A Mi\u27kmaq First Nation cosmology: investigating the practice of contemporary Aboriginal Traditional Medicine in dialogue with counselling – toward an Indigenous therapeutics

This paper explores from a Mi’kmaq and Aboriginal standpoint foundational knowledge in Indigenous therapeutics. Based on an eco-social-psycho-spiritual way of working, the article proposes Indigenous cultural models that open a window to a rich cultural repository of meanings associated with Indigenous cosmology, ontology and epistemology. The three layers of meaning, theory and practice within the symbolic ‘Medicine Lodge’ or ‘Place of The Dreaming’ give rise to ways of working that are deeply integrative and wholistic. These forms of Indigenous theory and practice have much to offer the counselling and complimentary health professions

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

Diabetic ketoacidosis

Diabetic ketoacidosis (DKA) is the most common acute hyperglycaemic emergency in people with diabetes mellitus. A diagnosis of DKA is confirmed when all of the three criteria are present — ‘D’, either elevated blood glucose levels or a family history of diabetes mellitus; ‘K’, the presence of high urinary or blood ketoacids; and ‘A’, a high anion gap metabolic acidosis. Early diagnosis and management are paramount to improve patient outcomes. The mainstays of treatment include restoration of circulating volume, insulin therapy, electrolyte replacement and treatment of any underlying precipitating event. Without optimal treatment, DKA remains a condition with appreciable, although largely preventable, morbidity and mortality. In this Primer, we discuss the epidemiology, pathogenesis, risk factors and diagnosis of DKA and provide practical recommendations for the management of DKA in adults and children

Magnitude of latent heat in thermally loaded clays

International audienceTemperature changes are known to induce specific couplings in clay, in particular, an anomalously high thermal pressurization in undrained conditions, or a thermal compaction in drained conditions, both of which are potential threats for the mechan- ical stability and sealing capacity of the geomaterials. Thermodynamical analysis of those peculiar thermo-mechanical couplings points to a potentially important latent energy which in turn could limit the temperature change upon heating or cooling. The direct measurement of latent energy developed during a laboratory geomechanical test is challenging. Instead, proper identification of thermal hardening in conven- tional experiments with temperature changes provides an alternative route to estimate latent energy. In this work, existing laboratory thermomechanical tests of clays are analyzed with a rigorous thermodynamic framework to quantify the magnitude of latent energy in thermo-mechanically loaded clays. A thermodynamically consistent constitutive model for fully saturated clays that combines two key features: i) the temperature dependence of the blocked energy and ii) the framework of bounding plasticity, is proposed. The performance of the model is validated by reproducing results obtained in laboratory tests for Boom and Opalinus clays. The thermomechan- ical loads considered to validate the model performance, were then used to estimate the percentage ofwork that remains latent in the clayey material during plastic yield- ing. We find that the magnitude of latent energy is quite significant, typically a few tens of percent of the total dissipated energy, and increases significantly with temper- ature. Accordingly, it is expected to play an important role in the thermo-mechanical response of clays