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BackgroundIn comparison with the general population, adolescents with juvenile idiopathic arthritis (JIA) are at higher risk for morbidity and mortality. However, limited evidence is available about this condition's underlying metabolic profile in adolescents with JIA relative to healthy controls. In this untargeted, cross-sectional metabolomics study, we explore the plasma metabolites in this population.MethodsA sample of 20 adolescents with JIA and 20 controls aged 13-17 years were recruited to complete surveys, provide medical histories and biospecimens, and undergo assessments. Fasting morning plasma samples were processed with liquid chromatography-mass spectrometry. Data were centered, scaled, and analyzed using generalized linear models accounting for age, sex, and medications (p-values adjusted for multiple comparisons using the Holm method). Spearman's correlations were used to evaluate relationships among metabolites, time since diagnosis, and disease severity.ResultsOf 72 metabolites identified in the samples, 55 were common to both groups. After adjustments, 6 metabolites remained significantly different between groups. Alpha-glucose, alpha-ketoglutarate, serine, and N-acetylaspartate were significantly lower in the JIA group than in controls; glycine and cystine were higher. Seven additional metabolites were detected only in the JIA group; 10 additional metabolites were detected only in the control group. Metabolites were unrelated to disease severity or time since diagnosis.ConclusionsThe metabolic signature of adolescents with JIA relative to controls reflects a disruption in oxidative stress; neurological health; and amino acid, caffeine, and energy metabolism pathways. Serine and N-acetylaspartate were promising potential biomarkers, and their metabolic pathways are linked to both JIA and cardiovascular disease risk. The pathways may be a source of new diagnostic, treatment, or prevention options. This study's findings contribute new knowledge for systems biology and precision health approaches to JIA research. Further research is warranted to confirm these findings in a larger sample.

This update to Mezirow's Transformative Learning theory seeks to advance Mälkki's enhancement to the emotional dimension in phase one--the disorienting dilemma--by proposing the need for a complete grief process (as theorized by Kübler-Ross), to support movement from Mälkki's conceptualization of "edge-emotions" to a "comfort zone," thus removing a barrier to a successful transition to phase two and three--self-reflection and critical reflection--the latter considered essential to the transformative learning process. The authors also seek to stimulate new thinking about this topic in the literature; catalyze future empirical studies focusing on barriers, microprocesses, and phasic transitions of Mezirow's theory; and identify adaptive strategies to facilitate the transformative learning process.

BackgroundPrecision health in adolescents relies on the successful collection of data and biospecimens from an adequately sized sample of cases and comparison group(s), often healthy controls, to answer the research question. This research report describes the recruitment strategy, enrollment rates, and approach utilized in a successful biobehavioral research study. The study was designed to examine key health indicators in adolescents (13-17 years of age) with juvenile idiopathic arthritis (JIA) compared to a control group of healthy adolescents. The purpose of this analysis is to establish best practices and identify strategies to overcome barriers to recruitment of older adolescents, an age group that tends to be underrepresented in research studies.MethodsA retrospective secondary analysis of data from a parent study about JIA with high consent rates was employed to explore factors affecting enrollment into the biobehavioral study.ResultsOf the 113 subjects who were recruited to the study, 74 met the eligibility criteria and reviewed the consent form. The consented group (n=40) represents 54% of those who were eligible upon initial screening. The rate of project enrollment was 2.7 participants per month. The pediatric rheumatologists referred 85% of the JIA group, and the study's principal investigator, a nurse scientist, referred 95% of the control group. Typical recruitment strategies, such as posting on social media, distributing flyers, and cold-calling potential participants from the clinic schedule were ineffective for both cases and controls. Barriers to enrollment included scheduling and fear of venipuncture. There were no demographic characteristics that significantly explained enrollment, differentiating between those who agreed to participate compared to those who refused. Successful strategies for enrollment of adolescents into this biobehavioral research study included scheduling study visits on weekends and school holidays; an informed consent and assent process that addressed adolescent fears of venipuncture; including a JIA patient on the study team; and utilizing existing relationships to maximize enrollment efforts.ConclusionsEffective recruitment and enrollment practices were relationship-specific and patient-centered. Researchers should utilize best practices to ensure that precision health for adolescents is advanced.

Intended as a forum for the discussion of governance and management in community colleges, this book details current trends in management approaches at the institutions, provides a practical description of management roles and responsibilities for college faculty and staff, and examines critical issues facing leaders engaged in management transformation. The following nine chapters are included: (1) "Rethinking the Business of Management," by Richard L. Alfred and Patricia Carter; (2) "Adapting Institutional Structure and Culture to Change," by Robert E. Parilla; (3) "From Boxing to Ballet: Remaking a Community College," by Garth Jackson and Nancy Moulton; (4) "Managing Uncertainty: Thinking and Planning Strategically," by Albert L. Lorenzo; (5) "Quality-Focused Management," by Robbie Lee Needham; (6) "Students First! Reconceptualizing Support Services," by James L. Hudgins, Sandi Oliver, and Starnell K. Williams; (7) "New Players in Management," by Ruth Burgos-Sasscer; (8) "Leadership in the Learning Organization," by Margaret Gratton; and (9) "Sources and Information: The Dynamics of Change in Managerial Responsibilities and Roles," by David Deckelbaum. (BCY)

Discrepancies between subjective and objective sleep measures have been reported for some time; however, it is critical to consider the implications of inaccurate or incomplete sleep assessment for frail older adults who are struggling to maintain independence. To compare sleep assessment methods, we collected objective sleep measurements, subjective measures via self-report sleep surveys, and qualitative data through semi-structured audio-recorded interviews, from five older adults who self-reported sleep problems while living in a retirement community in the southwestern US. Participants' objective sleep and qualitative narratives were congruent, but self-report measures failed to capture several unique sleep problems identified in the sample. A sleep assessment tool specifically designed to measure older people's sleep experiences could provide more accurate and sensitive data. [ABSTRACT FROM AUTHOR]

The poor quality and quantity of data collected in tribal communities today reflects a lack of true community participation and commitment. This is especially problematic for evaluation studies, in which the needs and desires of the community should be the central focus. This challenge can be met by emphasizing indigenous methods and voice. The authors provide an illustration of how to do this.

Highlights the importance of developing community college leaders capable of demonstrating strategic leadership and responding to the global forces that influence community college education. Discusses the Consortium for Community College Development's Strategic Leadership Forum and its principles, format, content, and early results. (RC)

Reports that changes in the number of people seeking higher education as a means to a more sound economic future and shifting skill requirements of business and industry are impacting community colleges. Urges colleges to develop a credentialing system that is valid, reliable, flexible, and comprehensive, with clear performance indicators. (PGS)

Argues that institutional effectiveness is a multidimensional construct that varies according to the perspective of the stakeholder. Identifies core effectiveness indicators derived from a survey given to a wide range of college staff in three key areas: student outcomes, institutional processes, and fiscal and human resources. Contains four data tables and one figure. (JDI)