Treatment of Distal Radius Fractures in Patients Over 80 Years of Age: Functional Outcomes After Open Reduction and Internal Fixation versus Nonoperative Treatment

INTRODUCTION Distal radius fractures are one of the most common fractures seen in the elderly. With the younger physiological age of patients over 60 years, the expectation of functional outcomes is changing. The management of distal radius fractures in the elderly patient, especially those over the age of 80, has not been well defined. The purpose of this study was to compare operative to nonoperative treatment of distal radius fractures in patients older than 80 years to determine if there is any difference in functional outcomes or complications. METHODS A retrospective review was performed to identify patients 80 years or older who were treated for a distal radius fracture with either open reduction internal fixation (ORIF) or nonsurgical management. Medical records were reviewed for demographics, past medical history, and functional outcomes including wrist range of motion, quick Disabilities of the Arm, Shoulder, and Elbow (DASH), VAS pain scores, and complications. RESULTS There were 237 patients in the operative cohort and 458 patients in the nonoperative cohort. Average age was 84 years in the operative and 86 years in the nonoperative groups. Wrist flexion was significantly better in the operative cohort; 50 versus 45 degrees in the nonoperative group. The remainder of wrist range of motion was not different between the two groups. The quick DASH at final follow-up in the operative cohort was significantly better than the nonoperative group; 26 versus 45. Complications were similar in both groups. DISCUSSION/CONCLUSION Distal radius fractures in patients older than 80 years of age treated with ORIF have superior functional outcomes and comparable complication rates than those treated nonoperatively. Increased functionality of the elderly and updated implant design make surgical management of these fractures an effective treatment that leads to improved outcomes in patients over 80 years of age

Impaired peripheral reaching and on-line corrections in patient DF: optic ataxia with visual form agnosia

An influential model of vision suggests the presence of two visual streams within the brain: a dorsal occipito-parietal stream which mediates action and a ventral occipito-temporal stream which mediates perception. One of the cornerstones of this model is DF, a patient with visual form agnosia following bilateral ventral stream lesions. Despite her inability to identify and distinguish visual stimuli, DF can still use visual information to control her hand actions towards these stimuli. These observations have been widely interpreted as demonstrating a double dissociation from optic ataxia, a condition observed after bilateral dorsal stream damage in which patients are unable to act towards objects that they can recognize. In Experiment 1, we investigated how patient DF performed on the classical diagnostic task for optic ataxia, reaching in central and peripheral vision. We replicated recent findings that DF is remarkably inaccurate when reaching to peripheral targets, but not when reaching in free vision. In addition we present new evidence that her peripheral reaching errors follow the optic ataxia pattern increasing with target eccentricity and being biased towards fixation. In Experiments 2 and 3, for the first time we examined DF’s on-line control of reaching using a double-step paradigm in fixation-controlled and free-vision versions of the task. DF was impaired when performing fast on-line corrections on all conditions tested, similarly to optic ataxia patients. Our findings question the long-standing assumption that DF’s dorsal visual stream is functionally intact and that her on-line visuomotor control is spared. In contrast, in addition to visual form agnosia, DF also has visuomotor symptoms of optic ataxia which are most likely explained by bilateral damage to the superior parietal occipital cortex. We thus conclude that patient DF can no longer be considered as an appropriate single-case model for testing the neural basis of perception and action dissociations

THE HYDROBORATION OF REPRESENTATIVE CROTYL(2-BUTENYL) DERIVATIVES AND RELATED STRUCTURES

Abstract not availabl

The development and implementation of NHS treatment centres as an organisational innovation

The idea for Treatment Centres was first heralded in the NHS Plan (DH, 2000). From a planned small scale introduction of four ‘Diagnostic and Treatment Centres’ (soon renamed as Treatment Centres) in 2001, the plan was to increase the number, range of services and type of provider (with the introduction of the private sector) so that 50 TCs would be operational by 2004/05 (DH,2002). Using the existing Ambulatory Care and Diagnostic Centre at Central Middlesex Hospital (London) and models of surgicentres (developed overseas) as prototypes, the TC model was innovative as it proposed a ‘one-stop shop’ for planned (nonemergency) care. Patients could obtain diagnostic and treatment services under one roof. TCs aimed to reduce inappropriate delays and waiting lists through the separation of elective surgery from emergency and unplanned treatment. By focussing on high volume and routine surgical procedures in orthopaedics, gynaecology, ophthalmology and cardiology, TCs sought to increase efficiency by delivering high volumes of activity and high quality health care using modern methods. This proposed service development was timely for NHS change managers who were seeking ways to make progress towards national waiting time targets and to introduce more patientcentred models of care.Whilst many had not previously considered the TC model, they were eager to explore its advantages at a local level

Tight non-linear loop timing estimation

Parametric worst case execution time (WCET) bounds are useful in removing restrictions, such as known loop bounds, on algorithms for important applications such as scheduling for real-time embedded systems. However, current parametric approaches have difficulties with multiple loop nests that include non-rectangular loops, zero-trip loops, and/or loops with non-unit strides. These difficulties may result in the increased looseness of the upper bound, increased complexity in determining the bound, or loss of the upper bound property of the estimate. In this paper, we propose a new framework to compute tight parameterized WCET bounds for multiple loop nests that may include nonrectangular loops, zero-trip loops, and loops with non-unit strides. The framework requires only very simple symbolic manipulation capabilities and is restricted only by certain monotonic properties required of the iteration spaces of the inner loops. 1

Parametric Timing Estimation With Newton-Gregory Formulae

To determine safe and tight worst-case execution time (WCET) estimates of scientific and multimedia codes that spent most of the execution time on executing loop iterations, efficient and accurate loop iteration count estimation methods are required. To support dynamic scheduling decisions based on WCET estimations, an effective loop iteration count estimation method should generate parametric formulae that can be evaluated at runtime. Therefore, the loop iteration count estimation methods utilized for WCET estimation must be effective in analyzing loops with symbolic bounds, non-rectangular loops, zero-trip loops, loops with multiple critical paths, and loops with non-unit strides. In this paper we present a novel approach to parametric WCET estimation to handle loops with both affine and nonaffine loop bounds in an efficent manner using a formulation based on Newton-Gregory interpolating polynomials