Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background 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

Retrospective evaluation of whole exome and genome mutation calls in 746 cancer samples

Funder: NCI U24CA211006Abstract: The Cancer Genome Atlas (TCGA) and International Cancer Genome Consortium (ICGC) curated consensus somatic mutation calls using whole exome sequencing (WES) and whole genome sequencing (WGS), respectively. Here, as part of the ICGC/TCGA Pan-Cancer Analysis of Whole Genomes (PCAWG) Consortium, which aggregated whole genome sequencing data from 2,658 cancers across 38 tumour types, we compare WES and WGS side-by-side from 746 TCGA samples, finding that ~80% of mutations overlap in covered exonic regions. We estimate that low variant allele fraction (VAF < 15%) and clonal heterogeneity contribute up to 68% of private WGS mutations and 71% of private WES mutations. We observe that ~30% of private WGS mutations trace to mutations identified by a single variant caller in WES consensus efforts. WGS captures both ~50% more variation in exonic regions and un-observed mutations in loci with variable GC-content. Together, our analysis highlights technological divergences between two reproducible somatic variant detection efforts

Accurate methodology to determine slip velocity, yield stress and the constitutive law for molten chocolate

International audienceFlow of concentrated soft materials like molten chocolate often has the ambiguity of behaving like a solid or a liquid depending on the external constraints. Determination of the constitutive law is often unreliable and consequently the yield stress value too. This difficulty of determining yield stress, particularly when using a standards protocol such as the IOCCC for chocolate, is a consequence of the presence of wall slip. Most attempts to assess slip velocity using Yoshimura and Prud'homme's method have resulted in failure. We propose to tackle this problem by using an easy and reliable methodology applied to a commercial chocolate in a melted state with, as equipment, a plate-plate rotational rheometer. This method allows precise determination of the yield stress value, the constitutive law and the slip velocity, as well as also providing an explanation to the apparent Newtonian plateau and thickening behavior of the raw flow curve

Probing the Mechanical Strength of an Armored Bubble and Its Implication to Particle-Stabilized Foams

Bubbles are dynamic objects that grow and rise or shrink and disappear, often on the scale of seconds. This conflicts with their uses in foams where they serve to modify the properties of the material in which they are embedded. Coating the bubble surface with solid particles has been demonstrated to strongly enhance the foam stability, although the mechanisms for such stabilization remain mysterious. In this paper, we reduce the problem of foam stability to the study of the behavior of a single spherical bubble coated with a monolayer of solid particles. The behavior of this armored bubble is monitored while the ambient pressure around it is varied, in order to simulate the dissolution stress resulting from the surrounding foam. We find that above a critical stress, localized dislocations appear on the armor and lead to a global loss of the mechanical stability. Once these dislocations appear, the armor is unable to prevent the dissolution of the gas into the surrounding liquid, which translates into a continued reduction of the bubble volume, even for a fixed overpressure. The observed route to the armor failure therefore begins from localized dislocations that lead to large-scale deformations of the shell until the bubble completely dissolves. The critical value of the ambient pressure that leads to the failure depends on the bubble radius, with a scaling of ΔP_{collapse}∝R^{-1}, but does not depend on the particle diameter. These results disagree with the generally used elastic models to describe particle-covered interfaces. Instead, the experimental measurements are accounted for by an original theoretical description that equilibrates the energy gained from the gas dissolution with the capillary energy cost of displacing the individual particles. The model recovers the short-wavelength instability, the scaling of the collapse pressure with bubble radius, and the insensitivity to particle diameter. Finally, we use this new microscopic understanding to predict the aging of particle-stabilized foams, by applying classical Ostwald ripening models. We find that the smallest armored bubbles should fail, as the dissolution stress on these bubbles increases more rapidly than the armor strength. Both the experimental and theoretical results can readily be generalized to more complex particle interactions and shell structures

The Effect of Arabinoxylan and Wheat Bran Incorporation on Dough Rheology and Thermal Processing of Rotary-Moulded Biscuits

Wheat bran incorporation into biscuits may increase their nutritional value, however, it may affect dough rheology and baking performance, due to the effect of bran particles on dough structure and an increase in water absorption. This study analyzed the enrichment effect of wheat bran and arabinoxylans, the most important non-starch polysaccharides found in whole wheat flour, on dough rheology and thermal behaviour during processing of rotary-moulded biscuits. The objective was to understand the contribution of arabinoxylans during biscuit-making and their impact when incorporated as wheat bran. Refined flour was replaced at 25, 50, 75, or 100% by whole flour with different bran particle sizes (fine: 4% &gt; 500 μm; coarse: 72% &gt; 500 μm). The isolated effect of arabinoxylans was examined by preparing model flours, where refined flour was enriched with water-extractable and water-unextractable arabinoxylans. Wheat bran had the greatest impact on dough firmness and arabinoxylans had the greatest impact on the elastic response. The degree of starch gelatinization increased from 24 to 36% in biscuits enriched with arabinoxylans or whole flour and coarse bran. The microstructural analysis (SEM, micro-CT) suggested that fibre micropores may retain water inside their capillaries which can be released in a controlled manner during baking

Morphology development in single drop drying for native and aggregated whey protein dispersions

Native and aggregated whey proteins (WP) are used in food and pharmaceutical applications as stabilizers, thickeners and carriers. For increasing shelf-life and facilitating transportation, WP are transformed into powders by spray-drying. Powder functional properties strongly depend on the final particle morphology. Focusing on colloidal aspects of drying, the goal of this work is to: (i) investigate morphology development during single drop drying of native and aggregated whey protein dispersions; (ii) use structure-mechanical parameters to predict the final morphology. Results showed evaporation rate and morphology development characteristic times are not affected significantly by colloidal size. However, the final morphology of particles depends on WP colloidal size. For small colloids, particles are shriveled, while their shape is cup-like for larger colloids. Structure–mechanical parameters allowed predicting a buckled/shriveled morphology in agreement with experimental observations. Specifically, predictions anticipated the formation of a solid shell at the particle surface, which is compressed during drying, as a result of colloidal interactions being dominated by van der Waals forces. This work provides a rationalization of morphology development of WP particles. In addition, the work suggests that the elastic – or gel – formation, that is governed by the permeation, may be very different depending on the permeability of the proteins gel. The collapse from a dispersion to an elastic gel may be responsible for the shriveled to buckled transition. The work shows that diverse final morphologies can be achieved using same drying conditions and composition, while only changing the degree of colloidal aggregation.ISSN:0927-7757ISSN:1873-435

Quantification of Spontaneous W/O Emulsification and its Impact on the Swelling Kinetics of Multiple W/O/W Emulsions

An osmotic imbalance between the two water phases of multiple water-in-oil-in-water (W1/O/W2) emulsions results in either emulsion swelling or shrinking due to water migration across the oil layer. Controlled mass transport is not only of importance for emulsion stability but also allows transient emulsion thickening or the controlled release of encapsulated substances, such as nutriments or simply salt. Our prior work has shown that mass transport follows two sequential stages. In the first stage, the oil-phase structure is changed in a way that allows rapid, osmotically driven water transport in the second, osmotically dominated stage. These structural changes in the oil layer are strongly facilitated by the spontaneous formation of tiny water droplets in the oil phase, induced by the oil-soluble surfactant, i.e., polyglycerol polyricinoleate (PGPR). This study provides a simple method based on microscopy image analysis, allowing a detailed investigation of spontaneous W/O emulsification. It quantitatively describes the volume of droplets generated and the rate of droplet creation. Moreover, it describes the effect of spontaneous W/O emulsification on the swelling kinetics of microfluidic processed W1/O/W2 emulsions. Two different concentration regimes of the oil-soluble surfactant are identified: below a critical concentration the overall water transport rate increases, and above a critical concentration water transport stagnates because of maximized structure formation.ISSN:0743-7463ISSN:1520-582

Arresting dissolution by interfacial rheology design

ISSN:0027-8424ISSN:1091-649

Quantification of Spontaneous W/O Emulsification and its Impact on the Swelling Kinetics of Multiple W/O/W Emulsions

An osmotic imbalance between the two water phases of multiple water-in-oil-in-water (W1/O/W2) emulsions results in either emulsion swelling or shrinking due to water migration across the oil layer. Controlled mass transport is not only of importance for emulsion stability but also allows transient emulsion thickening or the controlled release of encapsulated substances, such as nutriments or simply salt. Our prior work has shown that mass transport follows two sequential stages. In the first stage, the oil-phase structure is changed in a way that allows rapid, osmotically driven water transport in the second, osmotically dominated stage. These structural changes in the oil layer are strongly facilitated by the spontaneous formation of tiny water droplets in the oil phase, induced by the oil-soluble surfactant, i.e., polyglycerol polyricinoleate (PGPR). This study provides a simple method based on microscopy image analysis, allowing a detailed investigation of spontaneous W/O emulsification. It quantitatively describes the volume of droplets generated and the rate of droplet creation. Moreover, it describes the effect of spontaneous W/O emulsification on the swelling kinetics of microfluidic processed W1/O/W2 emulsions. Two different concentration regimes of the oil-soluble surfactant are identified: below a critical concentration the overall water transport rate increases, and above a critical concentration water transport stagnates because of maximized structure formation.ISSN:0743-7463ISSN:1520-582