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Critics of virtue reliabilism allege that the view cannot account for testimonial knowledge, as the acquisition of such knowledge is creditable to the testifier, not the recipient's cognitive abilities. I defend virtue reliabilism by attending to empirical work concerning human abilities to detect sincerity, certainty, and seriousness through bodily cues and properties of utterances. Then, I consider forms of testimony involving books, newspapers, and online social networks. I argue that, while discriminatory abilities directed at bodily cues and properties of utterances are impotent in the face of such testimony, alternative abilities facilitate the acquisition of knowledge from these sources.

Knowledge intellectualism is the view that knowledge-how requires propositional knowledge. Knowledge intellectualism has a Gettier problem, or so many of its critics allege. The essence of this problem is that knowledge-how is compatible with epistemic luck in a way that ordinary propositional knowledge is not. Hence, knowledge-how can allegedly be had in the absence of knowledge-that, a fact inconsistent with knowledge intellectualism. This paper develops two responses to this challenge to knowledge intellectualism. First, it is not clear that propositional knowledge is incompatible with the forms of epistemic luck with which knowledge-how is allegedly compatible. Second, existing cases intended to serve as counterexamples to knowledge intellectualism are flawed, and revised versions of these cases no longer elicit the judgments necessary to challenge knowledge intellectualism.

This paper describes the ways in which trolls and bots impede the acquisition of knowledge online. I distinguish between three ways in which trolls and bots can impede knowledge acquisition, namely, by deceiving, by encouraging misplaced skepticism, and by interfering with the acquisition of warrant concerning persons and content encountered online. I argue that these threats are difficult to resist simultaneously. I argue, further, that the threat that trolls and bots pose to knowledge acquisition goes beyond the mere threat of online misinformation, or the more familiar threat posed by liars offline. Trolls and bots are, in effect, fake persons. Consequently, trolls and bots can systemically interfere with knowledge acquisition by manipulating the signals whereby individuals acquire knowledge from one another online. I conclude with a brief discussion of some possible remedies for the problem of fake persons.

Renal autoregulation maintains renal blood flow and glomerular filtration rate (GFR) in a wide range of renal perfusion pressure (RPP). This mechanism is impaired in diabetes and chronic kidney disease (CKD), such that even modest increases in arterial pressure (AP) are transmitted to glomerular capillaries resulting in glomerular injury. Elevated RPP drives renal immune cell infiltration ( Hypertens. 76: 849-858, 2020). We showed that hypertensive mechanical stretch and T cell cytokine interleukin (IL)-17A synergistically promote vascular fibrosis ( Wu, Circ. Res. 114: 616-625, 2014). However, the mechanisms by which hemodynamic and inflammatory stimuli cause CKD remain poorly understood. We sought to investigate the contributions of glomerular hyperfiltration (GHF) and inflammation on glomerular damage in a mouse CKD model induced by reduced kidney mass (RKM). This model is characterized by impaired autoregulation, early onset hypertension and subsequent lymphocytic inflammation, albuminuria and glomerulosclerosis. We hypothesize that the initial rise in AP post RKM surgery promotes kidney injury through both GHF and renal inflammation. Eight-week old male 129/S6 mice were implanted with radiotelemeters. After a 10-day recovery, mice underwent sham surgery or RKM which involved uninephrectomy and partial renal artery ligation in the remaining kidney, such that the functional renal mass is reduced by ~ 2/3. AP, urine albumin, and transcutaneous GFR were measured at baseline, day (D) 3, D7, D14, D21, D28, and D56 after RKM.Immediately after RKM, GFR dropped to 30% of sham levels (Mean ± SEM in μL/min/100 g: RKM 279 ± 59 vs Sham 913 ± 61, n = 4 – 6, p < 0.05, two-way ANOVA RM), consistent with the extent of renal mass ablation. The mean AP of RKM mice was identical to sham controls at baseline (115 ± 2 vs 116 ± 2 mmHg) but increased by 29 mmHg by D5 (144 ± 8 vs 112 ± 2 mmHg, p < 0.05), and remained significantly elevated through D56, albeit a declining trend. Compared to GFR of sham mice (100%), the GFR of RKM mice gradually increased to 36% at D3, 43% at D7 and 69% at D14. By D21 post surgery, the GFR of RKM mice rose to 71% of sham (800 ± 106 vs 1121 ± 47 μL/min/100 g, p > 0.05) and plateaued through day 28 (69% of sham), suggesting that the early rise in AP and impaired autoregulation may have caused GHF in the RKM mice. The adaptive increase in GFR post RKM surgery was associated with a trend towards increased renal leukocytes, monocyte/macrophages, CD3 T cells and CD4/CD8 subsets at D14 and significantly elevated albuminuria at D28 (832 ± 227 vs 341 ± 15 μg/day, p < 0.05), implying hyperfiltration-induced renal inflammation and glomerular damage. Importantly, the GFR declined to 57% of sham levels by day 56 (597 ± 86 vs 1047 ± 80 μL/min/100 g, p < 0.05), suggesting progressive glomerular injury. We conclude that impaired autoregulation exposes the kidney to both inflammation and GHF, causing glomerular injury, albuminuria, and CKD progression. This work is supported by a NIDDK K01 DK126792 and a University of Rochester Environmental Health Science Center Pilot award (as part of a NIEHS P30ES001247) to JW. This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Study Objective: Understand the response to acute water load in mice lacking the insulin-regulated aminopeptidase (IRAP). Hypothesis: IRAP degrades vasopressin in vivo, therefore, mice lacking IRAP would have impaired ability to dilute urine and to excrete water. Methods: Age matched 8–10-week-old IRAP WT and KO male mice were used for all experiments. Immunofluorescence and immunoblotting were performed on kidneys at baseline and after 1-hr acute water load (2ml sterile water/IP). Urine/serum electrolytes and urine osmolality were measured before and after water load. Urine was collected from IRAP WT and KO mice before and after 1-hr administration of OPC 31260 (10mg/kg/IP) and furosemide (2.5mg/ml/IP) for urine osmolality and electrolyte measurements. Results: IRAP is expressed in the glomerulus, thick ascending loop of Henle, distal tubule, connecting and collecting ducts. At baseline, IRAP WT and KO mice have similar systolic blood pressure (122 ± 6.6 vs 128 ± 1.9 mmHg), glomerular filtration rate (251 ± 20 vs 254 ± 16 uL/min), and serum Na+ levels (142 ± 1.9 vs 143 ± 2.6 mmol/L), but KO mice have reduced proteinuria (3.3 ± 0.57 vs 4.5 ± 1.6 mg/mg). At baseline, IRAP KO have elevated serum copeptin levels (111 ± 43 vs 53 ± 31 pg/mL) and urine osmolality compared to respective IRAP WT (2506 ± 310 vs 1007 ± 212 mOsm/L). Urine osmolality decreased in IRAP KO after administration of vasopressin type 2 receptor antagonist, OPC 31260 (473 ± 341 vs 2479 ± 215 mOsm/L) and loop diuretic, furosemide (517 ± 96 vs 2750 ± 414 mOsm/L). After an acute water load, IRAP KO have lower serum Na+ levels (127 ± 3.8 vs 134 ±3.1 mmol/L) and increased urine osmolality compared to IRAP WT (2741 ± 400 vs 577 ± 274 mOsm/L). Additionally, after an acute water load, IRAP KO mice also have higher protein abundance of the Na+/K+/2Cl- (NKCC2) co-transporter (0.36 ± 0.04 vs 0.20 ± 0.03 AU) and phosphorylation of water channel, AQP2 (0.032 ± 0.005 vs 0.025 ± 0.003 AU). Conclusions: IRAP is required to dilute urine and to increase water excretion in response to an acute water load due to persistent activation of NKCC2 and AQP2. Funding Sources: Harold Amos Medical Faculty Development Award - Robert Wood Johnson Foundation; Vanderbilt Center for Kidney Disease This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

We previously reported that global deletion of angiotensin II (Ang II) AT1a receptors significantly lowered basal blood pressure and impaired urine concentration in mice. As we also demonstrated that renomedullary interstitial cells (RMICs) of the kidney expressed a high level of AT1 (AT1a) receptors, we hypothesized that AT1a receptors in RMICs may play an important physiological role in maintaining basal blood pressure and urine concentration homeostasis. To test the hypothesis, we generated a novel mouse model with deletion of AT1a receptors selectively in the RMICs of the kidney medulla using inducible Tenascin-C-CreER2/Agtr1af/f recombination approach (RMIC- Agtr1a-/- ) in the present study. Adult male wildtype (WT) and RMIC- Agtr1a-/- mice (n=10-18 per group) were phenotyped under basal conditions and treated with or without a slow pressor dose of Ang II infusion via an osmotic minipump (~500 μg/kg/day, i.p.) for 2 weeks to determine the roles of AT1a receptors in RMICs in maintaining basal blood pressure and urine concentration homeostasis and in the development of Ang II-induced hypertension. Under basal conditions, telemetry systolic blood pressure was significantly lower in adult male RMIC- Agtr1a-/- than WT mice (WT: 122 ± 4 mmHg vs. RMIC-Agtr1a-/-: 102 ± 3 mmHg, P-/- mice was associated with significant decreases in 24 h urine output (WT: 1.56 ± 0.15 mL/24 h vs. RMIC- Agtr1a-/- : 0.98 ± 0.13 mL/24 h, P-/- : 145.2 ± 5.4 μmol/24 h, P-/- mice even though 24 h urine output was lowered (WT: 1724 ± 335 mOsm/Kg H2O vs. RMIC- Agtr1a-/- : 1128 ± 102 mOsm/Kg H2O, P-/- mice ( P-/- mice (1226 ± 110 mOsm/Kg H2O, n.s.). In conclusion, we demonstrated for the 1st time that AT1a receptors in RMICs of the kidney medulla play a key role in physiologically maintaining basal blood pressure homeostasis and urine concentration, as well as in the development of Ang II-induced hypertension. R01DK123144, R01DK067299, R01DK102429 This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Heteromeric Kir4.1/Kir5.1 (KCNJ10/KCNJ16) inward rectifier potassium (Kir) channels play key roles in the brain and kidney, but pharmacological tools for probing their physiology and therapeutic potential have not been developed. Here, we report the discovery, in a high-throughput screening of 80,475 compounds, of the moderately potent and selective inhibitor VU0493690, which we selected for characterization and chemical optimization. VU0493690 concentration-dependently inhibits Kir4.1/5.1 with an IC(50) of 0.96 μM and exhibits at least 10-fold selectivity over Kir4.1 and ten other Kir channels. Multidimensional chemical optimization of VU0493690 led to the development of VU6036720, the most potent (IC(50) = 0.24 μM) and selective (>40-fold over Kir4.1) Kir4.1/5.1 inhibitor reported to date. Cell-attached patch single-channel recordings revealed that VU6036720 inhibits Kir4.1/5.1 activity through a reduction of channel open-state probability and single-channel current amplitude. Elevating extracellular potassium ion by 20 mM shifted the IC(50) 6.8-fold, suggesting that VU6036720 is a pore blocker that binds in the ion-conduction pathway. Mutation of the “rectification controller” asparagine 161 to glutamate (N161E), which is equivalent to small-molecule binding sites in other Kir channels, led to a strong reduction of inhibition by VU6036720. Renal clearance studies in mice failed to show a diuretic response that would be consistent with inhibition of Kir4.1/5.1 in the renal tubule. Drug metabolism and pharmacokinetics profiling revealed that high VU6036720 clearance and plasma protein binding may prevent target engagement in vivo. In conclusion, VU6036720 represents the current state-of-the-art Kir4.1/5.1 inhibitor that should be useful for probing the functions of Kir4.1/5.1 in vitro and ex vivo. SIGNIFICANCE STATEMENT: Heteromeric inward rectifier potassium (Kir) channels comprising Kir4.1 and Kir5.1 subunits play important roles in renal and neural physiology and may represent inhibitory drug targets for hypertension and edema. Herein, we employ high-throughput compound library screening, patch clamp electrophysiology, and medicinal chemistry to develop and characterize the first potent and specific in vitro inhibitor of Kir4.1/5.1, VU6036720, which provides proof-of-concept that drug-like inhibitors of this channel may be developed.

Particularists maintain that conspiracy theories are to be assessed individually, while generalists hold that conspiracy theories may be assessed as a class. This paper seeks to clarify the nature and importance of the debate between particularism and generalism, while offering an argument for a version of generalism. I begin by considering three approaches to the definition of conspiracy theory, and offer reason to prefer an approach that defines conspiracy theories in opposition to the claims of epistemic authorities. I argue that particularists rely on an untenably broad definition of conspiracy theory. Then, I argue that particularism and its counterpart are best understood as constellations of theses, rather than a pair of incompatible theses. While some particularist theses are highly plausible, I argue that one important particularist thesis is false. The argument for this conclusion draws on the history of false conspiracy theories. I then defend this conclusion against a pair of potential objections.

This paper defends two main theses related to emerging deepfake technology. First, fears that deepfakes will bring about epistemic catastrophe are overblown. Such concerns underappreciate that the evidential power of video derives not solely from its content, but also from its source. An audience may find even the most realistic video evidence unconvincing when it is delivered by a dubious source. At the same time, an audience may find even weak video evidence compelling so long as it is delivered by a trusted source. The growing prominence of deepfake content is unlikely to change this fundamental dynamic. Thus, through appropriate patterns of trust, whatever epistemic threat deepfakes pose can be substantially mitigated. The second main thesis is that focusing on deepfakes that are intended to deceive, as epistemological discussions of the technology tend to do, threatens to overlook a further effect of this technology. Even where deepfake content is not regarded by its audience as veridical, it may cause its viewers to develop psychological associations based on that content. These associations, even without rising to the level of belief, may be harmful to the individuals depicted and more generally. Moreover, these associations may develop in cases in which the video content is realistic, but the audience is dubious of the content in virtue of skepticism toward its source. Thus, even if—as I suggest—epistemological concerns about deepfakes are overblown, deepfakes may nonetheless be psychologically impactful and may do great harm.

Psychological-epistemic accounts take scientific progress to consist in the development of some psychological-epistemic attitude. Disagreements over what the relevant attitude is – true belief, knowledge, or understanding – divide proponents of the semantic, epistemic, and noetic accounts of scientific progress, respectively. Proponents of all such accounts face a common challenge. On the face of it, only individuals have psychological attitudes. However, as I argue in what follows, increases in individual true belief, knowledge, and understanding are neither necessary nor sufficient for scientific progress. Rather than being fatal to the semantic, epistemic, and noetic accounts, this objection shows that these accounts are most plausible when they take the psychological states relevant to scientific progress to be states of communities, rather than individuals. I draw on recent work in social epistemology to develop two ways in which communities can be the bearers of irreducible psychological-epistemic states. Each way yields a strategy by which proponents of one of the psychological-epistemic accounts might attempt to account for the social dimensions of scientific progress. While I present serious reasons for concern about the first strategy, I argue that the second strategy, at least, offers a promising path forward for a psychological-epistemic account of scientific progress.

Philosophers and psychologists have devoted considerable attention to the study of intellectual humility and intellectual arrogance. To this point, theoretical and empirical studies of intellectual humility and arrogance have focused on these traits as possessed by individual reasoners. However, it is natural in some contexts to attribute intellectual humility or intellectual arrogance to collectives. This paper investigates the nature of collective intellectual humility and arrogance and, in particular, how these traits are related to the attitudes of individuals. I discuss three approaches to collective intellectual humility and arrogance. Rather than arguing that one of these approaches is applicable to all instances of collective intellectual humility and arrogance, I argue that there are at least two and perhaps three distinct forms of both collective intellectual humility and arrogance. Recognizing these distinct forms of collective intellectual humility and arrogance, I argue, is crucial to understanding how intellectual humility and arrogance are related to troubling phenomena like political polarization.

The defensibility of the extended mind thesis (EMT) is often thought to hinge on the possibility of extended selves. I argue that the self cannot extend and consider the ramifications of this finding, especially for EMT. After an overview of EMT and the supposed cruciality of the extended self to the defensibility of the former thesis, I outline several lines of argument in support of the possibility of extended selves. Each line of argument appeals to a different account of diachronic personal identity. I argue that no such argument for extended selves succeeds, as no account of diachronic personal identity is both plausible and supports the view that the self can extend. Next, I consider three objections that, if successful, would undercut the preceding argument that the self cannot extend. I conclude by reflecting on the implications of the conclusion that the self cannot extend, including the prospects for EMT.

Despite clear overlap between the study of extended minds and the study of group minds, these research programs have largely been carried out independently. Moreover, whereas proponents of the exte...

Introduction Glomerular diseases are characterized by variable disease activity over many years. We aimed to analyze the relationship between clinical disease activity and duration of glomerular disease. Methods Disease activity in adults with chronic minimal change disease, focal segmental glomerulosclerosis, membranous nephropathy, and IgA nephropathy (IgAN; first diagnostic biopsy >5 years before enrollment; Of Longstanding Disease [OLD] cohort, n = 256) followed at Columbia University Medical Center (CUMC), was compared with disease activity of an internal and external cohort of patients with first diagnostic biopsy, Graphical abstract

The construction of three-dimensional multi-modal tissue maps provides an opportunity to spur interdisciplinary innovations across temporal and spatial scales through information integration. While the preponderance of effort is allocated to the cellular level and explore the changes in cell interactions and organizations, contextualizing findings within organs and systems is essential to visualize and interpret higher resolution linkage across scales. There is a substantial normal variation of kidney morphometry and appearance across body size, sex, and imaging protocols in abdominal computed tomography (CT). A volumetric atlas framework is needed to integrate and visualize the variability across scales. However, there is no abdominal and retroperitoneal organs atlas framework for multi-contrast CT. Hence, we proposed a high-resolution CT retroperitoneal atlas specifically optimized for the kidney across non-contrast CT and early arterial, late arterial, venous and delayed contrast enhanced CT. Briefly, we introduce a deep learning-based volume of interest extraction method and an automated two-stage hierarchal registration pipeline to register abdominal volumes to a high-resolution CT atlas template. To generate and evaluate the atlas, multi-contrast modality CT scans of 500 subjects (without reported history of renal disease, age: 15-50 years, 250 males & 250 females) were processed. We demonstrate a stable generalizability of the atlas template for integrating the normal kidney variation from small to large, across contrast modalities and populations with great variability of demographics. The linkage of atlas and demographics provided a better understanding of the variation of kidney anatomy across populations., 8 pages, 5 figures

Presentations of the extended mind thesis are often ambiguous between two versions of that thesis. According to the first, the extension of mind consists in the supervenience base of human individuals’ mental states extending beyond the skull and into artifacts in the outside world. According to a second interpretation, human individuals sometimes participate in broader cognitive systems that are themselves the subjects of extended mental states. This ambiguity, I suggest, contributes to several of the most serious criticisms of the extended mind thesis, for these criticisms only apply to the first interpretation of the thesis. In what follows, I argue that several significant objections to the extended mind thesis fail to undermine the latter interpretation of that thesis. Having defended the second interpretation, I argue that the extension of mind does not involve the extension of self. Consequently, the subject of extended mental states is not the same individual whose causal coupling with external artifacts gives rise to extended mentality.

Scope: Obtain kidney tissue and metadata about tissue location within the whole kidney for storage and analysis. Expected Outcome: A portion of kidney tissue and a series of images that provide information about the original location of the smaller tissue.

Patient-oriented applications of cell culture include cell therapy of organ failure like chronic renal failure. Clinical deployment of a cell-based device for artificial renal replacement requires qualitative and quantitative fidelity of a cultured cell to its in vivo counterpart. Active specific apicobasal ion transport reabsorbs 90–99% of the filtered load of salt and water in the kidney. In a bioengineered kidney, tubular transport concentrates wastes and eliminates the need for hemodialysis, but renal tubule cells in culture transport little or no salt and water. We previously identified transforming growth factor-beta as a signaling pathway necessary for in vitro differentiation of renal tubule cells. Inhibition of TGF-β receptor-1 led to active inhabitable electrolyte and water transport by primary human renal tubule epithelial cells in vitro. Addition of metformin increased transport, in the context of a transient effect on 5′ AMP-activated kinase phosphorylation. The signals that undermine in vitro differentiation are complex, but susceptible to pharmacologic intervention. This achievement overcomes a major hurdle limiting the development of a bioreactor of cultured cells for renal replacement therapy that encompasses not only endocrine and metabolic functions but also transport and excretion. IMPACT STATEMENT: Clinical tissue engineering requires functional fidelity of the cultured cell to its in vivo counterpart, but this has been elusive in renal tissue engineering. Typically, renal tubule cells in culture have a flattened morphology and do not express key transporters essential to their function. In this study, we build on our prior work by using small molecules to modulate pathways affected by substrate elasticity. In doing so, we are able to enhance differentiation of these cells on conventional noncompliant substrates and show transport. These results are fundamentally enabling a new generation of cell-based renal therapies.

American Indians and Alaska Natives have the highest obesity prevalence in the United States, but the influence of early childhood variables on body mass index (BMI; calculated as kg/mThis study investigated the association between breastfeeding in infancy and BMI in American Indians and Alaska Native and non-Hispanic white adolescents and young adults.Longitudinal analysis based on data from the National Longitudinal Study of Adolescent to Adult Health (1994 to 2008).Adolescent respondents who self-identified as American Indians and Alaska Native or non-Hispanic white, and whose parents completed the parental questionnaire, reported their height and weight. The final sample included 655 American Indians and Alaska Native and 10,305 non-Hispanic white respondents.Generalized estimating equations were used to measure the mean differences, 95% CIs, and P values of the association between breastfeeding in infancy and offspring BMI in adolescence, stratifying by race, and adjusting for demographic and socioeconomic variables.The length of breastfeeding was inversely associated with BMI in both populations. American Indians and Alaska Natives that were breastfed for 6 to 12 months or for more than 12 months had a mean BMI of 2.69 (95% CI -3.46 to -1.92; P0.01) and 1.54 (95% CI -2.75 to -0.33; P0.05) units lower than those that were never breastfed. Non-Hispanic whites that were breastfed for 3 to 6 months, 6 to 12 months, or more than 12 months had a mean BMI of 0.71 (95% CI -0.93 to -0.50; P0.01), 0.68 (95% CI -0.87 to -0.50; P0.01), and 0.85 (95% CI -1.09 to -0.62; P0.01) units lower than those that were never breastfed. The association between the length of breastfeeding and offspring BMI varied by race (P0.01).Breastfeeding in infancy is associated with lower mean BMI. Future research should investigate causal pathways and whether interventions promoting breastfeeding in American Indians and Alaska Natives can prevent increasing BMI.

Scope: Obtain kidney tissue and metadata about tissue location within the whole kidney for storage and analysis. Expected Outcome: A portion of kidney tissue and a series of images that provide information about the original location of the smaller tissue.

Introduction The Cure Glomerulonephropathy Network (CureGN) is a 66-center longitudinal observational study of patients with biopsy-confirmed minimal change disease, focal segmental glomerulosclerosis, membranous nephropathy, or IgA nephropathy (IgAN), including IgA vasculitis (IgAV). This study describes the clinical characteristics and treatment patterns in the IgA cohort, including comparisons between IgAN versus IgAV and adult versus pediatric patients. Methods Patients with a diagnostic kidney biopsy within 5 years of screening were eligible to join CureGN. This is a descriptive analysis of clinical and treatment data collected at the time of enrollment. Results A total of 667 patients (506 IgAN, 161 IgAV) constitute the IgAN/IgAV cohort (382 adults, 285 children). At biopsy, those with IgAV were younger (13.0 years vs. 29.6 years, P < 0.001), more frequently white (89.7% vs. 78.9%, P = 0.003), had a higher estimated glomerular filtration rate (103.5 vs. 70.6 ml/min per 1.73 m2, P < 0.001), and lower serum albumin (3.4 vs. 3.8 g/dl, P < 0.001) than those with IgAN. Adult and pediatric individuals with IgAV were more likely than those with IgAN to have been treated with immunosuppressive therapy at or prior to enrollment (79.5% vs. 54.0%, P < 0.001). Conclusion This report highlights clinical differences between IgAV and IgAN and between children and adults with these diagnoses. We identified differences in treatment with immunosuppressive therapies by disease type. This description of baseline characteristics will serve as a foundation for future CureGN studies.

Public health policy relies on accurate data, which are often unavailable for small populations, especially indigenous groups. Yet these groups have some of the worst health disparities in the United States, making it an ethical imperative to explore creative solutions to the problem of insufficient data. We discuss the limits of widely applied methods of data aggregation and propose a mixed-methods approach to data borrowing as a way to augment sample sizes. In this approach, community partners assist in selecting related populations that make suitable “neighbors” to enlarge the data pool. The result will be data that are substantial, accurate, and relevant to the needs of small populations, especially for health-related policy and decision-making at all levels.

American Indians and Alaska Natives (AI/ANs) suffer a disproportionate burden of diabetes and kidney failure. For those with chronic kidney disease, transplantation may be the most effective treatment option. However, low rates of organ donation and transplantation are reported for AI/ANs, who face significant barriers in accessing the transplant waiting list. They are also less likely than Whites to consent to become organ donors. We partnered with five tribal colleges and universities to conduct focus groups to assess knowledge, cultural beliefs, and behaviors related to organ donation and transplantation among AI/AN college students. Focus group data were used to develop a culturally targeted media campaign and outreach strategy aimed at increasing rates of consent to donate organs. Community knowledge typically drew from direct family experience with chronic illness. Study findings confirmed that attitudes about organ donation were influenced by cultural beliefs. Nevertheless, many participants supported organ donation even when it conflicted with cultural and spiritual beliefs about keeping the body intact for burial. Participants also expressed mistrust of the local health care system, suggesting that trust issues might interfere with health messaging on this topic. This is the first study to examine sociocultural beliefs about organ donation among AI/AN college students. Through focus group findings, study staff were better positioned to develop culturally relevant outreach materials. Rising rates of chronic illness among AI/ANs ensure that organ donation and transplantation will be a long-term feature of the health landscape in AI/AN communities. Targeted health messaging must be part of the strategy to reduce donor shortages.

In response to community concerns, we used the Tribal Participatory Research framework in collaboration with 5 American-Indian communities in Washington, Idaho, and Montana to identify the appropriate criteria for aggregating health data on small tribes. Across tribal sites, 10 key informant interviews and 10 focus groups (n = 39) were conducted between July 2012 and April 2013. Using thematic analysis of focus group content, we identified 5 guiding criteria for aggregating tribal health data: geographic proximity, community type, environmental exposures, access to resources and services, and economic development. Preliminary findings were presented to focus group participants for validation at each site, and a culminating workshop with representatives from all 5 tribes verified our final results. Using this approach requires critical assessment of research questions and study designs by investigators and tribal leaders to determine when aggregation or stratification is appropriate and how to group data to yield robust results relevant to local concerns. At project inception, tribal leaders should be consulted regarding the validity of proposed groupings. After regular project updates, they should be consulted again to confirm that findings are appropriately contextualized for dissemination.