Chop Sticks and Geisha...

How would you like, says your Japanese host, at the end of a viciously hot summer day of sightseeing in Kyoto, to take dinner in true Japanese fashion tonight

The Iowa Homemaker vol.13, no.4

Chop Sticks and Geishea… By Mitchell V. Charnley Coeds Choose Clever Clothes… By Virginia Kirstein ‘Twas a Lucky Guess… By Gladys M. Johnson Flowers in a Pumpkin Shell… By Ruth Coo

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

The associative basis of cue-elicited drug taking in humans.

Rationale: Drug cues play an important role in motivating human drug taking, lapse and relapse, but the psychological basis of this effect has not been fully specified. Method: To clarify these mechanisms, the study measured the extent to which pictorial and conditioned tobacco cues enhanced smoking topography in an ad libitum smoking session simultaneously with cue effects on subjective craving, pleasure and anxiety. Results: Both cue types increased the number of puffs consumed and craving, but pleasure and anxiety responses were dissociated across cue type. Moreover, cue effects on puff number correlated with effects on craving but not pleasure or anxiety. Finally, whereas overall puff number and craving declined across the two blocks of consumption, consistent with burgeoning satiety, cue enhancement of puff number and craving were both unaffected by satiety. Conclusions: Overall, the data suggest that cue-elicited drug taking in humans is mediated by an expectancy-based associative learning architecture, which paradoxically is autonomous of the current incentive value of the drug