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

Effects of Anacetrapib in Patients with Atherosclerotic Vascular Disease

BACKGROUND: Patients with atherosclerotic vascular disease remain at high risk for cardiovascular events despite effective statin-based treatment of low-density lipoprotein (LDL) cholesterol levels. The inhibition of cholesteryl ester transfer protein (CETP) by anacetrapib reduces LDL cholesterol levels and increases high-density lipoprotein (HDL) cholesterol levels. However, trials of other CETP inhibitors have shown neutral or adverse effects on cardiovascular outcomes. METHODS: We conducted a randomized, double-blind, placebo-controlled trial involving 30,449 adults with atherosclerotic vascular disease who were receiving intensive atorvastatin therapy and who had a mean LDL cholesterol level of 61 mg per deciliter (1.58 mmol per liter), a mean non-HDL cholesterol level of 92 mg per deciliter (2.38 mmol per liter), and a mean HDL cholesterol level of 40 mg per deciliter (1.03 mmol per liter). The patients were assigned to receive either 100 mg of anacetrapib once daily (15,225 patients) or matching placebo (15,224 patients). The primary outcome was the first major coronary event, a composite of coronary death, myocardial infarction, or coronary revascularization. RESULTS: During the median follow-up period of 4.1 years, the primary outcome occurred in significantly fewer patients in the anacetrapib group than in the placebo group (1640 of 15,225 patients [10.8%] vs. 1803 of 15,224 patients [11.8%]; rate ratio, 0.91; 95% confidence interval, 0.85 to 0.97; P=0.004). The relative difference in risk was similar across multiple prespecified subgroups. At the trial midpoint, the mean level of HDL cholesterol was higher by 43 mg per deciliter (1.12 mmol per liter) in the anacetrapib group than in the placebo group (a relative difference of 104%), and the mean level of non-HDL cholesterol was lower by 17 mg per deciliter (0.44 mmol per liter), a relative difference of -18%. There were no significant between-group differences in the risk of death, cancer, or other serious adverse events. CONCLUSIONS: Among patients with atherosclerotic vascular disease who were receiving intensive statin therapy, the use of anacetrapib resulted in a lower incidence of major coronary events than the use of placebo. (Funded by Merck and others; Current Controlled Trials number, ISRCTN48678192 ; ClinicalTrials.gov number, NCT01252953 ; and EudraCT number, 2010-023467-18 .)

Prediction in discourse The problems and potential of qualitative forecasting in psychology

SIGLEAvailable from British Library Document Supply Centre-DSC:DXN052499 / BLDSC - British Library Document Supply CentreGBUnited Kingdo

Satisficing in engineering design: Causes, consequences and implications for design support

We describe an approach to investigating design cognition which involved comparing prescriptive theories of good design practice with observations of actual design behaviour. The tenet of prescriptive theory which formed the focus of the research is the idea that designers should generate and evaluate multiple design alternatives in order to increase the chances of attaining better design solutions than might arise if they fixated upon an initial solution. Our study focused upon six professional electronic engineers attempting a novel integrated-circuit design problem. Verbal-protocol data revealed: (i) a failure to search for alternative solutions; (ii) a marked inclination to stick with early 'satisficing' solution ideas even when these were showing deficiencies; and (iii) only superficial modelling and assessment of competing alternatives when such options were actually considered. We argue that while minimal solution search in design may sometimes be caused by motivational factors and working-memory limitations, its major determinant relates to inhibitory memory processes that arise subsequent to the recognition-based emergence of familiar design solutions. We conclude by exploring the implications of minimal solution search for design support, with particular reference to an agent-based indexing system which we are developing in order to facilitate the pursuit of design alternatives in engineering contexts. © 1998 Published by Elsevier Science B.V

Direct electrothermal atomic absorption spectrometric determination of lead in wine

A method for direct electrothermal at. absorption spectrometric detn. of lead in wine is described. A mixed chem. modifier contg. 20 mg of tungsten as ammonium paratungstate and 4 mg palladium as palladium chloride is applied to thermally stabilize Pb in wine up to pyrolysis temps. of 800-850 DegC. Matrix-matched stds. are used for calibration. The characteristic mass for integrated absorbance measurements (mo) is 20 pg, and the limit of detection is 3 mg/L for a wine sample. The accuracy and precision of the method were assessed by analyzing the ref. CQiR and CQiB materials (Food Science Lab., Ministry of Agriculture, Fisheries and Food, UK

Direct electrothermal atomic absorption spectrometric determination of lead in wine

A method for direct electrothermal at. absorption spectrometric detn. of lead in wine is described. A mixed chem. modifier contg. 20 mg of tungsten as ammonium paratungstate and 4 mg palladium as palladium chloride is applied to thermally stabilize Pb in wine up to pyrolysis temps. of 800-850 DegC. Matrix-matched stds. are used for calibration. The characteristic mass for integrated absorbance measurements (mo) is 20 pg, and the limit of detection is 3 mg/L for a wine sample. The accuracy and precision of the method were assessed by analyzing the ref. CQiR and CQiB materials (Food Science Lab., Ministry of Agriculture, Fisheries and Food, UK)