Prognostic model to predict postoperative acute kidney injury in patients undergoing major gastrointestinal surgery based on a national prospective observational cohort study.

Background: Acute illness, existing co-morbidities and surgical stress response can all contribute to postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. The aim of this study was prospectively to develop a pragmatic prognostic model to stratify patients according to risk of developing AKI after major gastrointestinal surgery. Methods: This prospective multicentre cohort study included consecutive adults undergoing elective or emergency gastrointestinal resection, liver resection or stoma reversal in 2-week blocks over a continuous 3-month period. The primary outcome was the rate of AKI within 7 days of surgery. Bootstrap stability was used to select clinically plausible risk factors into the model. Internal model validation was carried out by bootstrap validation. Results: A total of 4544 patients were included across 173 centres in the UK and Ireland. The overall rate of AKI was 14·2 per cent (646 of 4544) and the 30-day mortality rate was 1·8 per cent (84 of 4544). Stage 1 AKI was significantly associated with 30-day mortality (unadjusted odds ratio 7·61, 95 per cent c.i. 4·49 to 12·90; P < 0·001), with increasing odds of death with each AKI stage. Six variables were selected for inclusion in the prognostic model: age, sex, ASA grade, preoperative estimated glomerular filtration rate, planned open surgery and preoperative use of either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker. Internal validation demonstrated good model discrimination (c-statistic 0·65). Discussion: Following major gastrointestinal surgery, AKI occurred in one in seven patients. This preoperative prognostic model identified patients at high risk of postoperative AKI. Validation in an independent data set is required to ensure generalizability

Pan-cancer analysis of whole genomes

Cancer is driven by genetic change, and the advent of massively parallel sequencing has enabled systematic documentation of this variation at the whole-genome scale(1-3). Here we report the integrative analysis of 2,658 whole-cancer genomes and their matching normal tissues across 38 tumour types from the Pan-Cancer Analysis of Whole Genomes (PCAWG) Consortium of the International Cancer Genome Consortium (ICGC) and The Cancer Genome Atlas (TCGA). We describe the generation of the PCAWG resource, facilitated by international data sharing using compute clouds. On average, cancer genomes contained 4-5 driver mutations when combining coding and non-coding genomic elements; however, in around 5% of cases no drivers were identified, suggesting that cancer driver discovery is not yet complete. Chromothripsis, in which many clustered structural variants arise in a single catastrophic event, is frequently an early event in tumour evolution; in acral melanoma, for example, these events precede most somatic point mutations and affect several cancer-associated genes simultaneously. Cancers with abnormal telomere maintenance often originate from tissues with low replicative activity and show several mechanisms of preventing telomere attrition to critical levels. Common and rare germline variants affect patterns of somatic mutation, including point mutations, structural variants and somatic retrotransposition. A collection of papers from the PCAWG Consortium describes non-coding mutations that drive cancer beyond those in the TERT promoter(4); identifies new signatures of mutational processes that cause base substitutions, small insertions and deletions and structural variation(5,6); analyses timings and patterns of tumour evolution(7); describes the diverse transcriptional consequences of somatic mutation on splicing, expression levels, fusion genes and promoter activity(8,9); and evaluates a range of more-specialized features of cancer genomes(8,10-18).Peer reviewe

A Descriptive Study on Registered Nurses' Continuing Educational Needs in Research from Three Different Health Care Institutes in Singapore

Introduction: Nurses are encouraged to engage in research activities in order to stay abreast with the current nursing practice. However, limited knowledge about the research process may influence their level of involvement and utilisation of research in their daily nursing practices. This study examines Singapore nurses' perceived knowledge and educational needs in research as well as to explore their preferred mode and duration of education delivery. Methods: This is a multi-site, cross-sectional study that recruited 2248 registered nurses working in Singapore. A self-administered tool was used to examine nurses' perceived knowledge and educational needs in research. Descriptive statistics were used to present the nurses' demographic data; the Kruskal-Wallis and chi-square tests were used to examine the relationship between the nurses' education level and their perceived knowledge and educational needs in research. Results: Nurses in this study perceived low levels of knowledge in research. Majority of those who were involved in research activities had a bachelor's degree. There were statistically significant differences between education level and perceived knowledge (p=0.001). However, there was no significant difference between education level and perceived educational needs. Younger nurses (19–35 years old) preferred shorter duration when attending workshops compared to older nurses (36 years old and above). Skill-based workshop and tutorial or seminar that last no longer than a week was the most preferred educational mode and duration. Conclusion: Nurses with high level of education perceived a higher level of research knowledge and thus reported lower educational needs in research. The results showed the need for continual training programs, even for nurses with bachelor's and master's degrees, in order to better prepare them for evidence-based practice. Understanding the demographic of the nurses and their learning styles is important when devising strategies to teach research

Mechanical and cultural strategies to control Cirsium arvense

Infestation with Cirsium arvense in organic cropping is an increasing problem in many parts of Europe. Non-chemical management strategies against C. arvense based on cultivation tactics and/or different cutting regimes have acquired very little attention for years. This study presents results from four experiments, undertaken under organic growing conditions, on the effects of repeated mowing or hoeing during the first part of the growing season used in combination with competition from a suppressive crop (grass white-clover mixture and red clover). The strategies were mainly aimed at diminishing the regenerative capacity of C. arvense and effects were thus measured in the subsequent year in spring barley. In general, number of passes of mowing and hoeing linearly reduced the amount of aboveground C. arvense biomass in the subsequent year. Increased competition induced by the competitive crops further reduced C. arvense biomass. Differences in barley yield were explained by the amount of C. arvense biomass in the two experiments, while strong confounding effects from Elymus repens infestations occurred in the other two experiments. Our results suggest that the strategies studied are likely to increase crop yield and that an acceptable level of C. arvense control can be achieved within one growing season only