Ultrasonography of Inflammatory and Structural Lesions in Hand Osteoarthritis: An OMERACT Agreement and Reliability Study

Objective: To standardize and assess the reliability of ultrasonographic assessment of inflammatory and structural lesions in patients with hand osteoarthritis (OA). Methods: The Outcome Measures in Rheumatology (OMERACT) Ultrasound Working Group selected synovial hypertrophy (SH), joint effusion (JE), and power Doppler (PD) signals as the main inflammatory lesions in hand OA, and suggested osteophytes in the scapho-trapezio-trapezoid (STT) and cartilage defects in the proximal interphalangeal (PIP) joints as novel additions to previous structural scoring systems. A complementary imaging atlas provided detailed examples of the scores. A reliability exercise of static images was performed for the inflammatory features, followed by a patient-based exercise with six sonographers testing inflammatory and structural features in twelve hand OA patients. We used Cohen's kappa (\u3ba) for intra-reader and Light's \u3ba for inter-reader reliability for all features except PD, in which Prevalence-Adjusted Bias-Adjusted Kappa (PABAK) was applied. Percentage agreement was also assessed. Results: The web-based reliability exercise demonstrated substantial intra- and inter-reader reliability for all inflammatory features (\u3ba>0.64). In the patient-based exercise, intra- and inter-reader reliability varied: SH \u3ba=0.73 and 0.45; JE \u3ba=0.70 and 0.55; PD PABAK=0.90 and 0.88; PIP cartilage \u3ba=0.56 and 0.45; STT osteophytes \u3ba=0.62 and 0.36. Percentage close agreement was high for all features (>85%). Conclusion: With ultrasound, substantial to excellent intra-reader reliability was found for inflammatory features of hand OA. Inter-reader reliability was moderate, but overall high close agreement between readers suggest that better reliability is achievable after further training. Assessment of osteophytes in the STT joint and cartilage in the PIP joints achieved less good reliability and the latter is not endorsed. Keywords: Hand osteoarthritis; outcome measures; ultrasonography

Ernæringssammensetningen til Norsk storfekjøtt

Research conducted in other countries than Norway has shown an association between meat intake and colorectal cancer risk. The Norwegian Directorate of Health recommends limiting the intake of red and processed meat to 500 g/week based on this research. The nutritional value of Norwegian meat may differ in nutrients to meat from other countries because of breed and feed differences. In order to understand better the link to colon cancer observed in other countries the typical composition of Norwegian red meat should be better understood. The nutritional value of products is registered in the Norwegian Food Composition table. Calculating intake of various nutrients, declaration of food, research, teaching and nutrition politics are all based on the numbers of these tables. The values on minced meat have not been updated since 2005 and it is important to get updated numbers that can be used in e.g. health research. Updated numbers for the nutritional value and oxidation indicators (heme, DPPH, TBARS and total PV) of standardized 14% minced beef meat, measured 10 days post- slaughter, can be found in this thesis. Eighteen animals of the breed Norwegian Red Cattle were chosen based on the assumption that these animals were representative for the Norwegian meat intake. The variation in the data was identified and the average nutrition values were compared to values reported from other countries in food composition tables. The results showed a variation in following fatty acids, vitamins and minerals: C14:0, C16:0, C18:0, C16:1, C18:1trans, C18:1n-7, C18:1, n-9, C18:2trans, C18:2, CLA, C20:4, C18:3, cholesterol, iron, zinc, sodium, calcium, magnesium, phosphorous, potassium, selenium, iodine, retinol, β−carotene, α-tocopherol, γ- tocopherol, vitamin K1,, vitamin K2, thiamin, riboflavin, vitamin B6, pyridoxal, pyridoxine, pyridoxamine, niacin and vitamin B12. Norwegian minced meat fulfills the EU criteria for the following nutrient claims: ”a source of”: iron, phosphorus, potassium, niacin and vitamin B6 as well as the claim ”rich source of”: protein, zinc and vitamin B12. Compared with other countries the Norwegian minced meat has room for improvement regarding SFA content, n-6:n-3 ratio, calcium, magnesium, phosphorous, potassium, selenium, iodine, thiamin, riboflavin, vitamin B6, niacin and vitamin B12. Variation was also identified in all oxidation indicators. Norwegian minced meat contains on average 13.2 mg/100g hemin, has a TBARS level of 0.194 mg/kg, a DPPH value of 71.9% and a total peroxide value of 0.740 mmol/kg. Utenlandsk forskning har vist en mulig sammenheng mellom tykktarmskreft og kjøttinntak. Basert på denne forskningen anbefaler helsedirektoratet å redusere inntaket av rødt og bearbeidet kjøtt til 500 g i uken. Næringsverdien til Norsk storfekjøtt kan være forskjellig fra andre land grunnet forskjeller i storferaser og fôr. For å bedre kunne forstå sammenhengen mellom tarmkreft og kjøtt observert i andre land burde den typiske sammensetningene til norsk rødt kjøtt bli bedre forstått. Næringsverdien til norske råvarer er beskrevet i Matvaretabellen. Deklarasjon av matvarer, forskning, undervisning og ernæringspolitikk tar utgangspunkt i disse tallene. Verdiene for kjøttdeig har ikke blitt oppdatert siden 2005 og det er viktig å skaffe oppdaterte tall som kan brukes i ernæringsforskning. Oppdaterte tall for ernæringsverdi og oksidasjonsindikatorer (heme, DPPH, TBARS og total PV) til 14 % standardisert kjøttdeig, målt 10 dager etter slakting, ble fremskaffet i denne oppgaven. Datagrunnlaget besto av 18 dyr av rasen Norsk Rødt Fe som antas å være representative for norsk kjøttinntak. Gjennomsnittet og variasjonen i datasettet ble identifisert og den gjennomsnittlige ernæringsverdien ble sammenlignet med tall fra utenlandske matvaretabeller. Resultatene viste at det var variasjon mellom følgende fettsyrer, vitaminer og mineraler: C14:0, C16:0, C18:0, C16:1, C18:1trans, C18:1n-7, C18:1, n-9, C18:2trans, C18:2, CLA, C20:4, C18:3, ukjente fettsyrer, kolesterol, jern, sink, natrium, kalsium, magnesium, fosfor, kalium, selen, jod, retinol, β−karoten, α-tokoferol, γ- tokoferol, vitamin K1, vitamin K2, tiamin, riboflavin, vitamin B6, pyridoxal, pydridoxine, pyridoxamine, niacin og vitamin B12. Norsk kjøttdeig oppfyller EU sine krav til å benytte næringsstoffpåstandene: ”kilde til”: jern, fosfor, kalium, niacin og vitamin B6 samt ”rik kilde til” protein, sink og vitamin B12 basert på gjennomsnittlig næringsinnhold. Sammenlignet med andre land har norsk kjøttdeig forbedringspotensialer når det kommer til SFA-innhold, n-6:n-3 ratio, kalsium, magnesium, fosfor, kalium, selen, jod, tiamin, riboflavin, vitamin B6, niacin og vitamin B12. Det ble også påvist variasjon i alle oksidasjonsindikatorene. Norsk kjøttdeig inneholder i gjennomsnitt 13,2 mg/100 hemin, har en TBARS på 0,194 mg/kg, en DPPH verdi på 71,9% og har en total peroxide verdi 0,740 mmol/kg.M-MA

The nutritional value of Norwegian beef meat

Research conducted in other countries than Norway has shown an association between meat intake and colorectal cancer risk. The Norwegian Directorate of Health recommends limiting the intake of red and processed meat to 500 g/week based on this research. The nutritional value of Norwegian meat may differ in nutrients to meat from other countries because of breed and feed differences. In order to understand better the link to colon cancer observed in other countries the typical composition of Norwegian red meat should be better understood. The nutritional value of products is registered in the Norwegian Food Composition table. Calculating intake of various nutrients, declaration of food, research, teaching and nutrition politics are all based on the numbers of these tables. The values on minced meat have not been updated since 2005 and it is important to get updated numbers that can be used in e.g. health research. Updated numbers for the nutritional value and oxidation indicators (heme, DPPH, TBARS and total PV) of standardized 14% minced beef meat, measured 10 days post- slaughter, can be found in this thesis. Eighteen animals of the breed Norwegian Red Cattle were chosen based on the assumption that these animals were representative for the Norwegian meat intake. The variation in the data was identified and the average nutrition values were compared to values reported from other countries in food composition tables. The results showed a variation in following fatty acids, vitamins and minerals: C14:0, C16:0, C18:0, C16:1, C18:1trans, C18:1n-7, C18:1, n-9, C18:2trans, C18:2, CLA, C20:4, C18:3, cholesterol, iron, zinc, sodium, calcium, magnesium, phosphorous, potassium, selenium, iodine, retinol, β−carotene, α-tocopherol, γ- tocopherol, vitamin K1,, vitamin K2, thiamin, riboflavin, vitamin B6, pyridoxal, pyridoxine, pyridoxamine, niacin and vitamin B12. Norwegian minced meat fulfills the EU criteria for the following nutrient claims: ”a source of”: iron, phosphorus, potassium, niacin and vitamin B6 as well as the claim ”rich source of”: protein, zinc and vitamin B12. Compared with other countries the Norwegian minced meat has room for improvement regarding SFA content, n-6:n-3 ratio, calcium, magnesium, phosphorous, potassium, selenium, iodine, thiamin, riboflavin, vitamin B6, niacin and vitamin B12. Variation was also identified in all oxidation indicators. Norwegian minced meat contains on average 13.2 mg/100g hemin, has a TBARS level of 0.194 mg/kg, a DPPH value of 71.9% and a total peroxide value of 0.740 mmol/kg. Utenlandsk forskning har vist en mulig sammenheng mellom tykktarmskreft og kjøttinntak. Basert på denne forskningen anbefaler helsedirektoratet å redusere inntaket av rødt og bearbeidet kjøtt til 500 g i uken. Næringsverdien til Norsk storfekjøtt kan være forskjellig fra andre land grunnet forskjeller i storferaser og fôr. For å bedre kunne forstå sammenhengen mellom tarmkreft og kjøtt observert i andre land burde den typiske sammensetningene til norsk rødt kjøtt bli bedre forstått. Næringsverdien til norske råvarer er beskrevet i Matvaretabellen. Deklarasjon av matvarer, forskning, undervisning og ernæringspolitikk tar utgangspunkt i disse tallene. Verdiene for kjøttdeig har ikke blitt oppdatert siden 2005 og det er viktig å skaffe oppdaterte tall som kan brukes i ernæringsforskning. Oppdaterte tall for ernæringsverdi og oksidasjonsindikatorer (heme, DPPH, TBARS og total PV) til 14 % standardisert kjøttdeig, målt 10 dager etter slakting, ble fremskaffet i denne oppgaven. Datagrunnlaget besto av 18 dyr av rasen Norsk Rødt Fe som antas å være representative for norsk kjøttinntak. Gjennomsnittet og variasjonen i datasettet ble identifisert og den gjennomsnittlige ernæringsverdien ble sammenlignet med tall fra utenlandske matvaretabeller. Resultatene viste at det var variasjon mellom følgende fettsyrer, vitaminer og mineraler: C14:0, C16:0, C18:0, C16:1, C18:1trans, C18:1n-7, C18:1, n-9, C18:2trans, C18:2, CLA, C20:4, C18:3, ukjente fettsyrer, kolesterol, jern, sink, natrium, kalsium, magnesium, fosfor, kalium, selen, jod, retinol, β−karoten, α-tokoferol, γ- tokoferol, vitamin K1, vitamin K2, tiamin, riboflavin, vitamin B6, pyridoxal, pydridoxine, pyridoxamine, niacin og vitamin B12. Norsk kjøttdeig oppfyller EU sine krav til å benytte næringsstoffpåstandene: ”kilde til”: jern, fosfor, kalium, niacin og vitamin B6 samt ”rik kilde til” protein, sink og vitamin B12 basert på gjennomsnittlig næringsinnhold. Sammenlignet med andre land har norsk kjøttdeig forbedringspotensialer når det kommer til SFA-innhold, n-6:n-3 ratio, kalsium, magnesium, fosfor, kalium, selen, jod, tiamin, riboflavin, vitamin B6, niacin og vitamin B12. Det ble også påvist variasjon i alle oksidasjonsindikatorene. Norsk kjøttdeig inneholder i gjennomsnitt 13,2 mg/100 hemin, har en TBARS på 0,194 mg/kg, en DPPH verdi på 71,9% og har en total peroxide verdi 0,740 mmol/kg

Monitoring adverse events in Norwegian hospitals from 2010 to 2013

-Objectives To describe how adverse event (AE) rates were monitored and estimated nationally across all Norwegian hospitals from 2010 to 2013, and how they developed during the monitoring period. Monitoring was based on medical record review with Global Trigger Tool (GTT). Setting All publicly and privately owned hospitals were mandated to review randomly selected medical records to monitor AE rates. The initiative was part of the Norwegian patient safety campaign, launched by the Norwegian Ministry of Health and Care Services. It started in January 2011 and lasted until December 2013. 2010 was the baseline for the review. One of the main aims of the campaign was to reduce patient harm. Method To standardise the medical record reviews in all hospitals, GTT was chosen as a standard method. GTT teams from all hospitals reviewed 40 851 medical records randomly selected from 2 249 957 discharges from 2010 to 2013. Data were plotted in time series for local measurement and national AE rates were estimated, plotted and monitored. Results AE rates were estimated and published nationally from 2010 to 2013. Estimated AE rates in severity categories E-I decreased significantly from 16.1% in 2011 to 13.0% in 2013 (−3.1% (95% CI −5.2% to −1.1%)). Conclusions Monitoring estimated AE rates emerges as a potential element in national systems for patient safety. Estimated AE rates in the category of least severity decreased significantly during the first 2 years of the monitoring

Monitoring adverse events in Norwegian hospitals from 2010 to 2013

OBJECTIVES: To describe how adverse event (AE) rates were monitored and estimated nationally across all Norwegian hospitals from 2010 to 2013, and how they developed during the monitoring period. Monitoring was based on medical record review with Global Trigger Tool (GTT). SETTING: All publicly and privately owned hospitals were mandated to review randomly selected medical records to monitor AE rates. The initiative was part of the Norwegian patient safety campaign, launched by the Norwegian Ministry of Health and Care Services. It started in January 2011 and lasted until December 2013. 2010 was the baseline for the review. One of the main aims of the campaign was to reduce patient harm. METHOD: To standardise the medical record reviews in all hospitals, GTT was chosen as a standard method. GTT teams from all hospitals reviewed 40 851 medical records randomly selected from 2 249 957 discharges from 2010 to 2013. Data were plotted in time series for local measurement and national AE rates were estimated, plotted and monitored. RESULTS: AE rates were estimated and published nationally from 2010 to 2013. Estimated AE rates in severity categories E-I decreased significantly from 16.1% in 2011 to 13.0% in 2013 (−3.1% (95% CI −5.2% to −1.1%)). CONCLUSIONS: Monitoring estimated AE rates emerges as a potential element in national systems for patient safety. Estimated AE rates in the category of least severity decreased significantly during the first 2 years of the monitoring

Evaluation of CMIP5 and CMIP6 simulations of historical surface air temperature extremes using proper evaluation methods

Reliable projections of extremes by climate models are becoming increasingly important in the context of climate change and associated societal impacts. Extremes are by definition rare events, characterized by a small sample associated with large uncertainties. The evaluation of extreme events in model simulations thus requires performance measures that compare full distributions rather than simple summaries. This paper proposes the use of the integrated quadratic distance (IQD) for this purpose. The IQD is applied to evaluate CMIP5 and CMIP6 simulations of monthly maximum and minimum near-surface air temperature over Europe and North America against both observation-based data and reanalyses. Several climate models perform well to the extent that these models' performance is competitive with the performance of another data product in simulating the evaluation set. While the model rankings vary with region, season and index, the model evaluation is robust against changes in the grid resolution considered in the analysis. When the model simulations are ranked based on their similarity with the ERA5 reanalysis, more CMIP6 than CMIP5 models appear at the top of the ranking. When evaluated against the HadEX2 data product, the overall performance of the two model ensembles is similar