The 2019 Joseph W. St. Geme, Jr Leadership Award Address: Ubuntu: The Power of Social Connections.

The following is an address given by the author in receipt of the Joseph W. St. Geme, Jr Leadership Award, presented by the Federation of Pediatric Organizations at the Pediatric Academic Societies Meeting in Baltimore, Maryland, on April 27, 2019.

Training Pediatricians to Address Health Disparities: An Innovative Residency Track Combining Global Health With Community Pediatrics and Advocacy.

PROBLEM: Pediatric residency programs have been tasked to train a workforce of pediatricians with skills in community pediatrics (CP) and advocacy, and knowledge of global child health priorities. APPROACH: In 2009, the University of Washington (UW) Seattle Children's Hospital pediatric residency program developed the Resident Education in Advocacy and Child Health (REACH) program, a combined pathway for global health (GH) and CP training. After participating in a combined curriculum, residents complete a community immersion either in Kisii, Kenya (GH) or rural Washington (CP). This approach provides an efficient use of faculty and administrative resources and delivers a sustainable and ethical strategy for inspiring pediatric residents to address child health problems at a systems level. OUTCOMES: Between 2009 and 2013, the percentage of graduating residents from the UW pediatric residency program who rated GH training as "outstanding/excellent/good" increased from 58.4% to 100%, and the percentage rating community and population health training as "outstanding/excellent/good" increased from 56% to 88.8%. Annual applicant surveys in the period 2011-2014 revealed that the REACH program led a significant percentage of candidates to rank the UW pediatric residency more favorably because of its GH (37%-48%) and CP (55%-74%) training. NEXT STEPS: A mixed-methods assessment will evaluate the impact on resident confidence in core areas of community health and advocacy including collaborating with community groups, setting professional career goals, addressing underlying determinants of health during patient encounters, communicating in cross-cultural settings, and advocating for child health. A survey will assess outcomes on graduates' careers.

Can preeclampsia be considered a renal compartment syndrome? A hypothesis and analysis of the literature.

The morbidity and mortality associated with preeclampsia is staggering. The physiology of the Page kidney, a condition in which increased intrarenal pressure causes hypertension, appears to provide a unifying framework to explain the complex pathophysiology. Page kidney hypertension is renin-mediated acutely and ischemia-mediated chronically. Renal venous outflow obstruction also causes a Page kidney phenomenon, providing a hypothesis for the increased vulnerability of a subset of women who have what we are hypothesizing is a "renal compartment syndrome" due to inadequate ipsilateral collateral renal venous circulation consistent with well-known variation in normal venous anatomy. Dynamic changes in renal venous anatomy and physiology in pregnancy appear to correlate with disease onset, severity, and recurrence. Since maternal recumbent position is well known to affect renal perfusion and since chronic outflow obstruction makes women vulnerable to the ischemic/inflammatory sequelae, heightened awareness of renal compartment syndrome physiology is critical. The anatomic and physiologic insights provide immediate strategies to predict and prevent preeclampsia with straightforward, low-cost interventions that make renewed global advocacy for pregnant women a realistic goal.

An agenda for children for the 113th Congress: recommendations from the pediatric academic societies.

The 113th Congress of the United States begins in January 2013. With each new Congress, there are many changes, not only in the faces of the newly elected, but also in the membership of committees and the staff serving the members. As agendas for the session are set, there is a resurgence of conflicting priorities. In the past, when these conflicts were resolved, children were rarely at the top of the list. Given the numerous pressing national issues, both domestic and foreign, the same trend will likely occur.

Modifying the Toyota Production System for continuous performance improvement in an academic children's hospital.

The Toyota Production System (TPS) has become a successful model for improving efficiency and eliminating errors in manufacturing processes. In an effort to provide patients and families with the highest quality clinical care, our academic children's hospital has modified the techniques of the TPS for a program in continuous performance improvement (CPI) and has expanded its application to educational and research programs. Over a period of years, physicians, nurses, residents, administrators, and hospital staff have become actively engaged in a culture of continuous performance improvement. This article provides background into the methods of CPI and describes examples of how we have applied these methods for improvement in clinical care, resident teaching, and research administration.

A position statement on kidney disease from powdered infant formula-based melamine exposure in Chinese infants.

Melamine, a man-made non-nutritive substance containing nitrogen, can falsely elevate measures of protein content in foodstuffs. Several manufacturers of powdered infant formula in China apparently added melamine to raise the measured protein content and thereby exposed thousands of infants and young children to very high levels of melamine. Such exposure resulted in cases of acute kidney failure and nephrolithiasis. This Editorial from members of the world-wide Pediatric Nephrology community provides a common-sense approach to the care of infants who may have been exposed to powdered infant formula in 2007-2008.

Role of a pediatric department chair: factors leading to satisfaction and burnout.

OBJECTIVE: To determine factors associated with satisfaction and burnout in pediatric department chairs. STUDY DESIGN: A 1-time online survey of 250 current and former pediatric chairs who were members of Association of Medical School Pediatric Department Chairs anytime between 1993 and 2005. The questionnaire included demographics, satisfaction levels, stress experienced, and time spent on various work activities. We also included the Maslach Burnout Inventory-Human Services Survey and the abbreviated Workplace Climate Questionnaire. Burnout was defined as high scores on the depersonalization or emotional exhaustion subscales of the Maslach Burnout Inventory-Human Services Survey. RESULTS: Our response rate was 62%; most chairs (65%) reported being very satisfied with their job. Approximately 30% of chairs for <5 years experienced burnout, compared with 15% of chairs who held their positions for >5 years (P < .05). Factors associated with burnout included years as chair (odds ratio [OR], 0.9; 95% CI, 0.80-0.99), >1 night worked per week (OR, 5.9; 95% CI, 1.5-22.9), high workload (OR, 3.0; 95% CI, 1.3-6.7), and lack of supportive work environment (OR, 2.2; 95% CI, 1.1-4.2). CONCLUSION: Steps should be taken to decrease burnout in chairs, including policies that promote physician well being as integral to successful departments.