The epidemiology and outcomes of acute kidney injury following orthopaedic procedures: A retrospective cohort study.

BACKGROUND: Acute kidney injury (AKI) is a serious complication following major surgery. This study examined the incidence and risk factors of AKI following orthopaedic surgeries in an Icelandic cohort, as well as the association between AKI and patient- and surgery-related factors. METHODS: This retrospective cohort study comprised all patients 18 years and older who underwent orthopaedic surgeries at Landspitali - The National University Hospital in the years 2006-2018 with available serum creatinine (SCr) measurements adjacent to the surgery to stage AKI. AKI was defined according to SCr portion of the KDIGO criteria. Logistic regression was used to identify patient- and surgical factors related to progression of AKI and Poisson-regression was used to explore changes in incidence. RESULTS: A total of 222 cases of AKI following 3208 surgeries (6.9%) were identified in the study period with a rise in the incidence by about 17% per year. Higher age (odds ratio (OR), 1.02, 95% confidence interval (CI), 1.01-1.04 per year) and underlying reduction in kidney function (OR 1.93 (1.30-2.81), 3.24 (2.08-4.96) and 4.08 (2.35-6.96) for estimated glomerular filtration rate (eGFR) of 30-59, 15-29 and <15 mL/min/1.73 m2 compared with eGFR >60 mL/min/1.73 m2 ) were associated with higher risk of AKI, but female sex was associated with decreased odds (OR = 0.73; 95% CI, 0.54-0.98). After correcting for age, sex, preoperative kidney function, emergency surgery and underlying comorbidities and frailty, there was an increased risk of long-term mortality in patients with AKI (HR 1.41, 95% CI 1.08-1.85), and patients who developed AKI also had accelerated progression of chronic kidney disease compared with patients who did not develop AKI. CONCLUSIONS: The incidence of AKI following orthopaedic surgeries is increasing and is associated with adverse outcomes. It is important that elderly individuals and patients who have reduced kidney function receive adequate monitoring and surveillance in the perioperative period.

Letter-sound knowledge in Icelandic children at the age 6 years-old.

The aim of this study was to examine letter-sound knowledge when children start at school in Iceland. 392 children aged 5-6 years completed assessments of letter-sound knowledge, i.e., the names and sounds of uppercase and lowercase letters of the Icelandic alphabet (uppercase letter-name; uppercase letter-sound; lowercase letter-name; lowercase letter-sound). Whether the child had broken the reading code (could read words) was also recorded. The results revealed no significant difference between girls and boys in the four factors (letter name, letter sound). The results indicated that 56.9 % of the children had broken the reading code when they started school. 58.2 % of the girls and 55.6 % of the boys, not significant difference between the genders. There was a significant difference between the group which had broken the reading code and the group which have not in all the four factors. There was also a high significant correlation between all 4 variables from 0.915 between uppercase letter and lowercase sound to 0.963 between uppercase sounds and uppercase letter. Based on these data, it seems reasonable to advocate learning letter-sound correspondences early in the first year of school to form the best possible basis for breaking the reading code and further reading development.

Reading: From the Simple to the Complex.

The aim of this article was to present an important perspective on reading skill development. The perspective 'READ' builds on the phonics approach which has been found to be most important in relation to reading achievement i.e., to teach children to break the reading code. In addition, READ builds on theories within learning and skill development. The Ericsson concept of 'deliberate practice' refer to baseline measurements that provide a basis for follow-up and deliberate practice. The concept of 'flow' is also of great importance where challenges are always in relation to the skills. It means that each child will be able to experience 'flow' where mastery is the key word, feeling I CAN! When mastery is experienced, the dopamine hormone gives the feeling of reward. Stimuli, experience, and repetition is also a key word in the 'training hour' where children get the possibility to strengthen the neural network that is used for specific skills which are trained. In this respect, the letter-sound knowledge is trained until the child has broken the reading code. The results from the first year in the school in Vestmannaeyjar in Iceland indicates that all the children were able to break the reading code or read simple words. In addition, 96% of the children were able to read sentences, and 88% where able to read text. These promising results are discussed in relation to Ericsson's and Csikszentmihalyi's important theories.