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

The (geo)politics of land and foreign real estate investment in China: the case of Hong Kong FDI

2016-2017 > Academic research: refereed > Publication in refereed journalbcrcAuthor’s OriginalOthersCentennial College (CRG)Publishe

Le Canada superpuissance énergétique? L'affaire Nexen et la crédibilité de la politique conservatrice envers la Chine

La coopération énergétique sino-canadienne découle d'une dépendance stratégique mutuelle. Pour le gouvernement canadien, assurer les débouchés internationaux et développer la capacité de transport guident l'action gouvernementale et la politique étrangère. C'est dans ce contexte qu'il faut comprendre la priorité accordée à la Chine, malgré d'importantes réticences sur le plan du contrôle d'un État étranger sur ce secteur stratégique. Pour les autorités chinoises, par-delà les discours et les symboles, l'autorisation par les autorités canadienne du rachat de Nexen par la société d’État chinoise China National Offshore Oil Corp (CNOOC) représente à la fois un test de crédibilité de la nouvelle politique conservatrice et l'expression concrète du nouveau partenariat stratégique Chine-Canada

Conflicts between biodiversity conservation and development in a biosphere reserve

1. Integrating biodiversity conservation and the development of local communities is a major challenge for biosphere reserves. Their zonation (core, buffer and transition) is intended to promote biodiversity conservation and sustainable development, although only the core zone is legally constituted to conserve biological diversity. Inevitably, and especially in developing countries, the management of biosphere reserves has to reconcile trade-offs between conservation and development, and address the pressures placed by local communities on the biodiversity resources of the reserve. 2. We studied the effects of development in the three zones of Yancheng Biosphere Reserve (eastern China) on the endangered red-crowned crane Grus japonensis, the waterbird communities and the economic benefits to local communities. We tested the hypothesis that allowing different developments within each zone can reduce conflict between biodiversity conservation and community development. 3. The number of cranes in the reserve increased from 361 to approximately 1100 between 1982 and 1999, but declined markedly to 612 in 2003. The cranes also became increasingly concentrated in the core zone and switched to feeding predominantly in artificial habitats. The proportion of cranes in the core, buffer and transition zones was largely associated with the proportion of developed land area and the total number of cranes in the reserve as a whole. 4. Developments in the transition zone have reduced and degraded the wetlands, and have disadvantaged cranes and waterbirds. In contrast, the transformation of natural wetlands into artificial ones in the core zone has, to date, continued to support cranes and waterbirds. This has brought economic benefits to the reserve and local communities, but at the cost of the integrity of the wetland ecosystem as a whole. 5. Synthesis and applications. Despite an increase in the number of red-crowned cranes in Yancheng Biosphere Reserve, their range has collapsed into the core of the reserve where there is now a substantial artificial wetland complex. Allowing development in all three zones, together with a lack of resources for conservation, appears to have contributed to the reserve becoming overdeveloped. The loss of ecosystem integrity across the reserve as a whole highlights the need for an ecosystem-based approach to future management combined with the restoration of natural wetlands