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

Measuring Gender Differences in Information Sharing Using Network Analysis: The Case of the Austrian Interlocking Directorship Network in 2009

In recent literature a relevant problem has been the relationship between career/personal contactnetworks and different career paths. In addition the recent advances in social capital theory have shown the way in which networks impact on personal careers. In particular womens careers appear to be negatively affected by the informational network structure. The main contribution of this work is to propose empirical evidence of this phenomenon by considering the gendered directorship network with relation to Austria and to show the structural differences by gender in the network. By using community detection techniques we have found various communities in which females seem not to be present at all, where females show significantly fewer contacts than males in the network, and finally where the proportion of males exceeds 91%. The results show the predominant role in the network of male directors;these differences are very relevant if we consider the network as a tool of vehicle information and as a power mechanism. In this paper we wish to make an original contribution to the debate of the well-known glass-ceiling effect