 (6·3 per cent) as V. Agreement between classification systems was poor overall (ICC 0·41, 95 per cent c.i. 0·20 to 0·55), and in LMICs (ICC 0·23, 0·05 to 0·38) and HICs (ICC 0·46, 0·25 to 0·59). Conclusion Caution is recommended when using a treatment approach to grade complications in global surgery studies, as this may introduce bias unintentionally.

Abstract: —J. BLUNDEN, T. BOYER, AND E. BARTOW-GILLIES Earth’s global climate system is vast, complex, and intricately interrelated. Many areas are influenced by global-scale phenomena, including the “triple dip” La Niña conditions that prevailed in the eastern Pacific Ocean nearly continuously from mid-2020 through all of 2022; by regional phenomena such as the positive winter and summer North Atlantic Oscillation that impacted weather in parts the Northern Hemisphere and the negative Indian Ocean dipole that impacted weather in parts of the Southern Hemisphere; and by more localized systems such as high-pressure heat domes that caused extreme heat in different areas of the world. Underlying all these natural short-term variabilities are long-term climate trends due to continuous increases since the beginning of the Industrial Revolution in the atmospheric concentrations of Earth’s major greenhouse gases. In 2022, the annual global average carbon dioxide concentration in the atmosphere rose to 417.1±0.1 ppm, which is 50% greater than the pre-industrial level. Global mean tropospheric methane abundance was 165% higher than its pre-industrial level, and nitrous oxide was 24% higher. All three gases set new record-high atmospheric concentration levels in 2022. Sea-surface temperature patterns in the tropical Pacific characteristic of La Niña and attendant atmospheric patterns tend to mitigate atmospheric heat gain at the global scale, but the annual global surface temperature across land and oceans was still among the six highest in records dating as far back as the mid-1800s. It was the warmest La Niña year on record. Many areas observed record or near-record heat. Europe as a whole observed its second-warmest year on record, with sixteen individual countries observing record warmth at the national scale. Records were shattered across the continent during the summer months as heatwaves plagued the region. On 18 July, 104 stations in France broke their all-time records. One day later, England recorded a temperature of 40°C for the first time ever. China experienced its second-warmest year and warmest summer on record. In the Southern Hemisphere, the average temperature across New Zealand reached a record high for the second year in a row. While Australia’s annual temperature was slightly below the 1991–2020 average, Onslow Airport in Western Australia reached 50.7°C on 13 January, equaling Australia's highest temperature on record. While fewer in number and locations than record-high temperatures, record cold was also observed during the year. Southern Africa had its coldest August on record, with minimum temperatures as much as 5°C below normal over Angola, western Zambia, and northern Namibia. Cold outbreaks in the first half of December led to many record-low daily minimum temperature records in eastern Australia. The effects of rising temperatures and extreme heat were apparent across the Northern Hemisphere, where snow-cover extent by June 2022 was the third smallest in the 56-year record, and the seasonal duration of lake ice cover was the fourth shortest since 1980. More frequent and intense heatwaves contributed to the second-greatest average mass balance loss for Alpine glaciers around the world since the start of the record in 1970. Glaciers in the Swiss Alps lost a record 6% of their volume. In South America, the combination of drought and heat left many central Andean glaciers snow free by mid-summer in early 2022; glacial ice has a much lower albedo than snow, leading to accelerated heating of the glacier. Across the global cryosphere, permafrost temperatures continued to reach record highs at many high-latitude and mountain locations. In the high northern latitudes, the annual surface-air temperature across the Arctic was the fifth highest in the 123-year record. The seasonal Arctic minimum sea-ice extent, typically reached in September, was the 11th-smallest in the 43-year record; however, the amount of multiyear ice—ice that survives at least one summer melt season—remaining in the Arctic continued to decline. Since 2012, the Arctic has been nearly devoid of ice more than four years old. In Antarctica, an unusually large amount of snow and ice fell over the continent in 2022 due to several landfalling atmospheric rivers, which contributed to the highest annual surface mass balance, 15% to 16% above the 1991–2020 normal, since the start of two reanalyses records dating to 1980. It was the second-warmest year on record for all five of the long-term staffed weather stations on the Antarctic Peninsula. In East Antarctica, a heatwave event led to a new all-time record-high temperature of −9.4°C—44°C above the March average—on 18 March at Dome C. This was followed by the collapse of the critically unstable Conger Ice Shelf. More than 100 daily low sea-ice extent and sea-ice area records were set in 2022, including two new all-time annual record lows in net sea-ice extent and area in February. Across the world’s oceans, global mean sea level was record high for the 11th consecutive year, reaching 101.2 mm above the 1993 average when satellite altimetry measurements began, an increase of 3.3±0.7 over 2021. Globally-averaged ocean heat content was also record high in 2022, while the global sea-surface temperature was the sixth highest on record, equal with 2018. Approximately 58% of the ocean surface experienced at least one marine heatwave in 2022. In the Bay of Plenty, New Zealand’s longest continuous marine heatwave was recorded. A total of 85 named tropical storms were observed during the Northern and Southern Hemisphere storm seasons, close to the 1991–2020 average of 87. There were three Category 5 tropical cyclones across the globe—two in the western North Pacific and one in the North Atlantic. This was the fewest Category 5 storms globally since 2017. Globally, the accumulated cyclone energy was the lowest since reliable records began in 1981. Regardless, some storms caused massive damage. In the North Atlantic, Hurricane Fiona became the most intense and most destructive tropical or post-tropical cyclone in Atlantic Canada’s history, while major Hurricane Ian killed more than 100 people and became the third costliest disaster in the United States, causing damage estimated at $113 billion U.S. dollars. In the South Indian Ocean, Tropical Cyclone Batsirai dropped 2044 mm of rain at Commerson Crater in Réunion. The storm also impacted Madagascar, where 121 fatalities were reported. As is typical, some areas around the world were notably dry in 2022 and some were notably wet. In August, record high areas of land across the globe (6.2%) were experiencing extreme drought. Overall, 29% of land experienced moderate or worse categories of drought during the year. The largest drought footprint in the contiguous United States since 2012 (63%) was observed in late October. The record-breaking megadrought of central Chile continued in its 13th consecutive year, and 80-year record-low river levels in northern Argentina and Paraguay disrupted fluvial transport. In China, the Yangtze River reached record-low values. Much of equatorial eastern Africa had five consecutive below-normal rainy seasons by the end of 2022, with some areas receiving record-low precipitation totals for the year. This ongoing 2.5-year drought is the most extensive and persistent drought event in decades, and led to crop failure, millions of livestock deaths, water scarcity, and inflated prices for staple food items. In South Asia, Pakistan received around three times its normal volume of monsoon precipitation in August, with some regions receiving up to eight times their expected monthly totals. Resulting floods affected over 30 million people, caused over 1700 fatalities, led to major crop and property losses, and was recorded as one of the world’s costliest natural disasters of all time. Near Rio de Janeiro, Brazil, Petrópolis received 530 mm in 24 hours on 15 February, about 2.5 times the monthly February average, leading to the worst disaster in the city since 1931 with over 230 fatalities. On 14–15 January, the Hunga Tonga-Hunga Ha'apai submarine volcano in the South Pacific erupted multiple times. The injection of water into the atmosphere was unprecedented in both magnitude—far exceeding any previous values in the 17-year satellite record—and altitude as it penetrated into the mesosphere. The amount of water injected into the stratosphere is estimated to be 146±5 Terragrams, or ∼10% of the total amount in the stratosphere. It may take several years for the water plume to dissipate, and it is currently unknown whether this eruption will have any long-term climate effect.

Abstract: e13533 Background: The accelerated use of next generation sequencing (NGS) in oncology requires the integration of cancer genomics and precision oncology education to facilitate appropriate clinical decisions. The Molecular Tumour Board (MTB) in Ireland was established in November 2020 as a cross-institutional, educational and multi-disciplinary pilot and expanded nationally under Cancer Trials Ireland as a resource for clinicians and other oncology groups. Methods: The Irish MTB program was co-designed with Roche and local Health Care Providers (HCPs) over the pillars of co-creation, co-benefitting and co-education. Individual anonymized patient cases are discussed at each monthly meeting, supported by four multidisciplinary experts that discuss genomic findings, characterized mutations and their actionability, in addition to available therapies. The standardized end-to-end process to ensure preparation and proper handling of sensitive data is managed by an independent partner. A survey questionnaire was regularly administered to the MTB attendees to evaluate progress since the MTB initiation. Results: From November 2020 until December 2021, the program has grown to a monthly meeting where 30 patient cases have been discussed and 157 cumulative participants have been part of the sessions from 16 institutions. Survey findings revealed all of participants admitted that MTBs they attended met, exceeded, or significantly exceeded their expectations and 90% of presenters confirmed that experts communicated effectively. The majority of participants (87%) considered the discussions on clinical implications of targeted therapies or immunotherapies associated with genomic alterations as the most valuable component, 80% of presenters confirmed that the MTB discussions helped them to confirm, modify or change the treatment plan for at least one of their patients, and 65% of participants were very satisfied with the insights shared around molecular profiling and biological pathways. The pilot MTB has now been incorporated by the national trials group, Cancer Trials Ireland. Conclusions: The development of a national MTB in Ireland utilized pharmaceutical sponsorship and support to gather impetus for an independent national MTB managed by Cancer Trials Ireland. It offers a national forum for the discussion of cancers with specific molecular alterations in addition to complex clinical cases. Furthermore, it has created academic opportunities for the clinical application of precision medicine. Future directions will include leveraging the MTB infrastructure for research and the creation of a national Molecular Cancer Registry. Continued integration of experts will be key to secure the continuation of the national Irish MTB and to ultimately improving precision oncology delivery in patient care and trial enrolment through meaningful insights based on the collected data.

Abstract: This summary looks at the southern hemisphere and equatorial climate patterns for spring 2016, with particular attention given to the Australasian and equatorial regions of the Pacific and Indian Ocean basins. Spring 2016 was marked by the later part of a strong negative phase of the Indian Ocean Dipole, alongside cool neutral El Niño–Southern Oscillation conditions. September was exceptionally wet over much of Australia, contributing to a wet spring with near-average temperatures. The spring was one of the warmest on record over the southern hemisphere as a whole, with Antarctic Sea ice extent dropping to record low levels for the season.

Abstract: El Niño–Southern Oscillation (ENSO) is often characterized through the use of sea surface temperature (SST) departures from their climatological values, as in the Niño-3.4 index. However, this approach is problematic in a changing climate when the climatology itself is varying. To address this issue, van Oldenborgh et al. proposed a relative Niño-3.4 SST index, which subtracts the tropical mean SST anomaly from the Niño-3.4 index and multiplies by a scaling factor. We extend their work by providing a simplified calculation procedure for the scaling factor, and confirm that the relative index demonstrates reduced sensitivity to climate change and multidecadal variability. In particular, we show in three observational SST datasets that the relative index provides a more consistent classification of historical El Niño and La Niña oceanic conditions that is more robust across climatological periods compared to the nonrelative index. Forecast skill of the relative Niño-3.4 index in the North American Multimodel Ensemble (NMME) and ACCESS-S2 is slightly reduced for targets during the first half of the year because subtracting the tropical mean removes a source of additional skill. For targets in the second half of the year, the relative and nonrelative indices are equally skillful. Observed ENSO teleconnections in 200-hPa geopotential height and precipitation during key seasons are sharper and explain more variability over Australia and the contiguous United States when computed with the relative index. Overall, the relative Niño-3.4 index provides a more robust option for real-time monitoring and forecasting ENSO in a changing climate. Significance Statement The goal of this study is to further explore a relative sea surface temperature index for monitoring and prediction of El Niño–Southern Oscillation. Sea surface temperature indices are typically computed as a difference from a 30-yr climatological average, and El Niño and La Niña events occur when values exceed a certain threshold. This method is suitable when the climate is stationary. However, because of climate change and other lower-frequency variations, historical El Niño and La Niña events are reclassified depending on which climatological period is selected. A relative index is investigated to ameliorate this problem.