Medicine and Health Sciences Commons^™

Prospective Testing And Redesign Of A Temporal Biomarker Based Risk Model For Patients With Septic Shock: Implications For Septic Shock Biology, Hector R. Wong, Natalie R. Cvijanovich, Nick Anas, Geoffrey L. Allen, Neal J. Thomas, Robert J. Freishtat, +17 Additional Authors

Pediatrics Faculty Publications

The temporal version of the pediatric sepsis biomarker risk model (tPERSEVERE) estimates the risk of a complicated course in children with septic shock based on biomarker changes from days 1 to 3 of septic shock. We validated tPERSEVERE performance in a prospective cohort, with an a priori plan to redesign tPERSEVERE if it did not perform well. Biomarkers were measured in the validation cohort (n = 168) and study subjects were classified according to tPERSEVERE. To redesign tPERSEVERE, the validation cohort and the original derivation cohort (n = 299) were combined and randomly allocated to training (n = 374) and …

Effect Of Kidney Function On Drug Kinetics And Dosing In Neonates, Infants, And Children., Frederique Rodieux, Melanie Wilbaux, Johannes N. Van Den Anker, Marc Pfister

Pediatrics Faculty Publications

Neonates, infants, and children differ from adults in many aspects, not just in age, weight, and body composition. Growth, maturation and environmental factors affect drug kinetics, response and dosing in pediatric patients. Almost 80 % of drugs have not been studied in children, and dosing of these drugs is derived from adult doses by adjusting for body weight/size. As developmental and maturational changes are complex processes, such simplified methods may result in subtherapeutic effects or adverse events. Kidney function is impaired during the first 2 years of life as a result of normal growth and development. Reduced kidney function during …

Overweight Predicts Poorer Exercise Capacity In Congenital Heart Disease Patients, Karen Kuehl, Alicia Tucker, Munziba Khan, Paula Goldberg, E. Anne Greene, Megan Smith

Pediatrics Faculty Publications

Background

Overweight (OW) and obesity (OB) are endemic in the United States and affect adolescents and adults with congenital heart disease (ACHD). Defining the burden of excess weight on the cardiovascular system in ACHD is the goal of this study. Limitation of exercise capacity due to overweight or obesity might be reversible with weight loss and improve quality of life for ACHD adults.

Methods

Exercise tests performed using a Bruce protocol and measurement of maximum oxygen consumption were retrospectively reviewed on 418 CHD patients. OW and OB were defined as the 85–95 or > 95 percentile respectively for age and gender …

Effect Of Kidney Function On Drug Kinetics And Dosing In Neonates, Infants, And Children., Frederique Rodieux, Melanie Wilbaux, Johannes N. Van Den Anker, Marc Pfister

Pediatrics Faculty Publications

Neonates, infants, and children differ from adults in many aspects, not just in age, weight, and body composition. Growth, maturation and environmental factors affect drug kinetics, response and dosing in pediatric patients. Almost 80% of drugs have not been studied in children, and dosing of these drugs is derived from adult doses by adjusting for body weight/size. As developmental and maturational changes are complex processes, such simplified methods may result in subtherapeutic effects or adverse events. Kidney function is impaired during the first 2 years of life as a result of normal growth and development. Reduced kidney function during childhood …

Subjective Outcome Evaluation Of A University Subject On Service Leadership, Daniel T. L. Shek, Jianqiang Liang

Pediatrics Faculty Publications

University students (n=58) responded to a 45-item subjective outcome evaluation scale after taking a credit-bearing elective subject titled “Service Leadership” at The Hong Kong Polytechnic University in the first semester of the 2013–14 academic year. Results showed that the students generally displayed positive perceptions of the program content and the instructors, and most of them perceived the subject to be beneficial to different aspects of their development. As predicted, three subscales of the scale (Program Content, Program Implementer, and Program Benefits) were significantly correlated. Similar to the previous studies, perceived quality of the program but not quality of instructors and …

Character Strengths And Service Leadership, Daniel T. L. Shek, Lu Yu

Pediatrics Faculty Publications

Character strengths refer to the moral aspects of personality that have multiple dimensions. As a basic requirement of a service leader, character strengths provide the most inherent power for fulfilling different tasks and pursuing continuous development. In this paper, a lecture that aims to foster character strengths in undergraduate students is introduced. The theoretical foundation of the lecture on character strengths is first presented, including the concepts and theories related to character strengths, their relevance to service leadership and methods to promote the development of character strengths. The basic content and activities designed for this particular lecture are then outlined …

Character Strengths In Chinese Philosophies: Relevance To Service Leadership, Daniel T. L. Shek, Rachel C. F. Sun, Ting Ting Liu

Pediatrics Faculty Publications

According to the Hong Kong Institute of Service Leadership and Management, moral character or character strength is an important attribute of an effective service leader. In connection to this, “Character Strengths in Chinese Philosophies” is one of the lecture topics taught in a course titled “Service Leadership” in a university in Hong Kong. Several topics are covered in that lecture. First, the relevance of Chinese philosophies to service leadership is discussed. Second, the core virtues in Confucian thoughts are presented. Third, the relevance of Confucian virtues to service leadership is examined. Finally, conclusions and reflections on the relevance of Confucian …

The Role Of A Caring Disposition In Service Leadership, Daniel T. L. Shek, Xiang Li

Pediatrics Faculty Publications

A caring disposition is an important and fundamental attribute of a service leader. At the Hong Kong Polytechnic University, a lecture on a caring disposition in the subject “Service Leadership” was designed to help students understand the importance of caring dispositions. The curriculum design with reference to the basic concepts and theories as well as the content of the lecture are presented in this paper. In the first part of the paper, several uncaring cases are presented to serve as negative examples to inspire students’ reflection on caring leaders. Then, the three most important traits of a caring disposition, including …

The Role Of Self-Leadership In Service Leadership, Daniel T. L. Shek, Cecilia M. S. Ma, Ting Ting Liu, Andrew M. H. Siu

Pediatrics Faculty Publications

One of the core beliefs of the service leadership curriculum proposed by the Hong Kong Institute of Service Leadership and Management is that ‘Every day, every human occupies a position of leadership and possesses the potential to improve his leadership quality and effectiveness’. This core belief is in sharp contrast to some of the mainstream leadership theories that only a few people and elites can be leaders. In this paper, a lecture plan regarding the nature of self-leadership with reference to service leadership is presented. The topics include definitions and concepts of self-leadership, relationships between self-leadership and service leadership, ways …

Focus Group Evaluation Of A Service Leadership Subject In Hong Kong, Daniel T. L. Shek, Moon Y. M. Law, Ting Ting Liu

Pediatrics Faculty Publications

Two focus groups with six randomly selected students were conducted to understand the views and experiences of students taking a subject entitled “Service Leadership” at The Hong Kong Polytechnic University. Several observations were highlighted from the findings. First, students generally had positive views of the subject. Second, students felt that they had positive experience in the subject. Third, the instructors were seen in a positive light by the students. Fourth, the students perceived the subject to be beneficial to their development. Fifth, students had positive impression about the subject. Finally, recommendations regarding time allocation, teaching style, and classroom environment were …

Leadership And Mentorship: Service Leaders As Mentors Of The Followers, Daniel T. L. Shek, Li Lin

Pediatrics Faculty Publications

According to the Hong Kong Institute of Service Leadership and Management, an effective service leader serves as a mentor for his/her followers. Aside from promoting their followers’ professional and personal growth, mentoring also contributes to the development of the service leaders themselves. In this paper, a lecture addressing the concept and functions of mentoring is outlined, along with its relationship with service leadership. The professional and psychosocial functions of mentoring to service leaders and followers and various ways to promote mentoring in service leadership are highlighted. Students are also encouraged to reflect on the potential harmful effects of mentoring on …

General Education Program In A New 4-Year University Curriculum In Hong Kong: Findings Based On Multiple Evaluation Strategies, Daniel T. L. Shek, Lu Yu, Florence K. Y. Wu

Pediatrics Faculty Publications

Since the 2012−2013 academic year, undergraduate programs in Hong Kong have been changed from 3 years to 4 years, with the additional year focusing primarily on general education. A new general education framework entitled General University Requirements (GUR) implemented at The Hong Kong Polytechnic University (PolyU) was examined in a 5-year longitudinal project. Based on different evaluation strategies, including objective outcome evaluation, subjective outcome evaluation and qualitative evaluation (focus groups, case studies, and document analyses), findings consistently showed that students had positive perceptions of the subject content, teachers as well as teaching and learning methods in GUR subjects. A large …

Evaluation Of An Innovative Leadership Training Program For Chinese Students: Subjective Outcome Evaluation, Daniel T. L. Shek, Xiang Li

Pediatrics Faculty Publications

As a part of the Global Youth Leadership Program (GYLP), a 30-h “Service Leadership” subject was provided to 48 undergraduate students studying at The Hong Kong Polytechnic University (PolyU) or Peking University (PKU). This study evaluated the subjective outcomes of the “Service Leadership” subject, including students’ views on the course contents, lecturers, and perceived benefits from the course. A majority of students in the program showed very positive perceptions of the course content, lecturers, and course benefits, with more than 85% of the students indicating that they were very satisfied with this subject and would suggest their friends to take …

Evaluation Of A General Education Program In Hong Kong: Secondary Data Analyses Based On Student Feedback Questionnaires, Daniel T. L. Shek, Lu Yu, Joe Ngai

Pediatrics Faculty Publications

The General University Requirements (GUR) at The Polytechnic University of Hong Kong (PolyU) has been developed and implemented since the 2012–13 academic year under the reform of education system in Hong Kong. To examine the effectiveness of GUR at PolyU, the present study investigated student’s subjective perception in the academic years of 2012–13 and 2013–14 using the Student Feedback Questionnaires. Results showed that the GUR subjects were generally well-received by the students. Besides, students held different perceptions of different GUR components, and there was improvement in students’ learning experience and staff teaching over time. While there was an increased satisfaction …

Segmented Nitinol Guidewires With Stiffness-Matched Connectors For Cardiovascular Magnetic Resonance Catheterization: Preserved Mechanical Performance And Freedom From Heating., Burcu Basar, Toby Rogers, Kanishka Ratnayaka, Adrienne E Campbell-Washburn, Jonathan R Mazal, William H Schenke, +4 Additional Authors

Pediatrics Faculty Publications

BACKGROUND: Conventional guidewires are not suitable for use during cardiovascular magnetic resonance (CMR) catheterization. They employ metallic shafts for mechanical performance, but which are conductors subject to radiofrequency (RF) induced heating. To date, non-metallic CMR guidewire designs have provided inadequate mechanical support, trackability, and torquability. We propose a metallic guidewire for CMR that is by design intrinsically safe and that retains mechanical performance of commercial guidewires.

METHODS: The NHLBI passive guidewire is a 0.035" CMR-safe, segmented-core nitinol device constructed using short nitinol rod segments. The electrical length of each segment is less than one-quarter wavelength at 1.5 Tesla, which eliminates …

Use Of Modeling And Simulation In The Design And Conduct Of Pediatric Clinical Trials And The Optimization Of Individualized Dosing Regimens, Chris Stockmann, J. S. Barrett, Jessica K. Roberts, Catherine M.T. Sherwin

Pediatrics Faculty Publications

Mathematical models of drug action and disease progression can inform pediatric pharmacotherapy. In this tutorial, we explore the key issues that differentiate pediatric from adult pharmacokinetic (PK) / pharmacodynamic (PD) studies, describe methods to calculate the number of participants to be enrolled and the optimal times at which blood samples should be collected, and therapeutic drug monitoring methods for individualizing pharmacotherapy. The development of pediatric‐specific drug dosing dashboards is also highlighted, with an emphasis on clinical‐relevance and ease of use.

Hdl In Sepsis - Risk Factor And Therapeutic Approach, Emily E. Morin, Ling Guo, Anna Schwendeman, Xiang-An Li

Pediatrics Faculty Publications

High-density lipoprotein (HDL) is a key component of circulating blood and plays essential roles in regulation of vascular endothelial function and immunity. Clinical data demonstrate that HDL levels drop by 40-70% in septic patients, which is associated with a poor prognosis. Experimental studies using Apolipoprotein A-I (ApoAI) null mice showed that HDL deficient mice are susceptible to septic death, and overexpressing ApoAI in mice to increase HDL levels protects against septic death. These clinical and animal studies support our hypothesis that a decrease in HDL level is a risk factor for sepsis, and raising circulating HDL levels may provide an …

Impact Of Environmental Health On Teen Outcomes In Rural Kentucky, Lesley Davidson, Alissa Briggs, Hatim A. Omar

Pediatrics Faculty Publications

Understanding the impact of family dynamics on health has become an environmental health priority in the field of adolescent medicine. Family dynamics are much more complex than they were 60 years ago and so are behavioral outcomes. This transformation in the American family has led towards a large array of adolescent living situations. Rural Kentucky is a prime example of an area with a high rate of non-traditional family composition. Poor family dynamics may be associated with increased rates of high risk behaviors among teenagers. Among these behaviors are drug use, sexual activity, and depression. In this study, we evaluated …

Women With Disabilities: Reproductive Care And Women’S Health, Stephanie Stockburger, Hatim A. Omar

Pediatrics Faculty Publications

Children, adolescents, and women with disabilities experience the same sexual development, pubertal changes, concerns, and desire to reproduce as their typically developing counterparts. However, society has tended to stigmatize women with disabilities as “asexual” and ignore this aspect of their health care. These women are less likely to receive gynecological exams, contraception, and evaluation of sexual dysfunction. Unfortunately, having a disability places women at risk for sexual exploitation and abuse as well as sexually transmitted infections. Therefore, reproductive health care for these women is imperative. A number of barriers to receiving reproductive care exist. However, with proper education and knowledge …

The P53 Tumor Suppressor Protein Protects Against Chemotherapeutic Stress And Apoptosis In Human Medulloblastoma Cells., Sarah Waye, Aisha Naeem, Muhammad Umer Choudhry, Erika Parasido, Lucas Tricoli, Brian R. Rood, +6 Additional Authors

Pediatrics Faculty Publications

Medulloblastoma (MB), a primitive neuroectodermal tumor, is the most common malignant childhood brain tumor and remains incurable in about a third of patients. Currently, survivors carry a significant burden of late treatment effects. The p53 tumor suppressor protein plays a crucial role in influencing cell survival in response to cellular stress and while the p53 pathway is considered a key determinant of anti-tumor responses in many tumors, its role in cell survival in MB is much less well defined. Herein, we report that the experimental drug VMY-1-103 acts through induction of a partial DNA damage-like response as well induction of …

Intrapersonal Competencies And Service Leadership, Daniel T. L. Shek, Li Lin

Pediatrics Faculty Publications

Intrapersonal competencies form the foundation of one’s development, and they are fundamental qualities of leadership competences. Four types of intelligence are highlighted in the literature of positive psychology: intelligence quotient (IQ), emotional intelligence quotient (EQ), adversity quotient (AQ) and spiritual intelligence quotient (SQ). It is argued that these competences are important in a service leader. Through this lecture, it is expected that students will understand the basic concepts and the importance of different intrapersonal competencies (IQ, EQ, AQ and SQ). We also discuss the relationship between these intrapersonal competencies and effective service leadership. Finally, ways to promote different intrapersonal competencies …

Nurturing University Students To Be Social Entrepreneurs: Relevance Of Service Leadership Education, Daniel T. L. Shek, Li Lin

Pediatrics Faculty Publications

When the concept of social entrepreneurship becomes more popular, many universities explicitly claim that they wish to nurture social entrepreneurs. In this paper, the concept of social entrepreneurship and the successful attributes of social entrepreneurs are outlined. With reference to the question of how university students can be nurtured to be social entrepreneurs, it is suggested that the service leadership model proposed by the Hong Kong Institute of Service Leadership and Management is a good framework to be considered. In the framework, it is asserted that there are three attributes of a successful service leader – leadership competence, moral character, …

Manufacturing Economy Vs. Service Economy: Implications For Service Leadership, Daniel T. L. Shek, Po P.Y. Chung, Hildie Leung

Pediatrics Faculty Publications

In the past few decades, there has been a shift from manufacturing to service economy in many places throughout the world. In Hong Kong, 95% of its GDP is made up by the service industries. Conceptually, these two economies are associated with different production characteristics, organizational structures, and desired attributes of workers and leaders. The differences between these two economies in terms of the production modes are discussed in this paper. In particular, the implications of the economy on effective leadership requirements are outlined. With specific reference to the Service Leadership model proposed by the Hong Kong Institute of Service …

Interpersonal Competence And Service Leadership, Daniel T. L. Shek, Lu Yu, Andrew M. H. Siu

Pediatrics Faculty Publications

According to the Hong Kong Institute of Service Leadership and Management, interpersonal competence is an important component of an effective service leader. The present paper introduces a lecture embedded in a service leadership subject that focuses on promoting students’ interpersonal competence. Several topics are covered in this lecture. First, concepts and theories about interpersonal competence are introduced. Second, the relevance of interpersonal competence to service leadership is outlined. Third, methods of developing interpersonal competence are presented, particularly different conflict management strategies and assertiveness skills. Finally, conclusions and reflections on students’ own interpersonal competence and its relevance to the service leadership …

How Unique Is The Service Leadership Model? A Comparison With Contemporary Leadership Approaches, Daniel T. L. Shek, Po P.Y. Chung, Hildie Leung

Pediatrics Faculty Publications

The growth of the service economy in the contemporary world has resulted in a different set of requirements for effective leadership as compared with the industrial era, which focused primarily on manufacturing industries. To nurture “service leaders” in the service economy, the Hong Kong Institute of Service Leadership and Management proposed the service leadership model. The key characteristics of the service leadership model are outlined in this paper. A systematic comparison was also conducted to identify the common and unique features of the service leadership model with reference to the existing leadership theories, including the trait, servant, spiritual, authentic, ethical, …

Core Beliefs In The Service Leadership Model Proposed By The Hong Kong Institute Of Service Leadership And Management, Daniel T. L. Shek, Li Lin

Pediatrics Faculty Publications

The service leadership model and related curriculum were developed by the Hong Kong Institute of Service Leadership and Management. To nurture service leadership qualities in university students, a 2-credit service leadership subject was developed at The Hong Kong Polytechnic University. This paper presents the core beliefs and key components of the service leadership model and outlines the content of one of the lectures in the subject. The lecture attempts to help students recognize the importance of leadership competencies, moral character and caring disposition in successful leadership, and to explore ways to develop service leadership qualities. In addition to the lecture, …

Evolution And Realms Of Service Leadership And Leadership Models, Daniel T. L. Shek, Rachel C. F. Sun, Ting Ting Liu

Pediatrics Faculty Publications

This paper presents a lesson plan in a course entitled “Service Leadership” at The Hong Kong Polytechnic University. In that lecture, three basic aspects of the service leadership model are presented. First, the origin of service leadership from an evolutionary anthropology perspective is outlined. Second, three realms of service leadership with reference to self, others and systems are presented. Third, two leadership models (i.e. top-down and bottom-up models) are introduced, and their strengths and weaknesses are examined. Students are also invited to reflect on their assumptions of men with reference to leadership. Several class activities including role-play, self-reflection exercises and …

Adolescent Developmental Assets And Service Leadership, Daniel T. L. Shek, Cecilia M. S. Ma, Ting Ting Liu

Pediatrics Faculty Publications

In the field of positive youth development, it is generally asserted that developmental assets or positive youth development qualities contribute to positive adolescent developmental outcomes. In the context of training for service leadership, it is argued that the promotion of developmental assets would help university students develop the foundational competence of service leaders. In this paper, the lesson plan of Lecture Eleven in a course entitled “Service Leadership” run in The Hong Kong Polytechnic University is discussed. In the lecture, four developmental assets related to positive identity (self-esteem, self-efficacy, purpose in life and optimism about the future) proposed by Peter …

Factors Leading To The Creation, Development, And Maintenance Of Positive Social Relationship, Daniel T. L. Shek, Jocelyn L. Lin

Pediatrics Faculty Publications

In contrast to the manufacturing economy where the focus is primarily placed on the man-machine interface, social relationships are important building blocks in the service economy. Hence, identifyig the factors leading to creation, development, and maintenance of positive social relationships within the context of leadership is an important consideration. In this paper, a lecture covers the nature of social relationships and the related determinants (including trust, care, and respect) are outlined. Through this lecture, students can develop the ability to identify the characteristics and determinants of positive social relationships, appreciate the importance of positive relationships to service leaders, and evaluate …

Discordant Identification Of Pediatric Severe Sepsis By Research And Clinical Definitions In The Sprout International Point Prevalence Study, S. L. Weiss, J. C. Fitzgerald, F. A. Maffei, J. M. Kane, A. Rodriguez-Nunez, Michael C. Spaeder, +260 Additional Authors

Pediatrics Faculty Publications

Introduction

Consensus criteria for pediatric severe sepsis have standardized enrollment for research studies. However, the extent to which critically ill children identified by consensus criteria reflect physician diagnosis of severe sepsis, which underlies external validity for pediatric sepsis research, is not known. We sought to determine the agreement between physician diagnosis and consensus criteria to identify pediatric patients with severe sepsis across a network of international pediatric intensive care units (PICUs).

Methods

We conducted a point prevalence study involving 128 PICUs in 26 countries across 6 continents. Over the course of 5 study days, 6925 PICU patients <18 years of age were screened, and 706 with severe sepsis defined either by physician diagnosis or on the basis of 2005 International Pediatric Sepsis Consensus Conference consensus criteria were enrolled. The primary endpoint was agreement of pediatric severe sepsis between physician diagnosis and consensus criteria as measured using Cohen’s κ. Secondary endpoints included characteristics and clinical outcomes for patients identified using physician diagnosis versus consensus criteria.

Results

Of the …