Retrospective Look Research Articles

Abstract 19 Cleveland Cord Blood Center (CCBC) Best Practices Throughout the COVID-19 Pandemic and How It Impacted Collection of Cord Blood Units

IntroductionOur commitment to provide quality cord blood units (CBUs) to patients in need was challenged with the outbreak of COVID-19 and the pandemics continued impact through early 2022. We continually monitored the ever-evolving COVID-19 public health threat to make adjustments to our practices to achieve optimal collections while maintaining the safety and quality of our CBUs.ObjectiveThe CCBC continued collections at all five collection sites with a brief mandated pause at our California site due to hospital restrictions. We maintained minimal staffing at the cord blood center to reduce the number of employees impacted should an exposure occur. Donors were screened upon admission for symptoms, exposure, positive testing, and recent vaccination, and donors with identified risks were excluded from collection.MethodsOur study design takes a retrospective look at data collected from the onset of the COVID-19 pandemic through December 2021 compared to data from 2018-2019. Factors included were birth numbers, number of patients testing positive for COVID-19, and staffing shortages due to coordinator illness with COVID-19.ResultsWe saw limited impact to our collection staff at the hospital or on site at the CCBC. Our biggest reduction of donors consented was between 2019 and 2020, which we attribute to the COVID peak and introduction of vaccinations. Most sites were trending downward for consenting on a yearly basis before COVID-19 at a rate of 6%-10% per year; during 2019-2020 we saw 19%, but the trend has returned to 8% from 2020-2021. This same trending occurred during the ZIKA outbreak. There was no further data review to determine if these mothers would have been excluded for other reasons. We collected a total of 15,561 units between 2018 and 2019 and a total of 10,121 units between 2020 and 2021.DiscussionOverall productivity of the collections was not dramatically affected by our response to the COVID-19 pandemic. Further research at time of pre-consent, to determine if the mother would have been ineligible to donate for reasons other than COVID-19, would have given us a more accurate count of donors lost for reasons related to the COVID-19 pandemic.

“And You May Ask Yourself, ‘Well, How Did I Get Here?'”

I've been thinking a great deal about the trajectory of our journal. As Editor, I've been writing about how exciting it is to see the content for each issue develop over time. I've mentioned to anyone who will listen that I love talking with authors about ideas, and I love reading each iteration of the articles as they go through revisions. So, of course I ask myself, “Well, how did we get here?” In exploration, I started at the beginning.Have you ever read the very first issue of American Archivist?2 Published in January 1938, the issue is slim compared to those of today. It lists SAA officers, Council members (including Margaret Cross Norton), the members of the journal's Editorial Board, and Theodore Calvin Pease as managing editor. There is a single article about manuscript repair in European archives—“Part I: Great Britain”—and Pease's review of Hilary Jenkinson's A Manual of Archive Administration. There are professional notices and abstracts of European archival publications. The style is formal, the information specific and primarily technical.It's interesting to read this brief issue, because it is clear that American Archivist is not the “same as it ever was.” Even as we remain concerned about preservation and practice, the content we are currently writing is far from where we stood in 1938. What was then a budding professional concern—specifically the work of American archives—is now a vibrant network of professional scholarship, research, and communities of practice. Where we once looked to Europe to find structure and “suggestions” for our institutions, we've cultivated a professional mindset that reaches toward diverse voices and international colleagues to collaborate and contribute to an ongoing discussion about theory, practice, and the implications of our work.Our content in this issue is a mix of material—all in that continued vein of moving our professional conversation forward. This issue invites readers to read a handful of elegant articles about specific practice areas such as born-digital archives, finding aid aggregation, and reference staffing. We're considering assessment of our technical skills, how we teach with primary sources, and how the classroom provides us with a way to connect to underserved students. Case studies address how modern soldiers create their own archival record, and two international contributions—from Germany and Australia—consider disaster planning and a retrospective look at an important digital project.In addition, this issue asks us to look inward to examine the development of our profession. In particular, these articles explore archival education programs and the Guidelines for Graduate Programs in Archival Studies (GPAS)3 as well as the relationship between educators and the Academy of Certified Archivists.4 We also have the opportunity to consider the influence of the Archives Leadership Institute on professional career-building. This introspective look at how we have formed/are forming our profession is a first foray into examining professional identity.I say a first foray because, in forthcoming American Archivist issues and on the journal's Reviews Portal, we'll see some interesting reflections on that question of “Well, how did we get here?” Upcoming issues will bring you the opportunity to consider different segments of our professional work, our history, and implications for the future. We will begin to publish information from and about A*CENSUS II, and we're excited to be developing a special section on Middle Eastern and North African Archives. The Reviews Portal will debut a series entitled “Intergenerational Conversations,” which will bring new voices into conversation with articles and authors from the archival canon. American Archivist 85.2 is wonderful. Issue 86.1 is shaping up to be just as engaging.So, in my reflection on the trajectory of this journal and in reading its first issue, I realized that there is a statement made in the Announcement of American Archivist 1.1 that represents where I return, again and again: The editors are quite aware that in spite of the co-operation of the Society, THE AMERICAN ARCHIVIST may be a failure. Without that co-operation, no matter what their efforts, they know it cannot succeed. . . . the journal can never be a success unless each individual member of the Society of American Archivists recognizes a personal responsibility for furnishing it with worthy material. In the hands of the membership, therefore, rests the ultimate fate of the publication.5This statement was written in part as a consideration of the journal's finances—important to understand at the beginning of a publishing venture. But more than that, this statement prioritizes from the outset what we continue to see 84 years later—that the contributions to this journal are made by our members, that the work of peer review and editorial guidance are done by our members, and that the journal is used and shared and valued by our members. You all have made this journal what it is. This is how we got here, same as it ever was. . . .

Deaf Empowerment: Towards Decolonization

Abstract Deaf empowerment is a newly popular concept that is discussed, but often in vague and ill-defined ways. This article examines the literature to establish what empowerment is and, more importantly, the processes by which empowerment occurs. This is used as a framework to take a retrospective look at past events and activities among Deaf/Sign Language Peoples and examine how these fit into the models of empowerment and decolonization outlined in the first section. Some issues specific to Deaf/SLP that hinder the processes of empowerment are also raised.

A Retrospective Look on the Use of DNA Evidence in a Sexual Assault Investigation in the Philippines

In 1998, biological samples were collected from the body of a 17-year old female rape-homicide victim within 24 hours post-contact. In the absence of a sexual assault investigation kit, locally available medical supplies were used to collect biological samples. The victim’s family filed a case naming the victim’s uncle as the assailant. More than a year into the trial, samples from the victim and the accused were tested for DNA. The vaginal smears yielded DNA profiles originating from at least two persons, with one DNA source being male. Upon discovery, the victim’s age, the state of her body, and medicolegal examination results supported the allegation of sexual assault rather than consensual sex. This paper described the DNA testing conducted for this rape with homicide case. The prosecution used the DNA test results to support the charges against the accused, who was eventually convicted and sentenced to death in 2001. Upon automatic review in 2004, the Philippine Supreme Court affirmed the conviction and dismissed the defense’s claim that DNA testing violated the defendant’s right against self-incrimination. The defendant’s death conviction was commuted to life imprisonment when the Death Penalty was suspended via Republic Act No. 9346 in 2006. The case described here is considered one of the DNA landmark cases cited in the Philippine Rule on DNA Evidence of 2007.

Research in Child Protection Against Abuse and Neglect: at the crossroads of analysis, strategy, and policy

Research in Child Protection Against Abuse and Neglect: at the crossroads of analysis, strategy, and policy

“Spice”-related deaths in and around Munich, Germany: A retrospective look at the role of synthetic cannabinoids in our postmortem cases over a seven-year period (2014–2020)

The synthetic cannabinoid receptor agonists (SCRAs, “Spice”) are a diverse group of recreational drugs, with their structural and pharmacological differences still evolving. Due to limited data on their pharmacokinetics and pharmacodynamics in humans, the assessment of their role in fatal cases remains challenging. Forensic toxicologists thus often rely on previous reports of intoxication cases. This work provides detailed information on forensic cases for which SCRAs could be detected in postmortem specimens. All cases included underwent an autopsy at the Institute of Forensic Medicine in Munich between 2014 and 2020, followed by routine toxicological analyses, including analysis for alcohol. Pharmaceutical substances and classical drugs of abuse were detected and quantified in postmortem femoral venous blood (or liver where not available) by liquid chromatography-tandem mass spectrometry (LC-MS/MS) at the Forensic Toxicological Centre Munich. Based on circumstantial data and case histories, additional targeted analyses for the detection of SCRAs and other new psychoactive substances were performed on those cases for which a prior consumption was indicated or suspected. Synthetic cannabinoids were detected and quantified in femoral venous blood (81 cases), cardiac blood (12 cases), liver tissue (2 cases), antemortem blood (2 cases) and urine (1 case) by LC-MS/MS at the Institute of Forensic Medicine in Freiburg, Germany. The cause of death and the roles of the SCRAs in the individual fatalities were assessed based on the concentrations detected, the presence and concentrations of other drugs, pathological findings at autopsy and case histories. Furthermore, the total number of SCRAs detected and how these substances were scattered over the investigated period (i.e. how often a particular substance was detected each year) were determined. The latter was correlated with the number of SCRAs detected in police seizures analysed at the Bavarian State Criminal Police Office (BLKA), as well as the change in their legal status in Germany. The concentration range for each SCRA detected in femoral venous blood was defined and correlated with the estimated interval between death and sample collection. We were able to identify 98 “Spice”-related fatalities among our autopsy cases from 2014 to 2020. Most of the deceased were male (91.8%), with a median age of 36 years. SCRAs played a causative role in 51%, a contributory role in 26% and no significant role in 23% of cases. The most common cause of death was polydrug intoxications that include synthetic cannabinoids. Altogether 41 different synthetic cannabinoids could be detected during the investigated period. 5F-ADB was the most prevalent SCRA among our cases ( n = 25), at median and maximum concentrations in femoral venous blood of 0.22 μg/L and 14 μg/L, respectively, followed by 5F-MDMB-PICA (0.64 μg/L; 7.2 μg/L) and AB-CHMINACA (3.95 μg/L; 28 μg/L). Cumyl-CBMICA and 5F-MDMB-P7AICA were two of the least frequently detected synthetic cannabinoids. These results correlate with the number of SCRAs detected in local police seizures. No direct correlation between synthetic cannabinoid concentrations and postmortem interval was evident from our results. Our awareness of the importance of SCRAs in fatal intoxication cases has clearly increased since 2014, as is evident from our numbers in toxicological analyses for their postmortem detection. Nonetheless, the number of identified “Spice”-related fatalities has significantly decreased in our cohort of cases after the New Psychoactive Substances Act was implemented in Germany. Furthermore, the causative role of SCRAs in these fatalities has since also diminished in significance. Considering the continuing evolvement of SCRAs and the limited knowledge about their pharmacology, postmortem distribution and stability in humans, forensic toxicologists will undoubtedly benefit from more detailed postmortem case studies to assess their role in fatal intoxication cases.

Malignant pericardial effusions: A retrospective look at etiology and prognosis in a tertiary oncological center.

Cancer and the associated treatments are important causes of pericardial effusion. However, the natural history of malignant pericardial effusion is largely unknown, especially in the context of newer cancer treatments. We investigated the causes of pericardial effusions in a tertiary oncology center, with particular focus on the prognosis of malignant effusions in the era of contemporary oncological therapies. We obtained data from electronic medical records. Survival analyses were performed utilizing the Kaplan-Meier method. We performed Cox regression to explore the potential clinical factors associated with survival. Forty-four patients had pericardial effusion treated with pericardiocentesis during the study period. The mean age was 62-years, and 55% were female. Sixty-eight percent of these patients also had cancer, with approximately half (47%) receiving prior chemotherapy, and a quarter (27%) having had chest radiotherapy. Seventy percent of the patients with active cancer had malignant cells on cytology of pericardial fluid. The median survival of the cohort was 227 days, with malignant effusions having a median survival of 62-days compared to nonmalignant effusions with 1408 days (Logrank statistic 7.4, p-value .007). Malignant cytology was significantly associated with mortality on univariable analysis (HR 2.5, 95% CI 1.2-5.3). Complication rates were low, with no deaths as a direct complication of pericardiocentesis. Malignancy is the most common cause of pericardial effusion in this tertiary medical and oncological center. Abnormal cytology with malignant cells has a poor median survival, despite advances in oncological treatment over the last decade. Pericardiocentesis is a safe procedure for these patients.

The development of a scientific view of history in the early works of K. Marx

The subject of this study is the dynamics of the ideas of materialism in the views on society and the history of K. Marx. The object of research is the early works of the thinker (the 40s of the XIX century). The author pays special attention to the reconstruction of the method developed by K. Marx for the analysis of history and society. The relevance of this topic lies in the fact that a retrospective look at the method created by K. Marx will allow it to be applied more effectively in modern social research. The methods used are the analysis of primary sources, as well as comparative-historical, analytical-interpretive, hermeneutic methods. The novelty of the research lies in the fact that historical reconstruction is carried out through the prism of a modern scientific approach to the analysis of society, the essence of which is in the progressive unfolding of human nature. As a result, it is revealed that at the beginning of his creative career K. Marx took the position of dialectical idealism and revolutionary democracy. However, the practical activity of the thinker allowed him to gradually ideologically evolve, which is shown in this article. And already in the Preface to the Critique of Political Economy, we can observe the quintessence of the theory of materialism in views on society and history. This theory is at the same time a method, an analysis tool that has not lost its heuristic value and is applicable to the analysis of modern society.

A retrospective look at influenza during the COVID-19 pandemic

Aim: Influenza is the main cause of acute respiratory disease worldwide and is transmitted via the respiratory secretions of infected individuals. The aim of this study was to retrospectively investigate influenza, a virus with which we have a longer history, during a period in which the COVID-19 pandemic has dominated current events in terms of viral infections.
 Material and Method: Epidemiological and laboratory data of patients over 18 years of age who tested positive for influenza infection and received inpatient treatment in the Erzurum Regional Training and Research Hospital between January 1, 2019 and December 31, 2020 according to the influenza management algorithm of the Public Health Institution of Turkey were evaluated retrospectively.
 Results: Of the 164 patients included in our study, 129 were hospitalized due to influenza A and 35 due to influenza B. Procalcitonin, aspartate transaminase, alanine transaminase, creatine kinase, total bilirubin, and direct bilirubin levels were significantly higher in the influenza A group compared to the influenza B group (p=0.002, 0.005, 0.006, 0.030, 0.010, and 0.004, respectively). Ten of the patients in the study died; there was no significant difference in mortality based on influenza subtype or presence of comorbidity (p=0.999 and 0.756, respectively). Forty-one (54.7%) of the patients with comorbidities had received an influenza vaccine.
 Conclusion: Although COVID-19 has dominated the global stage since the pandemic started, the effects of periodic pandemics of our old acquaintance influenza still continue. Vaccination, which is our strongest weapon against pandemics, can reduce mortality in patients with comorbidities, as seen in our study.

ANALYZING AND FORECASTING CONTRACTORS’ GREEN BUILDING REVENUES

The sustainability movement is increasingly impacting the construction industry, which has been quick to adopt innovative methods to deliver sustainable facilities. The literature shows that energy consumption in the building sector is increasing at a rate comparable to those of industrial and transportation sectors, and that buildings are responsible for close to 40 percent of energy use and 74 percent of electricity retail sales. Numerous studies also show that this sector has high potential for energy savings and pollution reduction. There is an opportunity for stakeholders of the architecture, engineering, and construction industry to increase their revenues in delivering green buildings. Accordingly, this study presents quantitative analyses of green contractors’ market performance in terms of topline revenue. More than a decade’s worth of business data was used to perform statistical analyses to gauge and discover the green building construction revenue growth over the past decade, uncover trends and develop a forecasting model for the next decade. Results indicate that there is an average 3.7 percent growth in green building revenue on a yearly basis, and that green building revenue constitutes about 35 percent of the total revenue for the top 100 green building contractors, with an expected increase of $3 billion every year. Such findings give researchers a retrospective look at the green contractors’ market performance to investigate the underlying reasons for such significant growth, while also providing practitioners with a forecasted growth rate informing their decision to grow their green building business.

North–South Dialogue on Territorial Policies and Discourses: Insights for the Future of Nature Conservation

Environmental issues such as the progressive loss of biodiversity on a global scale and climate change cannot be separated from other territorial problems caused by social injustice, economic inequality, access to natural resources, gender violence and the fight for human and nature’s rights. The evaluation of biodiversity management strategies must by necessity draw on a retrospective look at the interpretation of the problem and the conceptual approach of the general territorial management policies in which they are framed. From a critical view, these approaches have different nuances depending on the historical journey, theories and main actors involved with territorial policies in different regions of the world. In this work, we apply qualitative content analysis to contrast the key concepts on which the main European territorial policies of recent decades have been based with the main guidelines of the emerging Latin American territorial perspectives. Thus, we seek to initiate a dialogue between the northern hemisphere’s globally hegemonic notions of nature, territory, biodiversity and its management and new theories and proposals from the South, whilst simultaneously contrasting both with the content of the latest Convention on Biological Biodiversity Strategic Plan 2011–2020. We conclude with some recommendations aimed at building bridges and contributing to the construction of future global conservation strategies from a critical and territorial perspective that tends towards integrating sustainability with social and environmental justice.

Lapsed ja sõda. Sõjatrauma Tiina Kurnimi autobiograafias „Sõrve rahva elukeerdkäigud“ ja Ülo Tuuliku romaanis „Sõja jalus“ / Children and War. War trauma in Tiina Kurnim’s Ups and Downs in the Life of the People of Sõrve and Ülo Tuulik’s novel In the Way

Lapsed ja sõda. Sõjatrauma Tiina Kurnimi autobiograafias „Sõrve rahva elukeerdkäigud“ ja Ülo Tuuliku romaanis „Sõja jalus“ / Children and War. War trauma in Tiina Kurnim’s Ups and Downs in the Life of the People of Sõrve and Ülo Tuulik’s novel In the Way

Long-term Effects of Remote Patient Monitoring in Patients Living with Diabetes: A Retrospective Look at Participants of the Mississippi Diabetes Telehealth Network Study.

Introduction:Remote patient monitoring (RPM) has demonstrated value as a tool to aid patients in management of their chronic illness in the home. Although the Mississippi Diabetes Telehealth Network Study (MSDTNS) was successful in reducing HbgA1c levels for patients participating in RPM in the Mississippi Delta, the long-term effect of RPM on patients and how to support patients to maintain the treatment effect after discharge remain unclear.Objective:This study evaluated the long-term effectiveness of an RPM program after the intervention was withdrawn.Materials and Methods:A retrospective review of medical records of patients who completed all phases of the MSDTNS from 2014 to 2016 was performed over a period of 6 months. Data collected included HbgA1c values, demographics, and changes in social determinants of health.Results:Of the 31 participants, African Americans displayed a significant difference in HbgA1c values compared with Caucasians since the end of the MSDTNS. No significant effect of other variables, such as income, marital status, insurance coverage, or age, on the change in HbgA1c values was detected since the end of the original study.Conclusions and Relevance:This limited study implies that African Americans are at higher risk for an increase in hemoglobin A1C after the program is completed. More investigation is needed to identify ways to reduce their risk and equalize the long-term effects of RPM on clinical outcomes of patients in rural or underserved communities.

ANALYZING AND FORECASTING CONTRACTORS’ GREEN BUILDING REVENUES

The sustainability movement is increasingly impacting the construction industry, which has been quick to adopt innovative methods to deliver sustainable facilities. The literature shows that energy consumption in the building sector is increasing at a rate comparable to those of industrial and transportation sectors, and that buildings are responsible for close to 40 percent of energy use and 74 percent of electricity retail sales. Numerous studies also show that this sector has high potential for energy savings and pollution reduction. There is an opportunity for stakeholders of the architecture, engineering, and construction industry to increase their revenues in delivering green buildings. Accordingly, this study presents quantitative analyses of green contractors’ market performance in terms of topline revenue. More than a decade’s worth of business data was used to perform statistical analyses to gauge and discover the green building construction revenue growth over the past decade, uncover trends and develop a forecasting model for the next decade. Results indicate that there is an average 3.7 percent growth in green building revenue on a yearly basis, and that green building revenue constitutes about 35 percent of the total revenue for the top 100 green building contractors, with an expected increase of $3 billion every year. Such findings give researchers a retrospective look at the green contractors’ market performance to investigate the underlying reasons for such significant growth, while also providing practitioners with a forecasted growth rate informing their decision to grow their green building business.

Perspectives of Parents regarding the Appropriateness of Physical Restraint Alone or in Conjunction with Sedative Techniques for Managing Challenging Pediatric Dental Behaviour

Purpose: A retrospective look at parents’ responses to having witnessed their children of varying levels of apprehension undergo sedative treatment visits across a 35 year period. Sedation visits with outcomes ranging from optimal or adequate, to inadequate and over-dosage, were assessed by both parents and their clinician. Methods: After witnessing their child’s visits, parents were asked if they would choose sedation for future visits under circumstances where outcomes cited need for persistent application of restraints vs more favorable outcomes. Post-treatment surveys of over 4,360 parents were conducted at the time of discharge after observing their children’s responses to oral sedation visits in a private practice setting. Variable dosing of Chloral hydrate-Hydroxyzine with and without Meperidine, and Midazolam with and without Meperidine were compared. Results: Not surprisingly, for parents where sedation was rated inadequate, 95% indicated they would likely opt for alternative modalities rather than subject their children to measures which ultimately necessitated persistent applications of restraint. Under circumstances where outcomes enabled treatment objectives to be accomplished without any form of restraint, parents correspondingly indicated they would have no reservation in accepting a pharmacological modality for future visits. Where transient application of physical restraint was needed to overcome minimally, moderately, or severely interfering behaviors, reactions were mixed among parents while clearly leaning in the direction of finding sedation desirable. Parents observing less than adequate success of sedation indicated they would consent to using sedation procedures for future visits only if it meant avoiding use of general anesthesia. Conclusion: Perceptions of parents where persistent application of restraints were needed found their use neither acceptable, appropriate nor desirable. There appears to be a trend in this direction amongst clinicians of today but in lieu of current practices which make little or no use of sedative modalities, this appears by no means universal.

Progressivism, Old and New: The Spiritual Moorings of Progressive Reforms.

With the tide of progressive reforms facing strong headwinds today, this essay offers a retrospective look at the progressive movement in the U.S.A. and reflects on the lessons to be learned from its triumphs and failures. The case is made that major advances in the progressive agenda came at historical junctions precipitated by dramatic events. The stretch between 1900 and 1920 saw the first wave of social reforms following the late nineteenth century recessions and upsurge in labor unrest. The New Deal took shape in the 1930s in the aftermath of the Great Depression. The Civil Rights movement burst onto the scene in the 1960s in the face of bitter attempts to shore up segregationist practices in southern states. And the 2020s spike in progressive activism gained momentum against the backdrop of the COVID-19 pandemic and the January 6 Capitol riots. Special attention is paid to the interfaces between Social Gospel theology and efforts to ground progressive rhetoric in what John Dewey called “common faith,” Robert Bellah “civil religion,” and Richard Rorty “liberal pragmatism.”

A Retrospective Look at 50 Years of Acupuncture in the United States.

This article describes several key events concerning the introduction of acupuncture to the United States, considers the mainstream acceptance of acupuncture and the development of the acupuncture "infrastructure" for the past 50 years, and speculates on acupuncture's future trajectory. In the author's opinion, "the two factors which will contribute the most to the continuing development of acupuncture are acupuncture consumers and scientific research."

Specificity of Author’s Modality and Representation of Russia’s Image in Claudia Erdheim’s Book “Früher war alles besser”: an Austrian View

The reception of a foreign cultural (Russian) code by the European (Austrian) literary consciousness on the problematic, stylistic and lexical levels are studied in the article. The main trend characteristic for the representation of the image of Russia in the book by Claudia Erdheim is revealed: a retrospective look into the “bright past”. It is emphasized that the refrain phrase “Früher war alles besser” in the title has a symbolic meaning. Five mini-stories were analyzed. Attention is paid to the stereotypes of the Russian mass consciousness. Political stereotypes, ethical canons are studied in the perception of the author-narrator. It is argued that the antinomy of the Western way of thinking and the Russian mentality is the prevailing motive in the work under study. It is proved that the problem of the Russian-Austrian cultural dialogue is realized through the prism of the fundamental components of the Austrian mentality Einfühlung (feeling) and Gemütlichkeit (comfort, tranquility). Among the mental clichés of the narrator, stereotyped ideas about the Russian character (“broad soul”, “Russian scope”, “Russian maybe”, “longing”) are found. The book by K. Erdheim is a vivid example of the representation of the “Other” / “Alien” ideas about the “Other” national character and recreates the image of the Russian people in its artistic system.

A Retrospective Look at a Cervical Spine Clearance Protocol in Pediatric Trauma Patients at a Level-1 Trauma Center.

Adult studies have demonstrated the efficacy of written protocols for clearance of the cervical spine. However, less than half of recently surveyed pediatric trauma centers report using a documented protocol. Little data exists on such protocols in pediatric populations, but interest remains because of potential reductions in radiation exposure, time to clearance, hospital stay, and specialist referral. However, missed injury can have devastating consequences. The purpose of this study is to examine the efficacy in detecting injury of an implemented cervical spine clearance protocol at a level-1 pediatric trauma hospital. A retrospective review was performed on pediatric patients presenting as activated traumas to the emergency department of a single level-1 pediatric trauma hospital between May 2010 and October 2018. This institution has utilized a written cervical spine clearance protocol throughout this time. Presence of cervical spine injury, documented clearance, cervical spine imaging, and follow-up documentation were reviewed for any missed injuries. There were no missed cervical spine injuries. Five-hundred sixty-three clinically significant cervical spine injuries were identified, representing 16.5% of patients. Of these, 96 were fractures, dislocations, or ligamentous injuries, representing 2.8% of all patients. Most cervical spine clearances were performed by trauma surgery. Advanced imaging of the cervical spine was ordered for 43.2% of patients overall and trended down over time. Documented cervical spine clearance protocols are effective for detection of significant injury in pediatric trauma patients. This study suggests these protocols minimize risk of missed injury and may prevent unnecessary radiation exposure, delayed clearance, prolonged hospitalization, or unnecessary specialist referral. Utilization of a standard written protocol for cervical spine clearance likely prevents missed injury and helps to minimize radiation exposure in pediatric populations. Further research is needed on evaluation and management of pediatric cervical spine trauma.

Failures of imagination: Racial justice in philosophy and education

This article is a retrospective look at Chris Lebron’s essay ‘Thoughts on Racial Democratic Education and Moral Virtue’. I argue that Lebron’s work remains extremely relevant, both for its vision of antiracist education, and for the methodological questions it allows readers to contend with. As we are living in an age of increasing backlash to antiracist education, taking another look at Lebron’s essay also allows us to consider the reasonableness of this backlash and what this backlash says about imagination and failures of imagination.