EPIdemiology of Surgery-Associated Acute Kidney Injury (EPIS-AKI) : Study protocol for a multicentre, observational trial

More than 300 million surgical procedures are performed each year. Acute kidney injury (AKI) is a common complication after major surgery and is associated with adverse short-term and long-term outcomes. However, there is a large variation in the incidence of reported AKI rates. The establishment of an accurate epidemiology of surgery-associated AKI is important for healthcare policy, quality initiatives, clinical trials, as well as for improving guidelines. The objective of the Epidemiology of Surgery-associated Acute Kidney Injury (EPIS-AKI) trial is to prospectively evaluate the epidemiology of AKI after major surgery using the latest Kidney Disease: Improving Global Outcomes (KDIGO) consensus definition of AKI. EPIS-AKI is an international prospective, observational, multicentre cohort study including 10 000 patients undergoing major surgery who are subsequently admitted to the ICU or a similar high dependency unit. The primary endpoint is the incidence of AKI within 72 hours after surgery according to the KDIGO criteria. Secondary endpoints include use of renal replacement therapy (RRT), mortality during ICU and hospital stay, length of ICU and hospital stay and major adverse kidney events (combined endpoint consisting of persistent renal dysfunction, RRT and mortality) at day 90. Further, we will evaluate preoperative and intraoperative risk factors affecting the incidence of postoperative AKI. In an add-on analysis, we will assess urinary biomarkers for early detection of AKI. EPIS-AKI has been approved by the leading Ethics Committee of the Medical Council North Rhine-Westphalia, of the Westphalian Wilhelms-University Münster and the corresponding Ethics Committee at each participating site. Results will be disseminated widely and published in peer-reviewed journals, presented at conferences and used to design further AKI-related trials. Trial registration number NCT04165369

The discourse about infraction act embodied embodied in the Statute of the Child and Adolescent

A pesquisa tem como objetivo analisar o discurso sobre o ato infracional materializado no Estatuto da Criança e do Adolescente (ECA, 1990) e nos outros artigos jurídicos que se relacionam ao tema, sob a perspectiva teórica e metodológica da Análise do Discurso Pêcheutiana e da Psicanálise lacaniana. Para essas duas áreas do saber, a linguagem é estruturada por um furo, apresentando como composição lógica a equivocidade e a ambiguidade. Seguindo essa concepção, primeiramente, analisamos o funcionamento do discurso do Direito, especificamente no que se refere ao conceito de lei, de infração e de sanção; na sequência, apresentamos o processo sócio-histórico sobre a transgressão na adolescência, conforme as legislações, ao mesmo tempo em que delimitamos o corpus da pesquisa (recorte dos artigos jurídicos). Consideramos que esta lei opera como um dispositivo de controle da prática de ato infracional e que o funcionamento do discurso do Direito mascara a estrutura faltante da Lei e da linguagem. Essas observações nos levaram a traçar o fio discursivo dos outros capítulos - o sujeito do direito, o sujeito do desejo e a forma-sujeito-, já que todo discurso não é sem sujeito. Analisamos as posições ocupadas pelo adolescente que comete o ato infracional na visão dos regulamentos jurídicos, que têm como finalidade estabilizar o funcionamento social. Na continuação, articulamos o sujeito do direito, o ato infracional e as medidas socieducativas como manifestações do discurso capitalista, onde a norma jurídica ganha um estatuto de fetiche, assim como as mercadorias. Ao supormos a existência do sujeito do desejo, não tomamos o ato infracional somente como produto e condição do contexto social e econômico, pois há a singularidade do autor do ato. Concluímos que as legislações não produzem um lugar Simbólico para o sujeito, apenas um lugar Imaginário, como conferem o Estado e o ECA ao ofertar a ideologia de um sujeito de direito e a forma-sujeito de pessoa em desenvolvimento. Desse modo, a criação dos termos ato infracional e medida socioeducativa são interpretadas como efeitos de sentido do eu idealizado proposto pela ideologia capitalista e pela concepção psicológica de desenvolvimento. Nas condições de produção do ECA o adolescente é concebido como alguém passível de ser educado e cujo lugar de sujeito do desejo é ignorado. Portanto, o ato infracional configura-se como um sintoma social e um mal-estar na sociedade pós-moderna e a medida socioeducativa apresenta-se como um fracasso no que diz respeito a uma normalização do sujeito.This research aims to analyze the discourse on infraction act embodied in the Statute of the Child and Adolescent (ECA, 1990) and other legal articles that relate to the theme, from the theoretical and methodological perspective of Pêcheutiana Discourse Analysis and Lacanian Psychoanalysis. For these two areas of knowledge, language is structured by a hole, presenting as logic composition the equivocality and ambiguity. First, we analyze the functioning of the discourse of law, specifically with regard to the concept of law, the offense and sanction; following, we present the socio-historical process of transgression in adolescence, according to the legislation, while we delimit the research corpus (clipping of legal articles). We believe that this law operates as a control device of the practice of an offense and that the operation of the discourse of law masks the missing structure of law and language. These observations led us to trace the discursive thread of the other chapters - the subject of the right, the subject of desire and form-subject - since all speech is not without a subject. We analyzed the positions occupied by the adolescent who commits the offense in view of the legal regulations, which are intended to stabilize the social functioning. In continuation, we articulated the subject of law, infraction and educational measures as manifestations of capital.ist discourse, where the legal norm gains a fetish status, as well as goods. By assuming the existence of the subject of desire, we do not take offense only as the product and condition of the social and economic context, because there is uniqueness of the author of the act. We conclude that the laws do not produce a symbolic place for the subject, just an imaginary place, as conferring the State and the ECA to offer the ideology of a \"subject of law\" and the form-subject \"developing person\". Thus, the creation of the terms offense and socio-educational measures is idealized sense of the idealized \"I\" suggested by capitalist ideology and concept of development. Inside conditions of production of the ECA, adolescent is conceived as someone capable of being educated and whose place of subject of desire is ignored. Therefore, the infraction act configures itself as a social symptom and malaise in postmodern society and the socio-educational measures constitute a failure when it comes to a normalization of the subject

EPIdemiology of Surgery-Associated Acute Kidney Injury (EPIS-AKI): Study protocol for a multicentre, observational trial

Introduction More than 300 million surgical procedures are performed each year. Acute kidney injury (AKI) is a common complication after major surgery and is associated with adverse short-term and long-term outcomes. However, there is a large variation in the incidence of reported AKI rates. The establishment of an accurate epidemiology of surgery-associated AKI is important for healthcare policy, quality initiatives, clinical trials, as well as for improving guidelines. The objective of the Epidemiology of Surgery-associated Acute Kidney Injury (EPIS-AKI) trial is to prospectively evaluate the epidemiology of AKI after major surgery using the latest Kidney Disease: Improving Global Outcomes (KDIGO) consensus definition of AKI. Methods and analysis EPIS-AKI is an international prospective, observational, multicentre cohort study including 10 000 patients undergoing major surgery who are subsequently admitted to the ICU or a similar high dependency unit. The primary endpoint is the incidence of AKI within 72 hours after surgery according to the KDIGO criteria. Secondary endpoints include use of renal replacement therapy (RRT), mortality during ICU and hospital stay, length of ICU and hospital stay and major adverse kidney events (combined endpoint consisting of persistent renal dysfunction, RRT and mortality) at day 90. Further, we will evaluate preoperative and intraoperative risk factors affecting the incidence of postoperative AKI. In an add-on analysis, we will assess urinary biomarkers for early detection of AKI. Ethics and dissemination EPIS-AKI has been approved by the leading Ethics Committee of the Medical Council North Rhine-Westphalia, of the Westphalian Wilhelms-University Münster and the corresponding Ethics Committee at each participating site. Results will be disseminated widely and published in peer-reviewed journals, presented at conferences and used to design further AKI-related trials. Trial registration number NCT04165369.