bluuebunny/crossref_metadata_2025 huggingface dataset:
Reconceptualizing and Reimagining Early Childhood Education
Authors: Cant Annabella
Published: August 2023

The reform of educational systems has been taking place since the beginnings of institutionalized education. Continuing to contest, rethink, reconceptualize, and reimagine the field of early childhood education is necessary owing to the prevalent presence of dominant discourses that have a firm hold on its values, praxis, and pedagogies. These dominant discourses have emerged in times when standardization, measurability, and the economic gains of educating citizens have been the ultimate goals of education. Today, those goals are considered narrow and outdated, complexified by current discourses and practices taken up in a globalized world that starts to see itself with faults, errors, and even guilt. The so-called Reconceptualist movement launched during the 1980s as a series of events, such conferences and scholarly gatherings. Special publications were organized by critical scholars and educators who were questioning developmentalism as the core of early childhood education, recognizing the lack of diversity of pedagogical practices in the field. Scholars who were drawn to this movement started to question and unsettle modernist views that were based primarily in Euro-American privileged knowledges. By doing so, they have opened space for alternative perspectives rooted in critical feminist, postcolonial, and postmodern paradigms. The first wave of Reconceptualists were deeply inspired by thinkers such as Michel Foucault, Jacques Derrida, and Jean-François Lyotard. They emphatically critiqued the dominance of so-called developmentally appropriate practices. As a response to the control of universal truths being so widely accepted and taken for granted by practices in early childhood education, Reconceptualists have responded by opposing such practices by considering them through a social-constructionist lens of understanding and interpreting the world and the human condition. Reconceptualist scholars have contested the globalization of childhood and deconstructed the idea that all children should be measured and qualitatively compared to a Western model of the developed child. Their critique of these structural and modernist ways of seeing the child is based on the lack of contextualization of childhoods: the value of culture, place, socioeconomic situation, traditions, histories, and so on. By exposing the power of narrowly understood developmentalism and the deep effects of the sociopolitical contexts in education, they proposed frameworks based in social justice and equity. This movement’s momentum continues to present times, with myriad scholars fighting for the idea of reframing and reimagining early childhood education. The following bibliography presents some of the initiators and the sustainers of the movement, along with philosophies and practices that inspired or were inspired by them.
Dion Boucicault
Authors: Meer Sarah
Published: August 2023

Dionysus Lardner Boucicault (known as Dion Boucicault, also sometimes spelt Bourcicault) was a prolific playwright and a successful actor and manager. Active between about 1840 and 1890, he was most prominent and popular in the years 1850–1880. He was born in Dublin, but he spent his heyday shuttling between London and New York; he also toured Australia and New Zealand, and spent seasons in California, Chicago, and New Orleans. As a writer, Boucicault was identified most closely with adaptation from the French, translating the plots of Parisian boulevard melodramas into British or American settings. At the same time, he achieved a string of massive commercial hits, and is credited with importing to London the sensational melodrama that became the theatrical hallmark of the 1860s. Sensation drama combined high production values with violent and exciting plots; while these had once been associated with working-class theatres, Boucicault fused sensation with comedy and sentiment to mesmerize prosperous audiences and even the Queen. His creations underpinned the rise of London’s West End as a pleasure district, and they helped establish long runs and touring productions. Boucicault also contributed to the extension of theatrical copyright and performance rights, through campaigns and litigation. As an academic subject, Boucicault has traditionally interested quite distinct constituencies. He has long held a place in the Irish canon, although it has sometimes been a slightly dubious one; popular in the nineteenth century, he fell out of favor after the founding of the Irish Literary Theatre. Then he was rediscovered in the 1960s, and returned to the fore in the 1990s, as transnational approaches recognized his significance for the Irish diaspora. In American Studies, Boucicault tends to be remembered for plays set in the United States, above all for his ‘race’ play, The Octoroon, which takes place on a Louisiana plantation. Critics have discussed its racial politics, its attitude to slavery, and its representations of photography, law, and the frontier. Outside academia, The Octoroon found a new prominence in 2014 when Branden Jacobs-Jenkins adapted and analyzed it in An Octoroon. Victorianists have analyzed Boucicault’s plays in relation to railways, sport, cities, prostitution, and the Indian Rebellion of 1857; theatre and film historians have been drawn to Boucault’s inventive staging, his legal and business innovations, and his contribution to the narrative techniques of the early motion picture.
The Role of the Expert Witness in Forensic Psychology
Authors: Beeley Camilla , Trupp Gabriele , Murrie Daniel
Published: August 2023

The legal system routinely relies on experts to help shed light on scientific or technical matters that are usually beyond the knowledge of the judges and attorneys involved, or the layperson jurors who render verdicts in many cases. These experts can come from virtually any discipline, because virtually any subject matter can become a focus of litigation. Experts from any subfield of psychology (e.g., developmental, cognitive, social, or industrial-organizational psychology) may testify when their input is relevant. Of course, the broad discipline of forensic psychology—that is, psychology applied to legal matters—most often features experts providing input to the legal system. Furthermore, this field of forensic psychology has generated much of the research addressing expert testimony, and that research is potentially instructive to expert witnesses from any discipline. Expert witnesses can be retained by either side in adversarial proceedings, but judges—following legal rules of evidence—make the final decision as to whether the expert is admitted to testify. Judges may also independently appoint an expert, though this occurs far less often. Regardless of how the expert was retained or appointed, experts in psychology should testify in a manner consistent with the American Psychological Association’s Ethical Principles of Psychologists and Code of Conduct, as well as the Specialty Guidelines for Forensic Psychology. Though their testimony must be honest and objective, experts also strive to be effective, delivering testimony that is clear and compelling. In pursuing effective and compelling testimony, experts in forensic psychology may consult a rich body of literature—ranging from rigorous empirical studies to lists of practical tips—that guide the content and delivery of expert testimony.
Military Geographies of Popular Culture
Authors: Bos Daniel
Published: August 2023

Popular culture and the media play an integral role in shaping public perceptions concerning the geographies of military activities and power. Critical approaches in studying military geography have started to pay closer attention to cultural representations of the military and their constitutive role in legitimizing and justifying military presence and practices within varying geographical contexts. It is important to note that there is no definitive or coherent scholarship on the topic of military geographies of popular culture. Therefore, this review does not chart a single cohesive body of scholarship. Instead, it offers an illustrative account of the interdisciplinary nature of studying the popular cultural geographies of militarism and militarization. There are several ways in which geographical scholarship, especially in the field of popular geopolitics, has contributed to understanding the relationship between the military and popular culture. First, geographical work has offered critical insights into the political-economic structures of what has been termed the “military-entertainment complex,” revealing the intimate symbiotic relationship between military institutes and the entertainment industries. Second, and where the predominant focus lies, geography has brought critical attention to the cultural politics of popular military representation. This has involved a detailed critical analysis of various popular cultural forms, texts, and visual media, exposing the geopolitical imaginaries that are both reflective and constitutive of the militarized violence they depict. More recently, such work has been advanced through an interest in material cultures and “more-than-representational” accounts to consider how cultures of militarism become embedded within the context of everyday geographies. Finally, geographers have reflected on the significance of place and the everyday situated contexts in which popular militarized cultures are embedded, experienced, and negotiated. Such work has considered the role of scale, highlighting how cultures of militarism are performed and internalized, especially within the domestic setting. Such work has adopted in-depth qualitative methodological approaches to recognize how popular forms of militarism are experienced in everyday life. The review article begins with an overview of the interdisciplinary work that seeks to expose and explore the military-entertainment complex. It then proceeds with thematic sections drawing attention to how scholars, within and beyond the discipline of human geography, have critically analyzed an array of diverse popular cultural militarized texts, representations, and material objects. It ends by drawing attention to the emergent methodological approaches and techniques to studying popular military geographies.
Military Geographies of Urban Space and War
Authors: Danielsson Anna
Published: August 2023

In military and academic circles, there is today an acknowledgment that war is urban and, for some commentators, that the urban also is war—in the sense of an ongoing militarization of cities and urban environments. Indeed, that war is (partly) urban has been the case for as long as humans have lived in cities and towns. What is new at present though is the recognized topicality of the manifold links between urban geographies and war. Until the last couple of decades, urban war and urban warfare were considered phenomena either of the past or of the future, but less of the present. It was only in the late 1990s and early 2000s that the significance of urban spaces in and of war became widely acknowledged, partly as an effect of military and everyday wartime experiences from places such as Grozny, Mostar, and Sarajevo. Other coinciding developments involve the post–Cold War revival of geopolitics, as well as emergent scholarly linkages between (critical) urban geopolitics, on the one hand, and studies of the military, war, and peace, on the other hand. However, this is not to say that military organizations themselves have not historically been preoccupied with urban spaces. With a focus on both intrastate and interstate urban conflict and urban war, the contribution at hand offers an understanding both of the academic study of military urban geographies and of military geographical approaches to and imaginaries of urban warfare and urban space (without going into military urban warfare practices as such). This is done over five sections, each with a specific theme that also illustrates the many links between academia and the military when it comes to cities and urban environments. The first section frames the topic. It offers a broad introductory perspective in the sense of an overview of academic literatures that are often combined in the scholarly study of military urban geographies. First are the conventional and the critical approaches, respectively, to military geography, and second is the literature on urban war that to a varying degree targets geographical aspects. The second section addresses in more depth conventional military geographical approaches to urban spaces, in a way that includes both academic works and military treaties and doctrines. The third section develops further conventional military geographical approaches to and imaginaries of urban space. It details some of the more recent military operational and strategic modes of imagining and approaching urban geographies. The fourth section shifts the focus back to the scholarly study of military urban geographies, but from critical perspectives. As further developed here, critical scholarship on the topic shifts attention to the conditions and effects of military presence on cities and urban spaces and to how military operations are both constituted by and constitutive of urban spaces and sites. The fifth and final section introduces a specific subtheme in critical scholarship on urban spaces in and of war: the literature on urbicide.
Critical Military Geographies
Authors: Woodward Rachel , Cree Alice
Published: August 2023

‘Critical military geography’ can be loosely defined as a subsection of critical military studies that is attuned to space and place. Critical military studies (CMS) as a broader project is interdisciplinary in its approach, and is concerned primarily with an examination of militaries, militarism, and military power. Scholarship in CMS spans across international relations, politics, sociology, history, the creative arts, and of course geography. Critical military geography emerged in counterpoint to a more traditional military geography which emerged at the end of the nineteenth century and which is concerned with the application of geographic information, tools, and techniques to the solution of military problems. The critical military geography approach, in contrast, centers the power relations through which military phenomena are geographically constituted and expressed. For this reason, critical military geography parallels the approaches of critical geopolitics and critical sociologies of the military as responses to older traditions within, respectively, political geography and sociology. Geographers have shed light on the myriad ways in which military phenomena are innately geographical; how they are rooted in place and spatially and temporally contingent, as well as practiced through and in particular bodies.
Pedagogical Content Knowledge in Geography Education
Authors: Jo Injeong
Published: August 2023

The most important intellectual component of a teaching profession is a distinct body of specialized knowledge. This specialized knowledge is defined as pedagogical content knowledge (PCK), the discipline-specific pedagogical knowledge necessary to teach in a distinct content area. PCK is one of the seven interconnected components of Lee Shulman’s conception of the knowledge base for teaching: content knowledge (CK); general pedagogical knowledge (PK); curriculum knowledge; PCK; knowledge of learners and their characteristics; knowledge of educational contexts; and knowledge of educational ends, purposes, and values. PCK represents the blending of content and pedagogy into an understanding of how particular content is organized, represented, and adapted to the diverse interests and abilities of students and presented for instruction. PCK identifies teachers’ unique expertise and distinguishes content specialists from professional teachers. Since the advent of the concept, PCK has been widely used and received special attention among teacher educators and education researchers. It has been one of the most influential concepts in teacher education and teacher education research because it constitutes the distinctive body of knowledge that every teacher should develop. Researchers, especially in science and mathematics education, have actively investigated the nature and characteristics of PCK and developed PCK models that can lead to effective teaching of science and mathematics. While PCK has not been as widely used in geography education research as in other subject areas, geography educators and education researchers agree that PCK is an essential quality of a geography teacher, so they have examined it. Teacher knowledge has long been an important topic in geography education research and examined from various perspectives including the curriculum-making and the capabilities approaches. This article provides an overview of the literature on PCK for geography teaching, which I define here as GeoPCK. Citations included represent selected empirical research that sheds light on the nature, components, and strategies to develop GeoPCK. The last two sections provide brief overviews of the two closely related concepts to PCK—technological pedagogical and content knowledge (TPCK or TPACK) and pedagogical reasoning and action (PR&A)—reflecting the increasing interest in geography teachers’ knowledge for the use of geospatial technologies (GST); for student-centered, curriculum-based, and inquiry-oriented education; and for the recognition of the significance of understanding how teachers’ knowledge base is enacted, refined, and reconstructed in and through their own practice.
Antibacterial Utilization for Febrile Illnesses and Laboratory-Confirmed Bloodstream Infections in Northern Tanzania
Authors: Moorthy Ganga S , Madut Deng B , Kilonzo Kajiru G , Lwezaula Bingileki F , Mbwasi Ronald , Mmbaga Blandina T , Ngocho James S , Saganda Wilbrod , Bonnewell John P , Carugati Manuela , Egger Joseph R , Hertz Julian T , Tillekeratne L Gayani , Maze Michael J , Maro Venance P , Crump John A , Rubach Matthew P
Published: August 2023

Background

We describe antibacterial use in light of microbiology data and treatment guidelines for common febrile syndromes in Moshi, Tanzania.

Methods

We compared data from 2 hospital-based prospective cohort studies, cohort 1 (2011–2014) and cohort 2 (2016–2019), that enrolled febrile children and adults. A study team member administered a standardized questionnaire, performed a physical examination, and collected blood cultures. Participants with bloodstream infection (BSI) were categorized as receiving effective or ineffective therapy based upon antimicrobial susceptibility interpretations. Antibacterials prescribed for treatment of pneumonia, urinary tract infection (UTI), or presumed sepsis were compared with World Health Organization and Tanzania Standard Treatment Guidelines. We used descriptive statistics and logistic regression to describe antibacterial use.

Results

Among participants, 430 of 1043 (41.2%) and 501 of 1132 (44.3%) reported antibacterial use prior to admission in cohorts 1 and 2, respectively. During admission, 930 of 1043 (89.2%) received antibacterials in cohort 1 and 1060 of 1132 (93.6%) in cohort 2. Inpatient use of ceftriaxone, metronidazole, and ampicillin increased between cohorts (P ≤ .002 for each). BSI was detected in 38 (3.6%) participants in cohort 1 and 47 (4.2%) in cohort 2. Of 85 participants with BSI, 81 (95.3%) had complete data and 52 (64.2%) were prescribed effective antibacterials. Guideline-consistent therapy in cohort 1 and cohort 2 was as follows: pneumonia, 87.4% and 56.8%; UTI, 87.6% and 69.0%; sepsis, 84.4% and 61.2% (P ≤ .001 for each).

Conclusions

Receipt of antibacterials for febrile illness was common. While guideline-consistent prescribing increased over time, more than one-third of participants with BSI received ineffective antibacterials.
Sprayed PAA-CaO2 nanoparticles combined with calcium ions and reactive oxygen species for antibacterial and wound healing
Authors: Yu Hong , Sun Jiale , She Kepeng , Lv Mingqi , Zhang Yiqiao , Xiao Yawen , Liu Yangkun , Han Changhao , Xu Xinyue , Yang Shuqing , Wang Guixue , Zang Guangchao
Published: August 2023

The most common socioeconomic healthcare issues in clinical are burns, surgical incisions and other skin injuries. Skin lesion healing can be achieved with nanomedicines and other drug application techniques. This study developed a nano-spray based on cross-linked amorphous calcium peroxide (CaO2) nanoparticles of polyacrylic acid (PAA) for treating skin wounds (PAA-CaO2 nanoparticles). CaO2 serves as a ‘drug’ precursor, steadily and continuously releasing calcium ions (Ca2+) and hydrogen peroxide (H2O2) under mildly acidic conditions, while PAA-CaO2 nanoparticles exhibited good spray behavior in aqueous form. Tests demonstrated that PAA-CaO2 nanoparticles exhibited low cytotoxicity and allowed L929 cells proliferation and migration in vitro. The effectiveness of PAA-CaO2 nanoparticles in promoting wound healing and inhibiting bacterial growth in vivo was assessed in SD rats using full-thickness skin defect and Staphylococcus aureus (S.aureus)-infected wound models based thereon. The results revealed that PAA-CaO2 nanoparticles demonstrated significant advantages in both aspects. Notably, the infected rats’ skin defects healed in 12 days. The benefits are linked to the functional role of Ca2+ coalesces with H2O2 as known antibacterial and healing-promoted agents. Therefore, we developed nanoscale PAA-CaO2 sprays to prevent bacterial development and heal skin lesions.
In vitro evaluation of microencapsulated organic acids and pure botanicals as a supplement in lactating dairy cows diet on in vitro ruminal fermentation
Authors: Lobo Richard R , Watson Michael , Vinyard James R , Johnson Mikayla L , Bahmam Aneesa , Ma Szu-Wei , Dagaew Gamonmas , Sumadong Phussorn , Sarmikasoglou Efstathios , Grilli Ester , Arce-Cordero Jose A , Faciola Antonio P
Published: August 2023

The utilization of microencapsulated organic acids and pure botanicals (mOAPB) is widely used in the monogastric livestock industry as an alternative to antibiotics; in addition, it can have gut immunomodulatory functions. More recently, an interest in applying those compounds in the ruminant industry has increased; thus, we evaluated the effects of mOAPB on ruminal fermentation kinetics and metabolite production in an in vitro dual-flow continuous-culture system. For this study, two ruminal cannulated lactating dairy Holstein cows were used as ruminal content donors, and the inoculum was incubated in eight fermenters arranged in a 4 × 4 Latin square design. The basal diet was formulated to meet the nutritional requirements of a 680-kg Holstein dairy cow producing 45 kg/d of milk and supplemented with increasing levels of mOAPB (0; 0.12; 0.24; or 0.36% of dry matter [DM]), which contained 55.6% hydrogenated and refined palm oil, 25% citric acid, 16.7% sorbic acid, 1.7% thymol, and 1% vanillin. Diet had 16.1 CP, 30.9 neutral detergent fiber (NDF), and 32.0 starch, % of DM basis, and fermenters were fed 106 g/d split into two feedings. After a 7 d adaptation, samples were collected for 3 d in each period. Samples of the ruminal content from the fermenters were collected at 0, 1, 2, 4, 6, and 8 h postmorning feeding for evaluation of the ruminal fermentation kinetics. For the evaluation of the daily production of total metabolites and for the evaluation of nutrient degradability, samples from the effluent containers were collected daily at days 8 to 10. The statistical analysis was conducted using MIXED procedure of SAS and treatment, time, and its interactions were considered as fixed effects and day, Latin square, and fermenter as random effects. To depict the treatment effects, orthogonal contrasts were used (linear and quadratic). The supplementation of mOAPB had no major effects on the ruminal fermentation, metabolite production, and degradability of nutrients. The lack of statistical differences between control and supplemented fermenters indicates effective ruminal protection and minor ruminal effects of the active compounds. This could be attributed to the range of daily variation of pH, which ranged from 5.98 to 6.45. The pH can play a major role in the solubilization of lipid coat. It can be concluded that mOAPB did not affect the ruminal fermentation, metabolite production, and degradability of dietary nutrients using an in vitro rumen simulator.
One genus, four different stories: evolutionary history, bionomics and biogeography of the monotypic tribe Stenostomatini (Coleoptera: Oedemeridae)
Authors: Poloni Riccardo , Bologna Marco A , Riccieri Alessandra
Published: August 2023

The false blister beetle tribe Stenostomatini includes only the genus Stenostoma, with four species showing an intriguing distribution: Stenostoma lowei (Madeira), Stenostoma cossyrense (Pantelleria), Stenostoma melitense (Malta and southern Sicily) and Stenostoma rostratum, widely distributed along the Mediterranean and North Atlantic coasts. The evolutionary history leading to this distribution has not been investigated. Here, we explore the phylogeny and evolutionary history of the tribe, adopting an integrative approach that combines morphological and molecular data (mitochondrial COI and nuclear CAD and 28S). Moreover, we propose a new key for species identification and update the knowledge on adult and larval ecology. Finally, we propose the following explanation for the current distribution of the species. The genus originated in the Miocene, with S. lowei belonging to the oldest lineage. The remaining species share a common ancestor, dating to the Messinian Salinity Crisis. Stenostoma melitense and S. cossyrense are well differentiated according to morphology, but not according to molecular analysis. The wide distribution of S. rostratum might be related to its strategy of laying eggs within beached driftwood, where larvae develop, easily transported by the currents. Given that neither morphological nor molecular differentiation was detected between the two subspecies of S. rostratum, we propose the new synonymy Stenostoma rostratum septentrionaleŠvihla, 2005 = Stenostoma rostratum (Fabricius, 1787) syn. nov.
Meta-analysis Investigating the Efficacy of Liquid Dressing and Ostomy Powder for the Treatment of Incontinence-Associated Dermatitis
Authors: Wang Jie , Ma Liang , Zhou Dan , Yu Bin-Hong
Published: August 2023

OBJECTIVE

To study the effect of liquid dressing and ostomy powder on the treatment of incontinence-associated dermatitis (IAD).

METHODS

The authors searched PubMed, Web of Science, CNKI (China National Knowledge Internet), and Google Scholar databases for literature through July 28, 2022. After literature screening, two investigators independently extracted data from the included studies and applied the Newcastle-Ottawa Scale to assess the quality of the included studies. The χ
2-based Q statistic test and the I
2 statistic were used to measure the heterogeneity of the included studies. Publication bias was measured with funnel plots and the Egger test. Sensitivity analysis was conducted by eliminating each study one by one.

RESULTS

Four high-quality studies were included in the meta-analysis, involving a total of 307 participants. The meta-analysis results showed that compared with traditional care, treatment with liquid dressing and ostomy powder significantly improved the effective rate (pooled odds ratio, 21.42; 95% CI, 8.58 to 53.44), shortened the healing time (pooled mean difference, −10.73; 95% CI, −12.92 to −8.54), and reduced the recurrence rate (pooled mean difference, −2.03; 95% CI, −2.30 to −1.77) of IAD. Among the included studies, no publication bias was detected. Sensitivity analysis results confirmed the robustness of the pooled estimates.

CONCLUSIONS

Treatment with liquid dressing and ostomy powder has clinical value for patients with IAD.
A Systematic Review of Pressure Injuries Associated with Urethrocutaneous Fistula
Authors: Zogheib Serge , Khalil Nour , Mjaess Georges , Feghaly Charbel , Daou Bechara , Hanna Cyril , Nasr Marwan
Published: August 2023

OBJECTIVE

To review the literature about combined urologic and reconstructive management of pressure injuries (PIs) with urethral fistulas.

DATA SOURCES

Authors searched the PubMed, MEDLINE, EMBASE, and Cochrane databases using the following keywords: “Perineum” or “Perineal” and “Pressure Ulcers” or ‘’ Pressure Injury‘’ and “Urethral Fistula.”

STUDY SELECTION

The search yielded a total of 95 articles. Study selection followed the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) statement, and the study was designed according to the PICOS (Population, Intervention, Comparison, Outcomes, Study) guidelines. Congress abstracts, letters to the editor, and editorial comments were excluded. After screening, a total of 9 studies (30 patients) were included in the review.

DATA EXTRACTION

Included patients received treatment for a perineal or ischial PI associated with a urinary fistula. The outcomes were recovery, complications, treatment failure, recurrence, and illness-related death.

DATA SYNTHESIS

Pressure injuries were mainly ischiatic (50%) and perineal (43%). Forty-six percent of patients had spinal cord injuries, and at least 40% reported voiding dysfunction. Sixteen percent had previous ischiectomy. Flaps such as posterior thigh flap, biceps femoris flap, and inferiorly based transverse rectus abdominal muscle flap had 88% to 100% success rates when used with urinary diversion techniques. Suprapubic cystostomy, the simplest method of urinary diversion, was successful in 47% of cases when performed alone and in 100% when combined with a pedicled omental flap or a transverse rectus abdominal muscle flap.

CONCLUSIONS

Prevention and wound care are essential for PI management, but when combined with a urinary fistula, surgical management is unavoidable. Urinary diversion is essential before undergoing any type of ulcer reconstruction. Urethral reconstruction showed favorable results, further strengthened when combined with a musculocutaneous flap.
The 2022 Update on Pressure Injuries: A Review of the Literature
Authors: Berlowitz Dan , Forget Julia G. , Saindon Kelley
Published: August 2023

The pressure injury literature is rapidly growing, challenging busy clinicians who are trying to stay current. In this article, the authors summarize six articles published in 2022 that provide important new data or change how we may think about pressure injuries. The articles cover a range of topics including epidemiology, prevention, prediction, and nurse staffing. For each article, the authors provide a description of the study results along with a comment on why the results are important. This information will help clinicians remain current with the field and highlight new findings to incorporate into their clinical practice.

GENERAL PURPOSE

To review six articles published in 2022 that provide important new data or change how clinicians may think about pressure injuries.

TARGET AUDIENCE

This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care.

LEARNING OBJECTIVES/OUTCOMES

After participating in this educational activity, the participant will:

1. Identify evidence-based risk factors for the development of pressure injuries (PIs).

2. Distinguish the predictors for PI development that prompted intervention.

3. Identify inconsistencies in documented stages of PIs.

4. Explain the impact of staffing on PI development rates.
Feasibility Assessment of a Biomarker-Guided Kidney-Sparing Sepsis Bundle: The Limiting Acute Kidney Injury Progression In Sepsis Trial
Authors: Gómez Hernando , Zarbock Alexander , Pastores Stephen M. , Frendl Gyorgy , Bercker Sven , Asfar Pierre , Conrad Steven A. , Creteur Jaques , Miner James , Mira Jean Paul , Motsch Johan , Quenot Jean-Pierre , Rimmelé Thomas , Rosenberger Peter , Vinsonneau Christophe , Birch Bob , Heskia Fabienne , Textoris Julien , Molinari Luca , Guzzi Louis M. , Ronco Claudio , Kellum John A.
Published: August 2023

OBJECTIVES:

To determine the feasibility, safety, and efficacy of a biomarker-guided implementation of a kidney-sparing sepsis bundle (KSSB) of care in comparison with standard of care (SOC) on clinical outcomes in patients with sepsis.

DESIGN:

Adaptive, multicenter, randomized clinical trial.

SETTING:

Five University Hospitals in Europe and North America.

PATIENTS:

Adult patients, admitted to the ICU with an indwelling urinary catheter and diagnosis of sepsis or septic shock, without acute kidney injury (acute kidney injury) stage 2 or 3 or chronic kidney disease.

INTERVENTIONS:

A three-level KSSB based on Kidney Disease: Improving Global Outcomes (KDIGOs) recommendations guided by serial measurements of urinary tissue inhibitor of metalloproteinases-2 and insulin-like growth factor-binding protein 7 used as a combined biomarker [TIMP2]•[IGFBP7].

MEASUREMENTS AND MAIN RESULTS:

The trial was stopped for low enrollment related to the COVID-19 pandemic. Nineteen patients enrolled in five sites over 12 months were randomized to the SOC (n = 8, 42.0%) or intervention (n = 11, 58.0%). The primary outcome was feasibility, and key secondary outcomes were safety and efficacy. Adherence to protocol in patients assigned to the first two levels of KSSB was 15 of 19 (81.8%) and 19 of 19 (100%) but was 1 of 4 (25%) for level 3 KSSB. Serious adverse events were more frequent in the intervention arm (4/11, 36.4%) than in the control arm (1/8, 12.5%), but none were related to study interventions. The secondary efficacy outcome was a composite of death, dialysis, or progression of greater than or equal to 2 stages of acute kidney injury within 72 hours after enrollment and was reached by 3 of 8 (37.5%) patients in the control arm, and 0 of 11 (0%) patients in the intervention arm. In the control arm, two patients experienced progression of acute kidney injury, and one patient died.

CONCLUSIONS:

Although the COVID-19 pandemic impeded recruitment, the actual implementation of a therapeutic strategy that deploys a KDIGO-based KSSB of care guided by risk stratification using urinary [TIMP2]•[IGFBP7] seems feasible and appears to be safe in patients with sepsis.
Practice Standards for the Use of Multimodality Neuromonitoring: A Delphi Consensus Process*
Authors: Foreman Brandon , Kapinos Gregory , Wainwright Mark S. , Ngwenya Laura B. , O’Phelan Kristine H. , LaRovere Kerri L. , Kirschen Matthew P. , Appavu Brian , Lazaridis Christos , Alkhachroum Ayham , Maciel Carolina B. , Amorim Edilberto , Chang Jason J. , Gilmore Emily J. , Rosenthal Eric S. , Park Soojin
Published: August 2023

OBJECTIVES:

To address areas in which there is no consensus for the technologies, effort, and training necessary to integrate and interpret information from multimodality neuromonitoring (MNM).

DESIGN:

A three-round Delphi consensus process.

SETTING:

Electronic surveys and virtual meeting.

SUBJECTS:

Participants with broad MNM expertise from adult and pediatric intensive care backgrounds.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Two rounds of surveys were completed followed by a virtual meeting to resolve areas without consensus and a final survey to conclude the Delphi process. With 35 participants consensus was achieved on 49% statements concerning MNM. Neurologic impairment and the potential for MNM to guide management were important clinical considerations. Experts reached consensus for the use of MNM—both invasive and noninvasive—for patients in coma with traumatic brain injury, aneurysmal subarachnoid hemorrhage, and intracranial hemorrhage. There was consensus that effort to integrate and interpret MNM requires time independent of daily clinical duties, along with specific skills and expertise. Consensus was reached that training and educational platforms are necessary to develop this expertise and to provide clinical correlation.

CONCLUSIONS:

We provide expert consensus in the clinical considerations, minimum necessary technologies, implementation, and training/education to provide practice standards for the use of MNM to individualize clinical care.
Advances in Technology Promote Patient-Centered Care in Cardiac Rehabilitation
Authors: Ben-Tzur Dana , Sabovich Solomon , Hutzler Yeshayahu , Rimon Jordan , Zach Sima , Epstein Maor , Vadasz Brian , Diniz Camilla V. , Nabutovsky Irene , Klempfner Robert , Eilat-Adar Sigal , Gabizon Itzhak , Menachemi Doron M. , Grosman-Rimon Liza
Published: August 2023

Patient-centered health care (PCC) is a framework of clinical care focused on the patient’s individual health care needs. In particular, it emphasizes the development of a partnership between the patient, physician, and healthcare workers to actively involve and empower the patient in their health care decisions. Additionally, PCC goals include ensuring access to care, emotional support, engaging patient support systems, physical comfort, and continuity of care. Technology also provides a platform to engage patients and their families in their care and can be a useful tool to gauge their level of interest, knowledge, and motivations to adequately educate them on the many factors that contribute to their disease, including diet, exercise, medication adherence, psychological support, and early symptom detection. In this article, we summarize the importance of technology in promoting PCC in cardiac rehabilitation and the impact technology may have on the different aspects of patient and physician relationships. Modern technological devices including smartphones, tablets, wearables, and other internet-enabled devices have been shown to help patient-staff communication, cater to patients’ individual needs, increase access to health care, and implement aspects of PCC domains.
Clinical characteristics of pediatric hypertension: a multicenter study in China
Authors: Chen Yijun , Ye Peiyu , Dong Hongbo , Xu Xin , Shi Lin , Li Bin , Dong Jie , Lv Aiting , Su Zhe , Zhang Yong , Zhou Yunguo , Wang Juanli , Feng Guoshuang , Zeng Yueping , Ni Xin , Mi Jie
Published: August 2023

Objectives:

Hypertension in children has attracted increasing attention. However, clinical-based studies investigating characteristics and secular trends of pediatric hypertension remain limited. This study aimed to investigate the clinical characteristics and secular trends of different types of hypertension among hospitalized children in China.

Methods:

This retrospective analysis was based on medical records from nine tertiary children's hospitals in China during 2010∼2020. A total of 5847 pediatric inpatients (aged <18 years) with the diagnosis of hypertension were enrolled. Information on the clinical characteristics of each patient was obtained from their first admission records.

Results:

During the past decade, secondary hypertension sustained to be the dominant type of hypertension in children, with the proportion increased from 51.2% during 2010∼2015 to 59.8% during 2016∼2020. The main causes of secondary hypertension were neurologic disorders in children aged 0∼2 years, which changed to renal diseases after 3 years of age. Compared with primary hypertension, secondary hypertension was common in girls (43.1 vs. 23.3%) and children under 5 years of age (32.2 vs. 2.1%). Moreover, over four-fifths of primary hypertensive individuals had obesity and obesity-related comorbidities, and the proportion of clusters of one or more comorbidities increased in the past decade (79.7 → 85.2%).

Conclusion:

Secondary hypertension sustained to be the dominant type of hypertension among children, especially in girls. Renal diseases were the most common causes of secondary hypertension in children, followed by rheumatic immune diseases. For primary hypertension, over four-fifths of inpatients had obesity and obesity-related diseases, and the proportion kept rising.
A set of urinary peptides can predict early renal damage in primary hypertension
Authors: Lin Lirong , Ren Jiangwen , Wang Chunxuan , Mei Mei , Zheng Luquan , Yang Jurong
Published: August 2023

Objectives:

Renal diseases caused by primary hypertension (HTN) are often asymptomatic without sensitive markers for early diagnosis and prediction, easily progressing to severe and irreversible renal damage in patients with clinical manifestations. This study explored whether a set of urinary peptides could serve as a potential biomarker for early prediction of renal damage in HTN.

Methods:

Urinary peptides level of healthy individuals, HTN + normoalbuminuric and HTN + albuminuria patients were compared, and 22 baseline data including sex, age, renal function, hypertensive fundus lesions were collected. Patients diagnosed with HTN, albuminuria, and normal renal function were followed up. According to the follow-up results, the cut-off value of a set of urinary peptides in predicting hypertensive renal injury was calculated and analyzed in the high-risk and low-risk groups of HTN patients for its performance in detecting early hypertensive renal injury.

Results:

Among a sum of 319 participants, average urinary peptides level was significantly higher in patients with HTN than in normal individuals. A total of 147 HTN patients with normal albuminuria were followed up for a mean of 3.8 years. Thirty-five patients showed urinary albumin-to-creatinine ratio (uACR) at least 30 mg/g for three consecutive times. The receiver-operating characteristic (ROC) curve showed that the urinary peptides cut-off value for evaluating new-onset proteinuria in patients with HTN was 0.097. Based on this cut-off value, 39 and 108 patients were included in the high-risk and low-risk groups, respectively. Specifically, compared with patients in the low-risk group, those in the high-risk group showed significantly longer duration of HTN, higher proportions of hypertensive fundus lesions and at least 30 mg/g uACR, and higher levels of homocysteine (Hcy), cystatin C (CysC), beta-2 microglobulin (β2-MG), and uACR. 76.9% of high-risk patients had significantly higher new-onset proteinuria than the low-risk group. Correlation analysis demonstrated a positive correlation between urinary peptides and UACR (r = 0.494, P < 0.001). The incidence of new-onset albuminuria was significantly higher in the high-risk group than in the low-risk group, as shown by Cox regression analysis. The areas under the curve of urinary peptides, Hcy, β2-MG and CysC were 0.925, 0.753, 0.796 and 0.769, respectively.

Conclusion:

A set of urinary peptides is a predictor of new-onset proteinuria in patients with HTN, therefore, it can be used for diagnosing patients with early renal injury in patients with HTN, contributing to early prevention and treatment of hypertensive nephropathy.
Characteristics of Participants in Diabetic Retinopathy Clinical Research Clinical Trials Who Were Lost to Follow up
Authors: Bowe Theodore , Mahmoudzadeh Raziyeh , Soares Rebecca R. , Nguyen Michael K. , Hsu Jason , Kuriyan Ajay E.
Published: August 2023

Purpose:

Our study describes the racial/ethnic composition and the broad health status/severity of disease of the cohorts of Diabetic Retinopathy Clinical Research (DRCR) clinical trials and compares the rates of non-completion of the trial to the first data report (lost to follow up (LTFU)).

Methods:

This study is a retrospective cohort study of participants in Diabetic Retinopathy Clinical Research (DRCR) Retina Network clinical trials that met our inclusion criteria.

The primary outcome was the lost to follow up rates and their associated risk factors.

Results:

Eight clinical trials with 3492 participants met our inclusion criteria. Participants who were LTFU were more likely younger, Hispanic or Black, Type 1 DM, worse baseline BCVA, higher HbA1c, higher BP, and had PDR (Diabetic Retinopathy Severity Score >66).

Conclusions:

Participants who were LTFU during DRCR clinical trials tended to be younger, Hispanic or Black, and have worse diabetes and hypertension. This study highlights the importance of ensuring a representative population is maintained through the end of the study period.
CHLOROQUINE-INDUCED MACULAR TOXICITY IN A PATIENT LATER DEVELOPING SECTOR RETINITIS PIGMENTOSA: A CASE REPORT
Authors: Cañas-Martín Julia , Bolívar de Miguel Gema , Teus Guezala Miguel A. , Arruabarrena Sánchez Carolina
Published: August 2023

Purpose:

To describe how underlying retinal diseases, such as retinitis pigmentosa, increase the risk of chloroquine (CQ)-induced macular toxicity.

Methods:

A observational case report.

Results:

We present the case of a 57-year-old woman being annually followed up in the ophthalmology service because of a systemic treatment with CQ. The explorations were successive normal, until a 10:2 visual field shows central defects in both eyes. Despite CQ treatment is discontinued, 10:2 visual field reveals slowly progressive macular defects. During follow-up, fundus examination disclosed bone spicules in the inferonasal middle periphery: The electroretinogram shows slow amplitude responses under scotopic conditions, and the electrooculogram also shows pathological responses. Therefore, the diagnosis of sector retinitis pigmentosa plus CQ maculopathy is made. Currently, the slow but constant progression of both peripheral and central defects is evident, despite having discontinued CQ treatment more than 15 years ago.

Conclusion:

Underlying retinal diseases seem to increase the risk of photoreceptor damage when undergoing a toxic insult. Thus, we hypothesize a potential interplay between retinal dystrophies and toxic maculopathy induced by CQ and the influence of each of them in the evolution and prognosis of the other.
Quintuple Procedure for Ocular Surface Reconstruction and Visual Rehabilitation
Authors: Navia Juan Carlos , Carletti Piero , Camacho Matthew , Dubovy Sander R. , Martinez Jaime D.
Published: August 2023

Purpose:

The aim of this study was to describe a combined surgical approach for ocular surface and visual rehabilitation in patients with limbal stem cell deficiency, corneal scarring, and cataract. We aimed to introduce this combined approach as an alternative to a staged approach and to describe the intraoperative use of a diamond ophthalmic burr (DOB) and optical coherence tomography (OCT) to achieve and confirm a smooth graft–host interface during the anterior lamellar keratoplasty (ALK) portion of the procedure.

Methods:

The quintuple procedure described herein consists of a modified ALK, cataract extraction, intraocular lens implantation, simple limbal epithelial transplantation, and temporal tarsorrhaphy. Intraoperative OCT and DOB were used to guide the creation of the stromal bed during the ALK. The procedure was performed in a patient with limbal stem cell deficiency and corneal scarring after a chemical ocular burn.

Results:

The tarsorrhaphy was removed at 3 months postoperatively once complete corneal epithelialization was observed. The best-corrected visual acuity improved from light perception preoperatively to 20/30 at 16 months postoperatively with the use of scleral contact lenses. At this postoperative time point, the cornea was clear and compact, and the ocular surface was stable.

Conclusions:

The quintuple procedure allowed for visual and ocular surface rehabilitation in cases in which follow-up for a staged approach was not possible. Intraoperative OCT allowed for real-time visualization and dissection of the stromal bed, whereas the use of the DOB helped achieve a smooth stromal surface for an optimal graft–host interface.