The impact of an isolated mesoscale mountain on the diurnal cycle of moist convection and its spatial variation is investigated. Convection-resolving simulations of flow over 3D Gaussian-shaped mountains are performed for a conditionally unstable atmosphere under diurnal radiative forcing. The results show considerable spatial variability in terms of timing and amount of convective precipitation. This variability relates to different physical mechanisms responsible for convection initiation in different parts of the domain. During the late morning, the mass convergence from the radiatively driven diurnal upslope flow confronting the large-scale incident background flow triggers strong convective precipitation over the mountain lee slope. As a consequence, instabilities in the boundary layer are swept out by the emerging cold pool in the vicinity of the mountain, and some parts over the mountain near-field receive less rainfall than the far-field. Over the latter, an unperturbed boundary-layer growth allows for sporadic convective initiation. Still, secondary convection triggered over the leading edge of the cold pool spreads some precipitation over the downstream near-field. Detailed analysis of our control simulation provides further explanation of this frequently observed precipitation pattern over mountains and adjacent plains. Sensitivity experiments indicate a significant influence of the mountain height on the precipitation pattern over the domain.

This online structured survey has demonstrated the global impact of the COVID-19 pandemic on vascular services. The majority of centres have documented marked reductions in operating and services provided to vascular patients. In the months during recovery from the resource restrictions imposed during the pandemic peaks, there will be a significant vascular disease burden awaiting surgeons. One of the most affected specialties.

Objective

To document the recovery of vascular services in Europe following the first COVID-19 pandemic peak.

Methods

An online structured vascular service survey with repeated data entry between 23 March and 9 August 2020 was carried out. Unit level data were collected using repeated questionnaires addressing modifications to vascular services during the first peak (March - May 2020, "period 1"), and then again between May and June ("period 2") and June and July 2020 ("period 3"). The duration of each period was similar. From 2 June, as reductions in cases began to be reported, centres were first asked if they were in a region still affected by rising cases, or if they had passed the peak of the first wave. These centres were asked additional questions about adaptations made to their standard pathways to permit elective surgery to resume.

Results

The impact of the pandemic continued to be felt well after countries' first peak was thought to have passed in 2020. Aneurysm screening had not returned to normal in 21.7% of centres. Carotid surgery was still offered on a case by case basis in 33.8% of centres, and only 52.9% of centres had returned to their normal aneurysm threshold for surgery. Half of centres (49.4%) believed their management of lower limb ischaemia continued to be negatively affected by the pandemic. Reduced operating theatre capacity continued in 45.5% of centres. Twenty per cent of responding centres documented a backlog of at least 20 aortic repairs. At least one negative swab and 14 days of isolation were the most common strategies used for permitting safe elective surgery to recommence.

Conclusion

Centres reported a broad return of services approaching pre-pandemic "normal" by July 2020. Many introduced protocols to manage peri-operative COVID-19 risk. Backlogs in cases were reported for all major vascular surgeries.