text:
console table with stools
by editor k May 28, 2021
written by editor k May 28, 2021
While I'm sure you're wondering, "What is a console table?", it's a table that has a stool built into it. Console tables are great for parties, brunches, and just to have something to put your beverages under.
Console tables come in many different styles and colors, but the three most popular are white, black, and dark brown. So it's not all black and no brown. The only reason the dark brown consoles have been so popular is because they are the only ones that are available in any color. You can also find consoles that are white and black and the dark brown.
This console table has a stool built into it. A stool is a piece of furniture that stands on its own. Think of your favorite stool in a movie you watched when you were a kid. Now, pretend it's a console table with a stool built into it. Imagine that your stool is actually a console table with a stool built into it.
This console table is quite a bit larger than you might expect. It's actually about 7 feet long and 2 feet wide. It has what looks like a stool built into it. The stool is actually a console table with a stool built into it. The stool is actually the console table.
It gets a lot more interesting when you realize that the stool is actually a stool with a console table built into it. The console table is actually a console table with a console table built into it.
The console table is actually made of three consoles, with the stool as a fourth. So, it is a console table with a stool, a stool with a console table built into it, and a stool with a stool built into it. So, it can actually be used as a console table with a console table built into it. We will call this console table with a stool with a console table built into it Stool With A Console Table.
I feel like the console table with a stool with a console table built into it is a bit of an oddity, but the console table itself looks really cool. The console table is a very sleek item that is very easy to build as well. It is made of metal and looks very nice. It also has a high-end finish.
It is also a very sleek and cool looking table. The metal makes it look like it would be quite sturdy, but I think it is sturdy enough that if you were to be in the middle of construction somewhere and need a table, you would be fine. You could also fold it up and use it as a desk.
This console table was actually my first project in a project that I was working on. It was a pretty simple table, and I had a lot of fun building it. However, it is not quite as sturdy as I thought it would be. I think it would make a great desk for someone who is working in a building construction.
That is a great question. I have been building a couple of furniture projects with my team and we have a pretty sturdy one, but I think the console table is really sturdy. It has sturdy feet and an arched top that holds everything vertically. Plus, it doesn't have any drawers or cabinets and it looks great. I'm really curious to see how it goes down.
s and m
large circle mirror
counter top table
private label home decor
purple king size comforter set
lego room decor
kid vanity set
tempurpedic adjustable bases
space rug
bean bag chair for toddlers
tufted bed
wooden dresser
captain bed full
chaise lounge with storage


text:
HUGH WATSON
Home/HUGH WATSON
Dr. HUGH WATSON
BA Sydney, PGCE Oxford, M.Ed Canberra, PhD Oregon
The principal, Dr Hugh Watson, is a leading strategy and evaluation consultant. He not only brings more
than 20 years consulting experience he also has senior executive experience as a Partner-in-Charge of
Coopers & Lybrand in Canberra and Group General Manager on the Executive of the Sydney Organising
Committee for the Olympic Games (SOCOG). He has senior executive experience in both the public and
private sectors and was also a senior advisor to a Cabinet Minister. Hugh is currently a Visiting Fellow at
the College of Business and Economics at the Australian National University and Director of Hugh Watson
Hugh Watson has worked with private sector CEOs, Government Department CEOs and Secretaries and
Chiefs of the Defence Force as an organisational strategist and adviser on top team performance. He has
led national program evaluations and undertaken sensitive reviews for Government. He has also been an
executive coach to over 250 senior executives in the public sector.
Hugh Watson was a senior advisor to a Commonwealth Minister for Education and in that position
reviewed national policies and programs, helped develop a national participation strategy and a
strategy to improve Indigenous education teaching. As an academic, he taught in teacher education
faculties in Australia and the United States and was for two years head of evaluation for the ACT
school system leading national, system and school-level evaluations. Hugh has taught at primary,
secondary and tertiary levels and worked as a policy officer in the Curriculum Development
His Consulting Experience Includes:
● A national evaluation of the National Indigenous English Literacy and Numeracy Program for
the Department of Education, Science and Training
● National evaluation of the Students at Risk Program for the Department of Employment, Education
and Training
● National review of Commonwealth/State Expenditure on Adult Literacy for the Department of
● A review and analysis of the strategies and methods proposed by GenerationOne for Vocational Training
and Employment Centres (VTECs)
● An evaluation of Jobs Fund Projects where we visited and captured examples of best practice and
innovation in 23 successful Jobs Fund projects around Australia
● A review of the Indigenous Capital Assistance Scheme (ICAS)
● An investigation of the impact of the Global Recession and the operation of local Jobs Fund projects on
Indigenous people in selected areas
● A strategic consultancy to establish the new Commonwealth Office of the Information
Commissioner including strategy, structure and business processes (with Oakton Consulting)
● Strategic review of Headquarters Australian Defence Force for the Vice-Chief of the
● Feasibility of a National Gambling Research Institute – A report on options for the
establishment of a National Gambling Research Institute for the Minister for Family and
● Reviews of the operations and governance of National Indigenous Television (NITV), the
National Indigenous Radio Service (NIRS) and Imparja Television for the Department of
Environment, Heritage, Water and the Arts
● Strategic review of the Department of Communications and the Arts for the Secretary
● Strategic review and business process re-engineering for the Department of Primary Industries
and Energy for the Secretary
● Strategic planning and business adviser to Hamilton, James & Bruce, a publicly listed company
● Development of a change management strategy for a major company re-structure for Nestle
● Strategic review of the Department of Industry, Technology and Regional Development for the
● Major change management consultancies for the Attorney General's department, the Civil Aviation
Authority and the Department of Administrative Services as they commercialised their operations
● Development of High Performance Sporting Strategies for the Governments of New Zealand and
● Strategic reviews of the Australian Sports Commission and the Australian Institute of Sport
● Evaluation of several hundred NSW Government funded disability service standard providers for
the Department of Community Services
● A business development plan and Intellectual Property Inventory for the Australian Sports
By hwcons|2019-01-29T17:25:47+11:00June 28th, 2018|Comments Off on HUGH WATSON

redpajama_set_name: RedPajamaCommonCrawl


text:
Validity of the CR-POSSUM model in surgery for colorectal cancer in Spain (CCR-CARESS study) and comparison with other models to predict operative mortality
Marisa Baré1,2,12,
Manuel Jesús Alcantara3,
Maria José Gil4,
Pablo Collera5,
Marina Pont1,12,
Antonio Escobar6,12,
Cristina Sarasqueta7,12,
Maximino Redondo8,12,
Eduardo Briones9,
Paula Dujovne10,
Jose Maria Quintana11,12 &
on behalf of the CARESS-CCR Study Group
BMC Health Services Research volume 18, Article number: 49 (2018) Cite this article
To validate and recalibrate the CR- POSSUM model and compared its discriminatory capacity with other European models such as POSSUM, P-POSSUM, AFC or IRCS to predict operative mortality in surgery for colorectal cancer.
Prospective multicenter cohort study from 22 hospitals in Spain. We included patients undergoing planned or urgent surgery for primary invasive colorectal cancers between June 2010 and December 2012 (N = 2749). Clinical data were gathered through medical chart review. We validated and recalibrated the predictive models using logistic regression techniques. To calculate the discriminatory power of each model, we estimated the areas under the curve - AUC (95% CI). We also assessed the calibration of the models by applying the Hosmer-Lemeshow test.
In-hospital mortality was 1.5% and 30-day mortality, 1.7%. In the validation process, the discriminatory power of the CR-POSSUM for predicting in-hospital mortality was 73.6%. However, in the recalibration process, the AUCs improved slightly: the CR-POSSUM reached 75.5% (95% CI: 67.3–83.7). The discriminatory power of the CR-POSSUM for predicting 30-day mortality was 74.2% (95% CI: 67.1–81.2) after recalibration; among the other models the POSSUM had the greatest discriminatory power, with an AUC of 77.0% (95% CI: 68.9–85.2). The Hosmer-Lemeshow test showed good fit for all the recalibrated models.
The CR-POSSUM and the other models showed moderate capacity to discriminate the risk of operative mortality in our context, where the actual operative mortality is low. Nevertheless the IRCS might better predict in-hospital mortality, with fewer variables, while the CR-POSSUM could be slightly better for predicting 30-day mortality.
Trail registration
Registered at: ClinicalTrials.gov Identifier: NCT02488161
Colorectal cancer is one of the most common cancers in developed countries; in Europe alone, more than 340,000 people were diagnosed in 2012, and the incidence is increasing in many countries [1]. The mainstay of treatment is surgery, whether to resect the tumor and/or its metastases or to alleviate symptoms of the disease [2]. Surgery for colorectal cancer is highly complex and involves significant risks that can lead to unfavourable short-term outcomes. Operative mortality (death after surgery before discharge from hospital or within 30 days of surgery) is a quality indicator for surgery, because of its relationship with preoperative preparation and the quality of postoperative care, so it is of the utmost importance to have explicit criteria to know which patients require stricter surveillance.
Various authors have developed predictive models to estimate the adjusted risk of death after a surgical intervention; these models are based on a set of variables (4–18, depending on the model) related to the patients themselves, to their disease, and/or to the surgical process. Some of these models can be applied to any surgical patient, whereas others are specific to a particular type of surgery. The Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity [3] (POSSUM) and a modified version of this score, the Portsmouth-POSSUM [4] (P-POSSUM), are examples of models applicable to any surgical patient, whereas the Colorectal POSSUM (CR-POSSUM) is a version with fewer variables that is specific for patients undergoing colorectal surgery [5].
The CR-POSSUM was first published in 2004. It comprises 10 variables, and the weights assigned to these variables make it possible to calculate a physiologic component and an intervention component, which in turn make it possible to use logistic regression to estimate the expected probability of death [5]. These models have been validated in some developed countries; although their overall discriminatory capacity is acceptable, they tend to overestimate the risk of mortality in low risk patients [6]. In the recent years, other simpler models have been developed in Europe: The model elaborated by the Association Française de Chirurgie (AFC) to predict in-hospital mortality in colorectal surgery consists of only four variables [7], and the recently published and externally validated Identification of Risk in Colorectal Surgery (IRCS) score consists of five variables [8].
A good predictive model should be feasible (the variables should be measurable before surgery), simple, and able to discriminate or identify outcomes accurately. To date, although some of these models have been validated in the countries where they were devised or in other developed countries, there is no consensus about the most appropriate instrument for predicting the risk of operative mortality. In Spain, surgery for colorectal cancer is done both at smaller, local hospitals with relatively small volumes of surgical interventions and at larger, referral hospitals with large volumes of surgical interventions. Although estimations of some quality and outcome indicators for colorectal cancer surgery at a local level have been published in Spain [9,10,11], and although some departments of surgery in our setting used the POSSUM models for clinical purposes until we initiated this coordinated study in 2009, there had been no validation of those models in our context and neither no predictive model had been generally adopted by surgeons to guide clinical decision making. Because the variables in the CR-POSSUM and the other POSSUM models include those variables that are considered in the IRCS and the AFC models, we thought appropriate to validate also the IRCS and AFC models in Spain.
Thus, we aimed to estimate the operative mortality in surgery for colorectal cancer in Spain, to validate and recalibrate the CR- POSSUM model in the Spanish context, and to compare its discriminatory capacity with that of other models developed in Europe to predict operative mortality in surgery for colorectal cancer.
Design, setting, and patients
This prospective multicenter cohort study of patients from 22 hospitals located in different areas in Spain was done in the context of the REDISSEC (Health Services Research on Chronic Diseases Network)/CCR-CARESS (Colorectal Cancer Health Services Research) study, which addressed diverse research objectives in healthcare centres treating colorectal cancer in Spain. All the hospitals provided services for the National Health System, and their size, location and level of technology varied [12]. The Clinical Research Ethics Committees of the Parc Taulí Sabadell-University Hospital; Hospital del Mar; Fundació Unió Catalana d'Hospitals; Gipuzkoa Health Area; Basque Country (CEIC-E); Hospital Galdakao-Usansolo; Hospital Txagorritxu; Hospital Basurto; La Paz University Hospital; Fundación Alcorcón University Hospital; Hospital Universitario Clínico San Carlos (formerly Clinical Research Ethics Committee of Area 7 – Hospital Clínico San Carlos); Costa del Sol Health Agency and the Regional Committee of Clinical Trials of Andalusia approved the study, and all patients provided written informed consent.
We included patients undergoing scheduled or urgent surgery for primary invasive colorectal cancers in the period comprising June 2010 through December 2012, whether the goal of surgery was to excise the tumor or to palliate symptoms.
The CCR-CARESS study, excluded patients considered by the attending physician to be in very poor overall condition or have a very limited life expectancy; those who declined to participate or did not sign the consent form; those with only cancer in situ; those with relapsed tumors; those with cancer not located in the colon or rectum; those who died before the intervention; those with inoperable cancer; those transferred for surgery in another centre; and others (e.g., language problems).
Variables and data collection
Clinical data was gathered from clinical records or from the surgeons of the team. The variables analyzed were a) baseline characteristics such as age, sex, tumor location (colon or rectum and the distance at the anal margin), neurological comorbidities (dementia, cerebrovascular disease, hemiplegia), weight loss > 10% in 6 months and, clinical or pathological staging according to Dukes and TNM [13]. b) preoperative variables such as laboratory parameters (urea (mmol/l), haemoglobin (g/dL), leucocytes (× 10^12/l), sodium (mmol/l), potassium (mmol/l)), heart rate (beats/min), systolic blood pressure [SBP] (mmHg), heart failure (none, mild, moderate, or severe), signs of respiratory failure (no dyspnoea, dyspnoea on exertion, limiting dyspnoea, dyspnoea at rest), electrocardiogram (normal, atrial fibrillation [AF], other abnormal rhythm), and level of consciousness according to the Glasgow Coma Score. c) surgical process variables such as urgency of the intervention (scheduled, urgent, or, when done < 2 h after presentation at the emergency department, emergency), operative severity according to the National Institute for Health and Care Excellence [NICE] clinical guidelines (moderate, major or complex major) [14], tumor resection (yes or no), number of distinct surgical procedures in the same intervention (including tumor excision, ostomy, or surgery on other organs), peritoneal contamination (none, serous fluid, local pus, free pus or faeces or blood), and total blood loss (ml).
All patients were followed up after the intervention to estimate two types of operative mortality: in-hospital mortality, defined as death during the hospital stay, regardless of the length of stay, and 30-day mortality, defined as death within 30 days of the intervention, whether occurring in the hospital or after discharge.
Models for predicting the risk of death
Table 1 lists the five models chosen to predict operative mortality, and Additional file 1: Appendix A shows the logistic regression formula used in each of them to estimate the probability of death. All the models were elaborated from some of the variables discussed above plus an 'intercept'. The POSSUM and P-POSSUM models estimate a physiological score and an operative severity score from 18 variables; each individual's score is calculated by summing his or her values for each variable after weighting. Finally, each score is introduced into the model and is then multiplied by its corresponding β coefficient. The CR-POSSUM, the version specific for colorectal surgery, includes only 10 variables, but the formula for calculating the score is similar. The AFC model does not involve a mathematical equation or any weighting: it consists of 4 variables that are introduced into a regression model [7]. The IRCS comprises 5 variables, each of which has a weight for each category and is multiplied by the equation's β coefficient [8].
Sample size and exclusion criteria
Table 1 Review of scoring systems validated
Table 2 Univariate and Bivariate analysis of CR-POSSUM factors for operative mortality
Operative death estimated by POSSUM, P-POSSUM, CR-POSSUM and IRCS
Table 3 External validation and recalibration of models predicting in-hospital and 30-day mortality
Statistic analysis
Initially, we did a descriptive bivariate analysis of all the variables in the models in relation with in-hospital mortality and with 30-day mortality, using the chi-square test or Fisher's exact test for categorical variables.
We validated the 5 predictive models, using the mathematical equations published by their creators (Additional file 1: Appendix A) and calculating the risk of operative mortality for each patient with the logistic regression link function.
Then multivariate logistic regression techniques were applied to recalibrate the 5 models, thus obtaining the new β coefficients for each score (POSSUM, P-POSSUM and CR-POSSUM models) or category of the variable (IRCS and AFC models). For these purposes, patients missing on any risk factor were excluded.
To calculate the discriminatory power of each model, we used receiver operating characteristic curves, calculating the areas under the curve (AUC) and their 95% confidence intervals. We considered an AUC between 70% and 80% moderate discrimination, between 80% and 90% good discrimination, and greater than 90% excellent [15]. We also estimated the calibration of the models by applying the Hosmer-Lemeshow test. We defined statistical significance as p < 0.05. We used IBM SPSS Statistics 20 and R 2.15.3 for all analyses.
A total of 3915 patients were recruited; 1166 (29.8%) were excluded for the reasons shown in Fig. 1. Thus, we analyzed 2749 patients (63.6% men; age range, 24–97 y; mean age, 68 ± 11 y) operated on for primary invasive colorectal cancer. The tumor was located in the colon in 1980 (72%) and in the rectum in 769 (28%) patients.
During hospital stay, 41 patients died (in-hospital operative mortality, 1.5% [95% CI: 1.0–1.9]) and 47 patients died within 30 days of the intervention (30-day operative mortality, 1.7% [95% CI: 1.2–2.2]).
Table 2 shows the variables in the CR-POSSUM in relation to in-hospital and 30-day mortality, as well as the summary of the physiological and operative severity scores. All the variables were significantly associated with in-hospital mortality and 30-day mortality, except heart rate, urea, and cancer stage, although stage was associated with 30-day mortality. Mortality was especially high in older patients, those with hypotension or heart failure, those undergoing urgent surgery, and those with free pus or faeces or blood. Additional file 1: Appendices B and C show the analysis of the factors used in the POSSUM, P-POSSUM, IRCS and AFC models. In the validation analysis, the discriminatory power of the CR-POSSUM for predicting in-hospital mortality was 73.6%, and the discriminatory power of the other models was similar (Table 3), although the number of patients with complete data as well as the number of deaths included in each model is different. When the models were recalibrated, the AUCs improved slightly (see Additional file 1: Appendix D and E for re-calibrated equations): the CR-POSSUM reached 75.5% (95% CI: 67.3–83.7) and the IRCS model had the highest discriminatory power with an AUC of 76.2 (95% CI: 68.0–84.5). The discriminatory power of the CR-POSSUM for predicting 30-day mortality was 74.2% (95% CI: 67.1–81.2) after recalibration; among the other recalibrated models the POSSUM had the greatest discriminatory power, with an AUC of 77.0% (95% CI: 68.9–85.2). Although the Hosmer-Lemeshow test showed good fit for all the recalibrated models, the original CR-POSSUM, as well as the original versions of the other models tended to overestimate the probability of operative death (Fig. 2).
In surgery for colorectal cancer, in-hospital mortality was 1.5% and 30-day mortality was 1.7%. The CR-POSSUM model, like the other validated models, overestimated operative mortality; once recalibrated, it had moderate discriminatory power as evidenced by the 75.5% AUC for in-hospital mortality and the 74.2% AUC for 30-day mortality.
Operative mortality
The operative mortality observed in the present study is near the lower limits of the range of the estimations reported in similar studies [5, 16,17,18,19,20,21,22,23,24,25,26]. The 30-day mortality in these studies ranges from 0.7 and 11.3%. Various factors might have contributed to our low mortality rates. First, the proportion of patients undergoing urgent surgery in our study was low. Given that operative mortality is lower in scheduled than in urgent surgery, we would expect lower mortality in our series than in series with higher proportions of patients undergoing urgent surgery. Nevertheless, it is noteworthy that the operative mortality in the patients in our series that underwent urgent surgery was also lower than that reported in other previous studies. On the other hand, the patients in our study were operated on for a primary tumor in the period comprising 2010 through 2012, whereas most of the other studies discussed here examined earlier periods; thus, we cannot rule out a period effect involving a secular decrease in operative mortality for this kind of surgery over time due to various factors (e.g., improvements in perioperative management or different selection criteria for indication of surgery).
Validity of CR-POSSUM and other POSSUM models
This validation and recalibration study of models for predicting operative mortality in a widespread, sample of Spanish hospitals found that the CR-POSSUM, has moderate discriminatory power, similar to that found in the external validation studies [8, 18, 25]. However, the original versions of this and the other models overestimated the operative mortality. To a certain extent, the low mortality observed in our cohort and the number of variables in the model limits our capacity to identify significant associations. It is worth mentioning that the model was designed to estimate in-hospital mortality, but we have seen that the AUC is similar for both types of mortality measure. On the other hand, this model was not designed solely for patients with colorectal cancer. One of the most widely questioned aspects of this model and of its predecessors, the POSSUM and P-POSSUM, is that some of the variables (operative variables) are not available until after the intervention; thus, they are not useful for predicting operative death. Another questionable aspect refers to the difficulties involved in obtaining all of the required variables (e.g., urea, staging), as we have observed in our study, despite its prospective design. For this reason, the other POSSUM models have similar limitations because they require collecting an even larger number of variables than the CR-POSSUM without resulting in appreciable improvements in their predictive capacity. In the bivariate analysis, some of the variables were not significantly associated with either in-hospital or 30-day mortality. Nevertheless, the discriminatory capacity of the three models was similar, considering their AUC and confidence intervals. In 2010, Richards et al. [27] reviewed the validation studies of these models, concluding that the P-POSSUM had the greatest discriminatory power of the three for colorectal cancer and that the CR-POSSUM, with an AUC < 75%, did not add any value, although a more recent external validation study reported better results [28]. It is therefore not surprising that several research teams have attempted to develop better models, given the contradictory results published before [29].
Comparison with other models and with the literature
Of the models developed in Europe, the recently created IRCS model, which has fewer variables, yields a discriminatory capacity similar or even better than the POSSUM models; in our study, the IRCS predicted the outcome correctly in about three-quarters of the patients. In fact, of the models evaluated in this study, the IRCS is the one that best discriminated in-hospital operative mortality, although the POSSUM was slightly better at discriminating 30-day operative mortality. This difference might be related to the fact that advanced disease might not have as strong an impact on more immediate mortality as on longer-term mortality. Another advantage of the IRCS is the low number of variables, all of which, moreover, can be measured before the intervention, increasing the usefulness of the model for identifying patients at risk. None of the models used is specific for colorectal cancer; however, it might be that the more specific a model is for a particular disease or subgroup of patients (e.g., the elderly), the more complex its construction is, the lower its external validity, and the more difficult it will be to extend its use for clinical purposes or for assessment. This could explain why many of the models described in the literature have not had a great impact on clinical practice.
Very recently, a new model to predict in-hospital mortality in patients undergoing colorectal surgery, the Colorectal preOperative Surgical Score (CrOSS), was created and externally validated in Australia. Although it needs to be validated in other contexts, this model achieved an AUC of 0.87. It has the great advantage of considering only four variables, all of which can be assessed preoperatively (age, urgency of the intervention, albumin, and heart failure) [30]. The Association of Coloproctology of Great Britain and Ireland used multilevel analysis to devise a model specifically for predicting mortality risk in surgery for colorectal cancer, the ACPGBI-CRC. This model achieved an AUC of 77% [17]. Using one of the largest series of patients operated on for colorectal cancer, Walker et al. [24] devised a model that yielded an AUC of about 80% for estimating 90-day mortality. In this model, the predictor with the strongest association was the American Society of Anesthesiologists Physical Status classification (ASA grade), which itself has certain limitations in predicting surgical risk [31]. As for other predictive factors, advanced age is consistently associated with higher risk of death in the various models developed, as it is in many other health problems. Likewise, the urgency of the intervention, which reflects the patient's condition, and certain underlying heart conditions are present in many of the models. Albumin or weight loss > 10% in the 6 months preceding surgery, both of which are indirect indicators of malnutrition before the intervention, also appear in different models. In fact, malnutrition is a clear risk factor for worse postoperative outcome in general, especially in older patients; it might also be the only factor considered in the models that can be modified before scheduled surgery.
The introduction of laparoscopic surgery in recent decades changes the scenario, and it is important to consider to what extent the lower risk of death reported in some studies [32] is independent of other factors. One of the most illustrative clinical trials found no differences in mortality between laparoscopic surgery and conventional open surgery [33]. In fact, most variables in the models are more related to the patient's clinical condition than to the surgical technique used.
The cohort in this study includes a large series of patients recruited at 22 hospitals. As in all observational studies, the absence of information can be a limitation, although the prospective design and the quality control have enabled us to ensure thorough data collection. The missing data for some variables (e.g., some laboratory parameters) is due mostly to the unavailability of these factors in clinical practice, especially in the most urgent interventions. This made it impossible for us to use the entire sample of patients for some models; however, rather than a limitation due to the study design, this limitation is due to the models' incompatibility with the available clinical information and/or routine clinical practice in our context. On the other hand, the mortality rate was low, with fewer than 50 deaths in both mortality indicators, and this might have compromised our capacity for recalibrating the models; however, in part thanks to the low mortality in our series, we were able to see that the original models considerably overestimated the risk of death.
This is the first multicenter study in Spain to validate and recalibrate some of the models for predicting operative mortality in a large cohort of patients operated on for colorectal cancer. Our data show that the operative mortality in these patients was low and that the models based on few variables that can be obtained in patients undergoing urgent surgery as well as those undergoing scheduled surgery can be useful in our healthcare system. Of the models we evaluated, the IRCS, which takes into account the patient's age, the urgency of the intervention, the stage of disease, and the presence of respiratory failure or heart failure, is the one that might have the greatest discriminatory power for in-hospital mortality, although the POSSUM might be slightly better for predicting 30-day mortality. Nevertheless, there is considerable disparity in the factors that make up the models and none of them are generally used throughout Europe or in other areas, perhaps due to their moderate capacity to discriminate in the different contexts where they have been externally validated, as in our study. Our findings underline the need for a model that has better capacity to discriminate patients at greater risk; such a model should have face validity, be easy to apply, and be based on factors that can be measured before the intervention.
The CR-POSSUM and the other models analyzed in this study showed moderate capability to discriminate the risk of operative mortality in our context, where the actual operative mortality is low. The IRCS model yielded similar results with fewer variables, all of which are available before the intervention. To optimize preoperative management and reduce operative mortality in patients undergoing surgery for colorectal cancer as far as possible, we need a model that can better discriminate the patients with greater risk.
ACPGBI-CRC:
Association of Coloproctology of Great Britain and Ireland - Colorectal Cancer
AFC:
ASA grade:
American Society of Anesthesiologists Physical Status classification
CrOSS:
Colorectal preOperative Surgical Score
CR-POSSUM:
Colorectal - Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity
IRCS:
Identification of Risk in Colorectal Surgery
POSSUM:
Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity
P-POSSUM:
Portsmouth - Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity
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Quintana JM, Gonzalez N, Anton-Ladislao A, Redondo M, Bare M, Fernandez de Larrea N, REDISSEC-CARESS/CCR group, et al. Colorectal cancer health services research study protocol: the CCR-CARESS observational prospective cohort project. BMC Cancer. 2016;16:435.
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Tekkis PP, Poloniecki JD, Thompson MR, Stamatakis JD. Operative mortality in colorectal cancer: prospective national study. BMJ. 2003;327:1196–201.
Kong CH, Guest GD, Stupart DA, Faragher IG, Chan ST, Watters DA. Recalibration and validation of a preoperative risk prediction model for mortality in major colorectal surgery. Dis Colon rectum. 2013;56:844–9. doi:10.1097/DCR.0b013e31828343f2.
Morris EJ, Taylor EF, Thomas JD, Quirke P, Finan PJ, Coleman MP, et al. Thirty-day postoperative mortality after colorectal cancer surgery in England. Gut. 2011;60:806–13. doi:10.1136/gut.2010.232181.
Schootman M, Lian M, Pruitt SL, Hendren S, Mutch M, Deshpande AD, et al. Hospital and geographic variability in two colorectal cancer surgery outcomes: complications and mortality after complications. Ann Surg Oncol. 2014;21:2659–66. doi:10.1245/s10434-013-3472-x.
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We want to thank John Giba for editorial assistance. Collaborators: The REDISSEC- CARESS/CCR group included the following co-investigators: Dr Maximino Redondo (Servicio de Laboratorio. Hospital Costa del Sol, Málaga/REDISSEC); Francisco Rivas (Servicio de Epidemiología. Hospital Costa del Sol, Málaga/REDISSEC); Dr Eduardo Briones (Unidad de Epidemiología. Distrito Sevilla, Servicio Andaluz de Salud); Elena Campano (Instituto de Biomedicina de Sevilla. Hospital Universitario Virgen del Rocío, Sevilla); Dr Ana Isabel Sotelo (Servicio de Cirugía. Hospital Universitario Virgen de Valme, Sevilla); Dr Francisco Medina (Servicio de Cirugía General y Aparato Digestivo. Agencia Sanitaria Costa del Sol, Marbella); Dr Arturo Del Rey (Servicio de Cirugía. Hospital de Antequera); Maria M. Morales (Department of Preventive Medicine and Public Health, Univesity of Valencia/CIBER de Epidemiología y Salud Pública (CIBERESP)/CSISP-FISABIO, Valencia); Dr Segundo Gómez (Servicio de Cirugía General y Aparato Digestivo. Hospital Dr Pesset, Valencia); Dr Marisa Baré (Epidemiology and Cancer Screening. Parc Taulí Sabadell- University Hospital/Universidad Autónoma de Barcelona - UAB/REDISSEC); Marina Pont, Núria Torà (Epidemiology and Cancer Screening. Parc Taulí Sabadell- University Hospital, Sabadell/REDISSEC); Dr Manuel Jesús Alcántara (Coloproctology Unit, General and Digestive Surgery Service, Parc Taulí Sabadell - Hospital Universitari, Sabadell); Dr Maria José Gil, Dr Miquel Pera (General and Digestive Surgery Service, Parc de Salut Mar, Barcelona); Dr Pablo Collera (General and Digestive Surgery Service, Althaia - Xarxa Assistencial Universitaria, Manresa); Dr Josep Alfons Espinàs (Catalonian Cancer Strategy Unit, Department of Health, Institut Català d'Oncología); Dr Mireia Espallargues (Agency for Health Quality and Assessment of Catalonia – -AQuAS/REDISSEC); Dr Caridad Almazán (Agency for Health Quality and Assessment of Catalonia – AquAS - CIBER de Epidemiología y Salud Pública-CIBERESP); Mercè Comas (IMAS-Hospital del Mar, Barcelona/REDISSEC); Dr Nerea Fernández (Centro Nacional de Epidemiología. Instituto de Salud Carlos III, Madrid / REDISSEC); Dr Juan Antonio Blasco (Unidad de Evaluación de Tecnologías Sanitarias, Agencia Laín Entralgo, Madrid); Dr Isabel del Cura (Unidad Apoyo a Docencia-Investigación. Dirección Técnica Docencia e Investigación. Gerencia Adjunta Planificación. Gerencia de Atención Primaria de la Consejería de Sanidad de la Comunidad Autónoma de Madrid); Dr Paula Dujovne, Dr José María Fernández (Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Fundación Alcorcón, Madrid); Dr Rocío Anula, Dr Julio Ángel Mayol (Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario Clínico San Carlos, Madrid); Dr Ramón Cantero (Servicio Cirugía General y del Aparato Digestivo, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid); Dr Héctor Guadalajara, Dr María Heras, Dr Damián García (Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario La Paz, Madrid); Mariel Morey (REDISSEC. Unidad de Apoyo a la Investigación, Gerencia de Atención Primaria de Madrid, Madrid); Dr José María Quintana, Dr Nerea González, Dr Susana García, Iratxe Lafuente, Urko Aguirre, Dr Miren Orive, Dr Josune Martin, Ane Antón (Unidad de Investigación. Hospital Galdakao-Usansolo, Galdakao-Bizkaia/REDISSEC); Dr Santiago Lázaro (Servicio de Cirugía General. Hospital Galdakao-Usansolo, Galdakao); Dr Cristina Sarasqueta (Unidad de Investigación. Hospital Universitario Donostia/Instituto de Investigación Sanitaria Biodonostia, Donostia/REDISSEC); Dr Jose María Enriquez, Dr Carlos Placer (Servicio de Cirugía General y Digestiva. Hospital Universitario Donostia); Amaia Perales (Instituto de Investigación Sanitaria Biodonostia, Donostia); Dr Antonio Escobar, Amaia Bilbao (Unidad de Investigación. Hospital Universitario Basurto, Bilbao/REDISSEC); Dr Alberto Loizate (Servicio de Cirugía General. Hospital Universitario Basurto, Bilbao); Dr Inmaculada Arostegui (Departamento de Matemática Aplicada, Estadística e Investigación Operativa, UPV/REDISSEC); Dr José Errasti (Servicio de Cirugía General. Hospital Universitario Araba, Vitoria-Gasteiz); Dr Iñaki Urkidi (Servicio de Cirugía General y Digestiva. Hospital de Mendaro); Dr Jose María Erro (Servicio de Cirugía General y Digestiva. Hospital de Zumárraga); Dr Enrique Cormenzana (Servicio de Cirugía General y Digestiva. Hospital del Bidasoa); Dr Antonio Z. Gimeno (Servicio de Gastroenterología. Hospital Universitario de Canarias, La Laguna).
This work was supported in part by grants from the Fondo de Investigación Sanitaria (PS09/00314, PS09/00910, PS09/00746, PS09/00805, PI09/90460, PI09/90490, PI09/90397, PI09/90453, PI09/90441); The Department of Health of the Basque Country (2010111098); KRONIKGUNE –Centro de Investigación en Cronicidad (KRONIK 11/006); and the European Regional Development Fund (ERDF); and the thematic networks - REDISSEC (Health Services Research on Chronic Diseases Network; RD12/0001/0007) – of the Instituto de Salud Carlos III. These institutions had no further role in study design; in the collection, analysis and interpretation of data; in the writing of the manuscript; nor in the decision to submit the paper for publication.
The data cannot be shared because, as specified in the informed consent form, all information must be treated in strict confidence. The treatment, communication, or transfer of all participants' personal data is subject to the provisions of Law 15/1999 of 13 December about protection of personal data. However, additional information about the data (e.g., descriptive analysis or the data collection questionnaire) can be provided upon request.
Clinical Epidemiology and Cancer Screening, Parc Taulí Sabadell-University Hospital, Parc Taulí 1, 08208, Sabadell, Spain
Marisa Baré & Marina Pont
Obstetrics, Gynecology and Preventive Medicine Department, Autonomous University of Barcelona-UAB, Cerdanyola del Vallès, Spain
Marisa Baré
Coloproctology Unit, General and Digestive Surgery Service, Parc Taulí Sabadell- University Hospital, Sabadell, Spain
Manuel Jesús Alcantara
General and Digestive Surgery Service, Parc de Salut Mar, Barcelona, Spain
Maria José Gil
General and Digestive Surgery Service, Althaia - Xarxa Assistencial Universitaria, Manresa, Spain
Pablo Collera
Research Unit, Hospital Universitario Basurto, Bilbao, Spain
Antonio Escobar
Unidad de Investigación, Hospital Universitario Donostia/Instituto de Investigación Sanitaria Biodonostia, Donostia, Spain
Cristina Sarasqueta
Research Unit, Agencia Sanitaria Costa del Sol, Marbella, Spain
Maximino Redondo
Unidad de Epidemiología. Distrito Sevilla, Servicio Andaluz de Salud, Sevilla, Spain
Eduardo Briones
Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Fundación Alcorcón, Madrid, Spain
Paula Dujovne
Research Unit, Hospital Galdakao-Usansolo, Galdakao, Spain
Jose Maria Quintana
Health Services Research on Chronic Patients Network, Sabadell, Spain
Marisa Baré, Marina Pont, Antonio Escobar, Cristina Sarasqueta, Maximino Redondo & Jose Maria Quintana
Marina Pont
, Francisco Rivas
, Eduardo Briones
, Elena Campano
, Ana Isabel Sotelo
, Francisco Medina
, Arturo Del Rey
, Maria M. Morales
, Segundo Gómez
, Marisa Baré
, Marina Pont
, Núria Torà
, Manuel Jesús Alcántara
, Maria José Gil
, Miquel Pera
, Pablo Collera
, Josep Alfons Espinàs
, Mireia Espallargues
, Caridad Almazán
, Mercè Comas
, Nerea Fernández
, Juan Antonio Blasco
, Isabel del Cura
, Paula Dujovne
, José María Fernández
, Rocío Anula
, Julio Ángel Mayol
, Ramón Cantero
, Héctor Guadalajara
, María Heras
, Damián García
, Mariel Morey
, José María Quintana
, Nerea González
, Susana García
, Iratxe Lafuente
, Urko Aguirre
, Miren Orive
, Josune Martin
, Ane Antón
, Santiago Lázaro
, Cristina Sarasqueta
, Jose María Enriquez
, Carlos Placer
, Amaia Perales
, Antonio Escobar
, Amaia Bilbao
, Alberto Loizate
, Inmaculada Arostegui
, José Errasti
, Iñaki Urkidi
, Jose María Erro
, Enrique Cormenzana
& Antonio Z. Gimeno
MB and JMQ participated in the conception and design of the study. MB and MP participated in analysis and interpretation of the data and drafting of the present manuscript. MB, MJA, MJG, PC, AE, CS, MR, EB, PD, JMQ and The REDISSEC- CARESS/CCR Group participated in the design, provision of patients, collection and assembly of data, critical revision of the article for important intellectual content. MB, AE, CS, EB, JMQ obtained funding. And all authors read and approved the final article support.
Correspondence to Marisa Baré.
The Clinical Research Ethics Committees of the Parc Taulí Sabadell-University Hospital; Hospital del Mar; Fundació Unió Catalana d'Hospitals; Gipuzkoa Health Area; Basque Country (CEIC-E); Hospital Galdakao-Usansolo; Hospital Txagorritxu; Hospital Basurto; La Paz University Hospital; Fundación Alcorcón University Hospital; Hospital Universitario Clínico San Carlos (formerly Clinical Research Ethics Committee of Area 7 – Hospital Clínico San Carlos); Costa del Sol Health Agency and the Regional Committee of Clinical Trials of Andalusia approved the study, and all patients provided written informed consent.
Additional file 1: Appendix A.
Equations for calculating risk of death for each predictive score. Appendix B. Univariate and bivariate analyses of POSSUM and P-POSSUM factors for operative mortality. Appendix C. Univariate and bivariate analyses of IRCS and AFC factors for operative mortality. Appendix D. Re-calibrated equations for calculating risk of in-hospital mortality for each predictive score. Appendix E. Re-calibrated equations for calculating risk of 30-day mortality for each predictive score. (DOCX 63 kb)
Baré, M., Alcantara, M., Gil, M.J. et al. Validity of the CR-POSSUM model in surgery for colorectal cancer in Spain (CCR-CARESS study) and comparison with other models to predict operative mortality. BMC Health Serv Res 18, 49 (2018). https://doi.org/10.1186/s12913-018-2839-x
Cr-possum


text:
Photocatalytic degradation toward pharmaceutical pollutants using supported zinc oxide nanorods catalyzed visible light system
A. Al-Khadhuri, J. Al-Sabahi, H. Htet Kyaw, M. Tay Zar Myint, B. Al-Farsi, M. Al-Abri*
Petroleum and Chemical Engineering
This study investigates the photocatalytic degradation of pharmaceutical wastes in an aqueous solution using supported zinc oxide nanorods (ZnO NRs) catalysts under visible light. Specific mass and surface area, optical and electronic properties, and surface defects of the catalyst determined the enhanced degradation of the pharmaceutical contaminants. The growth time of ZnO NRs is optimized and utilized to investigate the photocatalytic degradation of 10 mg/L of paracetamol, amoxicillin, and ciprofloxacin. Results show 65%, 62%, and 44% degradation of paracetamol, amoxicillin, and ciprofloxacin after 5 h of visible light irradiation. Interestingly, all pharmaceutical compounds have two different kinetics (Faster degradation is observed in the first two hours and slower at later hours). As the highest degraded pharmaceutical compound, the intermediate byproducts of paracetamol show the presence of aminophenol, nitrophenol, benzoquinone, and hydroquinone. This research will pave the way to an environmentally friendly wastewater treatment process suitable for pharmaceutical and hospital wastewater.
International Journal of Environmental Science and Technology
Zinc oxide nanorods
Agricultural and Biological Sciences(all)
Al-Khadhuri, A., Al-Sabahi, J., Kyaw, H. H., Myint, M. T. Z., Al-Farsi, B., & Al-Abri, M. (Accepted/In press). Photocatalytic degradation toward pharmaceutical pollutants using supported zinc oxide nanorods catalyzed visible light system. International Journal of Environmental Science and Technology. https://doi.org/10.1007/s13762-022-04705-8
Photocatalytic degradation toward pharmaceutical pollutants using supported zinc oxide nanorods catalyzed visible light system. / Al-Khadhuri, A.; Al-Sabahi, J.; Kyaw, H. Htet et al.
In: International Journal of Environmental Science and Technology, 2022.
Al-Khadhuri, A, Al-Sabahi, J, Kyaw, HH, Myint, MTZ, Al-Farsi, B & Al-Abri, M 2022, 'Photocatalytic degradation toward pharmaceutical pollutants using supported zinc oxide nanorods catalyzed visible light system', International Journal of Environmental Science and Technology. https://doi.org/10.1007/s13762-022-04705-8
Al-Khadhuri A, Al-Sabahi J, Kyaw HH, Myint MTZ, Al-Farsi B, Al-Abri M. Photocatalytic degradation toward pharmaceutical pollutants using supported zinc oxide nanorods catalyzed visible light system. International Journal of Environmental Science and Technology. 2022. doi: 10.1007/s13762-022-04705-8
Al-Khadhuri, A. ; Al-Sabahi, J. ; Kyaw, H. Htet et al. / Photocatalytic degradation toward pharmaceutical pollutants using supported zinc oxide nanorods catalyzed visible light system. In: International Journal of Environmental Science and Technology. 2022.
@article{9990bbe3d7c347e080028cb420ec4296,
title = "Photocatalytic degradation toward pharmaceutical pollutants using supported zinc oxide nanorods catalyzed visible light system",
abstract = "This study investigates the photocatalytic degradation of pharmaceutical wastes in an aqueous solution using supported zinc oxide nanorods (ZnO NRs) catalysts under visible light. Specific mass and surface area, optical and electronic properties, and surface defects of the catalyst determined the enhanced degradation of the pharmaceutical contaminants. The growth time of ZnO NRs is optimized and utilized to investigate the photocatalytic degradation of 10 mg/L of paracetamol, amoxicillin, and ciprofloxacin. Results show 65%, 62%, and 44% degradation of paracetamol, amoxicillin, and ciprofloxacin after 5 h of visible light irradiation. Interestingly, all pharmaceutical compounds have two different kinetics (Faster degradation is observed in the first two hours and slower at later hours). As the highest degraded pharmaceutical compound, the intermediate byproducts of paracetamol show the presence of aminophenol, nitrophenol, benzoquinone, and hydroquinone. This research will pave the way to an environmentally friendly wastewater treatment process suitable for pharmaceutical and hospital wastewater.",
keywords = "Amoxicillin, Ciprofloxacin, Paracetamol, Phenol, Photocatalysis, Zinc oxide nanorods",
author = "A. Al-Khadhuri and J. Al-Sabahi and Kyaw, {H. Htet} and Myint, {M. Tay Zar} and B. Al-Farsi and M. Al-Abri",
note = "Funding Information: The authors would like to thank the Nanotechnology Research Center, Sultan Qaboos University, Oman for the financial support. It is also extended to the Department of Physics, College of Science and the Central instrumentation laboratory, College of Agricultural and Marine Sciences for their technical support. The authors would like to thank Oman telecommunication (Omantel) and Sultan Qaboos University for their financial support under Grant Numbers EG/SQU-OT/19/02 and IG/DVC/NRC/19/01. Publisher Copyright: {\textcopyright} 2022, The Author(s) under exclusive licence to Iranian Society of Environmentalists (IRSEN) and Science and Research Branch, Islamic Azad University.",
journal = "International Journal of Environmental Science and Technology",
publisher = "CEERS",
T1 - Photocatalytic degradation toward pharmaceutical pollutants using supported zinc oxide nanorods catalyzed visible light system
AU - Al-Khadhuri, A.
AU - Al-Sabahi, J.
AU - Kyaw, H. Htet
AU - Myint, M. Tay Zar
AU - Al-Farsi, B.
AU - Al-Abri, M.
N1 - Funding Information: The authors would like to thank the Nanotechnology Research Center, Sultan Qaboos University, Oman for the financial support. It is also extended to the Department of Physics, College of Science and the Central instrumentation laboratory, College of Agricultural and Marine Sciences for their technical support. The authors would like to thank Oman telecommunication (Omantel) and Sultan Qaboos University for their financial support under Grant Numbers EG/SQU-OT/19/02 and IG/DVC/NRC/19/01. Publisher Copyright: © 2022, The Author(s) under exclusive licence to Iranian Society of Environmentalists (IRSEN) and Science and Research Branch, Islamic Azad University.
N2 - This study investigates the photocatalytic degradation of pharmaceutical wastes in an aqueous solution using supported zinc oxide nanorods (ZnO NRs) catalysts under visible light. Specific mass and surface area, optical and electronic properties, and surface defects of the catalyst determined the enhanced degradation of the pharmaceutical contaminants. The growth time of ZnO NRs is optimized and utilized to investigate the photocatalytic degradation of 10 mg/L of paracetamol, amoxicillin, and ciprofloxacin. Results show 65%, 62%, and 44% degradation of paracetamol, amoxicillin, and ciprofloxacin after 5 h of visible light irradiation. Interestingly, all pharmaceutical compounds have two different kinetics (Faster degradation is observed in the first two hours and slower at later hours). As the highest degraded pharmaceutical compound, the intermediate byproducts of paracetamol show the presence of aminophenol, nitrophenol, benzoquinone, and hydroquinone. This research will pave the way to an environmentally friendly wastewater treatment process suitable for pharmaceutical and hospital wastewater.
AB - This study investigates the photocatalytic degradation of pharmaceutical wastes in an aqueous solution using supported zinc oxide nanorods (ZnO NRs) catalysts under visible light. Specific mass and surface area, optical and electronic properties, and surface defects of the catalyst determined the enhanced degradation of the pharmaceutical contaminants. The growth time of ZnO NRs is optimized and utilized to investigate the photocatalytic degradation of 10 mg/L of paracetamol, amoxicillin, and ciprofloxacin. Results show 65%, 62%, and 44% degradation of paracetamol, amoxicillin, and ciprofloxacin after 5 h of visible light irradiation. Interestingly, all pharmaceutical compounds have two different kinetics (Faster degradation is observed in the first two hours and slower at later hours). As the highest degraded pharmaceutical compound, the intermediate byproducts of paracetamol show the presence of aminophenol, nitrophenol, benzoquinone, and hydroquinone. This research will pave the way to an environmentally friendly wastewater treatment process suitable for pharmaceutical and hospital wastewater.
KW - Amoxicillin
KW - Ciprofloxacin
KW - Paracetamol
KW - Phenol
KW - Photocatalysis
KW - Zinc oxide nanorods
JO - International Journal of Environmental Science and Technology
JF - International Journal of Environmental Science and Technology


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Your Ecuador Shopping List
Ecuador's Award-Winning Eco Tourism Company
Suggests In-Country Shopping List
That Underscores Sustainable Mission
Ecuador's award-winning ecotourism company, Tropic Journeys in Nature, that since 1994 has led tours through the country's most engaging landscapes, suggests shopping for locally produced items that underscore sustainable tourism while visiting this Andean country.
"As with most Latin American countries, Ecuador has traditional wares and handmade crafts that are unique to our country and that will cost much less than if purchased at home. Some make really unique souvenirs," notes Jascivan Carvalho, founder/owner of Tropic Journeys in Nature (http://www.destinationecuador.com/).
His company represents two lodging accommodations, one on mainland Ecuador in the Amazon rain forest, and the other on a sparsely populated island in the Galapagos. Both accommodations support local communities and operate sustainably. The company also conducts guided tours of the country's cultural and historical centers and its highly protected national parks and reserves.
"We came up with this preferred shopping list to support Tropic's goals of creating sustainable, meaningful work that also enhances local communities and the environment," noted Carvalho.
The list includes; Panama hats, leather goods, socks and the Ecuadorian Alpaca hoodie, both made of Alpaca wool; chocolate and coffee; and Dragon's Blood (Sangre de Drago) that the locals use as a natural medicine for general health and to heal cuts.
However, there's also a please–do-not-buy list, he adds, that includes any souvenir made with animal parts.
"This is especially the case for crafts that use bird feathers because it is very likely that birds were killed to get them," he notes.
Carvalho suggests heading to the indigenous market at Otavalo to purchase the Alpaca garments. Both the soft, warm and comfortable socks that come in a variety of colors and the hoodie are traditionally woven with 100 percent Alpaca wool. The hoodie, featuring any number of Andean designs, keeps visitors warm while exploring the high elevations of Cotopaxi and Las Cajas National Parks as well as back at home during the northern winter.
Ecuador also boasts a long artisan tradition in leather goods. One way to take advantage of this tradition is to take a factory tour at La Mundial Custom Boots, a partner of Tropic. La Mundial was founded in the Centro Historico of Quito in 1906, and today the company continues to make boots using techniques passed down through three generations of the Rivas Family, while also integrating modern technology into their designs. Tours include a look at the bootmaking process, as well as the benefit of purchasing fully-custom boots at local prices.
Pharmacies are a good place to source Dragon's Blood, a red liquid that is the sap of Croton lechleri, a small tree native to northeastern Amazonia. In addition to having natural healing properties, forming a natural bandage over cuts and possessing anti-bacterial and anti-viral properties, studies have also shown that Dragon's Blood is an anti-oxidant.
A variety of home-grown, organic chocolates are available at specialty and souvenir stores in places like Mindo, Guayaquil, Quito and most Ecuadorian cities. The Cacao plant is native to tropical forests in the Americas, and farms in Ecuador produce some of the highest-quality chocolate in the world.
The country's mountains and volcanic soils offer perfect conditions for growing coffee. Since the country hasn't yet made a name for itself as a place that produces fine coffee, there are great deals to be found, even in high quality organic coffee. Bags of quality Ecuadorian coffee can be found in stores in much of the country, with more variety and better deals on Arabica coffee around Loja and towns in Manabi and Guayaquil. For Robusto, check the stores in western Pichincha (Mindo) and the eastern slope of the Andes.
The Panama hat is actually of Ecuadorian origin. A good one is both stylish and can ward off the sun. They can be found in classic varieties, from budget-friendly prices to top-end luxury in Cuenca and Monteristo whose artisans make more of them than anywhere else in the world.
Carvalho launched Tropic Journeys in Nature to demonstrate that environmentally sustainable and culturally sensitive tourism can be a viable business model. Tropic pioneered indigenous community tourism in the Amazon region with the Huaorani people and over many years has been a consistent supporter, partner and promoter of indigenous tourism initiatives with several indigenous communities and organizations including the Siecoya, Cofan, Siona, Achuar and Quichua.
The company also integrates tourism with ecological, economic, socio-cultural and political concerns with local community tourism initiatives in the Galapagos Islands, the Andean region and the Pacific coast region of Ecuador. The communities Tropic works with receive proper economic benefit from all tourism operations.
About Tropic Journeys in Nature
Established in 1994, Tropic is an award–winning ecotourism company specializing in responsible, community-based tourism in Ecuador. Programs combine life-changing, active-but-cultural ecotourism experiences focusing on nature, conservation, diversity and sustainability in three distinct areas:
Huaorani Ecolodge at the headwaters of the Amazon in Yasuni National Park - http://www.destinationecuador.com/huaorani-ecolodge-ecuador.html
Floreana Lava Lodge a beachside accommodation in the Galapagos Islands, on Floreana Island: http://www.destinationecuador.com/galapagos-hotel-lava-lodge-floreana.html
Journeys in Nature – Sustainable guided nature and culture-focused tours throughout Ecuador in collaboration with conservationists groups and local communities. http://www.destinationecuador.com/galapagos-island-adventure-trip.html
For information and reservations contact: Tropic Ecological Adventures LLC. / Phone: +593-02-2234-594 / 202. 657.5072 (US) / 593. 2. 222. 5907 (EC) / 1.888.207.8615 Website: http://www.destinationecuador.com/.
Follow Tropic on Twitter: https://twitter.com/DestEcuador
Follow Tropic on Facebook: https://www.facebook.com/DestinationEcuador
Summit Secrets: Travel Like an Insider
EAST Beijing
For today's travelers, globetrotting isn't just about checking off the "top 10 must-sees" in each destination — it's about getting a true sense of local culture. To help travelers experience their chosen destinations through a local's perspective, expert concierges from the Summit Hotels & Resorts collection offer insider tips on what to see and do in major cities worldwide. From foodie finds to specialty boutiques, the advice below will undoubtedly add local flair and memorable moments to any itinerary. Summit Hotels & Resorts offers 140 member hotels that are centrally located in top cities in 35 countries.
Top Cities and Tips from Summit Hotels & Resorts Concierges:
EAST, Beijing – Beijing, China
Situated next to the 798 Art Zone within the sprawling INDIGO project, EAST is Beijing's most vibrant hotel, offering a plethora of entertainment, both on-site and nearby, to satisfy a traveler's every whim. High-tech amenities and sweeping views of downtown Beijing are standard benefits of every guestroom.
• Concierge tip: Guests who want to experience a local favorite are sent to Dawanchu (19 Jiangtai West Rd.), a neighborhood gem that serves farmhouse-style dishes inspired by traditional Chinese medicines.
The Orlando – Los Angeles, California, USA
This European-style 98-room West Hollywood hotel recently completed a $5 million renovation that included completely revamped public spaces and new themed suites, such as the Entertainer Suite that offers a private 225 square-foot balcony. Other guest perks include a rooftop deck featuring a heated saltwater pool and pet-friendly programming.
• Concierge tip: Bypass The Grove shopping center and visit small boutiques on West 3rd St. such as Pyrrha, which sells silver, bronze, and gold handmade talisman jewelry cast with 19th century wax seals.
Ouro Minas Palace Hotel – Belo Horizonte, Brazil
The third most populated city in Brazil, Belo Horizonte has been called "the metropolis with the best quality of life in Latin America" by the United Nations. Ouro Minas Palace boasts the city's largest presidential suite, and offers a health center featuring an indoor thermal pool and massotherapy treatments, both designed to relieve travelers' aches.
• Concierge tip: For traditional Minas Gerais cuisine, dine at Dona Lucinha, which is dedicated to providing a culinary experience and ambience that preserves the flavor and food culture of colonial times. A popular stew on the menu is the Vaca Atolada, which features beef ribs and cassava.
Hotel Regina – Paris, France
The fashionable Hotel Regina is a Belle Epoque gem located in the First Arrondissement, putting guests within walking distance of The Louvre, Comédie Francais Theater, and the Garnier Opera House. All of the property's 119 guestrooms and 15 suites feature views of the Tuileries Gardens or the tree-shaded courtyard.
• Concierge tip: For guests that plan to have a late night on the town, La Poule au Pot, located a 15-minute walk from the hotel, is a great night owl spot that is open until 5 AM (a novelty in Paris!). The bistro serves old-school French fare, such as duck's leg cooked in fat, veal kidneys with mustard sauce, and raw minced steak.
Storchen Zurich – Zurich, Switzerland
Set along River Limmat in the historic Lindenhof quarter, Storchen Zurich is a romantic 67-room hotel that claims a laundry list of famous guests such as Composer Richard Wagner. Guests who touch the mosaic of a black egg on the lobby floor will be blessed with good luck during their travels - a custom dating back to the hotel's opening days in the 14th century.
• Concierge tip: Travelers with a sweet tooth are sent to Honold Confiserie & Tearoom, a 100-year-old family-owned confectionary that combines traditional craftsmanship with innovative flavor combinations, serving fresh pralines, truffles, and a variety of cakes.
About Preferred Hotel Group™
With a global reach extending into more than 85 countries, Preferred Hotel Group represents more than 650 of the finest hotels, resorts, and serviced residences in the world. Preferred Hotel Group's brands include Preferred Hotels® & Resorts, Preferred Boutique™, Summit Hotels & Resorts™, Sterling Hotels™, Sterling Design, and Summit Serviced Residences™. Travelers gain valuable benefits through branded programs that include Preferred Residences™; Preferred Golf ™; the I Prefer™ Guest Benefit Program; Preferred Pride, a collection of TAG-approved or IGLTA-member hotels; and Preferred Family, a collection of hotels and resorts certified to provide a rich experience for travelers of all ages. For more information, visit www.PreferredHotelGroup.com and follow the brand on Facebook and Twitter.


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Home Chevron icon It indicates an expandable section or menu, or sometimes previous / next navigation options. Finance
The future of retail, mobile, online, and digital-only banking technology in 2021
Alicia Phaneuf
An increasing demand for a digital banking experience from millennials and Gen Zers is transforming how the entire banking industry operates.
Consumers' growing desire to access financial services from digital channels has led to a surge in new banking technologies that are reconceptualizing the banking industry.
Do you work in the Banking industry? Get business insights on the latest tech innovations, market trends, and your competitors with data-driven research.
Digitalization is changing how people interact and do business on a day-to-day basis, and advancements in banking technology are continuing to influence the future of financial services around the world. An increasing demand for a digital banking experience from millennials and Gen Zers is transforming how the entire banking industry operates.
From retail and mobile banking, to neobank startups, technology has its hand in seemingly every aspect of the banking industry; and, the influence of technology will continue to launch banking into a digitized future.
Retail banking, also known as consumer banking, refers to the specific services banks can offer to consumers–such as savings and checking accounts , credit and debit cards, and loans. Consumers' growing desire to access financial services from digital channels has led to a surge in new banking technologies that are reconceptualizing the entire retail banking market.
Future of Retail Banking
Technology geared toward improving retail banks' operational efficiency is positively impacting the market. According to Insider Intelligence, 39% of retail banking executives say that reducing costs is where technology has the greatest impact, compared to only 24% who say it's improving customer experience.
Retail banks are also launching platforms in the Banking-as-a-Service (BaaS) space to remain competitive. For example, UK neobank Starling used to exclusively offer business-to-consumer (B2C) retail banking services; but, after launching a BaaS platform, Starling diversified its product and revenue streams, helping it remain relevant in the neobank space.
Meanwhile, mobile banking has solidified its place as a must-have feature for financial institutions to remain competitive, particularly among digitally-savvy millennials and Gen Zers. In fact, over 45% of respondents to Insider Intelligence's fourth annual Mobile Banking Competitive Edge Study identify mobile as a top-three factor that determines their choice of FI.
Future of Mobile Banking
Mobile banking has become the go-to method for users to make deposits, account transfers, and monitor their spendings and earnings—and a key differentiator for banking leaders. Nearly 80% of our survey respondents who have used mobile banking say it is the primary way they access their bank account.
Successful mobile banking options include money management features that help users cut spending and grow savings.
BI Intelligence
Since the onset of the coronavirus pandemic, mobile capabilities is a more significant factor in bank selection among respondents than it was last year. Financial institutions should understand which mobile banking features consumers value most and where they stand compared to their competitors, so they can pinpoint specific areas to devote the most attention to.
The foremost concern consumers have when mobile banking remains security. The fear of data breach increases the demand for services that keep users' data secure–allowing consumers to place holds on credit or debit cards, schedule travel alerts, and file and review card transaction disputes are some successful security banking features.
Online banking, which includes mobile banking, refers to the overall experience of banking through digital channels, including mobile apps, desktop, live chatbots, and more.
Future of Online Banking
The popularity of mobile banking has surpassed that of online banking, and the overall number of online customers has slowed worldwide. According to Insider Intelligence, mobile banking is growing at five times the rate of online banking, and half of all online customers are also mobile banking users.
Despite this growing popularity, some banks still fall short on the demand for mobile tasks, like bill pay and reward redemption, causing them to push users to online banking. However, even this push won't be enough to popularize online banking as millenials and Gen Zers continue gravitating toward the mobile market.
Digital-only banks, also known as neobanks, are redefining the future of banking around the world. Though off to a slow start in the US due to high regulatory barriers, recent developments and the loosening of regulations suggest that US neobanks are set to take off.
Future of Digital-Only Banks
Sophisticated mobile banking tools are a top factor fueling US neobanks' stratospheric rise—one that's taken on more importance amid COVID-19. Incumbent financial institutions, neobanks, and tech companies alike can benefit from understanding exactly how leading neobanks are raising the bar for customer expectations and trust to successfully scale their businesses.
Chime offers a "no-fees" bank account.
San Francisco-based Chime, the largest US neobank, has attracted over 7.4 million account holders by 2019, and is projected to grow this figure to 19.8 million in 2024. The development of more neobanks in the US will bring awareness to digital-only banking, and eventually wane-out traditional banking firms.
Banking Technology Trends
The future of banking technology is driven by consumers, especially Gen Zers, who see technology as something that enhances their lives. A common trend in banking technology is using an application programming interface (API) to make proprietary data available to anyone who has the consumer's permission to access it.
Banks are using AI to smooth customer identification and authentication, while also mimicking live employees through chatbots and voice assistants.
APIs could be used to enable a bank's mobile app to pull down customer account information. Fintechs have also used API technology to enable their businesses to work, and their success is encouraging competitors to develop their own APIs.
Additionally, Insider Intelligence reported that 48% of banking executives believe new technologies like blockchain and artificial intelligence (AI) will have the greatest impact on banking through 2020. According to Insider Intelligence, banks are exploring blockchain technology in hopes of streamlining processes and cutting costs.
Consumers can already see AI being used by most banks through chatbots in the front office. Banks are using AI to smooth customer identification and authentication, while also mimicking live employees through chatbots and voice assistants.
More Financial Industry Topics:
US Banking Companies
Fintech Companies & Startups
Insurtech Companies
Neobanks
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Dr. Chieffo is a full time interventional cardiologist specializing in advanced interventional procedures at the San Raffaele Hospital in Milan. She is also the Director of Research in Interventional Cardiology at San Raffaele Hospital and she is Scientific Director of the Master in Invasive Cardiology program at the University of Vita e Salute in Milan. Dr. Chieffo has won multiple research awards, authored more than 30 papers, and co-authored over 100 papers.
Dr. Granada is an active interventional cardiologist specializing in advanced interventional procedures and is the Executive Director and Chief Scientific Officer of the Skirball Center for Cardiovascular Research at the CRF. Over the last 10 years, Dr. Granada has focused on testing new emerging technologies and has been the leading investigator of technologies such as Cardiac imaging, new Endovascular therapies and tissue regeneration.
Dr. Montorfano is a full time interventional cardiologist specializing in advanced interventional procedures in both cardiovascular and structural heart disease. He is also the cath lab Director at the San Raffaele Scientific Institute in Milan, Italy.


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Patent Pick: Hydrogenating γ,δ-Unsaturated Ketones
Fragrance > Research
November 23, 2015 Contact Author
Most Popular in Research
1Kao Corporation Develops PRM database and Odor Intensity Prediction Method
2Smelly Signs: A Language for Scent
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5Olfactory fatigue: what it is and how to avoid it in product testing
6Open Sourcing Smell Culture: Past and Future Models for Perfumery
7[podcast] Two Sense: What does Attraction Smell Like?
8F&F Literature Review: Fragrance Release
9Scent & Spirit: A Taste of Mexican Gourmand
10BASF's Approach to Aroma Ingredient Innovation
Patent Picks are chosen by the editors from publicly available sources. Today's highlight relates to a process for hydrogenating γ,δ-unsaturated ketones for use as flavor and fragrances.
Hydrogenation of ketones having at least a carbon-carbon double bond in the γ,δ-position
U.S. Patent 9181163
Publication date: Nov. 10, 2015
Assignee: DSM IP Assets B.V.
This invention relates to a process for the hydrogenation of ketones having at least a carbon-carbon double bond in the γ,δ-position to the keto group by hydrogen in the presence of at least one chiral iridium complex. According to the inventors, it has been shown that this process leads to a strong increase in the preferential formation of a single isomer.
The process is particularly suitable for the hydrogenation of γ,δ-unsaturated ketones that can be used as flavors and fragrances, or for the preparation of vitamin E and its derivatives, or of flavors and fragrances.
Crave a Fatty Food? Smell It Instead!
2/1/2019, Ryan Daily
The Intimacy of Our Senses
5/30/2019, Ryan Daily, Assistant Editor, Perfumer & Flavorist
Smelling With Your Tongue? Monell Center Investigates
5/22/2019, Ryan Daily
Scent & Spirit: A Taste of Mexican Gourmand
3/27/2019, Alexis Palmer Karl
Naturally Sourced F&F Ingredients: Regulations and Verifications Through Carbon-14
9/30/2019, By Haley Gershon, Marketing Specialist, Beta Analytic


Stuffed Chicken Breasts with Mushrooms and Goat Cheese can go from an easy weeknight meal to entertaining weekend dinner guests. Simple to make and elegant!
I'll never forget one of the first times I made stuffed chicken breasts. It was the end of my Junior year of college. Ever the little hostess, I decided to have my friends over for a dinner party.
Things were going well! (Or, so I thought.) I'd made crab cakes for an appetizer and everyone was enjoying them. My stuffed chicken breasts were in the oven, and dinner was right on schedule.
Except, halfway through the crab cakes, I realized that I wasn't smelling the buttery aroma of chicken baking in my apartment. I excused myself into the kitchen, opened the oven, and found a raw pan of chicken.
Not quite knowing what to do, I cranked up the temperature on my oven. It felt warm. Well, kind of. A little while later, I returned to find the same sad little uncooked chicken breasts staring back at me.
My heart sank as I realized that my oven had broken. I had no stuffed chicken breasts to serve. It was my first solo entertaining disaster.
My friends were good sports. We polished off a side salad, garlic bread (which had somehow dried out to a nearly petrified loaf in the not-hot-enough-to-cook-chicken oven), and a delicious coconut layer cake that one of my friends had brought for dessert.
Not my finest moment. Despite the catastrophe, stuffed chicken breasts are still one of my favorite dinner recipes, whether I'm serving two for a weeknight dinner, or a tableful of guests.
When they're cooked, that is!
The stuffing for this recipe is so easy to make. All you need to do is sauté mushrooms with shallots, garlic, herbs, and a splash of white wine to deglaze the pan. It takes less than 10 minutes.
The type of mushrooms you use is up to you. Since they're one of the stars of the show here, I like to use a gourmet mushroom mix. My market sells it freshly-sliced and packaged, but if you want to make it up yourself, use a mix of cremini, shiitake, and oyster mushrooms.
I find button mushrooms on their own a little too mild for this filling. If you use them, I'd recommend mixing buttons and cremini.
Crumbled goat cheese (chèvre) brings creaminess and a little bit of tang to the filling. Just crumble it over the mushroom filling, and when it bakes, you'll get luscious pockets of cheese as you cut through the stuffed chicken breasts.
Generally speaking, you can make stuffed chicken with either bone-in or boneless breasts. For this baked recipe, I use bone-in chicken breasts, with the skin attached. I find that they come especially juicy, tender, and flavorful in the oven.
When stuffing a bone-in, skin-on chicken breast, you have two options. First, you can gently make a pocket under the skin with your fingers, so that the filling mixture sits on top of the juicy chicken breast. Or, you can cut a pocket in the side of the chicken breast with a paring knife, so that the filling is sandwiched by the meat.
For this post, I stuffed the chicken breasts under the skin, but you can use the same filling with the sandwiching technique.
I like to serve these Mushroom and Goat Cheese Stuffed Chicken Breasts with a squeeze of lemon on top and lightly-dressed greens on the side. The chicken is filling, so I find that you don't need a heavy side dish for a satisfying meal.
My Lemon-Brown Butter Haricots Verts would also be fantastic with these stuffed chicken breasts, as would my friend Sarah's Oven-Roasted Asparagus with Charred Lemon.
If you'd like to add a starch, my Cream Cheese Mashed Potatoes pair fantastically with roasted meats; or, my Parmesan Duchess Potatoes would add an extra touch of elegance to the meal. A simple Rice Pilaf is always a good choice as well.
For a wine pairing, I like to serve these stuffed chicken breasts with a full-bodied Sauvignon Blanc. It pairs well with both the mushrooms and the tangy goat cheese.
These Stuffed Chicken Breasts are an easy and versatile dinner recipe, whether you're cooking for two or for a crowd!
Preheat oven to 400 degrees F with rack in the lower-middle position. Lightly oil a roasting pan and set aside.
Heat olive oil in a skillet over medium-high heat. Add mushrooms and shallots with 1/2 teaspoon each kosher salt and freshly-ground black pepper. Cook, stirring occasionally, until mushrooms are cooked down and starting to brown, about 5-8 minutes. Add garlic and cook for 1 minute, until fragrant.
Add a splash of white wine to the pan to deglaze, scraping up any brown bits on the bottom of the pan. Cook for an additional 1-2 minutes, until wine is evaporated. Stir in parsley and thyme and set aside to cool.
Gently loosen skin of chicken breasts by running your finger between the skin and the meat from the bone side outward. Be careful not to tear the skin or detach it completely from the chicken.
Add 1/4 of the cooked mushroom mixture to the pocket underneath the skin, spreading it evenly across the length of the chicken breast.
Add 1 ounce of goat cheese per chicken breast on top of the mushrooms and pull skin over the filling. If the skin appears quite loose, secure it with skewers to keep it closed over the filling.
Place stuffed chicken breasts in a single layer in the prepared roasting pan. Lightly brush the skin with olive oil and season with a pinch of salt and pepper.
Roast for 35-45 minutes (depending on the size of the chicken breast), until the internal temperature in the thickest part, away from the bone, reads 165 degrees F on a meat thermometer.
Remove from oven, tent with foil, and let rest for 10 minutes. Serve with a wedge of lemon.
Alternately, you can stuff the middle of the chicken breast. Insert a paring knife into the side and create an opening about 3 inches wide. Use the tip of the knife to cut through almost to the bone to create a pocket, being careful not to cut all the way through.
Fill as you would under the chicken skin, and bake as directed.
The little kitchen disasters do always make for the best stories, and this one is no exception! I'm just impressed that you were hosting a dinner party during your junior year of college – I was living off of leftover bread from the sandwich shop where I worked and canned tomato soup, HA! :) This chicken looks amazing and I love the tips on using bone-in chicken breasts. That always adds great flavor and I will definitely remember that the next time I make a stuffed chicken recipe!
WOW!! You've come a long way baby!!! Your chicken breasts are cooked to perfection and they look juicy and moist. Super yummy!! Those dinner disasters just make for good stories later on when you don't feel like sitting down and crying. And as far as mushrooms go — I prefer the small bellas or the brown ones. They seem to have more taste — at least I think so. Great recipe, Amanda!!
This is such a gorgeous recipe and I love love love the flavors here. Goat cheese is a fave of mine. Unfortunately, my husband hates it, so I usually have to replace goat cheese with feta. I think I"m just going to have to go through the extra effort of making one of these for myself, complete with the goat cheese, because with the mushrooms, it would be perfection. Feta is great and all, but there's no denying that goat cheese has that extra *oumph*.
My oven also died on me at a totally inconvenient (and embarrassing) moment. Glad to know I'm not the only one! I have never made stuffed chicken breasts, but these look so delicious and you give such great directions and tips that I'm ready to give it a try. This is an awesome stuffing, as I adore mushrooms….any and all kinds. Thank you.
These are lovely, and perfect for entertaining guests or great date night dinner. Thank you so much for the tip of putting the filling under the skin! I love having extra options like this! I adore goat cheese anything, and this sounds amazing!
Amanda, your dinner party story had me cracking up… because it's happened to me more than once, but those little disasters also make for great stories — best told with a glass of wine. Your stuffed chicken breasts look positively succulent. I'm a sucker for wild mushrooms and goat cheese, so your recipe is calling my name. This also feels like a perfect recipe for the season, too — without being obvious — thank you for not stuffing it with pumpkin…. LOL.
Totally love stuffed chicken breasts. You can never go wrong with a great chicken dinner any night of the week. This presentation is perfect for entertaining too. I happen to love mushrooms and goat cheese….so ALL these flavours are great together. This is the holiday dinner to for people that don't want to make the whole bird!!


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LARGE MULTIPURPOSE WEEKENDER CROSSBODY BAG - Can be used as travel bag, gym bag, overnight weekend bag, duffle bag with plenty of space to carry your travel/basic essentials.
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