Case-mix adjustment to compare nationwide hospital performances after resection of colorectal liver metastases

Background: Differences in patient demographics and disease burden can influence comparison of hospital performances. This study aimed to provide a case-mix model to compare short-term postoperative outcomes for patients undergoing liver resection for colorectal liver metastases (CRLM). Methods: This retrospective, population-based study included all patients who underwent liver resection for CRLM between 2014 and 2018 in the Netherlands. Variation in case-mix variables between hospitals and influence on postoperative outcomes was assessed using multivariable logistic regression. Primary outcomes were 30-day major morbidity and 30-day mortality. Validation of results was performed on the data from 2019. Results: In total, 4639 patients were included in 28 hospitals. Major morbidity was 6.2% and mortality was 1.4%. Uncorrected major morbidity ranged from 3.3% to 13.7% and mortality ranged from 0.0% to 5.0%. between hospitals. Significant differences between hospitals were observed for age higher than 80 (0.0%-17.1%, p <0.001), ASA 3 or higher (3.3%-36.3%, p <0.001), histopathological parenchymal liver disease (0.0%-47.1%, p <0.001), history of liver resection (8.1%-36.3%, p <0.001), major liver resection (6.7%-38.0%, p <0.001) and synchronous metastases (35.5%-62.1%, p <0.001). Expected 30-day major morbidity between hospitals ranged from 6.4% to 11.9% and expected 30-day mortality ranged from 0.6% to 2.9%. After case-mix correction no significant outliers concerning major morbidity and mortality remained. Validation on patients who underwent liver resection for CRLM in 2019 affirmed these outcomes. Conclusion: Case-mix adjustment is a prerequisite to allow for institutional comparison of short-term postoperative outcomes after liver resection for CRLM. (C) 2020 University Medical Center Groningen. Published by Elsevier Ltd

Proposal of 0.5 mg of protein/100 g of processed food as threshold for voluntary declaration of food allergen traces in processed food-A first step in an initiative to better inform patients and avoid fatal allergic reactions : A GA(2)LEN position paper

Background Food anaphylaxis is commonly elicited by unintentional ingestion of foods containing the allergen above the tolerance threshold level of the individual. While labeling the 14 main allergens used as ingredients in food products is mandatory in the EU, there is no legal definition of declaring potential contaminants. Precautionary allergen labeling such as "may contain traces of" is often used. However, this is unsatisfactory for consumers as they get no information if the contamination is below their personal threshold. In discussions with the food industry and technologists, it was suggested to use a voluntary declaration indicating that all declared contaminants are below a threshold of 0.5 mg protein per 100 g of food. This concentration is known to be below the threshold of most patients, and it can be technically guaranteed in most food production. However, it was also important to assess that in case of accidental ingestion of contaminants below this threshold by highly allergic patients, no fatal anaphylactic reaction could occur. Therefore, we performed a systematic review to assess whether a fatal reaction to 5mg of protein or less has been reported, assuming that a maximum portion size of 1kg of a processed food exceeds any meal and thus gives a sufficient safety margin. Methods MEDLINE and EMBASE were searched until 24 January 2021 for provocation studies and case reports in which one of the 14 major food allergens was reported to elicit fatal or life-threatening anaphylactic reactions and assessed if these occurred below the ingestion of 5mg of protein. A Delphi process was performed to obtain an expert consensus on the results. Results In the 210 studies included, in our search, no reports of fatal anaphylactic reactions reported below 5 mg protein ingested were identified. However, in provocation studies and case reports, severe reactions below 5 mg were reported for the following allergens: eggs, fish, lupin, milk, nuts, peanuts, soy, and sesame seeds. Conclusion Based on the literature studied for this review, it can be stated that cross-contamination of the 14 major food allergens below 0.5 mg/100 g is likely not to endanger most food allergic patients when a standard portion of food is consumed. We propose to use the statement "this product contains the named allergens in the list of ingredients, it may contain traces of other contaminations (to be named, e.g. nut) at concentrations less than 0.5 mg per 100 g of this product" for a voluntary declaration on processed food packages. This level of avoidance of cross-contaminations can be achieved technically for most processed foods, and the statement would be a clear and helpful message to the consumers. However, it is clearly acknowledged that a voluntary declaration is only a first step to a legally binding solution. For this, further research on threshold levels is encouraged.Peer reviewe

Cs, Sr, and Ba Sorption on Clays and Fe-Oxides

Technical guidance for performance assessment (PA) of low-level radioactive waste (LLRW) sites is currently dependent upon experimental retardation factors (K{sub D}'s) to predict radionuclide transport. Accurate predictions of waste transport or retardation will require mechanistic models of radionuclide sorption so as to be applicable to a wide range of soil/groundwater environments. To that end, we have investigated Cs{sup +}, Sr{sup +}, and Ba{sup 2+} sorption on several clay and Fe-oxide minerals. Relative metal binding strengths for montmorillonite clay decrease from Ba{sup 2+} to Sr{sup +}, which is similar to that sorption trend noticed for kaolinite. Molecular dynamics simulations for kaolinite suggest that Cs{sup +} is sorbed at aluminol (010) edge sites as an inner-sphere complex and weakly sorbed as an outer-sphere complex on (001) basal surfaces. Sorption is thought to occur on similar sites for smectite clays, however, the basal plane residual charge and its increased basal plane exposure should have a greater influence on metal sorption. On the other hand, phase transformation kinetics (e.g., ferrihydrite to goethite) is a very important control of metal sorption and resorption for Fe-oxides/hydroxides. These results provide a basis for understanding and predicting metal sorption on complex soil minerals

Tracking precipitation patterns across a western U.S. metropolitan area using volunteer observers: RainLog

The southwestern United States experiences extreme hydroclimatic variability, including intense but localized monsoon thunderstorms, tropical storms, and winter storms, resulting in complex and variable patterns of precipitation over space and time. Official gauges associated with long‐term monitoring networks are sparsely distributed throughout the region and are unable to capture the spatial complexity and variability of these precipitation patterns. The RainLog program, a volunteer precipitation monitoring program, was started in southern Arizona in 2005 to leverage enthusiasm among non‐scientists around weather, water, and climate to address the gaps in official monitoring networks. An examination of the portion of the dataset that spans the Tucson metropolitan area illustrates the opportunities and challenges in using volunteer data to track precipitation. We compare near‐complete records to an official observation to highlight how the broader RainLog network supports characterizing hydroclimatic variability over the period of record. We also examine several case study events drawn from metrics of network variability that represent different forms of hydroclimatic extremes. We find that in most cases the RainLog network captures a range of precipitation values that were notably different than the single value recorded at the official observing site, adding substantial value in recording and reconstructing past extreme precipitation events. This work highlights how volunteer citizen science precipitation monitoring networks can provide critical data for tracking precipitation variability and changes, although are only one complementary piece of coherent, long‐term hydroclimatic monitoring.Climate Program OfficeOpen access articleThis item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]

JUSIFA—A new user‐dedicated ASAXS beamline for materials science

The fully computer‐controlled user‐dedicated small‐angle scattering facility JUSIFA was set up for general use at the DORIS Synchrotron Radiation Source in DESY (Hamburg). This beamline is especially designed for anomalous scattering studies of anisotropic samples in materials science and enables ASAXS studies to be undertaken on the length scale 0.5 to 100 nm in an energy range of 4.5 to 35 keV