Objective
Older adults are an increasing proportion of patients admitted to trauma services. Trauma in older adults’ results from many mechanisms of injury with the distribution of mechanisms of ...injury among older adults different than those of younger adults. The acute management of these injuries may determine the patients’ ability to return to independent living. It is known that prolonged immobilization of older patients results in deterioration of their functional status and increases the likelihood of hospital acquired complications, notably pneumonia, delirium, and loss of ambulation.
Design/Setting
We reviewed 213 patients aged 65 and older admitted to our trauma services who sustained cervical spine injuries that were either placed in c spine immobilization or were not to understand the outcomes associated with their mechanism of injury.
Results
The youngest patients (65–74 years) were proportionately more likely to have sustained high energy injuries associated with motor vehicle crashes (36%) with a mortality rate of 11.5%. The oldest age group (> 85 years) had a higher mortality rate from falls from standing injuries (31%). Patients discharged with a collar were more likely to return to independent living. In addition, 96% of the patients that died in the acute care setting were not in cervical collar immobilization.
Conclusion
Patients under 85 years with a cervical spine injury should be placed in c-spine immobilization and aggressively managed with a multidisciplinary team approach. The older adult trauma population requires specialty care including rapid cervical spine evaluation and prescreening of functional status on admission. The NEXUS guideline should be enhanced for the older adult trauma population.
The development of implicit finite-difference methods at the Computational Fluid Dynamics Branch (NASA Ames Research Center) in the 1970 to early 1980s timeframe is presented. The seminal work of ...Drs. Robert F. Warming and Richard M. Beam is highlighted. Their contribution (along with that of others in the Ames CFD Branch) paved the way for modern large scale application codes. The focus will be on a few of the significant developments (e.g., approximate factorization) and results from those early pioneering days.
The focus here is on the early development (mid 1970s–1980s) at NASA Ames Research Center of implicit methods in Computational Fluid Dynamics (CFD). A class of implicit finite difference schemes of ...the Beam and Warming approximate factorization type will be addressed. The emphasis will be on the Euler equations. A review of material pertinent to the solution of the Euler equations within the framework of implicit methods will be presented. The eigensystem of the equations will be used extensively in developing a framework for various methods applied to the Euler equations. The development and analysis of various aspects of this class of schemes will be given along with the motivations behind many of the choices. Various acceleration and efficiency modifications such as matrix reduction, diagonalization and flux split schemes will be presented.
Grid convergence studies for subsonic and transonic flows over airfoils are presented in order to compare the accuracy of several spatial discretizations for the compressible Navier–Stokes equations. ...The discretizations include the following schemes for the inviscid fluxes: (1) second-order-accurate centered differences with third-order matrix numerical dissipation, (2) the second-order convective upstream split pressure scheme (CUSP), (3) third-order upwind-biased differencing with Roe's flux-difference splitting, and (4) fourth-order centered differences with third-order matrix numerical dissipation. The first three are combined with second-order differencing for the grid metrics and viscous terms. The fourth discretization uses fourth-order differencing for the grid metrics and viscous terms, as well as higher-order approximations near boundaries and for the numerical integration used to calculate forces and moments. The results indicate that the discretization using higher-order approximations for all terms is substantially more accurate than the others, producing less than two percent numerical error in lift and drag components on grids with less than 13,000 nodes for subsonic cases and less than 18,000 nodes for transonic cases. Since the cost per grid node of all of the discretizations studied is comparable, the higher-order discretization produces solutions of a given accuracy much more efficiently than the others.
A matched comparison was made between total hip arthroplasties done for osteonecrosis and those done for osteoarthritis. Patients were matched for age, sex, surgical approach, prosthesis, and ...surgeon. All received cemented Charnley replacements and had minimal follow-up of 10 years. There were 118 women and 70 men with a mean age of 58 years. Thirty-five patients were younger than 50. The mean follow-up was 17.8 years (range, 10 to 25.4 years). Revision rates for osteonecrosis and osteoarthritis were 18% and 19% (not significant). The mechanical failure rate (revision for loosening plus radiographic loosening) was greater, but not significantly so, in the osteonecrosis group. In patients younger than 50 years, the revision rate in osteonecrosis (50%) was significantly higher than that in any other group. Similarly, the mechanical failure rate in osteonecrosis was significantly greater in the patients younger than 50. Radiographic femoral loosening was greater in osteonecrosis at all follow-up intervals, and dislocations occurred more frequently in the osteonecrosis group than in the osteoarthritis group. Results of arthroplasty in both groups were comparable in patients over 50 years of age, although patients with osteonecrosis had an increased rate of dislocation. Patients with osteonecrosis who are younger than 50 years have a significantly higher rate of mechanical failure than those with osteoarthritis who are younger than 50 years. Cemented total hip arthroplasty should be recommended in this group with caution if at all.
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