Age-Related Disparities in Trauma Center Access for Severe Head Injuries Following the Release of the Updated Field Triage Guidelines

Objective: In 2006, the American College of Surgeons’ Committee on Trauma and the Center for Disease Control released field triage guidelines with special consideration for older adults. Additional considerations for direct transport to a Level I or II trauma center (TC) were added in 2011, reflecting perceived undertriage to TCs for older adults. We examined whether age-based disparities in TC care for severe head injury decreased following introduction of the 2011 revisions. Methods: A pre-post design analyzing the 2009 and 2012 Healthcare Cost and Utilization Project State Emergency Department Databases (SEDD) and State Inpatient Databases (SID) with multivariable logistic regressions considered changes in (1) the trauma designation of the emergency department where treatment was initiated and (2) transfer to a TC following initial treatment at a non-TC. Results: Compared with adults aged 18–44 years, after multivariable adjustment, in both years TC care was less likely for adults aged 45–64 years (OR: 0.76 in 2009 and 0.74 in 2012), aged 65–84 years (OR: 0.61 and 0.59), and aged 85+ years (OR: 0.53 and 0.56). Between 2009 and 2012, the likelihood of TC care increased for all age groups, with the largest increase among those aged 85+ years (OR = 1.18), which was statistically different (p = .02) from the increase among adults aged 18–44 years (OR = 1.12). The analysis of transfers yielded similar results. Conclusions: Although patterns of increased TC treatment for all groups with severe head trauma indicate improvements, age-based disparities persisted

Age-Related Disparities in Trauma Center Access for Severe Head Injuries Following the Release of the Updated Field Triage Guidelines

Objective: In 2006, the American College of Surgeons’ Committee on Trauma and the Center for Disease Control released field triage guidelines with special consideration for older adults. Additional considerations for direct transport to a Level I or II trauma center (TC) were added in 2011, reflecting perceived undertriage to TCs for older adults. We examined whether age-based disparities in TC care for severe head injury decreased following introduction of the 2011 revisions. Methods: A pre-post design analyzing the 2009 and 2012 Healthcare Cost and Utilization Project State Emergency Department Databases (SEDD) and State Inpatient Databases (SID) with multivariable logistic regressions considered changes in (1) the trauma designation of the emergency department where treatment was initiated and (2) transfer to a TC following initial treatment at a non-TC. Results: Compared with adults aged 18–44 years, after multivariable adjustment, in both years TC care was less likely for adults aged 45–64 years (OR: 0.76 in 2009 and 0.74 in 2012), aged 65–84 years (OR: 0.61 and 0.59), and aged 85+ years (OR: 0.53 and 0.56). Between 2009 and 2012, the likelihood of TC care increased for all age groups, with the largest increase among those aged 85+ years (OR = 1.18), which was statistically different (p = .02) from the increase among adults aged 18–44 years (OR = 1.12). The analysis of transfers yielded similar results. Conclusions: Although patterns of increased TC treatment for all groups with severe head trauma indicate improvements, age-based disparities persisted

Do coarse resolution U.S. presettlement land survey records adequately represent the spatial pattern of individual tree species?

10.1007/s10980-005-6221-0Landscape Ecology2171003-1017LAEC

A review of morphing aircraft

Aircraft wings are a compromise that allows the aircraft to fly at a range of flight conditions, but the performance at each condition is sub-optimal. The ability of a wing surface to change its geometry during flight has interested researchers and designers over the years as this reduces the design compromises required. Morphing is short for metamorphose: however, there is neither an exact definition nor an agreement between the researchers about the type or the extent of the geometrical changes necessary to qualify an aircraft for the title “shape morphing”. Geometrical parameters that can be affected by morphing solutions can be categorized into: planform alteration (span, sweep and chord), out-of-plane transformation (twist, dihedral/gull, spanwise bending) and airfoil adjustment (camber and thickness).Changing the wing shape or geometry is not new. Historically, morphing solutions always led to penalties in terms of cost, complexity or weight, although in certain circumstances these were overcome by system level benefits. The current trend for highly efficient and “green” aircraft makes such compromises less acceptable, calling for innovative morphing designs able to provide more benefits and fewer drawbacks. Recent developments in “smart” materials may overcome the limitations and enhance the benefits from existing design solutions. The challenge is to design a structure that is capable of withstanding the prescribed loads, but is also able to change its shape: ideally there should be no distinction between the structure and the actuation system. The blending of morphing and smart structures in an integrated approach requires multi-disciplinary thinking from the early development, which significantly increases the overall complexity, even at the preliminary design stage. Morphing is a promising enabling technology for future, next generation aircraft. However, manufacturers and end users are still too skeptical of the benefits to adopt morphing in the near future. Many developed concepts have a technology readiness level that is still very low. The recent explosive growth of satellite services means that UAVs are the technology of choice for many investigations on wing morphing.This paper presents a review of the state of the art on morphing aircraft and focuses on structural, shape changing morphing concepts for both fixed and rotary wings, with particular reference to active systems. Inflatable solutions have been not considered, and skin issues and challenges are not discussed in detail. Although many interesting concepts have been synthesized, few have progressed to wing tunnel testing, and even fewer have flown. Furthermore, any successful wing morphing system must overcome the weight penalty due to the additional actuation systems.<br/