Nephrology & Hypertension
Permanent URI for this collectionhttp://hdl.handle.net/10342/93
Browse
Recent Submissions
Item Open Access Method and apparatus for treating renal disease with hemodialysis utilizing pulsatile pump(2002-08-22) Bolin, Paul Jr.A method of removing toxins from blood from a patient in need of such toxin removal includes: providing a countercurrent dialysis filter (20) having a blood compartment and a dialysate compartment separated from the blood compartment by a semi-permeable membrane; conveying blood from the patient through the blood compartment of a countercurrent filter (20) an back to the patient; and drawing dialysate from a reservoir (32) through the dialysate compartment of the countercurrent filter (20). At least one of the blood or dialysate experiences pulsatile flow. The steps are carried out such that blood toxins are drawn from the blood compartment through the semi-permeable membrane into the dialysate compartment.Item Open Access Introducing the global medical community to the information presented at local scientific conferences through nephrology blogs(2012-12) Desai, Tejas; Fang, Xiangming; Ferris, Maria E.An increasing number of healthcare providers author medical blogs (bloggers) to educate the public and fellow physicians. Traditionally, many bloggers have assumed that readers are most interested in information presented at prestigious and popular scientific meetings. As a result, the readers and bloggers often ignore blogs of local scientific meetings. We hypothesize that blog readers will utilize blogs about local scientific meetings less than those about national meetings. We examined nephrology-pertinent blogs from 2010-2012. Blogs were categorized as "local/regional" or "national/international" based on the majority of the audience that attended the live scientific meeting. We tracked the number of pageviews, reading time, and location of use per blog for the first 90-days after its first availability on the website. Wilcoxon testing was performed on all data. There were 9 local/regional and 11 national/international scientific meetings for which blogs were available. The mean number of page views was significantly lower in blogs from local/regional than national/international conferences (84.7 versus 160.3, respectively; p < 0.01). However, the mean difference in total reading time between both categories of blogs was not significant (p = 0.25). Data from this investigation do not fully support the hypothesis that readers utilized local/regional blogs less than national/international blogs. Although local/regional blogs attracted fewer readers (lower pageviews), the content in these blogs was compelling enough to keep the reader equally engaged as with national/international blogs.Item Open Access Tweeting the Meeting: An In-Depth Analysis of Twitter Activity at Kidney Week 2011(2012) Desai, Tejas; Shariff, Afreen; Shariff, Aabid; Kats, Mark; Fang, Xiangming; Christiano, Cynthia; Ferris, Maria E.In recent years, the American Society of Nephrology (ASN) has increased its efforts to use its annual conference to inform and educate the public about kidney disease. Social media, including Twitter, has been one method used by the Society to accomplish this goal. Twitter is a popular microblogging service that serves as a potent tool for disseminating information. It allows for short messages (140 characters) to be composed by any author and distributes those messages globally and quickly. The dissemination of information is necessary if Twitter is to be considered a tool that can increase public awareness of kidney disease. We hypothesized that content, citation, and sentiment analyses of tweets generated from Kidney Week 2011 would reveal a large number of educational tweets that were disseminated to the public. An ideal tweet for accomplishing this goal would include three key features: 1) informative content, 2) internal citations, and 3) positive sentiment score. Informative content was found in 29% of messages, greater than that found in a similarly sized medical conference (2011 ADA Conference, 16%). Informative tweets were more likely to be internally, rather than externally, cited (38% versus 22%, p<0.0001), thereby amplifying the original information to an even larger audience. Informative tweets had more negative sentiment scores than uninformative tweets (means −0.162 versus 0.199 respectively, p<0.0001), therefore amplifying a tweet whose content had a negative tone. Our investigation highlights significant areas of promise and improvement in using Twitter to disseminate medical information in nephrology from a scientific conference. This goal is pertinent to many nephrology-focused conferences that wish to increase public awareness of kidney disease.Item Open Access Factors that contribute to social media influence within an Internal Medicine Twitter learning community(2014-05) Desai, Tejas; Patwardhan, Manish; Coore, HunterMedical societies, faculty, and trainees use Twitter to learn from and educate other social media users. These social media communities bring together individuals with various levels of experience. It is not known if experienced individuals are also the most influential members. We hypothesize that participants with the greatest experience would be the most influential members of a Twitter community. We analyzed the 2013 Association of Program Directors in Internal Medicine Twitter community. We measured the number of tweets authored by each participant and the number of amplified tweets (re-tweets). We developed a multivariate linear regression model to identify any relationship to social media influence, measured by the PageRank. Faculty (from academic institutions) comprised 19% of the 132 participants in the learning community (p < 0.0001). Faculty authored 49% of all 867 tweets (p < 0.0001). Their tweets were the most likely to be amplified (52%, p < 0.01). Faculty had the greatest influence amongst all participants (mean 1.99, p < 0.0001). Being a faculty member had no predictive effect on influence (β = 0.068, p = 0.6). The only factors that predicted influence (higher PageRank) were the number of tweets authored (p < 0.0001) and number of tweets amplified (p < 0.0001) The status of “faculty member” did not confer a greater influence. Any participant who was able to author the greatest number of tweets or have more of his/her tweets amplified could wield a greater influence on the participants, regardless of his/her authority.Item Open Access Is Content Really King? An Objective Analysis of the Public's Response to Medical Videos on YouTube(2013) Desai, Tejas; Shariff, Afreen; Dhingra, Vibhu; Minhas, Deeba; Eure, Megan; Kats, MarkMedical educators and patients are turning to YouTube to teach and learn about medical conditions. These videos are from authors whose credibility cannot be verified & are not peer reviewed. As a result, studies that have analyzed the educational content of YouTube have reported dismal results. These studies have been unable to exclude videos created by questionable sources and for non-educational purposes. We hypothesize that medical education YouTube videos, authored by credible sources, are of high educational value and appropriately suited to educate the public. Credible videos about cardiovascular diseases were identified using the Mayo Clinic's Center for Social Media Health network. Content in each video was assessed by the presence/absence of 7 factors. Each video was also evaluated for understandability using the Suitability Assessment of Materials (SAM). User engagement measurements were obtained for each video. A total of 607 videos (35 hours) were analyzed. Half of all videos contained 3 educational factors: treatment, screening, or prevention. There was no difference between the number of educational factors present & any user engagement measurement (p NS). SAM scores were higher in videos whose content discussed more educational factors (p<0.0001). However, none of the user engagement measurements correlated with higher SAM scores. Videos with greater educational content are more suitable for patient education but unable to engage users more than lower quality videos. It is unclear if the notion “content is king” applies to medical videos authored by credible organizations for the purposes of patient education on YouTube.Item Open Access Expression of a protein involved in bone resorption, Dkk1, is activated by HTLV-1 bZIP factor through its activation domain(2010) Polakowski, Nicholas; Gregory, Heather; Mesnard, Jean-Michel; Lemasson, IsabelleBackground Human T-cell leukemia virus type 1 (HTLV-1) is the etiologic agent of adult T-cell leukemia, a malignancy characterized by uncontrolled proliferation of virally-infected CD4+ T-cells. Hypercalcemia and bone lesions due to osteoclast-mediated bone resorption are frequently associated with more aggressive forms of the disease. The HTLV-1 provirus contains a unique antisense gene that expresses HTLV-1 basic leucine zipper (bZIP) factor (HBZ). HBZ is localized to the nucleus where it regulates levels of transcription by binding to certain cellular transcriptional regulators. Among its protein targets, HBZ forms a stable complex with the homologous cellular coactivators, p300 and CBP, which is modulated through two N-terminal LXXLL motifs in the viral protein and the conserved KIX domain in the coactivators. Results To determine the effects of these interactions on transcription, we performed a preliminary microarray analysis, comparing levels of gene expression in cells with wild-type HBZ versus cells with HBZ mutated in its LXXLL motifs. DKK1, which encodes the secreted Wnt signaling inhibitor, Dickkopf-1 (Dkk1), was confirmed to be transcriptionally activated by HBZ, but not its mutant. Dkk1 plays a major role in the development of bone lesions caused by multiple myeloma. In parallel with the initial findings, activation of Dkk1 expression by HBZ was abrogated by siRNA-mediated knockdown of p300/CBP or by a truncated form of p300 containing the KIX domain. Among HTLV-1-infected T-cell lines tested, the detection of Dkk1 mRNA partially correlated with a threshold level of HBZ mRNA. In addition, an uninfected and an HTLV-1-infected T-cell line transfected with an HBZ expression vector exhibited de novo and increased DKK1 transcription, respectively. In contrast to HBZ, The HTLV-1 Tax protein repressed Dkk1 expression. Conclusions These data indicate that HBZ activates Dkk1 expression through its interaction with p300/CBP. However, this effect is limited in HTLV-1-infected T-cell lines, which in part, may be due to suppression of Dkk1 expression by Tax. Consequently, the ability of HBZ to regulate expression of Dkk1 and possibly other cellular genes may only be significant during late stages of ATL, when Tax expression is repressed.Item Open Access Alternative ideas to increase the percentage of filled seats in nephrology fellowships(2014-01) Desai, TejasInterest in nephrology has been decreasing for the last decade. In this opinion piece, the author provides four unconventional, outside-the-box strategies to increase the percentage of filled nephrology training positions.Item Open Access Comparing two models that reduce the number of nephrology fellowship positions in the United States(2015-01) Desai, TejasThere has been a steady decline in the number of applications to nephrology training programs. One solution is to decrease the number of available fellowship positions. Proponents believe that training programs have grown too big but the method for reduction has not been established. This investigation analyzes two models that decrease the number of available training positions and compares them head-to-head to identify the least burdensome method by which this reduction should occur. In the survival of the fittest model (SotFM) fellowship positions are eliminated if they were unfilled in the National Residency Match Program’s (NRMP) 2013 Specialty Match. In the equal proportions model (EPM) a formula is used to calculate a priority score using ESRD prevalence data from the 2013 USRDS Report and the geometric mean between a given jurisdiction’s current apportionment (n) and its next position (n + 1). The least burdensome model is that which results in the (1) least number of jurisdictions losing fellow positions and (2) lowest percent reduction for any single jurisdiction. There were 416 nephrology positions offered and 47 unfilled in 2013. In the SotFM, 23 jurisdictions would sacrifice these 47 positions. In the EPM, 369 positions were apportioned (=416–47); only 9 jurisdictions would experience a reduction. The largest single-jurisdiction reduction in fellow positions was 67% (SotFM) and 50% (EPM). The EPM results in a less burdensome reduction of fellow positions nationwide. The EPM is a time-tested model that injects fairness into the painful process of reducing the total number of fellow positions across America.Item Open Access Transplant Coordinators' Perceived Impact of Availability of Multiple Generic Immunosuppression Therapies on Patients, Workload, and Posttransplant Maintenance Therapy(2013) Parker, K.; Zagadailov, E. A.; Bruno, A. S.; Wiland, A. M.Background. No studies have evaluated the impact of multiple generic immunosuppression medications on transplant coordinators (TCs) and patients. Methods. A cross-sectional, multicenter online survey of TCs managing transplant recipients' outpatient immunosuppression was undertaken to assess TCs' perceptions of the impact of multiple generic immunosuppression therapies on patients and workload. Results. Forty-six of 106 transplant centers contacted (43%) completed the survey, with usable information from 34 TCs (53% in centers performing >100 solid organ transplants annually, 82% registered nurses, and 68% with >5-year experience working with transplant patients). TCs indicated that “change in strength,” “switching from branded to generics,” “heavy pill burden,” and “switching from one generic to another” were the four most frequent reasons for patient confusion regarding immunosuppression. TCs reported increased patient confusion over the previous year for patients on generic immunosuppression therapy: 44% answered ≥3 patient calls/day regarding confusion over immunosuppression therapy. Most TCs indicated increased workload since the introduction of generic immunosuppression therapy. TCs perceived “acute rejection rates,” “rate of graft loss,” and “poor patient adherence” as the three most likely consequences of multiple generic immunosuppression therapy. Conclusion. TCs associated availability of multiple generic immunosuppression therapy with increased patient confusion and time spent addressing patient concerns.Item Open Access Relationship Between Cardiovascular Disease Risk and Fast Food Consumption in Undergraduate Honors College Students(2014) Maidah, Atta N.College students are often pushed towards fast foods as a means of getting a pleasurable, quick bite to eat. Fast foods are high in fat, salt, and sugar content and can lead to cardiovascular disease(CVD) risk. Honors students may be more conscious of negative effects of bad dietary choices. Objectives include assessing Honors students knowledge of American Dietary Association nutritional recommendations and analyzing association between fast food consumption and CVD risk factors: physical inactivity, stress level, BMI, and family history of CVD and CVD risks. An 18-question survey was administered between April and June 2013 to East Carolina University Honors College students via the Honors College list serve. The survey measured frequency of fast food, sweetened beverage and snack consumption; height, weight, exercise frequency, stress levels, course load, and family history of CVD, and nutritional knowledge. Students were categorized as frequent fast food consumers (FFF) 3 or more times a week or infrequent fast food consumers (IFF) less than 3 times a week. 92 responses representing 36.2% of the 2012-2013 Honors College were collected. Twenty-three percent of participants were male, 79.3% White, 13% Asian, 5.4% Black descent, and 2% Other. Thirty-seven percent were able to correctly identify their nutritional recommendations. IFF were able to answer 2 out of 3 nutritional questions correctly versus only 30% of FFF. A fifth(21.7%) of participants had 3 or more CVD risks. Thirty percent of FFF had 3 or more cardiovascular disease risk factors versus 18.8% of IFF. Frequent fast food consumers had more risk factors compared to IFF. Students who answered nutritional questions correctly also consumed less fast food, demonstrating that they applied their knowledge to their own eating habits.Item Open Access Cocaine Disrupts Pup-Induced Maternal Behavior in Juvenile and Adult Rats(East Carolina University, 2007-11) Johns, Josephine M.; McMurray, Matthew S.; Hofler, Vivian E.; Jarrett, Thomas M.; Middleton, Christopher L.; Elliott, Deborah L.; Mirza, Raessa; Haslup, Amber; Elliott, Jay C.; Walker, Cheryl H.Impaired onset of maternal behavior in first generation rat dams was previously correlated with rearing by cocaine-treated dams and prenatal cocaine exposure. Pup-induced maternal behavior in non-lactating rats has not been examined with regard to cocaine exposure and rearing conditions. First generation male and female juveniles and young adult males reared by cocaine-treated or control dams and prenatally exposed to either cocaine or control conditions were tested for pup-induced maternal behavior at postnatal days 28 and 60. We now report disruptions in pup-induced maternal behavior in both 28 and 60 day old first generation offspring attributable to rearing condition and prenatal cocaine exposure. Originally published Neurotoxicology and Teratology, Vol. 29, No. 6, Nov 2007