IMPORTANCE Chronic kidney disease (low estimated glomerular filtration rate [eGFR] or albuminuria) affects approximately 14% of adults in the US.OBJECTIVE To evaluate associations of lower eGFR... Show moreIMPORTANCE Chronic kidney disease (low estimated glomerular filtration rate [eGFR] or albuminuria) affects approximately 14% of adults in the US.OBJECTIVE To evaluate associations of lower eGFR based on creatinine alone, lower eGFR based on creatinine combined with cystatin C, and more severe albuminuria with adverse kidney outcomes, cardiovascular outcomes, and other health outcomes.DESIGN, SETTING, AND PARTICIPANTS Individual-participant data meta-analysis of 27 503 140 individuals from 114 global cohorts (eGFR based on creatinine alone) and 720 736 individuals from 20 cohorts (eGFR based on creatinine and cystatin C) and 9 067 753 individuals from 114 cohorts (albuminuria) from 1980 to 2021.EXPOSURES The Chronic Kidney Disease Epidemiology Collaboration 2021 equations for eGFR based on creatinine alone and eGFR based on creatinine and cystatin C; and albuminuria estimated as urine albumin to creatinine ratio (UACR).MAIN OUTCOMES AND MEASURES The risk of kidney failure requiring replacement therapy, all-cause mortality, cardiovascular mortality, acute kidney injury, any hospitalization, coronary heart disease, stroke, heart failure, atrial fibrillation, and peripheral artery disease. The analyses were performed within each cohort and summarized with random-effects meta-analyses.RESULTS Within the population using eGFR based on creatinine alone (mean age, 54 years [SD, 17 years]; 51% were women; mean follow-up time, 4.8 years [SD, 3.3 years]), the mean eGFR was 90 mL/min/1.73m(2) (SD, 22 mL/min/1.73m(2)) and the median UACR was 11mg/g (IQR, 8-16mg/g). Within the population using eGFR based on creatinine and cystatin C (mean age, 59 years [SD, 12 years]; 53% were women; mean follow-up time, 10.8 years [SD, 4.1 years]), the mean eGFR was 88 mL/min/1.73m(2) (SD, 22 mL/min/1.73m(2)) and the median UACR was 9mg/g (IQR, 6-18mg/g). Lower eGFR (whether based on creatinine alone or based on creatinine and cystatin C) and higher UACR were each significantly associated with higher risk for each of the 10 adverse outcomes, including those in the mildest categories of chronic kidney disease. For example, among people with a UACR less than 10mg/g, an eGFR of 45 to 59 mL/min/1.73m(2) based on creatinine alone was associated with significantly higher hospitalization rates compared with an eGFR of 90 to 104 mL/min/1.73m(2) (adjusted hazard ratio, 1.3 [95% CI, 1.2-1.3]; 161 vs 79 events per 1000 person-years; excess absolute risk, 22 events per 1000 person-years [95% CI, 19-25 events per 1000 person-years]).CONCLUSIONS AND RELEVANCE In this retrospective analysis of 114 cohorts, lower eGFR based on creatinine alone, lower eGFR based on creatinine and cystatin C, and more severe UACR were each associated with increased rates of 10 adverse outcomes, including adverse kidney outcomes, cardiovascular diseases, and hospitalizations. Show less
Jungblut, J.; Gouglas, A.; Katz, G.; Bandola-Gill, J.; Brans, M.; Timmermans, A.; ... ; Xhindi, N. 2023
The relevance and impact of political scientists' professional activities outside of universities has become the focus of public attention, partly due to growing expectations that research should... Show moreThe relevance and impact of political scientists' professional activities outside of universities has become the focus of public attention, partly due to growing expectations that research should help address society's grand challenges. One type of such activity is policy advising. However, little attention has been devoted to understanding the extent and type of policy advising activities political scientists engage in. This paper addresses this gap by adopting a classification that distinguishes four ideal types of policy advisors representing differing degrees of engagement. We test this classification by calculating a multi-level latent class model to estimate key factors explaining the prevalence of each type based on an original dataset obtained from a survey of political scientists across 39 European countries. Our results challenge the wisdom that political scientists are sitting in an "ivory tower": the vast majority (80%) of political scientists in Europe are active policy advisers, with most of them providing not only expert guidance but also normative assessments. Show less
The use of 7 Tesla (T) magnetic resonance imaging (MRI) is expanding across medical specialties, particularly, clinical neurosciences and orthopedics. Investigational 7 T MRI has also been... Show moreThe use of 7 Tesla (T) magnetic resonance imaging (MRI) is expanding across medical specialties, particularly, clinical neurosciences and orthopedics. Investigational 7 T MRI has also been performed in cardiology. A limiting factor for expansion of the role of 7 T, irrespective of the body part being imaged, is the sparse testing of biomedical implant compatibility at field strengths >3 T. Implant compatibility can be tested following the American Society for Testing and Materials International guidelines. To assess the current state of cardiovascular implant safety at field strengths >3 T, a systematic search was performed using PubMed, Web of Science, and citation matching. Studies written in English that included at least 1 cardiovascular-related implant and at least 1 safety outcome (deflection angle, torque, or temperature change) were included. Data were extracted for the implant studied, implant composition, deflection angle, torque, and temperature change, and the American Society for Testing and Materials International standards were followed. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guidelines for scoping reviews were followed. A total of 9 studies were included. A total of 34 cardiovascular-related implants tested ex vivo at 7 T and 91 implants tested ex vivo at 4.7 T were included. The implants included vascular grafts and conduits, vascular access ports, peripheral and coronary stents, caval filters, and artificial valves. A total of 2 grafts, 1 vascular access port, 2 vena cava filters, and 5 stents were identified as incompatible with the 7 T MRI. All incompatible stents were 40 mm in length. Based on the safety outcomes reported, we identify several implants that may be compatible with >3 T MRI. This scoping review seeks to concisely summarize all the cardiovascular-related implants tested for ultrahigh field MRI compatibility to date. & COPY; 2023 Elsevier Inc. All rights reserved. (Am J Cardiol 2023;201:239-246) Show less
The use of 7 Tesla (T) magnetic resonance imaging (MRI) is expanding across neurosurgical and neurologic specialties. However, few neurosurgical-related implants have been tested for safety at 7 T,... Show moreThe use of 7 Tesla (T) magnetic resonance imaging (MRI) is expanding across neurosurgical and neurologic specialties. However, few neurosurgical-related implants have been tested for safety at 7 T, limiting its use in patients with cranial fixation, shunt placements, and other implants. Implant safety can be determined via the American Society for Testing Materials International (ASTM) guidelines. To assess the current state of neurosurgical implant safety at 7 T, a systematic search was performed using PubMed, MEDLINE, Web of Knowledge, and citation matching. Studies written in English that included at least one neurosurgical implant and at least one safety outcome were included. Data were extracted for implant studied, implant composition, deflection angle, torque, temperature change, and ASTM guidelines followed. PRISMA reporting guidelines for scoping reviews were followed. Overall, 18 studies consisting of 45 unique implants were included. Implants included cranial fixation devices, aneurysm clips, spinal rods, pedicle screws, ventriculoperitoneal (VP) shunts, deep brain stimulation devices, and electroencephalogram (EEG) caps and electrodes. Cranial fixation devices, deep brain stimulation devices, spinal rods, and pedicle screws are likely 7 T MRI compatible based on outcomes reported. Aneurysm clips and EEG devices had variable safety outcomes. The VP shunts studied lost functionality after 7 T MRI exposure. We identified several implants that are likely compatible with 7 T MRI. Given the growth in 7 T imaging and expansion of the technology, neurosurgical implants should be constructed with the aforementioned considerations. Caution must be taken with all implants, especially aneurysm clips, programmable VP shunts, and EEG recording devices. It is also noteworthy that several implant testing reports did not report following ASTM standards. This scoping review seeks to concisely summarize all neurosurgical-related implants that have been tested for safety in 7 T MRI. Show less
