ABSTRACT
The objective was to explore the characteristics and outcomes of multiple organ dysfunction syndrome (MODS) in older trauma patients. Background: Severely injured older people present an increasing challenge for trauma systems. Recovery for those who require critical care may be complicated by MODS. In older trauma patients, MODS may not be predictable based on chronological age alone and factors associated with its development and resolution are unclear. Methods: Consecutive adult patients (aged ≥16 years) admitted to 4 level 1 major trauma center critical care units were enrolled and reviewed daily until discharge or death. MODS was defined by a daily total sequential organ failure assessment score of >5. Results: One thousand three hundred sixteen patients were enrolled over 18 months and one-third (434) were aged ≥65 years. Incidence of MODS was high for both age groups (<65 years: 64%, ≥65 years: 70%). There were few differences in severity, patterns, and duration of MODS between cohorts, except for older traumatic brain injury (TBI) patients who experienced a prolonged course of MODS recovery (TBI: 9 days vs no TBI: 5 days, P < 0.01). Frailty rather than chronological age had a strong association with MODS development (odds ratio [OR], 6.9; 95% confidence intervals [CI], 3.0-12.4; P < 0.001) and MODS mortality (OR, 2.1; 95% CI, 1.31-3.38; P = 0.02). Critical care resource utilization was not increased in older patients, but MODS had a substantial impact on mortality (<65 years: 17%; ≥65 years: 28%). The majority of older patients who did not develop MODS survived and had favorable discharge outcomes (home discharge ≥65 years NoMODS: 50% vs MODS: 15%; P < 0.01). Conclusions: Frailty rather than chronological age appears to drive MODS development, recovery, and outcome in older cohorts. Early identification of frailty after trauma may help to predict MODS and plan care in older trauma.
ABSTRACT
To fully exploit van der Waals materials and their vertically stacked heterostructures, new mass-scalable production routes which are low cost but preserve the high electronic and optical quality of the single crystals are required. Here, we demonstrate an approach to realise a variety of functional heterostructures based on van der Waals nanocrystal films produced through the mechanical abrasion of bulk powders. We find significant performance enhancements in abraded heterostructures compared to those fabricated through inkjet printing of nanocrystal dispersions. To highlight the simplicity, applicability and scalability of the device fabrication, we demonstrate a multitude of different functional heterostructures such as resistors, capacitors and photovoltaics. We also demonstrate the creation of energy harvesting devices, such as large area catalytically active coatings for the hydrogen evolution reaction and enhanced triboelectric nanogenerator performance in multilayer films. The ease of device production makes this a promising technological route for up-scalable films and heterostructures.
ABSTRACT
Two-dimensional materials offer a novel platform for the development of future quantum technologies. However, the electrical characterisation of topological insulating states, non-local resistance, and bandgap tuning in atomically thin materials can be strongly affected by spurious signals arising from the measuring electronics. Common-mode voltages, dielectric leakage in the coaxial cables, and the limited input impedance of alternate-current amplifiers can mask the true nature of such high-impedance states. Here, we present an optical isolator circuit which grants access to such states by electrically decoupling the current-injection from the voltage-sensing circuitry. We benchmark our apparatus against two state-of-the-art measurements: the non-local resistance of a graphene Hall bar and the transfer characteristic of a WS2 field-effect transistor. Our system allows the quick characterisation of novel insulating states in two-dimensional materials with potential applications in future quantum technologies.