Necrotizing fasciitis (NF) is a potentially life-threatening bacterial infection of the skin, deep subcutaneous tissue, and fascia. Early symptoms may be misdiagnosed as cellulitis. A hallmark symptom that distinguishes NF from cellulitis is severe local pain that is out of proportion to the size and type of the wound present. Early diagnosis and treatment of NF is imperative for a patient's survival. This article describes the pathophysiologic mechanisms, clinical manifestations, and treatment of NF, as well as implications for perioperative nursing.

Acute care nurse practitioners (ACNPs) are advanced practice RNs who are educationally prepared to provide advanced nursing care to patients with complex acute, critical, and chronic illness. The education of advanced practice nurses should prepare them for the setting in which they practice; ACNPs are well prepared for hospital and specialty practice, particularly if they have experience as RN first assistants (RNFAs). This article provides a brief overview of the ACNP opportunity for RNFAs and the importance of additional training for ACNPs without OR experience who may be first assisting.

This article examines the vocality of teachers and schoolchildren in nineteenth-century English education discourse. Drawing on Andrew Bell's model of the monitorial schools of the early nineteenth century, as well as the annual reports of the school inspectorate for the Committee of Council on Education, the article investigates the disaggregation of vocal sound and linguistic meaning in speech training and reading instruction in the writing of the mass schoolroom. Of particular interest is the development of notions of the teacher's voice as a potentially powerful vehicle for the development of moral selfhood. Children's speaking voices were understood as crucial indices of an effective pedagogy, something which the Revised Code of 1862 simultaneously enshrined and misrecognized.The rising graph of literacy brought no corresponding decline in the use of the human voice. Children emerged from schools with their ears ringing with the noise of print. The first generation of inspected teachers aspired to harmony rather than silence in their lessons. Only in the more advanced schools of the last quarter of the nineteenth century were pupils permitted to spend part of their lessons quietly reading or writing. (Vincent 2000, 94) As critics such as David Vincent and more recently Ivan Kreilkamp have argued, print did not replace oral speech in Victorian culture so much as incorporate it into the broadly-encompassing project of universal print literacy. In the schoolroom, the reasons for this had much to do with numbers -numbers of students to teachers in a single room, and numbers of available printed texts. It was also a holdover from ancient catechetical pedagogy, in which students would mumble their lessons aloud before being examined individually by the master (Vincent 2000, 47). Taking Vincent's observations above as a starting

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