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

Implications of serial measurements of natriuretic peptides in heart failure: insights from BIOSTAT‐CHF

No abstract available

Influence of River-Induced Fronts on Hydrocarbon Transport: A Multiplatform Observational Study

The Taylor Energy Site is located in the vicinity of the Mississippi Delta region over the Northern Gulf of Mexico (NGoM). Surface oil patches have been persistently observed within this site since 2004, when an oil rig was destroyed by Hurricane Ivan. A multiplatform observational experiment was conducted in April 2017 to investigate, for the first time, the main hydrocarbon pathways from the Taylor Energy Site toward the NGoM continental shelves, and the Gulf interior, under the influence of local and regional physical processes. Results indicate that the Mississippi River (MR)-induced fronts over the Taylor Energy Site, in combination with local circulation, prevailing winds and broader regional dynamics determine the hydrocarbon transport. The drifters deployed during the field experiment, in tandem with satellite data, drone imagery, wind measurements, and radar-derived data, efficiently described three major hydrocarbon pathways, associated with MR plume dynamics (downstream/upstream coastal currents) and basin-wide circulation (offshore pathway). Two different types of drifters, drogued and undrogued, showed clearly different pathways, which suggest potential differences in the expected advection of oil, depending on whether it forms a surface slick or whether it is partially mixed below the surface. The existence of multiple river fronts influenced the fate of oiled waters, preventing the hydrocarbons from reaching the Delta, like a natural boom barrier, trapping and directing the oil either westward or eastward. Thermohaline measurements showed that the MR plume near Taylor was 5–10 m deep, while the clearer ocean was characterized by a 40 m upper ocean homogenous layer

Influence of River-Induced Fronts on Hydrocarbon Transport: A Multiplatform Observational Study

The Taylor Energy Site is located in the vicinity of the Mississippi Delta region over the Northern Gulf of Mexico (NGoM). Surface oil patches have been persistently observed within this site since 2004, when an oil rig was destroyed by Hurricane Ivan. A multiplatform observational experiment was conducted in April 2017 to investigate, for the first time, the main hydrocarbon pathways from the Taylor Energy Site toward the NGoM continental shelves, and the Gulf interior, under the influence of local and regional physical processes. Results indicate that the Mississippi River (MR)-induced fronts over the Taylor Energy Site, in combination with local circulation, prevailing winds and broader regional dynamics determine the hydrocarbon transport. The drifters deployed during the field experiment, in tandem with satellite data, drone imagery, wind measurements, and radar-derived data, efficiently described three major hydrocarbon pathways, associated with MR plume dynamics (downstream/upstream coastal currents) and basin-wide circulation (offshore pathway). Two different types of drifters, drogued and undrogued, showed clearly different pathways, which suggest potential differences in the expected advection of oil, depending on whether it forms a surface slick or whether it is partially mixed below the surface. The existence of multiple river fronts influenced the fate of oiled waters, preventing the hydrocarbons from reaching the Delta, like a natural boom barrier, trapping and directing the oil either westward or eastward. Thermohaline measurements showed that the MR plume near Taylor was 5–10 m deep, while the clearer ocean was characterized by a 40 m upper ocean homogenous layer

EPR dosimetry intercomparison using smart phone touch screen glass

This paper presents the results of an interlaboratory comparison of retrospective dosimetry using the electron paramagnetic resonance method. The test material used in this exercise was glass coming from the touch screens of smart phones that might be used as fortuitous dosimeters in a large-scale radiological incident. There were 13 participants to whom samples were dispatched, and 11 laboratories reported results. The participants received five calibration samples (0, 0.8, 2, 4, and 10 Gy) and four blindly irradiated samples (0, 0.9, 1.3, and 3.3 Gy). Participants were divided into two groups: for group A (formed by three participants), samples came from a homogeneous batch of glass and were stored in similar setting; for group B (formed by eight participants), samples came from different smart phones and stored in different settings of light and temperature. The calibration curves determined by the participants of group A had a small error and a critical level in the 0.37-0.40-Gy dose range, whereas the curves determined by the participants of group B were more scattered and led to a critical level in the 1.3-3.2-Gy dose range for six participants out of eight. Group A were able to assess the dose within 20 % for the lowest doses (<1.5 Gy) and within 5 % for the highest doses. For group B, only the highest blind dose could be evaluated in a reliable way because of the high critical values involved. The results from group A are encouraging, whereas the results from group B suggest that the influence of environmental conditions and the intervariability of samples coming from different smart phones need to be further investigated. An alongside conclusion is that the protocol was easily transferred to participants making a network of laboratories in case of a mass casualty event potentially feasible