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

Fatores de influência no comportamento de compra de alimentos por crianças

A escolha alimentar nas sociedades contemporâneas passa, inevitavelmente, pelo comércio, pois o alimento constitui-se mercadoria que é consumida, assim como tantos outros bens e serviços. Atualmente muitas crianças já definem sozinhas suas escolhas alimentares, provocando a atenção tanto de empresas como de organizações preocupadas com sua nutrição. Utilizando o modelo BPM (Behavioral Perpective Model), criado por Foxall (2010), fundamentado na psicologia do consumidor e estruturado na tríplice contingência de Skinner, analisaram-se os fatores que influenciam crianças em seu comportamento de compra de alimentos. Tendo como sujeitos 175 alunos com idades compreendidas entre 10 e 12 anos, identificaram-se 35 variáveis que foram classificadas entre estímulos antecedentes (cenário ou histórico de aprendizado) e consequentes (reforço utilitário ou informativo) no comportamento de compra. Verificou-se que os estímulos reforçadores (consequentes) têm maior grau de importância para a decisão de compra de alimentos desses sujeitos do que os estímulos antecedentes, sendo que as consequências utilitárias são mais influentes do que as informativas. Conclui-se que os atributos dos produtos, como sabor e qualidade, têm maior influência na decisão de compra do que os estímulos ambientais, como as promoções e publicidade dos alimentos.Food choice in contemporary societies is, inevitably, a buying decision. Food is a product that is consumed, like so many other goods and services. Nowadays many children choose their food themselves, which attracts attention not only from companies that develop products and advertising for that segment, but also organizations concerned with their nutrition. This paper analyzed the factors that influence children's food purchasing behavior using the Perpective Behavioral Model (BPM) created by Foxall (2010), which in turn is based on consumer psychology and structured on Skinner's triple contingency. The subjects were 175 students between 10 and 12 years old. Thirty-five variables were identified and classified as antecedent stimuli (setting or learning history) or purchase reinforcers (utilitarian or informational reinforcement). It was seen that reinforcement stimuli (consequent stimuli) are more important to these children's decisions than antecedent stimuli, and that utilitarian consequences are more influential than informational consequences. It was concluded that product attributes such as taste and quality have greater influence on purchasing decisions than environmental stimuli such as promotions and food advertising

What matters for life satisfaction among the oldest-old? Evidence from China

The world population is aging rapidly and the well-being of older people is of great interest. Therefore, this study investigates the determinants of life satisfaction among the oldest-old (i.e. individuals aged 80 or over) in China. Materials and methods We use the 2011/2012 Chinese Longitudinal Healthy Longevity Survey data (n = 6530) for this paper. Logistic regression is used to analyse the effects of socio-demographic, economic, health, instrumental activities of daily living, family and community factors on life satisfaction and depression among the oldest-old in China. Results Our analysis confirms the significance of many factors affecting life satisfaction among the oldest-old in China. Factors that are correlated with life satisfaction include respondent’s sex, education, place of residence, self-rated health status, cognitive ability (using mini mental state examination), regular physical examination, perceived relative economic status, access to social security provisions, commercialized insurances, living arrangements, and number of social services available in the community (p<0.05 for all these variables). Although life satisfaction is negatively associated with instrumental activities of daily living (β = -0.068, 95%CI = -.093—.043), and depression (β = -0.463, 95%CI = -.644—.282), the overall effect of self-rated health status is positive (p<0.001). This confirms the primacy of health as the determinant of well-being among the oldest-old. Conclusions Majority of the oldest-old in China rated their life satisfaction as good or very good. Our findings show that health and economic status are by far the most significant predictors of life satisfaction. Our finding on the primacy of health and relative income as determinants of well-being among the oldest-old, and the greater influence of self-rated health status over objective health measures is consistent with the findings of many past studies. Our results suggest that efforts should be directed at enhancing family support as well as health and social service provisions in the community to improve life satisfaction of older people

A clinical evaluation of the mandibular cervical traction gear

PLEASE NOTE: This work is protected by copyright. Downloading is restricted to the BU community: please click Download and log in with a valid BU account to access. If you are the author of this work and would like to make it publicly available, please contact [email protected] (M.Sc.D.)--Boston University School of Graduate Dentistry, 1973. Orthodontics.Bibliography included.The mandibular cervical traction gear has been mentioned in the literature as an anchorage adjunct in certain specific cases. It has not been widely used in orthodontics. nor had the broad range of usage been explored or investigated. The purpose of this investigation was to evaluate the mandibular cervical traction gear in a clinical situation, where an overall evaluation of its effectiveness could be done. The fact that an active orthodontist had employed the lower cervical traction gear in a variety of cases provided us with a large patient sample. The data obtained was based on clinical records which were very complete. above average in detail. It was also possible to clinically examine the patients in the study. The results obtained point out quite well that the mandibular cervical traction gear is indeed useful in anchora control. It also was shown that case selection is extremely important, due to the limitations observed clinically in many cases. The study also showed that the lower cervical traction gear has a wide variety of application in orthodontics