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

SARS-CoV-2 susceptibility and COVID-19 disease severity are associated with genetic variants affecting gene expression in a variety of tissues

Variability in SARS-CoV-2 susceptibility and COVID-19 disease severity between individuals is partly due to genetic factors. Here, we identify 4 genomic loci with suggestive associations for SARS-CoV-2 susceptibility and 19 for COVID-19 disease severity. Four of these 23 loci likely have an ethnicity-specific component. Genome-wide association study (GWAS) signals in 11 loci colocalize with expression quantitative trait loci (eQTLs) associated with the expression of 20 genes in 62 tissues/cell types (range: 1:43 tissues/gene), including lung, brain, heart, muscle, and skin as well as the digestive system and immune system. We perform genetic fine mapping to compute 99% credible SNP sets, which identify 10 GWAS loci that have eight or fewer SNPs in the credible set, including three loci with one single likely causal SNP. Our study suggests that the diverse symptoms and disease severity of COVID-19 observed between individuals is associated with variants across the genome, affecting gene expression levels in a wide variety of tissue types

Dimethyl fumarate in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial

Dimethyl fumarate (DMF) inhibits inflammasome-mediated inflammation and has been proposed as a treatment for patients hospitalised with COVID-19. This randomised, controlled, open-label platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]), is assessing multiple treatments in patients hospitalised for COVID-19 (NCT04381936, ISRCTN50189673). In this assessment of DMF performed at 27 UK hospitals, adults were randomly allocated (1:1) to either usual standard of care alone or usual standard of care plus DMF. The primary outcome was clinical status on day 5 measured on a seven-point ordinal scale. Secondary outcomes were time to sustained improvement in clinical status, time to discharge, day 5 peripheral blood oxygenation, day 5 C-reactive protein, and improvement in day 10 clinical status. Between 2 March 2021 and 18 November 2021, 713 patients were enroled in the DMF evaluation, of whom 356 were randomly allocated to receive usual care plus DMF, and 357 to usual care alone. 95% of patients received corticosteroids as part of routine care. There was no evidence of a beneficial effect of DMF on clinical status at day 5 (common odds ratio of unfavourable outcome 1.12; 95% CI 0.86-1.47; p = 0.40). There was no significant effect of DMF on any secondary outcome

Dimethyl fumarate in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial

Dimethyl fumarate (DMF) inhibits inflammasome-mediated inflammation and has been proposed as a treatment for patients hospitalised with COVID-19. This randomised, controlled, open-label platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]), is assessing multiple treatments in patients hospitalised for COVID-19 (NCT04381936, ISRCTN50189673). In this assessment of DMF performed at 27 UK hospitals, adults were randomly allocated (1:1) to either usual standard of care alone or usual standard of care plus DMF. The primary outcome was clinical status on day 5 measured on a seven-point ordinal scale. Secondary outcomes were time to sustained improvement in clinical status, time to discharge, day 5 peripheral blood oxygenation, day 5 C-reactive protein, and improvement in day 10 clinical status. Between 2 March 2021 and 18 November 2021, 713 patients were enroled in the DMF evaluation, of whom 356 were randomly allocated to receive usual care plus DMF, and 357 to usual care alone. 95% of patients received corticosteroids as part of routine care. There was no evidence of a beneficial effect of DMF on clinical status at day 5 (common odds ratio of unfavourable outcome 1.12; 95% CI 0.86-1.47; p = 0.40). There was no significant effect of DMF on any secondary outcome

A first update on mapping the human genetic architecture of COVID-19

peer reviewe

Dinner for one: A grounded theory of grocery shopping in the single -person household

A great deal of marketing thought and research has investigated household decision-making; however, much of this work has been accomplished under the assumption that families inhabit households and that household decision-making is actually family decision-making. Such an assumption does not take into consideration the changing nature of the family and the household as the nineteen-fifties ideal is left farther and farther behind. The purpose of this dissertation is to set aside the family-centric assumption and investigate a realm of household decision-making in a different household type. As such, I develop a grounded theory of grocery shopping in the single-person household, investigating how the unmarried person who lives alone and has no dependent children or other relatives fends for him or herself. By doing so, I aim to strip away any in-home influences upon the grocery shopping activity, leaving behind only those influences that drive the person to feed him or herself. The findings reveal that the major influence on the grocery shopping habits of the single person who lives alone revolve around the waste associated with feeding the self. These wasted resources include food, time and effort, money, and natural resources; and the recognition of this waste by the single person results in a variety of mealtime strategies for preparing and consuming meals that impact the types and amount of food purchased in the grocery store. This study also explores the differences between the grocery shopping and meal consumption habits of men and women as well as for members of different age groups. The resulting theory provides a challenge to current marketing thought and practice and promotes an awareness of alternative or non-traditional approaches to examining various marketing phenomena

Differences In Management Theory and Practice: Are Authors and Journals Contributin Factors?

The management literature offers evidence that thtere are differences in the way in which academicians and practitioners view the practice of management. It further suggests that those differences may, in part, be explained through the process by which management concepts are communicated to them, i.e. as a result of the way in which academic and practitioner oriented journals convey management concepts. This study examines journals with regard to their treatment of seleted concepts and finds that thtere are, in fact, no significant differences in their presentation. This suggested that earlier authors were incorrect in their assessment that differences in the journals service academic and practitioner marekts were, in part, responsible for differences between their readers\u27 views of management. It further suggests a possible alternate explanation

Digital Fandom: Mediation, Remediation, and Demediation of Fan Practices

It has been argued that fans make explicit what everyone else does implicitly. That is, fans interpret the world around them, communicate these meanings with others, and produce their own meanings based on those parts of the world that they like most. While all of us do this to various degrees, fans do so consciously, openly, and overtly. Also, fans actively appropriate the objects of culture in this process and rework them to further their interests in what has been referred to as a form of participatory culture. Fans do not merely consume culture; they creatively (re)produce culture, thus contributing directly to societal discourse. While some fan scholars have emphasized fan practices as a form of rebellion, others point out that this is a deeply affective process, even for anti-fans. For most, being a fan is ultimately a form of hedonic experience. Even though many fans devote a considerable amount of time, effort, and energy into their respective fandoms, it is usually a labor of love