Fostering Governance and Information Partnerships for Chronic Disease Surveillance: The Multi-State EHR-Based Network for Disease Surveillance.

CONTEXT: Electronic health records (EHRs) are an emerging chronic disease surveillance data source and facilitating this data sharing is complex. PROGRAM: Using the experience of the Multi-State EHR-Based Network for Disease Surveillance (MENDS), this article describes implementation of a governance framework that aligns technical, statutory, and organizational requirements to facilitate EHR data sharing for chronic disease surveillance. IMPLEMENTATION: MENDS governance was cocreated with data contributors and health departments representing Texas, New Orleans, Louisiana, Chicago, Washington, and Indiana through engagement from 2020 to 2022. MENDS convened a governance body, executed data-sharing agreements, and developed a master governance document to codify policies and procedures. RESULTS: The MENDS governance committee meets regularly to develop policies and procedures on data use and access, timeliness and quality, validation, representativeness, analytics, security, small cell suppression, software implementation and maintenance, and privacy. Resultant policies are codified in a master governance document. DISCUSSION: The MENDS governance approach resulted in a transparent governance framework that cultivates trust across the network. MENDS's experience highlights the time and resources needed by EHR-based public health surveillance networks to establish effective governance.

Lumbar intradiscal pressure measured in the anterior and posterolateral annular regions during asymmetrical loading.

OBJECTIVE: To analyze the effect of asymmetrical loading on intradiscal pressure. DESIGN: Human cadaveric lumbar spines were instrumented with multiple pressure sensors and subjected to external mechanical loads. BACKGROUND: Tears and radial fissures in the posterolateral annulus with no evidence of annular protrusion or nuclear extrusion are frequently observed in non-degenerated intervertebral discs. Cadaveric studies have shown that asymmetrical loads lead to posterolateral herniation. Regional overload may be responsible for a progressive structural weakness of the posterolateral annular fibres. METHODS: Three needles each equipped with three independent pressure sensors were inserted in the midplane of the L(3)/L(4) intervertebral disc (n = 16) in the anterior, right posterolateral and left posterolateral regions. Axial rotation was applied in the upright, flexed and extended positions and the pressures recorded. RESULTS: The largest intradiscal pressure increase was observed in the posterolateral inner annular regions, more so in flexion than extension, when combined with axial rotation. Significant centripetal pressure gradients were found only in the posterolateral needles during the upright and flexed positions. CONCLUSIONS: When applying compression and axial rotation, the posterolateral inner annular zones of the intervertebral disc show high stress peaks and centripetal pressure gradients. Asymmetrical loads (rotation) combined with postural changes in the sagittal plane increase these effects, and may be responsible for a chronic mechanical overload of these regions. RELEVANCE: Our findings suggest a predilection for the posterolateral inner annular regions to mechanical failure, especially under asymmetrical loading.