Non-affirmative Theory of Education as a Foundation for Curriculum Studies, Didaktik and Educational Leadership

This chapter presents non-affirmative theory of education as the foundation for a new research program in education, allowing us to bridge educational leadership, curriculum studies and Didaktik. We demonstrate the strengths of this framework by analyzing literature from educational leadership and curriculum theory/didaktik. In contrast to both socialization-oriented explanations locating curriculum and leadership within existing society, and transformation-oriented models viewing education as revolutionary or super-ordinate to society, non-affirmative theory explains the relation between education and politics, economy and culture, respectively, as non-hierarchical. Here critical deliberation and discursive practices mediate between politics, culture, economy and education, driven by individual agency in historically developed cultural and societal institutions. While transformative and socialization models typically result in instrumental notions of leadership and teaching, non-affirmative education theory, previously developed within German and Nordic education, instead views leadership and teaching as relational and hermeneutic, drawing on ontological core concepts of modern education: recognition; summoning to self-activity and Bildsamkeit. Understanding educational leadership, school development and teaching then requires a comparative multi-level approach informed by discursive institutionalism and organization theory, in addition to theorizing leadership and teaching as cultural-historical and critical-hermeneutic activity. Globalisation and contemporary challenges to deliberative democracy also call for rethinking modern nation-state based theorizing of education in a cosmopolitan light. Non-affirmative education theory allows us to understand and promote recognition based democratic citizenship (political, economical and cultural) that respects cultural, ethical and epistemological variations in a globopolitan era. We hope an American-European-Asian comparative dialogue is enhanced by theorizing education with a non-affirmative approach

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Mohs Micrographic Surgery in a pediatric patient with Squamous Cell Carcinoma

An 11-year old boy presented with biopsy proven squamous cell carcinoma (SCC) of the left cheek. Pathology demonstrated moderate to well-differentiated SCC with positive deep and peripheral margins and no signs of definitive perineural invasion. Past medical history was significant for radiation therapy, chemotherapy, and stem cell transplant seven years prior for the treatment of a spinal embryonal tumor with multilayered rosettes with no signs of recurrence. He never had any direct radiation therapy to the site of his SCC. Mohs micrographic surgery (MMS) was ultimately selected as the treatment of choice for his SCC. The main concern with MMS in this pediatric patient was regarding his tolerance for the long procedure with only local anesthesia. Therefore, modifications were made to decrease anxiety related to the procedure. Preoperatively, he was familiarized with the facility and the procedure room. Topical anesthetic cream was also applied one hour prior to the procedure. Perioperatively, he was provided a tablet for distraction and his mother was permitted to stay in the room for support. The patient underwent a successful two stage surgery with the final defect measuring 1.7 cm by 1.6 cm, located on the left cheek and inferior lower left eyelid. Primary linear closure was completed, and follow-up at 8 weeks showed a well-healed incisional scar without signs of recurrence. MMS is an effective treatment for cutaneous neoplasms that display high risk features including recurrence, aggression, poorly defined margins, growth in sensitive areas, or incomplete excision. Despite its frequent use in adults, MMS has not been widely adopted for the pediatric population due to lack of surgeon training and fears of patient tolerance. Several cases have demonstrated successful MMS in appropriate pediatric patients.1,2 The techniques used to optimize pediatric outcomes in MMS are similar to those in other surgical environments including sufficient preoperative preparation, perioperative distraction, and familial support.

Multiple eruptive dermatofibromas

We report a 34 year-old woman with psoriasis, systemic lupus erythematosus (SLE), and recent anti-TNFa therapy, who presented with multiple, eruptive dermatofibromas (MEDF). Although the pathogenesis of MEDF remains unknown, there is substantial evidence that this phenomenon represents an aberrant immune response. Like the more common presentation of solitary dermatofibromas, these lesions are benign, and no treatment is required. However, MEDF is increasingly recognized as a sign of immune dysregulation and an appropriate work-up should be initiated to identify an underlying cause in patients without a known trigger

Multiple eruptive dermatofibromas

We report a 34 year-old woman with psoriasis, systemic lupus erythematosus (SLE), and recent anti-TNFa therapy, who presented with multiple, eruptive dermatofibromas (MEDF). Although the pathogenesis of MEDF remains unknown, there is substantial evidence that this phenomenon represents an aberrant immune response. Like the more common presentation of solitary dermatofibromas, these lesions are benign, and no treatment is required. However, MEDF is increasingly recognized as a sign of immune dysregulation and an appropriate work-up should be initiated to identify an underlying cause in patients without a known trigger

Kaposi’s sarcoma in an HIV-negative patient

We report an HIV-negative, 55-year-old manwith recurrent Kaposi’s sarcoma (KS) of the lowerextremities, who does not fit into any of thefour previously described variants of KS: classicKS, AIDS-related KS, iatrogenic KS, and AfricanendemicKS. There are reports in the literature ofchildhood-onset KS, which is thought to be dueto an inherited immune deficiency that confers ahigher susceptibility to human Herpesvirus-8 (HHV-8), which is the virus that is known to cause KS. Ourpatient may be affected with an inherited immunedeficiency that has predisposed him to KS, and thismutation also may account for his prostate andbladder cancer