Scaling Community Health Coalitions: The Well Connected Communities Pilot Initiative

We outline the process and development of the Well Connected Communities health initiative as undertaken in three Utah communities. This transformative community-focused alternative to addressing public health issues through Extension situates local communities as the origin for health decision making. The initiative recognizes the need for varied community statuses (i.e., planner, implementer, and innovator) based on varying levels of readiness and diversity of populations. We concluded that the Utah Well Connected Communities initiative aligns well with the 2014 Extension Committee on Organization and Policy National Framework for Health and Wellness. Replication requirements and implications for other Extension programs are presented

Patellar Tendon Avulsion in a Pediatric Male: A Surgical Case Report with a Return to Sport

Isolated patellar tendon injuries in the pediatric population are considered rare and lack a well-accepted classification system. This injury pattern in pediatrics occurs more commonly in males around 14 years of age, typically presents with apophyseal involvement, and is frequently associated with athletic activity. The patient, in this case, was a 12-year-old male who sustained an isolated distal patellar tendon injury while running. This case is unique due to lack of apophyseal involvement commonly seen in the pediatric population. On exam, a classic high-riding patella was not seen on initial X-ray, and he was able to actively extend his knee, two clinical clues associated with the diagnostic triad of patellar tendon injury. Magnetic resonance imaging was utilized to confirm the injury pattern which prompted urgent surgical intervention to allow for initiation of rehabilitation with a goal of returning to athletic activities. The patient was able to progress to full weight-bearing at 1.5 months, achieved full range of motion at 3 months, demonstrated symmetric strength with uninvolved lower extremity at 4.5 months, and had progressed back into sporting activities by 5.75 months postoperatively. The low frequency of this injury in the pediatric population requires urgent recognition and diagnosis to allow for prompt surgical intervention followed by rehabilitation for efficient return to play

The communication bottleneck in knitwear design: Analysis and computing solutions

Communication between different members of a designteam often poses difficulties. This paper reports onthe results of a detailed empirical study ofcommunication in over twenty British, German andItalian knitwear companies. The knitwear designprocess is shared by the designers, who plan thevisual and tactile appearance of the garments, and thetechnicians, who have to realise the garment on aknitting machine. They comprise a typical but smalldesign team whose members have different backgroundsand expertise. Knitwear design allows a detailedanalysis of the causes and effects of communicationbreakdown. Designers specify their designsinaccurately, incompletely and inconsistently;technicians interpret these specifications accordingto their previous experience of similar designs, andproduce garments very different from the designers'original intentions. Knitwear is inherently difficultto describe, as no simple and complete notationexists; and the relationship between visual appearanceand structure and technical properties of knittedfabric is subtle and complex. Designers andtechnicians have different cognitive approaches andare very different people. At the same time theinteraction between designers and technicians is badlymanaged in many companies. This paper argues thatimproving the accuracy and reliability of designers'specifications would significantly enhance the designprocess. It concludes with a description of thearchitecture of an intelligent automatic design systemthat generates technically correct designs from thedesigners' customary notations

Presence of Preoperative Neurodegeneration Biofluid Markers in Patients with Postoperative Delirium

BackgroundThe pathophysiology of delirium is incompletely understood, including what molecular pathways are involved in brain vulnerability to delirium. This study examined whether preoperative plasma neurodegeneration markers were elevated in patients who subsequently developed postoperative delirium through a retrospective case-control study.MethodsInclusion criteria were patients of 65 yr of age or older, undergoing elective noncardiac surgery with a hospital stay of 2 days or more. Concentrations of preoperative plasma P-Tau181, neurofilament light chain, amyloid β1-42 (Aβ42), and glial fibrillary acidic protein were measured with a digital immunoassay platform. The primary outcome was postoperative delirium measured by the Confusion Assessment Method. The study included propensity score matching by age and sex with nearest neighbor, such that each patient in the delirium group was matched by age and sex with a patient in the no-delirium group.ResultsThe initial cohort consists of 189 patients with no delirium and 102 patients who developed postoperative delirium. Of 291 patients aged 72.5 ± 5.8 yr, 50.5% were women, and 102 (35%) developed postoperative delirium. The final cohort in the analysis consisted of a no-delirium group (n = 102) and a delirium group (n = 102) matched by age and sex using the propensity score method. Of the four biomarkers assayed, the median value for neurofilament light chain was 32.05 pg/ml for the delirium group versus 23.7 pg/ml in the no-delirium group. The distribution of biomarker values significantly differed between the delirium and no-delirium groups (P = 0.02 by the Kolmogorov-Smirnov test) with the largest cumulative probability difference appearing at the biomarker value of 32.05 pg/ml.ConclusionsThese results suggest that patients who subsequently developed delirium are more likely to be experiencing clinically silent neurodegenerative changes before surgery, reflected by changes in plasma neurofilament light chain biomarker concentrations, which may identify individuals with a preoperative vulnerability to subsequent cognitive decline.Editor’s perspectiv

Perioperative Gabapentin Does Not Reduce Postoperative Delirium in Older Surgical Patients: A Randomized Clinical Trial.

BackgroundPostoperative pain and opioid use are associated with postoperative delirium. We designed a single-center, randomized, placebo-controlled, parallel-arm, double-blinded trial to determine whether perioperative administration of gabapentin reduced postoperative delirium after noncardiac surgery.MethodsPatients were randomly assigned to receive placebo (N = 347) or gabapentin 900 mg (N = 350) administered preoperatively and for the first 3 postoperative days. The primary outcome was postoperative delirium as measured by the Confusion Assessment Method. Secondary outcomes were postoperative pain, opioid use, and length of hospital stay.ResultsData for 697 patients were included, with a mean ± SD age of 72 ± 6 yr. The overall incidence of postoperative delirium in any of the first 3 days was 22.4% (24.0% in the gabapentin and 20.8% in the placebo groups; the difference was 3.20%; 95% CI, 3.22% to 9.72%; P = 0.30). The incidence of delirium did not differ between the two groups when stratified by surgery type, anesthesia type, or preoperative risk status. Gabapentin was shown to be opioid sparing, with lower doses for the intervention group versus the control group. For example, the morphine equivalents for the gabapentin-treated group, median 6.7 mg (25th, 75th quartiles: 1.3, 20.0 mg), versus control group, median 6.7 mg (25th, 75th quartiles: 2.7, 24.8 mg), differed on the first postoperative day (P = 0.04).ConclusionsAlthough postoperative opioid use was reduced, perioperative administration of gabapentin did not result in a reduction of postoperative delirium or hospital length of stay