Recently, Early Warning Signals (EWS) have been developed to predict tipping points in Earth Systems. This discussion highlights the potential to apply EWS to human social and economic systems, which may also undergo similar critical transitions. Social tipping points are particularly difficult to predict, however, and the current formulation of EWS, based on a physical system analogy, may be insufficient. As an alternative set of EWS for social systems, we join with other authors encouraging a focus on heterogeneity, connectivity through social networks and individual thresholds to change.

The Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury (AKI) guidelines assign the same stage of AKI to patients whether they fulfil urine output criteria, serum creatinine criteria or both criteria for that stage. This study explores the validity of the KDIGO guidelines as a tool to stratify the risk of adverse outcomes in cardiac surgery patients. Prospective data from consecutive adult patients admitted to the cardiac intensive care unit (CICU) following cardiac surgery between January 2013 and May 2015 were analysed. Patients were assigned to groups based on the criteria they met for each stage of AKI according to the KDIGO guidelines. Short and mid-term outcomes were compared between these groups. A total of 2267 patients were included with 772 meeting criteria for AKI-1 and 222 meeting criteria for AKI-2. After multivariable adjustment, patients meeting both urine output and creatinine criteria for AKI-1 were more likely to experience prolonged CICU stay (OR 4.9, 95%CI 3.3–7.4, p < 0.01) and more likely to require renal replacement therapy (OR 10.5, 95%CI 5.5–21.9, p < 0.01) than those meeting only the AKI-1 urine output criterion. Patients meeting both urine output and creatinine criteria for AKI-1 were at an increased risk of mid-term mortality compared to those diagnosed with AKI-1 by urine output alone (HR 2.8, 95%CI 1.6–4.8, p < 0.01). Patients meeting both urine output and creatinine criteria for AKI-2 were more likely to experience prolonged CICU stay (OR 16.0, 95%CI 3.2–292.0, p < 0.01) or require RRT (OR 11.0, 95%CI 4.2–30.9, p < 0.01) than those meeting only the urine output criterion. Patients meeting both urine output and creatinine criteria for AKI-2 were at a significantly increased risk of mid-term mortality compared to those diagnosed with AKI-2 by urine output alone (HR 3.6, 95%CI 1.4–9.3, p < 0.01). Patients diagnosed with the same stage of AKI by different KDIGO criteria following cardiac surgery have significantly different short and mid-term outcomes. The KDIGO criteria need to be revisited before they can be used to stratify reliably the severity of AKI in cardiac surgery patients. The utility of the criteria also needs to be explored in other settings.

Background—: The calibration of several cardiac clinical prediction models has deteriorated over time. We compare different model fitting approaches for in-hospital mortality after cardiac surgery that adjust for cross-sectional case mix in a heterogeneous patient population. Methods and Results—: Data from >300 000 consecutive cardiac surgery procedures performed at all National Health Service and some private hospitals in England and Wales between April 2001 and March 2011 were extracted from the National Institute for Cardiovascular Outcomes Research clinical registry. The study outcome was in-hospital mortality. Model approaches included not updating, periodic refitting, rolling window, and dynamic logistic regression. Covariate adjustment was made in each model using variables included in the logistic European System for Cardiac Operative Risk Evaluation model. The association between in-hospital mortality and some variables changed with time. Notably, the intercept coefficient has been steadily decreasing during the study period, consistent with decreasing observed mortality. Some risk factors, such as operative urgency and postinfarct ventricular septal defect, have been relatively stable over time, whereas other risk factors, such as left ventricular function and surgery on the thoracic aorta, have been associated with lower risk relative to the static model. Conclusions—: Dynamic models or periodic model refitting is necessary to counteract calibration drift. A dynamic modeling framework that uses contemporary and available historic data can provide a continuously smooth update mechanism that also allows for inferences to be made on individual risk factors. Better models that withstand the effects of time give advantages for governance, quality improvement, and patient-level decision making.

We explore how cultural heterogeneity evolves without strong selection pressure or environmental differences between groups. Using a neutral transmission model with an isolation-by-distance spatiality, we test the effect of a simple representation of cultural ‘memory’ on the dynamics of heterogeneity. We find that memory magnifies the effect of affinity while decreasing the effect of individual learning on cultural heterogeneity. This indicates that, while the cost of individual learning governs the frequency of individual learning, memory is important in governing its effect.

Geochronology is essential for understanding Earth's history. The availability of precise and accurate isotopic data is increasing; hence it is crucial to develop transparent and accessible data reduction techniques and tools to transform raw mass spectrometry data into robust chronological data. Here we present a Monte Carlo sampling approach to fully propagate uncertainties from linear regressions for isochron dating. Our new approach makes no prior assumption about the causes of variability in the derived chronological results and propagates uncertainties from both experimental measurements (analytical uncertainties) and underlying assumptions (model uncertainties) into the final age determination. Using synthetic examples, we find that although the estimates of the slope and y-intercept (hence age and initial isotopic ratios) are comparable between the Monte Carlo method and the benchmark "Isoplot" algorithm, uncertainties from the later could be underestimated by up to 60%, which are likely due to an incomplete propagation of model uncertainties. An additional advantage of the new method is its ability to integrate with geological information to yield refined chronological constraints. The new method presented here is specifically designed to fully propagate errors in geochronological applications involves linear regressions such as Rb-Sr, Sm-Nd, Re-Os, Pt-Os, Lu-Hf, U-Pb (with discordant points), Pb-Pb and Ar-Ar.