Reflective Practice of a Hispanic Chief Financial Officer and Interim Superintendent in a Predominantly Hispanic South Texas School District

Reflective practice has been utilized in many fields. Education studies have recommended that reflexivity be used to enhance the practice of principals, teachers, and counselors. There has been little research in the area of reflective practice for superintendents and chief financial officers (CFOs) and the linking of Schön’s reflective practice with Mezirow’s transformative learning. Therefore, this study was aimed at examining my critical events and the use of reflective practice to improve professional development for superintendents and/or CFOs. The study was a first-person account of my experiences in a predominantly Hispanic South Texas school district. My autoethnography allowed me to be the primary participant and researcher in the study, and I used three types of reflective practice (reflection-in-action, reflection-on-action, and reflection-for-action) to narrate the critical events during my district tenure. Data collection included conducting a series of semistructured interviews with my committee chair, reviewing artifacts such as video tapes and board reports, and reflections from my journal. I ensured trustworthiness through data triangulation, thick description, and reflective journaling. My analysis included examining the data using Schön’s reflective practice and Mezirow’s precursors of transformative learning to identify disorienting dilemmas and examine my thinking, emotions, and reactions to the critical events and experiences. I identified five themes that were salient to my study: (a) disrespect, (b) ethical dilemmas, (c) politics, (d) bullying and oppression, and (e) change. Three suggestions to the adult learning process that will aid educational strategies for superintendents and CFOs have been identified: (a) that a chief financial officer not consider being an interim superintendent because being in such a position might create political situations, (b) that a new reflective practice model be considered where reflection-for-action (RFA) is used as a planning tool knowing that we are always in the reflection-in-action (RIA) mode, and (c) that journaling and peer discussions be used as a way to reflect on experience. The autoethnography should be carefully examined for limitations and personal interpretations. I believe that my stories will contribute to the preparation and practice of superintendents and CFOs as well as future research, and my stories are discussed herein

Familial hypercholesterolaemia in children and adolescents from 48 countries: a cross-sectional study

Background: Approximately 450 000 children are born with familial hypercholesterolaemia worldwide every year, yet only 2·1% of adults with familial hypercholesterolaemia were diagnosed before age 18 years via current diagnostic approaches, which are derived from observations in adults. We aimed to characterise children and adolescents with heterozygous familial hypercholesterolaemia (HeFH) and understand current approaches to the identification and management of familial hypercholesterolaemia to inform future public health strategies. Methods: For this cross-sectional study, we assessed children and adolescents younger than 18 years with a clinical or genetic diagnosis of HeFH at the time of entry into the Familial Hypercholesterolaemia Studies Collaboration (FHSC) registry between Oct 1, 2015, and Jan 31, 2021. Data in the registry were collected from 55 regional or national registries in 48 countries. Diagnoses relying on self-reported history of familial hypercholesterolaemia and suspected secondary hypercholesterolaemia were excluded from the registry; people with untreated LDL cholesterol (LDL-C) of at least 13·0 mmol/L were excluded from this study. Data were assessed overall and by WHO region, World Bank country income status, age, diagnostic criteria, and index-case status. The main outcome of this study was to assess current identification and management of children and adolescents with familial hypercholesterolaemia. Findings: Of 63 093 individuals in the FHSC registry, 11 848 (18·8%) were children or adolescents younger than 18 years with HeFH and were included in this study; 5756 (50·2%) of 11 476 included individuals were female and 5720 (49·8%) were male. Sex data were missing for 372 (3·1%) of 11 848 individuals. Median age at registry entry was 9·6 years (IQR 5·8-13·2). 10 099 (89·9%) of 11 235 included individuals had a final genetically confirmed diagnosis of familial hypercholesterolaemia and 1136 (10·1%) had a clinical diagnosis. Genetically confirmed diagnosis data or clinical diagnosis data were missing for 613 (5·2%) of 11 848 individuals. Genetic diagnosis was more common in children and adolescents from high-income countries (9427 [92·4%] of 10 202) than in children and adolescents from non-high-income countries (199 [48·0%] of 415). 3414 (31·6%) of 10 804 children or adolescents were index cases. Familial-hypercholesterolaemia-related physical signs, cardiovascular risk factors, and cardiovascular disease were uncommon, but were more common in non-high-income countries. 7557 (72·4%) of 10 428 included children or adolescents were not taking lipid-lowering medication (LLM) and had a median LDL-C of 5·00 mmol/L (IQR 4·05-6·08). Compared with genetic diagnosis, the use of unadapted clinical criteria intended for use in adults and reliant on more extreme phenotypes could result in 50-75% of children and adolescents with familial hypercholesterolaemia not being identified. Interpretation: Clinical characteristics observed in adults with familial hypercholesterolaemia are uncommon in children and adolescents with familial hypercholesterolaemia, hence detection in this age group relies on measurement of LDL-C and genetic confirmation. Where genetic testing is unavailable, increased availability and use of LDL-C measurements in the first few years of life could help reduce the current gap between prevalence and detection, enabling increased use of combination LLM to reach recommended LDL-C targets early in life