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

Analysis of protein-coding genetic variation in 60,706 humans

Large-scale reference data sets of human genetic variation are critical for the medical and functional interpretation of DNA sequence changes. We describe the aggregation and analysis of high-quality exome (protein-coding region) sequence data for 60,706 individuals of diverse ethnicities generated as part of the Exome Aggregation Consortium (ExAC). This catalogue of human genetic diversity contains an average of one variant every eight bases of the exome, and provides direct evidence for the presence of widespread mutational recurrence. We have used this catalogue to calculate objective metrics of pathogenicity for sequence variants, and to identify genes subject to strong selection against various classes of mutation; identifying 3,230 genes with near-complete depletion of truncating variants with 72% having no currently established human disease phenotype. Finally, we demonstrate that these data can be used for the efficient filtering of candidate disease-causing variants, and for the discovery of human “knockout” variants in protein-coding genes

Private schools, choice and the ethical environment

In this paper, we consider the relationship between the existence of private schools and public attitudes towards questions about educational provision. Data from the 2010 British Social Attitudes survey suggest that parents who choose to send children to private schools may become more entrenched in their support for more extensive forms of parental partiality, with potential ramifications for the future supporting of progressive education policy. We suggest that addressing questions about the existence of certain forms of education and school choice policies requires consideration of the broader ethical environment

Una asociación florística de helechos-bennettitales en acumulaciones travertínicas del Titónico-Berriasiense (Formación Aguilar, Burgos-Palencia, España) y sus implicaciones paleoclimáticas y vegetacionales

[EN] This report describes a macrofloral fossil assemblage discovered in travertine deposits of the Tithonian-Berriasian Aguilar Formation (provinces of Palencia and Burgos, N Spain). The assemblage includes megaremains of a single species of Filicales (Cladophlebis denticulata) and of eleven taxa tentatively identified as Bennettitales (Otozamites mundae, Otozamites sp., Ptilophyllum pecten, Ptilophyllum pectiniformis, Ptilophyllum sp. cf. pectiniformis, Ptilophyllum acutifolium, Ptilophyllum sp., Pterophyllum cycadites, Pterophyllum sp. cf. thomasii, Zamites pumilio, and cf. Pseudocycas sp.). Specimens were preserved as impressions coated with a microbial film up to 5 mm thick made up of: bacteria and cyanobacteria. Based on the available sedimentological and palaeobotanical data, a dry-savannah vegetation and an arid climate were deduced. Late Jurassic macrofloras are globally scarce and have not previously been reported in Spain. Hence, the Aguilar Formation macroflora provides valuable information on the coeval phytogeography and palaeoclimate of southwestern Europe. Furthermore, the lack of floras observed so far in palaeotravertine deposits older than Pliocene in age makes this macroflora exceptional.[ES] Se describe por vez primera vez una macroflora fósil acumulada en facies travertínicas de edad Titónico-Berriasiense, correspondientes a la Formación Aguilar (provincias de Burgos y Palencia). Esta macroflora incluye una especie de Filicales (Cladophlebis denticulata) y once taxa atribuibles al Orden Bennettitales (Otozamites mundae, Otozamites sp., Ptilophyllum pecten, Ptilophyllum pectiniformis, Ptilophyllum sp. cf. pectiniformis, Ptilophyllum acutifolium, Ptilophyllum spp., Pterophyllum cycadites, Pterophyllum sp. cf. thomasi, Zamites pumilio, and cf. Pseudocycas sp.). Los ejemplares corresponden a impresiones de restos de hojas cubiertos por un velo microbiano bien preservado, de cerca de 5 mm, formado por bacterias y cianobacterias. La composición de la flora y los datos sedimentológicos permiten inferir una vegetación de sabana que se desarrollo bajo un clima árido. Las macrofloras del Jurásico Superior son escasas a escala mundial, no habiendo sido descrita ninguna en España. Por todo ello, la macroflora de la Formación Aguilar aporta una relevante información que puede contribuir a una mejor comprensión fitogeográfica y paleoclimática del suroeste de Europa en dicha edad. Además, la ausencia, a nivel global, de floras acumuladas en travertinos anteriores al Plioceno, permite considerar esta macroflora como excepcional..V. Pujalte acknowledges the support of grant CGL2005- 02770/BTE awarded by the Ministerio de Educación y Ciencia for the fieldwork needed for this study.Peer reviewe