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RationaleMMPs (Matrix metalloproteinases) and their endogenous tissue inhibitors may contribute to lung injury through extracellular matrix degradation and modulation of inflammation and fibrosis.ObjectivesTo test for an association between MMP pathway proteins and inflammation, endothelial dysfunction, and clinical outcomes.MethodsWe measured MMPs in plasma collected on acute respiratory distress syndrome (ARDS) Day 1 from 235 children at five hospitals between 2008 and 2017. We used latent class analysis to identify patients with distinct MMP profiles and then associated those profiles with markers of inflammation (IL-1RA, -6, -8, -10, and -18; macrophage inflammatory protein-1α and -1β; tumor necrosis factor-α and -R2), endothelial injury (angiopoietin-2, von Willebrand factor, soluble thrombomodulin), impaired oxygenation (PaO2/FiO2 [P/F] ratio, oxygenation index), morbidity, and mortality.Measurements and main resultsIn geographically distinct derivation and validation cohorts, approximately one-third of patients demonstrated an MMP profile characterized by elevated MMP-1, -2, -3, -7, and -8 and tissue inhibitor of metalloproteinase-1 and -2; and depressed active and total MMP-9. This MMP profile was associated with multiple markers of inflammation, endothelial injury, and impaired oxygenation on Day 1 of ARDS, and conferred fourfold increased odds of mortality or severe morbidity independent of the P/F ratio and other confounders (95% confidence interval, 2.1-7.6; P

In times of economic uncertainty, local budgets undergo increased scrutiny. School boards and district administrators must collaborate to ensure the highest standards of budget development, implementation, and oversight. Those charged with the fiscal management of school districts must gain the public's confidence in their budgeting abilities. Budget recognition and award programs sponsored by professional organizations help district leaders develop high-quality budget documents that act as powerful communication tools. The Meritorious Budget Awards program offered through ASBO International requires organizations to submit a budget document describing organizational goals and objectives, expenditures and revenues, financial summaries, and performance-based measurements tied to resource allocation. Preparing a Meritorious Budget Award submittal offers many benefits, which include: (1) improved strategic planning; (2) board of education and public confidence; and (3) reciprocal learning.

This study presents an experiential exercise designed to heighten students' awareness of overconsumption in the United States and allow them to see how their own consumption habits are linked to larger social factors. Students engaged in the "Not Buying It" project--which involved refraining from purchasing all but essentials for a set number of days--as part of a broader lesson on consumerism. Qualitative and quantitative data, gathered from students enrolled in three sections of Introductory Sociology, suggest that the exercise was effective in enhancing students' sociological imaginations by helping students see how their own consumption habits are shaped by larger social forces and how they, along with most Americans, tend toward overconsumption. To a more limited extent, it may help enhance cognitive understanding of consumption. Teaching about consumption in general, and the Not Buying It project in particular, offers instructors an excellent pedagogical means by which students can acquire a sociological imagination, reinforces key sociological principles, and links to broader goals within the discipline. (Contains 4 figures, 2 tables, and 2 notes.)

The Lower Pioneer Valley Educational Collaborative, organized in 1974, consists of seven school districts legally bound in a governance structure. Although the member districts are located in Hampden County, Massachusetts, the collaborative provides educational programs and services to school districts and municipalities throughout western Massachusetts. The educational service agency in western Massachusetts outsources a number of services. The agency purchases food services from a local school district, and it outsources custodial services for its career and technical education center and central office. Outsourcing reduces fringe-benefit expenses and other post-employment benefit liabilities, or OPEB. When the authors and their colleagues initially explored the concept of outsourcing, they recognized the need for a methodical and thoughtful approach. They weighed instructional impact against the potential cost savings from outsourcing. They asked questions about the proximity of a service to a student's learning experience. They analyzed the effect outsourcing a particular service would have on teaching and learning. In a two-year period, the Lower Pioneer Valley Educational Collaborative has realized a cost savings of $208,300 in the operating budget.

Becoming an ethical leader requires a personal journey toward integrity and a public commitment to a common good. This begins with claiming one's core values, finding a personal voice, developing a vision, and consciously aligning one's attitudes and beliefs with one's actions and behaviors. In the process, ethical leaders create spaces where people can listen to others and have their ideas and insights valued and heard. The leadership that results encourages people to work together to envision and construct a common good. The authors talk about a schoolwide culture of ethical leadership that enables people to work together for a common good. Ethical leadership involves the entire school community and can be facilitated with the help of some free tools and resources. The authors discuss the tools discovered by West Springfield (Massachusetts) High School that foster a culture of ethical leadership at the Center for Ethical Leadership in Seattle, Washington, and at the Center for Ethics and Business at Loyola Marymount University in Los Angeles, California. The tools help the school community align its core values with its actions, understand its ethical style, create "gracious space," and foster interdependent decision making and inquiry. (Contains 3 resources.)

Objective: This manuscript describes the novel approach to developing a toolkit to support meaningful consumer involvement in clinical trials in Australia to help guide others in considering the development of similar resources. The toolkit aims to support greater consumer involvement in shaping how clinical research is prioritised, designed and conducted. Type of program or service: A working group of researchers, research organisations and consumers was established to co-develop the Consumer Involvement and Engagement Toolkit (the 'Toolkit'), a digital resource to guide researchers and organisations regarding consumer involvement in clinical trials. Findings: A literature review and international scan of best practice revealed numerous resources outlining best practice for consumer involvement in clinical research and clear evidence of its impact and value. Through a novel content-sharing process, we were able to utilise these resources to develop a comprehensive Toolkit for researchers and research organisations that provides world-class guidance. Lessons learnt: There is a growing movement to ensure consumer involvement in healthcare, including in clinical research. We discovered its proponents were willing to share their tools and resources to promote international consumer involvement. Although these international tools and resources needed adaptation to suit the Australian research environment, this was achievable with far less effort than developing them from scratch. [ABSTRACT FROM AUTHOR]