Importance: Delirium is a common problem in patients undergoing surgery. Evidence suggests that the type of anaesthesia used and post-operative pain management approach can impact delirium frequency, but there is no consensus on this issue. Objectives: This study explored the role of peri-operative pain management modalities, including nerve block, in managing postoperative pain and their association with delirium development. Design: This is a retrospective cohort study of 440 patients who underwent lower limb amputations, and hip and knee arthroplasties between January 2010 and December 2017 were reviewed. Setting: Charts of patients who underwent surgery and were admitted to the Hunter Holmes McGuire VA Medical Center, Richmond, VA, were reviewed. Participants: A total of 460 charts were reviewed (20 were excluded) of patients undergoing total hip arthroplasty, above knee amputation, total knee arthroplasty, below-knee amputation and trans metatarsal amputation. As a problem in the post-operative period, delirium had to be clearly stated in the patient’s record. Main outcome: Development of delirium during the post-operative period associated with the different types of pain management strategies. Results: A total of 60 patients (13.6%) from the 440 studied developed postoperative delirium. Among the different pain management strategies (IV Acetaminophen, gabapentin, oral narcotics, patient-controlled analgesia, and non-steroidal anti-inflammatory drugs), only gabapentin was associated with delirium, demonstrating 2.27 times higher risk (P=0.0085). We also found that prior narcotic use increased the odds of delirium (P=0.0053). Even after controlling for the anaesthesia type (general, local, regional, spinal and epidural), no association between nerve block and delirium was observed (P=0.41). Conclusion and Relevance: Taking gabapentin post-operatively for pain management, and having a history of ongoing narcotic usage before surgery, were associated with a higher risk of developing delirium. We found no association between nerve block used and the development of delirium.

Mica is an autonomous, photoreal human character that runs on the Magic Leap One spatial computing platform. The past ten years have seen tremendous improvements in virtual character technology on screen, in film and games. Spatial computing hardware such as Magic Leap One allows us to take the next step: interacting with virtual characters off the screen. We believe that virtual characters who are aware of and can interact directly with users in real-world environments will provide a uniquely compelling experience.

The Accreditation Council for Graduate Medical Education (ACGME) requires all residency programs, within every specialty, to participate in an annual survey of residents and faculty. The ACGME uses the results of these surveys to monitor graduate medical education quality and provide an early

This article explores the literacy practices associated with Let’s Play videos (or LPs) on YouTube. A hybrid of digital gaming and video, LPs feature gameplay footage accompanied by simultaneous commentary recorded by the player. Players may set out to promote, review, critique or satirize a game. In recent years, LPs have become hugely popular with young audiences, and currently make up over half the top hundred channels on YouTube. The authors identify LPs as emerging videogame paratexts with pedagogical potential. In particular, they ask how LPs function as sites of new literacies. They answer that question by discussing two key characteristics of LP practices: their emphasis on processes of meaning-making within games; and their mobilization of literacies associated with remix and appropriation. The final section of the article explores how LP practices might inform literacy instruction in schools.