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Environmental education research often emphasizes the importance of community context, but conceptualization and measurement of environmental literacy has mostly occurred at the individual level, often focusing on individual behaviors. The environmental problems facing the world today require collective action--communities coming together to address large-scale problems. Accordingly, understanding and encouraging collective action requires a shift in focus from individual to community-level environmental literacy (CLEL). Despite its importance, CLEL has been left largely undefined and unmentioned in environmental education literature. To understand the field's current conceptualizations and measurement strategies around CLEL, the authors held a convening of 24 researchers to discuss the topic. Here, we report the findings of this convening and present a series of tensions that emerged in conceptualizing and measuring CLEL. We see this area of research as rich with opportunity for innovation and offer considerations for researchers engaging in this work.

Objective This study examined whether service members and their families engage in communication with their primary care managers (PCMs) regarding their losses and to what extent PCMs provide counseling or referrals for grief-related concerns. Additionally, the study explored the potential associations between ethnicity, age, military status (dependent, service member, or veteran), gender, patients' disclosure of loss to their PCM, receipt of referrals for grief-related services, and treatment seeking. Methods A survey was administered to 161 patients enrolled in primary care at William Beaumont Army Medical Center, with 138 reporting a significant loss. Bereaved respondents completed the Inventory of Complicated Grief and the Prolonged Grief Disorder-13 Revised scale (PG-13). Respondents were also asked questions related to their loss and their interactions with their PCM related to the loss. Results One hundred twenty-five bereaved respondents completed the measures, 13 had missing information related to PCM interactions. Twenty-nine percent (n  = 36) of the 112 respondents reported a significant loss to their PCM. These respondents exhibited significantly higher symptom severity, as indicated by their total mean scores on the Inventory of Complicated Grief and the PG13. Seventeen percent (n  = 6) of these respondents reported receiving counseling on topics related to grief or a referral for grief care from their PCM. A moderate relationship was identified between military status and communication with PCM, such that current service members were least likely to report, followed by veterans, then dependents. A moderate relationship was also found between ethnicity and treatment seeking. Conclusion The study's findings have implications for primary care and highlight opportunities for improved outcomes, including the development of appropriate assessment protocols, interventions, and educational initiatives to address grief-related concerns within the military healthcare system. Future research should further investigate the specific needs and preferences of military personnel and their families to enhance the delivery of targeted and effective healthcare services. [ABSTRACT FROM AUTHOR]

High intensity gait training (HIGT) is established as best practice for patients following stroke. The optimal mode to implement HIGT is unknown. This study compares the use of usual care approaches and overground robotic exoskeletons (ORE) to achieve HIGT in people with stroke during inpatient rehabilitation. Prospective Observational Study. Large urban inpatient rehabilitation facility (IRF). Patients admitted to IRF within 6 months post-stroke with an appropriate walking goal. Patients received physical therapy (45-90 minutes) 5 days per week focused on HIGT including: conventional overground gait training, body weight supported treadmill training (BWSTT), LiteGait, and ORE. Heart rate (HR) was measured using the Polar A370 Fitness Watch. ORE was provided using Ekso Bionics exoskeleton. Intensity achieved during HIGT sessions was assessed by HR, time spent walking per session, and number of steps. Patients (n=46; age 64 ± 13 years; 52% female) were admitted for inpatient rehabilitation at 16.55 ± 22.22 days since onset of stroke for an average length of stay of 22.72 ± 12.19 days. Conventional overground gait training (51%) was the most common mode of all HIGT sessions, followed by BSWTT (28%), and ORE (11%). ORE sessions (63%) attained the greatest amount of time in moderate-to-vigorous intensity, followed by BSWTT (46%), Litegait (36%), and conventional overground (30%). Time spent walking across sessions was greatest during ORE (24.6±-7.1 minutes), followed by conventional overground gait training (19.3±10.5), BSWTT (20.9±6.4), and Litegait (19.6±6.0). The average number of steps during ORE sessions was 505.59±208.10. No mode of gait training attained HIGT cardiovascular intensity recommendations for patients with stroke. However, ORE elicited the greatest cardiovascular intensity and amount of time spent walking during IRF physical therapy sessions. The authors do not have any conflicts of interest. [ABSTRACT FROM AUTHOR]

Esophageal intubations are not an uncommon occurrence in prehospital settings, occurring as high as 17%. These "never events" are associated with significant morbidity and mortality especially when unrecognized or when there is delayed recognition. Here, we review the currently available techniques for confirming endotracheal tube intubation and their limitations, and present the case for the application of portable handheld point-of-care ultrasound as an emerging technology for detection of potentially unrecognized esophageal intubations such as during cardiac arrest. We also provide algorithms for confirmation of tracheal intubation. [ABSTRACT FROM AUTHOR]

While COVID-19 has primarily been characterized by the respiratory impact of viral pneumonia, it affects every organ system and carries a high consequent risk of death in critically ill patients. Higher sequential organ failure assessment (SOFA) scores have been associated with increased mortality in patients critically ill patients with COVID-19. It is important that clinicians managing critically ill COVID-19 patients be aware of the multisystem impact of the disease so that care can be focused on the prevention of end-organ injuries to potentially improve clinical outcomes. We review the multisystem complications of COVID-19 and associated treatment strategies to improve the care of critically ill COVID-19 patients. [ABSTRACT FROM AUTHOR]

• This case highlights two serious side effects of empagliflozin occurring concurrently. Those being diabetic ketoacidosis and Fournier's gangrene. • Diabetic ketoacidosis is an important cause of perioperative high anion gap metabolic acidosis in the context of SGLT2 inhibitors and needs to be carefully managed. • SGLT2 inhibitors should be held up to 48 h prior to surgery to minimize the risk of diabetic ketoacidosis perioperatively. Sodium glucose cotransporter-2 inhibitors (SGLT2) are an increasingly administered class of medication used to lower blood glucose levels in patients with type 2 diabetes mellitus. Diabetic ketoacidosis (DKA) and Fournier's gangrene are rare, but potentially catastrophic side effects of SGLT2 inhibitors. This manuscript reports a case of both DKA and Fournier's gangrene in the context of SGLT2 inhibitor use. A 51-year-old morbidly obese man with hypertension and poorly controlled Type 2 Diabetes Mellitus presented to the emergency department with a clinical presentation consistent with Fournier's gangrene. He was promptly taken to the operating room by the urology team where he had extensive debridement of the perineum and abdomen. Intra-operatively he was found to have DKA, which was managed appropriately. The acidosis and Fournier's gangrene were deemed a likely side effect of SGLT2 inhibitor use. After a thirty-day hospital admission, the patient was discharged to a rehabilitation facility where he is progressing well. His SGLT2 inhibitor was discontinued upon admission to hospital. Perioperative providers should have a high index of suspicion for diabetic ketoacidosis (DKA) and Fournier's gangrene in patients prescribed SGLT2 inhibitors. Prompt treatment of DKA through correction of underlying triggers, aggressive fluid resuscitation, insulin to close the anion gap, and appropriate potassium repletion is vital to optimize patient outcomes. The use of SGLT2 inhibitors among surgical populations is increasing. This case highlights the importance of being aware of the mechanism and side effects of SGLT2 inhibitors, and the management of DKA. [ABSTRACT FROM AUTHOR]

In the article, the authors discuss the issues raised on the use of prehospital ultrasound for endotracheal tube confirmation. Also cited are the need of post-intubation methods for confirmation due to alleged lack of hands-on intubation experience of emergency medical services (EMS) workforce, and the use of continuous quantitative waveform capnography as standard of care for said confirmation.

The article focuses on the Erin's Law, based on efforts of activist Erin Merryn that would require age appropriate child sexual abuse (CSA) education for students in pre-K through fifth grade, require that school personnel get additional CSA training, and require information to be sent home to parents and guardians. It mentions that efforts of educators, researchers, psychologists, law enforcement on child sexual abuse.