Diversity leadership: the Rush University Medical Center experience.

Meeting the challenges of diversity is crucial, and within healthcare organizations a particularly strong case exists for a diversity strategy. Rush University Medical Center in 2006 was at an important juncture. Since its founding, the organization had made notable progress toward advancing diversity and inclusiveness. On the other hand, many diversity-related problems continued. Rush convened a committee to review the work of the institution in this area. The committee's report called for changes, and a Diversity Leadership Group (DLG) model was established. This article documents the progress made since 2006 through implementation of the DLG model. The changes prescribed for Rush are presented as recommendations and challenges that other healthcare organizations may find applicable to their own institutions.

Focal glomerular sclerosis: contrasting clinical patterns in children and adults.

In a retrospective clinicopathological study, 48 kidney biopsy specimens from 16 children (mean age, 7 years) and 17 adults (mean age, 33 years) with histological evidence of focal glomerular sclerosis (FGS) were examined using light, immunofluorescence and electron microscopy. The histopathological findings were related to the clinical course of each patient. At the clinical onset of the disease, the nephrotic syndrome was seen more commonly in children (12/16) than adults (7/17), while the incidence of both hypertension (children 1/16 versus adults, 9/17) and renal insufficiency (children, 0/16 versus adults, 7/17) was greater in adults. Despite a shorter average follow-up, (adults 3 10/12 years versus children, 7 years), the incidence of hypertension (adults, 13/17 versus children, 7/16) and renal functional impairment (adults, 13/17 versus children, 3/16) remained greater in the adult patients. One child and three adults died in renal failure while two adults underwent transplantation and on requires regular dialysis therapy. Nine of 15 pediatric patients treated with corticosteroids experienced partial or complete remission in either their nephrotic syndrome or level of urine protein excretion, while just 3 of 6 adult patients treated with corticosteroids experienced a partial remission, but never became protein-free. There was an excellent correlation in all patients between the degree of functional renal impairment and the extent of glomerular and nonglomerular histopathological damage in the kidney. It is concluded that in the adults, FGS represents a more severe and progressive disease process and is less responsive to therapy.

Distal tubular feedback in the autoregulation of single nephron glomerular filtration rate.

Renal clearance and recollection micro-puncture experiments were conducted to evaluate the possible role of a distal tubular feedback mechanism in the phenomenon of renal autoregulation in dogs. Single nephron glomerular filtration rate (SNGFR) was measured from collection sites in both the proximal (proximal SNGFR) and distal tubules (distal SNGFR). Single nephron autoregulatory behavior was assessed by evaluating the response of SNGFR to a reduction in renal arterial pressure imposed by means of an aortic constrictor. Whole kidney function was evaluated by parallel measurements of renal blood flow and inulin clearance. Whole kidney autoregulation was observed when renal arterial pressure was decreased from 141 +/- 3 (SE) mm Hg to 101 +/- 2 mm Hg; renal blood flow and GFR were not significantly altered from control values of 3.76 +/- 0.2 ml/min.g and 0.69 +/- 0.04 ml/min.g kidney weight, respectively. In 11 autoregulating preparations, proximal transit time was likewise unchanged from the control value of 26 +/- 2 s, indirectly suggesting that the superficial nephrons also participated in the autoregulatory response. However, proximal SNGFR decreased significantly from 88 +/- 7 nl/min to 66 +/- 6 nl/min, a reduction which was proportional to the decrease in arterial pressure. In 14 dogs in which both proximal SNGFR and distal SNGFR were measured at control blood pressure (136 +/- 5 mm Hg), distal SNGFR was 47 +/- 4 nl/min, a value significantly lower than that for proximal SNGFR (79 +/- 6 nl/min). In contrast to the results based upon proximal collections, distal SNGFR was not significantly altered following aortic constriction (44 +/- 5 nl/min vs. 47 +/- 5 nl/min) therefore exhibiting autoregulation in association with that observed for the whole kidney. These experiments indicate that though superficial nephrons do possess autoregulatory capability, interruption of distal delivery due to complete collection from the proximal tubule interferes with that nephron's ability to manifest an autoregulatory response. They support the concept that a feedback mechanism, related to some function of distal delivery, is of significance in the intrinsic regulation of SNGFR. The data further suggest that quantitative estimates of SNGFR based on complete proximal collections may not be representative of those throughout the superficial cortex of the dog, at least in certain experimental circumstances.