Differentiated legitimacy, differentiated resilience: beyond the natural in ‘natural disasters’

This paper starts with a flood in southern Malawi. Although apparently a ‘natural’ event, those most affected argued that it was made much worse by the rehabilitation of a nearby irrigation scheme. We use this example to interrogate the current interest in resilience from a perspective informed by political ecology and political economy, arguing that a focus on resilience should not be at the expense of understanding the conditions that shape vulnerability, including the ways in which ‘communities’ are differentiated. Complex factors are at play – and the ways in which these combine can result in a ‘perfect storm’ for some individuals and households. These factors include the effects of history combining with ethnicity, of legitimacy influencing voice, and of the interplay of political dynamics at different levels. In particular, processes of commodification have played an important role in shaping how some may benefit at the cost of catastrophic harm to others

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

Introduction to special issue:New Times Revisited: Britain in the 1980s

The authors in this volume are collectively engaged with a historical puzzle: What happens if we examine the decade once we step out of the shadows cast by Thatcher? That is, does the decade of the 1980s as a significant and meaningful periodisation (equivalent to that of the 1960s) still work if Thatcher becomes but one part of the story rather than the story itself? The essays in this collection suggest that the 1980s only makes sense as a political period. They situate the 1980s within various longer term trajectories that show the events of the decade to be as much the consequence as the cause of bigger, long-term historical processes. This introduction contextualises the collection within the wider literature, before explaining the collective and individual contributions made

Gender myths and feminist fables: the struggle for interpretive power in gender and development

Gender and development has grown enormously as a field over the last thirty years. In this introduction, we interrogate the ambivalence that underpins feminist engagement with development and examine what current dilemmas may suggest about the relationship between feminist knowledge and development practice. In recent years, there has been growing frustration with the simplistic slogans that have come to characterize much gender and development talk, and with the gap between professed intention and actual practice in policies and programmes. Questions are now being asked about what has become of ‘gender’ in development. This collection brings together critical reflections on some ideas about gender that have become especially resonant in development narratives, particularly those that entail popularization and the deployment of iconic images of women. This introduction explores more closely the issues raised by such myth‐making, arguing that these myths stem from exigencies within the politics and practices of development bureaucracies, within the difficult politics of feminist engagement with development policy and practice and within feminist politics itself