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

Doxycycline for Malaria Chemoprophylaxis and Treatment: Report from the CDC Expert Meeting on Malaria Chemoprophylaxis

Doxycycline, a synthetically derived tetracycline, is a partially efficacious causal prophylactic (liver stage of Plasmodium) drug and a slow acting blood schizontocidal agent highly effective for the prevention of malaria. When used in conjunction with a fast acting schizontocidal agent, it is also highly effective for malaria treatment. Doxycycline is especially useful as a prophylaxis in areas with chloroquine and multidrug-resistant Plasmodium falciparum malaria. Although not recommended for pregnant women and children < 8 years of age, severe adverse events are rarely reported for doxycycline. This report examines the evidence behind current recommendations for the use of doxycycline for malaria and summarizes the available literature on its safety and tolerability

Proactive role-orientation toward workplace safety: Psychological dimensions, nomological network and external validity

In the light of the relevance of workers’ participation and initiative in improving safety in the workplace, a new measurement tool is presented to assess multiple psychological drivers (proactive motivations; future orientations) which support a proactive orientation by individuals toward safety management and accident prevention in the workplace. This validation study was developed with a survey methodology in two industrial samples (N = 327; 196) from the chemical and manufacturing sectors. The factor structure of the tool was tested with CFA’s. The analyses evidenced the goodness of a multidimensional structure, with a general superordinate dimension indicator of the overall construct of individuals’ proactive safety-role orientation. Moreover, the analysis of the nomological network of the new model showed positive correlations with both behavioral criteria (safety voice; safety initiative) and supervision antecedents (safety-specific transformational leadership) which were measured at the individual level. Finally, the external validity was positively verified by significant correlations with organizational outcomes assessed at the team level through external measures (supervisor evaluations; data archives) which were collected at team level (N = 32) in the following six months from the main survey. Theoretical and practical implications with indications for future research conclude the article

Rich contexts do not always enrich the accuracy of personality judgements

We test the common assumption that information ‘rich’ contexts lead to more accurate personality judgments than information ‘lean’ contexts. Pairs of unacquainted students rendered judgments of one another's personalities after interacting in one of three, increasingly rich, contexts: Internet ‘chat’, telephone, or face-to-face. Accuracy was assessed by correlating participants' judgments with a measure of targets' personalities that averaged self and informant ratings. As predicted, the visible traits of extraversion and conscientiousness were judged more accurately than the less visible traits of neuroticism and openness. However, judgment accuracy also depended on context. Judgments of extraversion and neuroticism improved as context richness increased (i.e., from Internet ‘chat’ to face-to-face), whereas judgments of conscientiousness and openness improved as context richness decreased (i.e., from face-to-face to Internet ‘chat’). Our findings suggest that context richness shapes not only the availability of personality cues but also the relevance of cues in any given context