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In this study, we aimed to explore early childhood educators' conceptualisations of physical literacy and how these are integrated in their teaching practice. To this end, we used a mixed-methods embedded design, with a primarily qualitative component that is supported by quantitative data (QUAL + quan). Participants consisted of class teachers (n = 26), head teachers (n = 8), and principals (n = 11), who participated in interviews and responded to questionnaires. Qualitative data were examined using thematic analysis, and quantitative data were analysed using non-parametric statistics. Early childhood educators articulated an incomplete conceptualisation of physical literacy and reported low awareness of the concept. While the concept is relatively novel to early childhood teachers, integration of physical literacy in teaching practice was found to encompass the inter-related physical, affective, cognitive, and behavioural domains. Availability of resources, teacher training, education policies, family environment, and community environment were found to influence the development of physical literacy in early childhood settings. We recommend that education policies be reviewed, and systems-based support be provided to enhance teachers' capabilities, as well as family and community environments.

Solid organ transplant recipients are at risk for infectious complications due to chronic immunosuppression. The outbreak of coronavirus disease 2019 (COVID-19) in the United States has raised growing concerns for the transplant patient population. We seek to add to the current limited literature on COVID-19 in transplant recipients by describing the clinical course of two kidney transplant recipients with SARS-CoV-2 infection monitored by both RT-PCR and serology. Through careful adjustment of their immunosuppression regimen, both patients had excellent recovery with intact graft function and development of anti-SARS-CoV-2 antibodies.

Hematopoietic cell transplantation (HCT) is potentially curative for patients with hematologic disorders, but carries significant risks of infection-related morbidity and mortality. Infectious diseases are the second most common cause of death in HCT recipients, surpassed only by progression of underlying disease. Many infectious diseases are difficult to diagnose and treat, and may only be first identified by autopsy. However, autopsy rates are decreasing despite their value. The clinical and autopsy records of adult HCT recipients at our center who underwent autopsy between 1 January 2000 and 31 December 2017 were reviewed. Discrepancies between premortem clinical diagnoses and postmortem autopsy diagnoses were evaluated. Of 185 patients who underwent autopsy, 35 patients (18.8%) had a total of 41 missed infections. Five patients (2.7%) had >1 missed infection. Of the 41 missed infections, 18 (43.9%) were viral, 16 (39.0%) were fungal, 5 (12.2%) were bacterial, and 2 (4.9%) were parasitic. According to the Goldman criteria, 31 discrepancies (75.6%) were class I, 5 (12.2%) were class II, 1 (2.4%) was class III, and 4 (9.8%) were class IV. Autopsies of HCT recipients frequently identify clinically significant infectious diseases that were not suspected premortem. Had these infections been suspected, a change in management might have improved patient survival in many of these cases. Autopsy is underutilized and should be performed regularly to help improve infection-related morbidity and mortality. Illustrative cases are presented and the lessons learned from them are also discussed.

The purpose of this paper is to offer a theoretical discussion on teacher leadership in early childhood education (ECE) in Chinese contexts. Since 2010, the Chinese government has initiated a comprehensive education reform in ECE, with strategies for developing teacher leadership and promoting education quality. However, at the school level there is a lack of leadership preparation and development, along with a gap between policy initiative and its implementation. How to narrow this gap between policy and practice in teacher leadership has become a critical issue for ECE in China. This paper suggests that 'formal role or informal role' and 'role or practice' are important dimensions of teacher leadership in a Chinese, policy-driven context. In this regard, it is worth exploring how teacher leadership is conceptualized and enacted in the process of quality improvement and related contextual factors. In doing so, an agenda could be identified for future research, contributing to theories on the development of teacher leadership in the global discourse.

Purpose: The purpose of this paper is to provide a research synthesis of findings drawn from studies of teacher leadership published in English-based journals from 2000 to 2018. The goal of the research synthesis was to develop new insights into teacher leadership through a theoretical discussion and to identify emerging themes for future research. Design/methodology/approach: The methodology employed in this study was systematic review. The study first identifies a body of relevant literature and research on teacher leadership from the English-based journals from 2000 to 2018. Information concerning the nature of the studies as well as substantive findings was extracted from each of the articles. Synthesis of findings was accomplished by identifying key themes in the literature. Findings: The synthesis yielded four themes: "the notion of teacher leadership," "the theoretical perspectives are used for understanding teacher leadership," "the factors are influencing the development of teacher leadership," and "the approach to build and develop leadership capacity." Originality/value: This paper attempts to offer a critical review on the current literature and research on teacher leadership, reveal if there are any gaps in the ongoing debate, and identify the agenda for future research. This paper not only explores "what there is," but also examines "what is missing," and "what could be improved upon" by reviewing research findings that emerged in the teacher leadership literature produced from 2000 to 2018. The paper could shed light on the existing research about teacher leadership.

Purpose: The purpose of this study is to construct a scale that is contextually suitable for measuring early childhood leadership in China. Design/methodology/approach: Following a standard scale development procedure, both qualitative and quantitative research approaches were addressed. Qualitative data was collected from 21 semistructured interviews with formal and informal teacher leaders in Xiamen City, China. Using survey data of 120 respondents and 305 respondents, an exploratory factor analysis was conducted twice to determine the underlying factorial structure of the scale. A further sample of 317 respondents were used to test the latent structure and validity of the scale using confirmatory factor analysis. Findings: Based on the results from reliability and validity tests, this study indicates that the scale demonstrates sound psychometric properties. A three-factor model was determined, including staff management and development, peer learning and support and communication with parents. Originality/value: The scale is the first of its kind for measuring early childhood leadership in China.

Over the last decade, the therapeutic landscape for hematological malignancies (HMs) has witnessed a remarkable surge in the development of novel biological and small‐molecule‐targeted immunomodulatory agents. These therapies have drastically improved survival, but some come at the cost of increased risk of bacterial, viral, and/or fungal infections and on‐target off‐tumor immunological side effects. To mitigate such risks, physicians must be well informed about infectious complications and necessary preventive measures, such as screening, vaccinations, and antimicrobial prophylaxis. Furthermore, physicians should be vigilant about the noninfectious side effects of these agents that can mimic infections and understand their potential drug–drug interactions with antimicrobials. Strengthening and harmonizing the current surveillance and reporting system for drug‐associated infections in real‐world settings is essential to better ascertain the potential infections associated with these agents. In this review, we aimed to summarize the infection risks associated with novel agents used for specific HMs and outline recommended strategies for monitoring and prophylaxis. [ABSTRACT FROM AUTHOR]

Background Neuroinvasive infection with Francisella tularensis , the causative agent of tularemia, is rare. Establishing clinical suspicion is challenging if risk factors or clinical features classically associated with tularemia are absent. Tularemia is treatable with antibiotics; however, there are limited data to inform management of potentially fatal neuroinvasive infection. Methods We collected epidemiologic and clinical data on 2 recent US cases of neuroinvasive F. tularensis infection, and performed a literature review of cases of neuroinvasive F. tularensis infection published after 1950. Results One patient presented with focal neurologic deficits and brain lesions; broad-range molecular testing on resected brain tissue detected F. tularensis. The other patient presented with meningeal signs; tularemia was suspected based on animal exposure, and F. tularensis grew in cerebrospinal fluid (CSF) culture. Both patients received combination antibiotic therapy and recovered from infection. Among 16 published cases, tularemia was clinically suspected in 4 cases. CSF often displayed lymphocytic pleocytosis. Among cases with available data, CSF culture was positive in 13 of 16 cases, and F. tularensis antibodies were detected in 11 of 11 cases. Treatment typically included an aminoglycoside combined with either a tetracycline or a fluoroquinolone. Outcomes were generally favorable. Conclusions Clinicians should consider neuroinvasive F. tularensis infection in patients with meningitis and signs suggestive of tularemia or compatible exposures, lymphocyte-predominant CSF, unrevealing standard microbiologic workup, or lack of response to empiric bacterial meningitis treatment. Molecular testing, culture, and serologic testing can reveal the diagnosis. Favorable outcomes can be achieved with directed antibiotic treatment. [ABSTRACT FROM AUTHOR]

In recent years, the role of school principals in providing leadership, and the impact of that leadership in promoting teacher professional development for building school capacity has attracted increasing attention worldwide. The study described in this paper explores the practices of leadership for promoting school-based teacher professional development (SBTPD) through a case study of a preschool in Hong Kong, the Special Administrative Region of China. The case study examines leadership and SBTPD. Semi-structured interviews were used for data collection. The research participants were the management team and teachers from the case study school. The findings of the study indicate that direction setting, communication and collaboration were associated with the practice of leadership for promoting SBTPD. We argue that teacher participation in decision-making is an important factor influencing the practice of leadership and its impact on SBTPD. There are implications for developing a critical awareness of the constraints that limit the extent to which SBTPD can be empowering in the hierarchical school structure in a Chinese educational context.

This article offers a theoretical discussion on the current problems and future challenges of school capacity building in early childhood education (ECE), aiming to highlight some key areas for future research. In recent years, there has been a notable policy shift from monitoring quality through inspection to improving quality through school capacity building in early childhood institutions in the global discourse for quality. Reflecting this policy shift and its implications on school development, ECE in Hong Kong is used as an illustrative example to deliberate the issues of school capacity building in Chinese educational contexts. We identify three challenging contexts: (1) low professional qualification and minimal teacher education resulting in a deficit approach to processional development, (2) absence of school-based professional learning culture for empowering teachers as internal agents of change, and (3) hierarchical culture within a school and between university and school hindering the process of school capacity building. Corresponding to these challenges, we aim to propose two suggestions, including (1) empowering teachers in ECE through school-based professional learning community and (2) promoting authentic external support in the process of university-school collaboration. Finally, we further propose specific directions for future research on school capacity building in ECE in Hong Kong. In doing so, it will contribute to knowledge-based development in school capacity building in Chinese educational contexts.

Purpose: The purpose of this paper is to examine the relationship between staff size and perceived organizational support (POS) in early childhood education (ECE) organizations. Design/methodology/approach: A territory-wide questionnaire survey was designed to investigate the perceptions of preschool teachers in Hong Kong on four dimensions of organizational support, namely, teacher participation in decision making, school management support, school performance in organizational support, and organizational negativity in organizational support. In total, 2,066 teachers from 189 schools were sampled with stratified random sampling. Confirmatory factor analysis and latent mean analysis were employed. Findings: There was a significant relationship between staff size and POS. Specifically, teachers working at small schools in terms of staff size reported significantly higher POS than their counterparts in medium and large schools in aspects including teacher participation in decision making, school management support, and school performance in POS. Conversely, both medium and large schools had higher scores on organizational negativity. Research limitations/implications: There may exist other factors (e.g. principal leadership), which are not investigated in this study, that influence POS. Future studies are needed to capture a fuller structural relationship among an array of factors that influence POS. Originality/value: Research on staff size and POS has been conducted separately, without one element informing the other. The findings of the present study will stimulate more research on POS and staff size. The study will stimulate thinking about whether larger preschools are more efficient than smaller preschools in terms of scale of economies in a marker driven, ECE context. Building upon the foundation laid by the study, future studies may explore the interaction between staff size and POS on intended student outcomes in ECE.

Emmonsia species are ubiquitous, soil-dwelling saprophytic fungi. Two species, E. crescens and E. parva, cause pulmonary disease (adiaspiromycosis) in rodents and other small animals. After inhalation, the conidia (adiaspores) grow [...]

This paper describes the process of school capacity building in Hong Kong's early childhood education at a time when there was a quest for quality education. A local preschool was selected for the study, which took part in a university-school support programme through which consultancy was hired from a university to provide school-based support. An action research approach was chosen in the research design. The process of building capacity was examined in the selected preschool over a year. The findings indicated that the preschool went through a process of capacity building, from the "status quo ante," through the exploration stage to the initial implementation stage of change. Restructuring and reculturing were emerging in the change process, with the support of the school consultants.

In recent years, the Western discourse on distributed leadership has attracted increased attention in Chinese societies that have traditionally relied on highly centralized administrative systems in which power is located in the person of the school principal or other unit leader. This article explores the implications of applying the concept of distributed leadership in a Chinese context and outlines a research agenda for future work in this area. The article focuses specifically on teacher leadership in early childhood education in Hong Kong as an illustrative case. It suggests that change agentry, collaboration, collegiality, power, and authority are key aspects of discourse on teacher leadership in a Chinese, policy-driven context. It is argued that existing studies of leadership have failed to recognize the complexity of employing teacher leadership in hierarchical, policy-driven, high power distance, collectivist cultural contexts.

This paper discusses the changing concepts of leadership in early childhood education (ECE) in England and Hong Kong during a period of significant education reform. We seek to illustrate the interplay between the impact of the policy agenda and the emerging quality leadership perspectives found in the theoretical literature, by first considering the recent education reform context in both England and Hong Kong, before examining the importance of leadership for quality provision given the constraints and drivers of policy expectation. The paper explores transformational, distributed and authentic models of leadership in the "New Leadership" paradigm and uses these constructions to examine the developing problems and opportunities for quality leadership as expected by the current policy reform agenda and understood by the practitioners. In conclusion, we raise questions about the interplay between policy agendas and the development of theoretical models of leadership for ECE in England and Hong Kong. (Contains 2 notes.)

Western frameworks for school improvement, including the stakeholder model and the model of decentralized leadership, have recently been promoted as solutions for school improvement. Using early childhood education in Hong Kong as an illustrative case, this article focuses on the power and authority of leadership in school decision making. The interview data collected from the two case study schools reveal a paradox of power in leadership that is characterized by tensions between centralization and decentralization in the change process, where decentralization is advocated by policymakers but traditional hierarchical cultures remain. The relationship between the leaders and school stakeholders incorporates a concept of harmony that functions to defuse the potential power struggle embedded in decision making. (Contains 1 table.)

This article aims to identify leadership roles for quality in early childhood programmes in the local settings of a sample of Hong Kong preschools. Two schools were selected for the study, both of which were rated as excellent in the quality assurance inspections of a local education authority. Effective leadership was explored from the multiple perspectives of various school stakeholders, including school governors, principals, teachers, members of support staff and parents. The qualitative interviews were used for data collection. The interview data indicated that the teachers, members of support staff and parents quite often viewed themselves as followers and were dependent on a single leader, the head. As perceived by the school stakeholders, the principals tended to take up three major roles: role model, school manager and mentor for curriculum and pedagogy. Characteristics of the associated patterns of the three leadership roles were similar to those of moral, managerial and instructional leadership documented in the Western literature. The implications of the study for promoting moral leadership and developing teacher leadership are discussed. (Contains 1 note and 2 tables.)

In recent years, teacher participation in school decision making has become an important topic for discussion in the field of early childhood education in Hong Kong. The purpose of this article is to discuss the theoretical significance, difficulties and issues of greater teacher participation in curriculum and pedagogical decision making in local preschools. It begins by setting out the key concepts relating to teacher participation in the process of school decision making. This is followed by a contextual analysis of the recent development of the field as the background for discussion. The third section re-examines Alutto and Belasco's typology for participatory decision making in order to outline the analytical framework of this article. Based on that framework, the fourth section examines the decision-making process of actual and desired teacher participation in the local context and discusses the factors that foster the movement towards the ideal condition of participation in decision making. It is argued that the leadership of preschool heads is cardinal in creating structures and promoting school culture for the increase of both actual and desired teacher participation in curriculum and pedagogical decision making. The possibilities and challenges of supporting and sustaining teachers in their engagement in curriculum leadership are discussed. (Contains 1 figure and 1 note.)

With a growing awareness of the importance of early childhood education, the governments of Hong Kong and England have both increased investment through providing fee assistance to parents for buying services and providing funding to providers for offering "free" places, respectively. Alongside the increased funding of early childhood education, a heightened interest in the quality of early years settings has arisen. This paper aims to develop a framework for comparative studies by addressing the similarities and differences in quality improvement of both systems. Three key issues are discussed: relevance of the quality criteria for assessment, interpretations of the quality improvement mechanism and its use in guiding practice, and the influence of contextual factors in terms of stakeholders' views of the quality process. It is argued that these key issues are fundamental to a framework for understanding different sociocultural contexts and dynamics in shaping the quality improvement of early childhood education. (Contains 1 note.)

Research Findings: This article describes research into leadership practice for school improvement in Hong Kong preschools at a time when there was a move toward increased accountability. Two schools were selected for study, both of which were rated as excellent in the quality assurance inspections of the Education Bureau. Leadership practice for school improvement and related factors were investigated from the perspectives of various school stakeholders. Practice or Policy: The findings indicate that the 2 case study schools adopted different approaches to the process of change. One school principal delegated more to her subordinates and sought a radical change in the curriculum. In contrast, the other school principal imposed more restrictions on the exercise of authority in decision making and delegation and tended to follow the logic of a quick-fix approach. Overall, though the 2 schools adopted different approaches to curriculum change, the exercise of leadership in both schools was still highly centralized. The characteristics of leadership practice as perceived by various school stakeholders were different from the concepts of distributed leadership documented in the Western literature. (Contains 2 tables.)

Herpes simplex virus (HSV) and varicella zoster virus (VZV) are alpha herpesviruses that establish life-long latent infection in neuronal ganglia after primary infection. Periodic reactivation of these viruses results in recurrent infections that can have significant impact on patients' quality of life. HSV commonly causes oral and genital mucocutaneous infections whereas VZV is responsible for varicella/chickenpox and herpes zoster/shingles, but cancer patients are at particularly higher risk of complications including disseminated and visceral infections due to impaired cell-mediated immunity. While diagnosis of more common HSV and/or VZV infections is frequently clinically based, immunocompromised hosts may have atypical skin presentation or visceral involvement. Thus, diagnostic confirmation using virus-specific tests such as polymerase chain reaction or immunohistochemical staining is crucial in some cases. Oral acyclovir, valacyclovir and famciclovir are usually used for mild to moderate infections and intravenous acyclovir is the drug of choice for severe or disseminated infections. Foscarnet can be used when acyclovir-resistance is confirmed or suspected. Pharmaceutical prophylaxis against HSV and/or VZV should be considered in high-risk cancers patients. Currently, there is no commercially available vaccine against HSV, but VZV vaccines are available to prevent varicella and zoster. [ABSTRACT FROM AUTHOR]

This article discusses a case of erythema gyratum repens (EGR), a dermatologic condition, associated with pulmonary tuberculosis (TB). EGR is typically linked to underlying malignancy, but in this case, TB was identified as the trigger. The patient, an immigrant from the Philippines, presented with skin lesions and other symptoms, but TB was initially overlooked due to a negative test result. The article emphasizes the importance of considering alternative causes of EGR and highlights the need for further testing in high-risk patients, regardless of test results. [Extracted from the article]

Invasive fungal diseases (IFDs) are common in patients with acute myeloid leukemia (AML), but no recent data on incidence without antifungal prophylaxis are available. We evaluated the incidence of IFDs in patients with AML undergoing induction chemotherapy at Stanford University Hospital from 2012 to 2017, for up to 12 weeks after induction. We also analyzed factors associated with IFD development. Thirty-six of 240 patients (13%) developed at least one proven or probable IFD. Seventy-eight percent of the proven or probable IFDs were due to Candida or Aspergillus species. Infection due to Fusarium and Mucorales was uncommon. Absolute neutrophil count (ANC) of <500 µL/L at the start of induction was associated with an increased risk of IFD. One hundred and eighty-seven patients (78%) were started on systemic antifungal drugs, even without microbiologic evidence of an IFD. IFDs remain frequent in AML patients undergoing induction chemotherapy without antifungal prophylaxis. [ABSTRACT FROM AUTHOR]

In this article, the authors report on their current work towards developing an international research project that will examine the leadership of quality provision in early years settings in England and Hong Kong. The main objective of the research is to explore the relationship between quality leadership and quality assurance as well as comparing and contrasting the different experiences of providers of early years care and education, thus beginning to draw some conclusions about the inter-relationship and inter-dependency of leadership and quality. This research will be of significant value to teacher educators and school leaders in their efforts to support the quality improvement agenda as well as helping to shape leadership education and training. It will also contribute to an understanding of the similarities and differences in the two systems and the interplay of different cultural contexts and dynamics in shaping early childhood education and care.

Invasive mold infection (IMI) of the gastrointestinal (GI) tract is a rare complication in immunocompromised patients that carries a high mortality rate. It is most often described in the setting of disseminated disease. Early diagnosis and treatment are critical in its management, but this is rarely obtained, leading to delayed therapy. To describe the clinical characteristics, treatment and outcomes of this infection, we reviewed all the cases of adult patients with histopathological findings from autopsy or surgical specimens that demonstrated fungal invasion into the GI tract at Stanford Hospital & Clinics from January 1997 to August 2020. Twenty-two patients that met criteria were identified and they were all immunocompromised, either due to their underlying medical conditions or the treatments that they received. The most common underlying disease was hematological malignancies (63.6%) and the most common symptoms were abdominal pain, GI bleeding and diarrhea. A majority of patients (72.7%) had disseminated invasive mold infection, while the rest had isolated GI tract involvement. In 2/3 of our cases, the fungal genus or species was confirmed based on culture or PCR results. Given the very high mortality associated with GI mold infection, this diagnosis should be considered when evaluating immunocompromised patients with concerning GI signs and symptoms. A timely recognition of the infection, prompt initiation of appropriate antifungal therapy as well as surgical intervention if feasible, are key to improve survival from this devastating infection. Lay summary Patients with a weakened immune system can suffer from mold infections in the bowel, which are difficult to diagnose and have very high death rate. We examined such cases in our institution in order to learn about their clinical and microbiological features. This study can further improve our understanding of these infections in order to improve patient outcome. [ABSTRACT FROM AUTHOR]

Background: Skull base osteomyelitis (SBO) is an infection of the central cranial bones, most commonly resulting from contiguous spread of infection from adjacent head and neck structures. SBO is a well‐recognized complication of treatment of head and neck cancer (HNC) that results in significant morbidity. Methods: We conducted a retrospective chart review of HNC patients diagnosed with SBO. Results: SBO was commonly diagnosed with nasal endoscopy showing mucosal breakdown between the naso/oropharynx and skull base and with characteristic changes on CT/MRI. Culture data were often polymicrobial, inclusive of naso/oropharyngeal flora, but half of the patients additionally had antibiotic‐resistant or atypical pathogens. The mean duration of antimicrobial therapy was 117 +/− 94 days. Recurrent SBO was found in half of the patients, associated with Pseudomonas aeruginosa and with persistent defects in the mucosa abutting the skull base. Conclusions: Diagnosis and management of SBO in HNC patients are challenging. Recommendations to aid in clinical care are proposed. Level of evidence: 4, case series. [ABSTRACT FROM AUTHOR]