When to Pee in the Cup

(by Pascale Lane) Sep 11 2014

Screening urinalysis (UA), usually performed by dipstick in a physician's office, ultimately results in a lot of referrals for nephrologists. I am reviewing this topic, and I will have a series of posts about UAs over the coming weeks. First, I want to start with a poll about what is really recommended for healthy, asymptomatic children:

Next week I will reveal the answers from the crowd, as well as what the real answer is.

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Reap What You Sow

(by Pascale Lane) Sep 10 2014

While in my fellowship, I became interested in the role of puberty and sex in the progression of kidney disease. I studied this and related sex differences in the renal responses for more than 20 years. Then the NIH would not, could not bring itself to fund my work. My spouse had a new job offer, and the writing on the wall was clear: I closed my lab and moved into full-time clinical medicine.

From this perspective, I can appreciate NPR's series on the state of NIH funding and folks quitting science. At least I knew my clinical skills made me employable, although at times I dream of running a distillery.

Of course, there is the additional irony of the NIH calling for more study of both sexes, even in basic science studies, earlier this year. Gee, exactly what I was doing that was not important enough to merit funding...and now you are issuing special calls for it. Any regrets, NIH?

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Is This Right?

(by Pascale Lane) Sep 09 2014

Today a new book from Dr. Seuss will hit the stores featuring stories from magazines 60 years ago.

Working in pediatrics, Dr. Seuss inspires a lot of stuff around me. Some of our junior artists based their work on his characters as shown below:

Hmmmm...

Hmmmm...

It took me a minute to realize that this is an articulated puppet; that string makes the arms and legs move when it's not mounted under glass.

I must admit my first thought was why on earth the Cat in the Hat needed a tampon...

I think I would have tucked the string behind the puppet before framing.

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Forty-Six

(by Pascale Lane) Sep 06 2014

It's been a dry week.

Zer0. Zip. Nada.

Today, the urine output box shows 46 mL overnight.

Less than an ounce, but an important sign of the return of kidney function.

Keep it up, kid.

Urine is golden.

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The Fix for Bad Slides: MORE SLIDES!

(by Pascale Lane) Aug 28 2014

I love this slide-show about breaking dense slides into "layers of slides." I have been trying to get some colleagues to do something like this for awhile.

Enjoy and please take this advice!

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"Happy" Women's Equality Day

(by Pascale Lane) Aug 26 2014

94 years ago, the 19th amendment to the Constitution was ratified, giving women the right to vote. Our fore-mothers fought for this right, believing that without political power any other rights could be denied. They also believed that with political voices we could achieve true equality.

Their belief in the vote sustained them through public humiliation, beatings, starvation, jail, forced feedings, and a number of other indignities.

Despite the passage of nearly a century, women still have not achieved full equality. We make less than 80% of our male counterparts in similar jobs. We are underrepresented in the best -paid careers, and even when we enter those fields we are marginalized. Corporate boards, congress, and other decision-making bodies rarely demonstrate gender equality, despite the evidence that more women in those positions increases profits and other measures of efficacy.

Today we see rights we thought were won under attack. It's time we used that vote, the political voice our ancestors fought for. Learn the issues and make your choices. Run for office, or at least support those you like in whatever way you can.

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Another Topic to Video: Thrombotic Microangiopathies

(by Pascale Lane) Aug 25 2014

My conversion of resident lectures to self-study videos continues with Thrombotic Microangiopathies.

These disorders are characterized by consumption of platelets and red blood cells with resulting anemia and blood clotting problems. Other organs can be affected, particularly the kidneys (duh-why else am I talking about it?). These disorders include hemolytic uremic syndrome (HUS) and thrombotic thrombocytopenic purpura (TTP).

I would enjoy hearing your comments about the video. Would an adapted version (with less attention on specific doctor-level stuff) be good for parents?

Let me know in comments below, please!

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Final Friday Thoughts

(by Pascale Lane) Aug 22 2014

I just read a post about the sexual and racial politics of the latest videos from Taylor Swift and Nicki Minaj. The author saw waaaaay more in these presentations than I did, although I found both songs and videos entertaining.

  1. "Shake it Off" is pretty much what you would expect from Taylor Swift if you have ever encountered her stuff before EXCEPT it is clearly not a country song.
  2. "Anaconda" may set a record for most phallic symbols in a video.
  3. How do they do that with their butts?
  4. While both tunes are catchy, it is unfortunately the work of Ms. Minaj that has provided today's earworm.

I will be off in a bit to do whatever it takes to get the phrase "My anaconda don't" off of continual replay in my head. I think I pulled a muscle trying to emulate some twerk moves as well.

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What I Am Reading: Dystopian Future

(by Pascale Lane) Aug 21 2014

CircleRemember reading 1984 in high school? Big Brother is watching you so you must conform to society's standards! The Circle tells the story of the genesis of an internet-age totalitarian society much like the one Orwell created.

I doubt that this one will make the jump to "literature that should be taught, but I might be wrong.

What is The Circle? Imagine that Google, Facebook, Twitter, Paypal, and every other major internet service were mashed up into one giant corporation. This company controls an online identity system that keeps people from participating anonymously or pseudonymously online. This led to complete internet civility (of course!). It also allowed more secure payment systems, even leading some to suggest that all cash be eliminated for Circle-based payments. Employees at the company propose new uses of The Circle to make life more pleasant and secure all the time. The one thing no one seems to do at The Circle is code or actually do computer stuff. Hmmmm.

The story focuses on Mae Holland, a new employee at The Circle. Through a friend who is in The Circle's inner circle, she secures an entry-level customer experience job that allows her to escape a mind-numbing position at a local utility company. The Circle resides on a California campus with all the bells and whistles we expect from an internet company: game rooms, free cafeterias, gardens, sports fields, the works. In addition, their seems to be multiple social events for employees every evening, some of which are mandatory. The campus also boasts beautiful dorms where employees can stay and give up life outside The Circle all together.

May starts out treating her employment like a job. As time goes on, she discovers that she is expected to participate in The Circle's ongoing social media (internal and external) as well as "extracurricular" activities or she will be viewed as "antisocial" and "not part of The Circle." May succeeds, and rises in her department, eventually resulting in 6 or 7 separate screens on her desk for various components of her work. Eventually, events occur that prod May to become "transparent." This means wearing a live web cam at all times so her life while awake becomes an open book. Nothing can be deleted from her video feed (even when she catches her parents having sex).

The leaders are intent on "Closing the Circle" which should make May ask some very critical questions. However, despite the obvious impending loss of freedom (and the reader screaming at her on the page), May seems disinclined to see anything but the rosy picture her supervisors paint. Even when someone brazenly spells it out for her, she fails to see the danger of the situation.

The use of tiles at the company echos parts of 1984. Instead of "Big Brother is Watching," we have "Secrets are Lies" and "Privacy is Theft."

We often look at totalitarian states and wonder how the regular people let this obviously bad government happen. This book tries to explain that, and does a reasonable job. I wish there had been a few more examples of resistance, other than an ex-boyfriend who I found generally unappealing. If anyone else has read this book, I would love to hear your thoughts in the comments.

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Change, change, change

(by Pascale Lane) Aug 14 2014

More and more learning requirements have been added to the curriculum for medical students and residents. Advocacy, quality improvement, and communication skills are all worthy subjects for the house officers learning a specialty, but it has cut the availability of slots for didactic teaching.

Good. Lectures mostly bored me silly; I learned more from reading about patients and thinking on my feet than I ever did from a talk.

This does not eliminate the need for we faculty members to provide appropriate information for our trainees. We just have to figure out other ways to do it. To that end, I am converting my lectures to short videos (amazing that something I spoke about for the better part of an hour can be condensed to 7 minutes) with accompanying handouts. These will be posted online so that whenever the resident needs the topic they can access it in the manner they prefer. Eventually we hope to have a series of online assessments as well.

I just finished my first conversion, Pediatric Acute Kidney Injury. Closed captioning is in progress (it's the slowest bit of YouTube). I've also embedded the video here for your "entertainment."

Things I learned:

  1. You can never practice your narration and cues too much
  2. An expensive microphone beats a cheapie every day
  3. It's amazing how long it takes to make a 7 minute video
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