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1. Influence of immunosuppression on seroconversion against SARS‐CoV‐2 in two kidney transplant recipients

Author

Wang, Aileen X, Cardona, Orlando Quintero, Ho, Dora Y, Busque, Stephan, and Lenihan, Colin R

Subjects
Infectious Diseases, Pneumonia, Pneumonia & Influenza, Biodefense, Vaccine Related, Lung, Transplantation, Prevention, Emerging Infectious Diseases, Organ Transplantation, Kidney Disease, Renal and urogenital, Infection, Good Health and Well Being, Aged, Female, Humans, Immunocompromised Host, Immunosuppressive Agents, Kidney Transplantation, Middle Aged, SARS-CoV-2, Seroconversion, Transplant Recipients, antibodies, COVID-19, immunosuppression, RT-PCR, seroconversion, Clinical Sciences, Surgery
Abstract

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.

Published
2021

2. Missed diagnosis and misdiagnosis of infectious diseases in hematopoietic cell transplant recipients: an autopsy study.

Author

Multani, Ashrit, Allard, Libby S, Wangjam, Tamna, Sica, R Alejandro, Epstein, David J, Rezvani, Andrew R, and Ho, Dora Y

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Emerging Infectious Diseases, Transplantation, Clinical Research, Infectious Diseases, Vaccine Related, Infection, Good Health and Well Being, Aged, Autopsy, Communicable Diseases, Diagnostic Errors, Hematopoietic Stem Cell Transplantation, Humans, Immunohistochemistry, Male, Middle Aged, Missed Diagnosis, Mortality, Patient Outcome Assessment, Transplant Recipients, Transplantation, Autologous, Transplantation, Homologous, Cardiovascular medicine and haematology
Abstract

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.

Published
2019

6. Understanding effective leadership for quality early childhood programmes in Hong Kong

Author

Ho, Dora Choi-wa and Tikly, Leon

Subjects
372.21095725
Abstract

This study aims to identify the characteristics of effective leadership for quality early childhood programmes in the local settings of a sample of Hong Kong preschools. To achieve this aim, effective leadership was investigated from the multiple perspectives of various school stakeholders including school governors, principals, teachers, members of support staff and parents. The interactions between school leadership, in-school processes, school outcomes and school context were examined in depth. One kindergarten and one child care centre were selected for study, both of which were rated as 'excellent' in the external validation of the quality assurance inspections of a local education authority. Data were collected from semi-structured, individual and group interviews, and the analysis of data was conducted based on the model of Attride-Stirling's Thematic Network (2001). As perceived by various school stakeholders, the school 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 literature. More importantly, research findings indicated that leadership was largely centralized in the hands of the school principals in this study. There was a gap between the form of centralized leadership in the case studies and the conceptual model of participative leadership experienced in many Western developed countries. Discussions drawn from the results of this study mainly focus on three areas: conflicts between market forces and professional values, dilemma between centralization and decentralization of school leadership, and sustainable development of the preschools. The implications of this study for professional development, leadership practice and government support are discussed and its implications for theoretical literature and further research are also presented.

Published
2006

12. Fatal Emmonsia sp. infection and fungemia after orthotopic liver transplantation

Author

Kappagoda, Shanthi, Adams, Jason Y., Luo, Robert, Banaei, Niaz, Concepcion, Waldo, and Ho, Dora Y.

Subjects
Diseases -- Canada -- Health aspects, Resveratrol -- Health aspects, Antifungal agents -- Health aspects, Liver transplantation -- Health aspects, Lung diseases -- Health aspects, Health, Stanford University. School of Medicine
Abstract

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 [...]

Published
2017
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14. Answer to April 2022 Photo Quiz

Author

Wang, Hannah, primary, Zhang, Jingjing, additional, Kao, Chia-Sui, additional, Budvytiene, Indre, additional, Ho, Dora Y., additional, Mathison, Blaine, additional, and Hogan, Catherine A., additional

Published
2022
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15. The Changing Landscape of Leadership in Early Childhood Education in China

Author

Ho, Dora, Mo, Wang, and He, Pan

Subjects
Social Science
Abstract

This chapter aims to offer a theoretical discussion on the changing landscape of leadership and explores the emerging practice of teacher leadership in ECE in China. In 2010, the central government of China introduced several waves of policies relating to teacher professional development to improve and promote the quality of ECE. The global discourses mainly developed in the West have indicated that school leadership plays an important role in promoting teachers’ professional development and the quality of education. These discourses have influenced the agenda for educational reform in China as reflected in the recent strategies formulated for the development of school leadership in ECE. Historically, ECE teachers have been viewed as babysitters rather than as educators, and preschool principals have been considered policy implementers and school managers rather than school leaders of innovation and change. This chapter discusses the changing landscape of school leadership in China’s ECE and how it is influenced by a hierarchical culture. It is argued that the practices of school leadership have been largely centralised in the hands of preschool principals, alongside of which there has been an emergence of teacher leadership co-exercised with principalship in home-school networks and teaching research groups.

Published
2022

19. Respiratory Viral Infections in Transplant Recipients

Author

Liu, Catherine, Ho, Dora Y., and Boeckh, Michael

Subjects
Parainfluenza virus, Transplantation, viruses, Human coronavirus, Respiratory syncytial virus, Human metapneumovirus, Influenza virus, Human rhinovirus, Article
Abstract

Respiratory viral infections (RVIs) are common among the general population; however, these often mild viral illnesses can lead to serious morbidity and mortality among recipients of hematopoietic stem cell and solid organ transplantation. The disease spectrum ranges from asymptomatic or mild infections to life-threatening lower respiratory tract infection or long-term airflow obstruction syndromes. Progression to lower respiratory tract infection or to respiratory failure is determined by the intrinsic virulence of the specific viral pathogen as well as various host factors, including the type of transplantation, status of the host’s immune dysfunction, the underlying disease, and other comorbidities. This chapter focuses on the epidemiology, clinical manifestations, diagnosis, and management of RVIs in this susceptible population and includes respiratory syncytial virus, parainfluenza virus, human metapneumovirus, influenza virus, human coronavirus, and human rhinovirus. The optimal management of these infections is limited by the overall paucity of available treatment, highlighting the need for new antiviral drug or immunotherapies.

Published
2018

35. Clinical Significance of Low Cytomegalovirus DNA Levels in Human Plasma

Author

Waggoner, Jesse, Ho, Dora Y., Libiran, Paolo, and Pinsky, Benjamin A.

Abstract

ABSTRACTThe clinical significance of the detection of low copy numbers of cytomegalovirus (CMV) DNA in immune-suppressed patients remains unclear. In this study, we compared the artusCMV Rotor-Gene PCR, utilizing an automated nucleic acid extraction and assay setup (the artusCMV protocol), with the COBAS Amplicor CMV Monitor test (our reference protocol). We then analyzed the results of all CMV PCR tests ordered following the implementation of the artusCMV protocol at our institution and followed 91 adult patients with positive test results. The artusCMV protocol had a linear range extending from 2.0 to 7.0 log10copies/ml and had a lower limit of 95% detection of 57 copies/ml. With archived plasma samples, this protocol demonstrated 100% sensitivity and 94% specificity for the detection of CMV DNA. Following implementation of the artusCMV protocol, 320 of 1,403 (22.8%) plasma samples tested positive (compared with 323/3,579 [9.0%] samples in the preceding 6 months), and 227 (16.2%) samples had copy numbers of <400/ml. Ninety-one adult patients had at least one positive test. The data were analyzed using a threshold of 200 copies/ml, and in 22 episodes, the viral load increased from <200 copies/ml to =200 copies/ml on sequential tests. In 21 of these 22 episodes, either the viral load continued to increase or antiviral treatment was initiated in response to the repeat value. In summary, we evaluate the performance characteristics of a protocol utilizing the artusCMV PCR and identify clinically meaningful changes in CMV DNA copy numbers even when they are initially detected at a low level.

Published
2012
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36. Brain Abscess Caused by Phaeoacremonium parasiticumin an Immunocompromised Patient

Author

McNeil, Candice J., Luo, Robert F., Vogel, Hannes, Banaei, Niaz, and Ho, Dora Y.

Abstract

ABSTRACTPhaeoacremonium parasiticumis an environmental fungus usually associated with subcutaneous infections. We report the first documented case of central nervous system involvement with brain abscess formation in a patient with chronic granulomatous disease and review the literature on Phaeoacremonium parasiticuminfections.

Published
2011
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