Mortality and Cardiovascular Disease among Older Live Kidney Donors

Over the past two decades, live kidney donation by older individuals (≥55 years) has become more common. Given the strong associations of older age with cardiovascular disease (CVD), nephrectomy could make older donors vulnerable to death and cardiovascular events. We performed a cohort study among older live kidney donors who were matched to healthy older individuals in the Health and Retirement Study. The primary outcome was mortality ascertained through national death registries. Secondary outcomes ascertained among pairs with Medicare coverage included death or CVD ascertained through Medicare claims data. During the period from 1996 to 2006, there were 5717 older donors in the United States. We matched 3368 donors 1:1 to older healthy nondonors. Among donors and matched pairs, the mean age was 59 years; 41% were male and 7% were black race. In median follow-up of 7.8 years, mortality was not different between donors and matched pairs (p = 0.21). Among donors with Medicare, the combined outcome of death/CVD (p = 0.70) was also not different between donors and nondonors. In summary, carefully selected older kidney donors do not face a higher risk of death or CVD. These findings should be provided to older individuals considering live kidney donation

Invisible interpretations: reflections on the digital humanities and intellectual history

Much has been made of the digital humanities, yet it remains an underexplored field in relation to intellectual history. This paper aims to add to the little literature which does exist by offering a survey of the ideas and issues facing would-be practitioners. This includes: an overview of what the digital humanities are; reflections on what they offer intellectual history and how they may be problematic in regard to, first, accessing texts, and second, analysing source material; a conclusion with three reflections on future best practices – to be sceptical of digital sources, to be reflective of methodologies and how they may need to be modified when engaging with the digital humanities, and to embrace more directly the methodological, statistical, and technical aspects behind digital humanities. The aim is not to provide all the answers – at this stage that is impossible – but to be part of an emerging and ongoing discussion

Measures of Global Health Status on Dialysis Signal Early Rehospitalization Risk after Kidney Transplantation

<div><p>Background</p><p>Early rehospitalization (<30 days) after discharge from kidney transplantation (KT) is associated with poor outcomes. We explored summary metrics of pre-transplant health status that may improve the identification of KT recipients at risk for early rehospitalization and mortality after transplant.</p><p>Materials and Methods</p><p>We performed a retrospective cohort study of 8,870 adult (≥ 18 years) patients on hemodialysis who received KT between 2000 and 2010 at United States transplant centers. We linked Medicare data to United Network for Organ Sharing data and data from a national dialysis provider to examine pre-KT (1) Elixhauser Comorbidity Index, (2) physical function (PF) measured by the Short Form 36 Health Survey, and (3) the number of hospitalizations during the 12 months before KT as potential predictors of early rehospitalization after KT. We also explored whether these metrics are confounders of the known association between early rehospitalization and post-transplant mortality.</p><p>Results</p><p>The median age was 52 years (interquartile range [IQR] 41, 60) and 63% were male. 29% were rehospitalized in <30 days, and 20% died during a median follow-up time of five years (IQR 3.6–6.5). In a multivariable logistic model, kidney recipients with more pre-KT Elixhauser comorbidities (adjusted odds ratio [aOR] 1.09 per comorbidity, 95% Confidence Interval [CI] 1.07–1.11), the poorest pre-KT PF (aOR 1.24, 95% CI 1.08–1.43), or >1 pre-KT hospitalizations (aOR 1.32, 95% CI 1.17–1.49) were more likely to be rehospitalized. All three health status metrics and early rehospitalization were independently associated with post-KT mortality in a multivariable Cox model (adjusted hazard ratio for rehospitalization: 1.41, 95% CI 1.28–1.56)</p><p>Conclusions</p><p>Pre-transplant metrics of health status, measured by dialysis providers or administrative data, are independently associated with early rehospitalization and mortality risk after KT. Transplant providers may consider utilizing metrics of pre-KT global health status as early signals of vulnerability when transitioning care after KT.</p></div

Correlating Spatial Ability With Anatomy Assessment Performance: A Meta-Analysis.

Interest in spatial ability has grown over the past few decades following the emergence of correlational evidence associating spatial aptitude with educational performance in the fields of science, technology, engineering, and mathematics. The research field at large and the anatomy education literature on this topic are mixed. In an attempt to generate consensus, a meta-analysis was performed to objectively summarize the effects of spatial ability on anatomy assessment performance across multiple studies and populations. Relevant studies published within the past 50 years (1969–2019) were retrieved from eight databases. Study eligibility screening was followed by a full-text review and data extraction. Use of the Mental Rotations Test (MRT) was required for study inclusion. Out of 2,450 screened records, 15 studies were meta-analyzed. Seventy-three percent of studies (11 of 15) were from the U.S. and Canada, and the majority (9 of 15) studied professional students. Across 15 studies and 1,245 participants, spatial ability was weakly associated with anatomy performance (r(pooled) = 0.240; CI at 95% = 0.09, 0.38; p = 0.002). Performance on spatial and relationship-based assessments (i.e., practical assessments and drawing tasks) was correlated with spatial ability, while performance on assessments utilizing non-spatial multiple-choice items was not correlated with spatial ability. A significant sex difference was also observed, wherein males outperformed females on spatial ability tasks. Given the role of spatial and non-spatial reasoning in learning anatomy, educators are encouraged to consider curriculum delivery modifications and a comprehensive assessment strategy so as not to disadvantage individuals with low spatial ability

Prediction of the outcome of early rehospitalization after kidney transplantation using global health metrics.

<p>Baseline and subsequent logistic models adjusted for (1) <i>recipient</i> age category at transplant, sex, race, hepatitis C serostatus, obesity by body mass index (≥30 kg/m²), dialysis vintage (years), time on the waitlist (years), history of diabetes, history of previous solid organ transplant, education status, (2) <i>donor</i> type (live vs. deceased donor, expanded criteria deceased [ECD] donor); (3) <i>allograft</i> variables of delayed graft function, and (4) <i>process-of-care</i> variables of length of initial transplant hospitalization (days), weekend discharge (defined as discharge on Saturday or Sunday), and low transplant center volume (defined as <150 kidney transplants performed, on average, per year).</p

Adjusted Probability (with 95% Confidence Intervals) of Rehospitalization Based on Pre-Transplant Health Metrics.

<p>Adjusted for (1) <i>recipient</i> age category at transplant, sex, race, hepatitis C serostatus, obesity by body mass index (≥30 kg/m²), dialysis vintage (years), time on the waitlist (years), history of diabetes, history of previous solid organ transplant, education status, (2) <i>donor</i> type (live vs. deceased donor, expanded criteria deceased [ECD] donor); (3) <i>allograft</i> variables of delayed graft function, and (4) <i>process-of-care</i> variables of length of initial transplant hospitalization (days), weekend discharge (defined as discharge on Saturday or Sunday), and low transplant center volume (defined as <150 kidney transplants performed, on average, per year).</p

Comparison of Logistic Regression Models for Early Rehospitalization.

<p>Comparison of Logistic Regression Models for Early Rehospitalization.</p

Poor Global Health Status and Early Rehospitalization Both Augment Mortality Risk after Kidney Transplantation.

<p>Cox models also adjusted for (1) <i>recipient</i> age category at transplant, sex, race, hepatitis C serostatus, obesity by body mass index (≥30 kg/m²), dialysis vintage (years), time on the waitlist (years), history of diabetes, history of previous solid organ transplant, education status, (2) <i>donor</i> type (live vs. deceased donor, expanded criteria deceased [ECD] donor); (3) <i>allograft</i> variables of delayed graft function, and (4) <i>process-of-care</i> variables of length of initial transplant hospitalization (days), weekend discharge (defined as discharge on Saturday or Sunday), and low transplant center volume (defined as <150 kidney transplants performed, on average, per year).</p

Distribution of Health Metrics, Stratified by Rehospitalization Status.

<p>Distribution of Health Metrics, Stratified by Rehospitalization Status.</p