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

On Human Terms – A First Evaluation of a Massive Open Online Course (MOOC) in Ergonomics

The Massive Open Online Course (MOOC) ‘Work and Technology on Human Terms’ (www.onhumanterms.org ) was launched in July 2017 with the aim to contribute to safer and healthier workplaces by increasing the knowledge about how products, systems, and work organizations can be designed on human terms. The purpose of this paper is to present the results of a first evaluation of the MOOC. The online course was used in four different university courses in Ergonomics in Sweden, two given at Chalmers University of Technology in Gothenburg and two given at Link\uf6ping University. The MOOC material was used in different ways in the courses: (1) suggested voluntary, alternative material for the students’ self-studies, (2) scheduled activity for self-studies with appointed chapters, and (3) mandatory, selected course material being discussed in follow-up seminars. Data for the evaluation was collected through questionnaires and semi-structured interviews with students and teachers. The results showed that the MOOC served as a repetition of lectured material and gave increased understanding of the theories. The recorded interviews with practitioners and researchers in the MOOC highlighted the importance of the subject in real working life. The knowledge tests were appreciated as rehearsal of understanding. However, the MOOC in parallel with the other course material was also considered to be too much work by some students. A recommendation is to carefully consider how to use and integrate the MOOC as a meaningful, individual, theoretical learning activity for the students. Thereby the lectures in classroom could focus more on discussions and problem-solving regarding the topics and less on basic theory

Working across species down on the farm: Howard S Liddell and the development of comparative psychopathology, c. 1923 to 1962

Seeking a scientific basis for understanding and treating mental illness, and inspired by the work of Ivan Pavlov, American physiologists, psychiatrists and psychologists in the 1920s turned to nonhuman animals. This paper examines how new constructs such as “experimental neurosis” emerged as tools to enable psychiatric comparison across species. From 1923 to 1962, the Cornell “Behavior Farm” was a leading interdisciplinary research center pioneering novel techniques to experimentally study nonhuman psychopathology. Led by the psychobiologist Howard Liddell, work at the Behavior Farm formed part of an ambitious program to develop new preventative and therapeutic techniques and bring psychiatry into closer relations with physiology and medicine. At the heart of Liddell’s activities were a range of nonhuman animals, including pigs, sheep, goats and dogs, each serving as a proxy for human patients. We examine how Pavlov’s conceptualization of ‘experimental neurosis’ was used by Liddell to facilitate comparison across species and communication between researchers and clinicians. Our close reading of his experimental system demonstrates how unexpected animal behaviors and emotions were transformed into experimental virtues. However, to successfully translate such behaviors from the animal laboratory into the field of human psychopathology, Liddell increasingly reached beyond, and, in effect, redefined, the Pavlovian method to make it compatible and compliant with an ethological approach to the animal laboratory. We show how the resultant Behavior Farm served as a productive “hybrid” place, containing elements of experiment and observation, laboratory and field. It was through the building of close and more naturalistic relationships with animals over extended periods of time, both normal and pathological, and within and outside of the experimental space, that Liddell could understand, manage, and make useful the myriad behavioral complexities that emerged from the life histories of experimental animals, the researchers who worked with them, and their shared relationships to the wider physical and social environments