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Observational studies have suggested that accelerated surgery is associated with improved outcomes in patients with a hip fracture. The HIP ATTACK trial assessed whether accelerated surgery could reduce mortality and major complications. HIP ATTACK was an international, randomised, controlled trial done at 69 hospitals in 17 countries. Patients with a hip fracture that required surgery and were aged 45 years or older were eligible. Research personnel randomly assigned patients (1:1) through a central computerised randomisation system using randomly varying block sizes to either accelerated surgery (goal of surgery within 6 h of diagnosis) or standard care. The coprimary outcomes were mortality and a composite of major complications (ie, mortality and non-fatal myocardial infarction, stroke, venous thromboembolism, sepsis, pneumonia, life-threatening bleeding, and major bleeding) at 90 days after randomisation. Patients, health-care providers, and study staff were aware of treatment assignment, but outcome adjudicators were masked to treatment allocation. Patients were analysed according to the intention-to-treat principle. This study is registered at ClinicalTrials.gov (NCT02027896). Between March 14, 2014, and May 24, 2019, 27 701 patients were screened, of whom 7780 were eligible. 2970 of these were enrolled and randomly assigned to receive accelerated surgery (n=1487) or standard care (n=1483). The median time from hip fracture diagnosis to surgery was 6 h (IQR 4–9) in the accelerated-surgery group and 24 h (10–42) in the standard-care group (p<0·0001). 140 (9%) patients assigned to accelerated surgery and 154 (10%) assigned to standard care died, with a hazard ratio (HR) of 0·91 (95% CI 0·72 to 1·14) and absolute risk reduction (ARR) of 1% (−1 to 3; p=0·40). Major complications occurred in 321 (22%) patients assigned to accelerated surgery and 331 (22%) assigned to standard care, with an HR of 0·97 (0·83 to 1·13) and an ARR of 1% (−2 to 4; p=0·71). Among patients with a hip fracture, accelerated surgery did not significantly lower the risk of mortality or a composite of major complications compared with standard care. Canadian Institutes of Health Research.

Better understanding of variations in neighborhood disadvantage could lead to improved insight into the sociobiologic mechanisms that underlie health disparities, which could, in turn, facilitate the development of improved therapeutics and interventions.

Tropical forests vary widely in biomass carbon (C) stocks and fluxes even after controlling for forest age. A mechanistic understanding of this variation is critical to accurately predicting responses to global change. We review empirical studies of spatial variation in tropical forest biomass, productivity and woody residence time, focusing on mature forests. Woody productivity and biomass decrease from wet to dry forests and with elevation. Within lowland forests, productivity and biomass increase with temperature in wet forests, but decrease with temperature where water becomes limiting. Woody productivity increases with soil fertility, whereas residence time decreases, and biomass responses are variable, consistent with an overall unimodal relationship. Areas with higher disturbance rates and intensities have lower woody residence time and biomass. These environmental gradients all involve both direct effects of changing environments on forest C fluxes and shifts in functional composition – including changing abundances of lianas – that substantially mitigate or exacerbate direct effects. Biogeographic realms differ significantly and importantly in productivity and biomass, even after controlling for climate and biogeochemistry, further demonstrating the importance of plant species composition. Capturing these patterns in global vegetation models requires better mechanistic representation of water and nutrient limitation, plant compositional shifts and tree mortality.

Recent studies have highlighted the importance of the atmosphere in the long-range transport of microplastic fibres. However, their dry deposition in the atmosphere is not fully understood, with the common spherical-shape assumption leading to significant uncertainties in predicting their travel distance and atmospheric residence time. Shapes of microplastic fibres vary greatly, which can be as long as 100 μm and as thin as 2 μm. Shapes of microplastic fibres may greatly affect their dry deposition in the atmosphere. Here we develop a theory-based settling velocity model for simulating atmospheric transport of microplastic fibres in different sizes and shapes. The model predicts a smaller aerodynamic size of microplastic fibres than that estimated by using volumetrically equivalent spherical counterparts. We find that the treatment of flat fibres as cylindrical ones, due to uncertainty in dimensions of sampled microplastic fibres, would cause overestimation of their dry deposition rate. Accounting for fibre thickness in sampled microplastic fibres leads to a mean enhancement of residence time by more than 450% compared to cylindrical ones. The results suggest a much more efficient long-range transport of flat fibres than previously thought.Flat microplastic fibres have much longer residence times and travel further in the atmosphere than previously appreciated, according to simulations of the settling of microplastics with different shapes.

Emerging evidence suggests that living near major roads might adversely affect cognition. However, little is known about its relationship with the incidence of dementia, Parkinson's disease, and multiple sclerosis. We aimed to investigate the association between residential proximity to major roadways and the incidence of these three neurological diseases in Ontario, Canada. In this population-based cohort study, we assembled two population-based cohorts including all adults aged 20–50 years (about 4·4 million; multiple sclerosis cohort) and all adults aged 55–85 years (about 2·2 million; dementia or Parkinson's disease cohort) who resided in Ontario, Canada on April 1, 2001. Eligible patients were free of these neurological diseases, Ontario residents for 5 years or longer, and Canadian-born. We ascertained the individual's proximity to major roadways based on their residential postal-code address in 1996, 5 years before cohort inception. Incident diagnoses of dementia, Parkinson's disease, and multiple sclerosis were ascertained from provincial health administrative databases with validated algorithms. We assessed the associations between traffic proximity and incident dementia, Parkinson's disease, and multiple sclerosis using Cox proportional hazards models, adjusting for individual and contextual factors such as diabetes, brain injury, and neighbourhood income. We did various sensitivity analyses, such as adjusting for access to neurologists and exposure to selected air pollutants, and restricting to never movers and urban dwellers. Between 2001, and 2012, we identified 243 611 incident cases of dementia, 31 577 cases of Parkinson's disease, and 9247 cases of multiple sclerosis. The adjusted hazard ratio (HR) of incident dementia was 1·07 for people living less than 50 m from a major traffic road (95% CI 1·06–1·08), 1·04 (1·02–1·05) for 50–100 m, 1·02 (1·01–1·03) for 101–200 m, and 1·00 (0·99–1·01) for 201–300 m versus further than 300 m (p for trend=0·0349). The associations were robust to sensitivity analyses and seemed stronger among urban residents, especially those who lived in major cities (HR 1·12, 95% CI 1·10–1·14 for people living <50 m from a major traffic road), and who never moved (1·12, 1·10–1·14 for people living <50 m from a major traffic road). No association was found with Parkinson's disease or multiple sclerosis. In this large population-based cohort, living close to heavy traffic was associated with a higher incidence of dementia, but not with Parkinson's disease or multiple sclerosis. Health Canada (MOA-4500314182).

Lasting updrafts are necessary to produce severe hail; conventional wisdom suggests that extremely large hailstones require updrafts of commensurate strength. Because updraft strength is largely controlled by convective available potential energy (CAPE), one would expect environments with larger CAPE to be conducive to storms producing larger hail. By systematically varying CAPE in a horizontally homogeneous initial environment, we simulate hail production in high-shear, high-instability supercell storms using Cloud Model 1 and a detailed 3D hail growth trajectory model. Our results suggest that CAPE modulates the updraft’s strength, width, and horizontal wind field, as well as the liquid water content along hailstones’ trajectories, all of which have a significant impact on final hail sizes. In particular, hail sizes are maximized for intermediate CAPE values in the range we examined. Results show a non-monotonic relationship between the hailstones’ residence time and CAPE due to changes to the updraft wind field. The ratio of updraft area to southerly wind speed within the updraft serves as a proxy for residence time. Storms in environments with large CAPE may produce smaller hail because the in-updraft horizontal wind speeds become too great, and hailstones are prematurely ejected out of the optimal growth region. Liquid water content (LWC) along favorable hailstone pathways also exhibits peak values for intermediate CAPE values, owing to the horizontal displacement across the midlevel updraft of moist inflow air from differing source levels. In other words, larger CAPE does not equal larger hail, and storm-structural nuances must be examined.

We assessed how the seasonal variability of precipitation δ2H and δ18O is propagated into soil and xylem waters of temperate trees, applied a hydrological model to estimate the residence time distribution of precipitation in the soil, and identified the temporal origin of water taken up by Picea abies and Fagus sylvatica over 4 yr. Residence times of precipitation in the soil varied between a few days and several months and increased with soil depth. On average, 50% of water consumed by trees throughout a year had precipitated during the growing season, while 40% had precipitated in the preceding winter or even earlier. Importantly, we detected subtle differences with respect to the temporal origin of water used by the two species. We conclude that both current precipitation and winter precipitation are important for the water supply of temperate trees and that winter precipitation could buffer negative impacts of spring or summer droughts. Our study additionally provides the means to obtain realistic estimates of source water δ2H and δ18O values for trees from precipitation isotope data, which is essential for improving model-based interpretations of δ18O and δ2H values in plants.

In‐stream structures can be used to promote hyporheic exchange, that is, the exchange of water and solutes between the stream and the underlying streambed. The modification of streambed permeability around these structures has been proposed to enhance their effectiveness in promoting hyporheic exchange. However, the topic has not been thoroughly studied yet. In this work, the effect of the increase of permeability around in‐stream structures has been assessed via numerical models. Different combinations of variations in permeability and geometry of sediments around in‐stream structures (steps) were tested to evaluate their potential for river management for improving hyporheic exchange. Structure performance is evaluated on the basis of hyporheic flow, vertical exchange velocity, and residence time distributions. Results showed that even when step‐induced exchange velocity values in homogeneous sediments are small, the increase of permeability around the step can effectively enhance hyporheic flow. The numerical simulations showed that a longer high‐permeability region resulted in smaller values of exchange velocity. The overall hyporheic flow was slightly larger for lengths of 0.3–0.7 m compared to 0.1 m, and the median residence time was slightly longer for lengths of 0.3–0.7 m compared to 0.1 m. The results also indicated that including low‐permeability blocks upstream and downstream of high‐permeability regions have no effect on hyporheic exchange. Additionally, the results indicate a moderate influence of the length of high‐permeability region on hyporheic exchange and point out the importance of considering the trade‐off between increased hyporheic flow and higher costs for replacing a larger volume of sediments.

BackgroundOlder people are at risk for health decline and loss of independence. Lifestyle interventions offer potential for reducing such negative outcomes. The aim of this study was to determine the effectiveness and cost-effectiveness of a preventive lifestyle-based occupational therapy intervention, administered in a variety of community-based sites, in improving mental and physical well-being and cognitive functioning in ethnically diverse older people.MethodsA randomised controlled trial was conducted comparing an occupational therapy intervention and a no-treatment control condition over a 6-month experimental phase. Participants included 460 men and women aged 60–95 years (mean age 74.9±7.7 years; 53% <$12 000 annual income) recruited from 21 sites in the greater Los Angeles metropolitan area.ResultsIntervention participants, relative to untreated controls, showed more favourable change scores on indices of bodily pain, vitality, social functioning, mental health, composite mental functioning, life satisfaction and depressive symptomatology (ps<0.05). The intervention group had a significantly greater increment in quality-adjusted life years (p<0.02), which was achieved cost-effectively (US $41 218/UK £24 868 per unit). No intervention effect was found for cognitive functioning outcome measures.ConclusionsA lifestyle-oriented occupational therapy intervention has beneficial effects for ethnically diverse older people recruited from a wide array of community settings. Because the intervention is cost-effective and is applicable on a wide-scale basis, it has the potential to help reduce health decline and promote well-being in older people.Trial Registrationclinicaltrials.gov identifier: NCT0078634.

Up-to-date evidence about levels and trends in disease and injury incidence, prevalence, and years lived with disability (YLDs) is an essential input into global, regional, and national health policies. In the Global Burden of Disease Study 2013 (GBD 2013), we estimated these quantities for acute and chronic diseases and injuries for 188 countries between 1990 and 2013. Estimates were calculated for disease and injury incidence, prevalence, and YLDs using GBD 2010 methods with some important refinements. Results for incidence of acute disorders and prevalence of chronic disorders are new additions to the analysis. Key improvements include expansion to the cause and sequelae list, updated systematic reviews, use of detailed injury codes, improvements to the Bayesian meta-regression method (DisMod-MR), and use of severity splits for various causes. An index of data representativeness, showing data availability, was calculated for each cause and impairment during three periods globally and at the country level for 2013. In total, 35 620 distinct sources of data were used and documented to calculated estimates for 301 diseases and injuries and 2337 sequelae. The comorbidity simulation provides estimates for the number of sequelae, concurrently, by individuals by country, year, age, and sex. Disability weights were updated with the addition of new population-based survey data from four countries. Disease and injury were highly prevalent; only a small fraction of individuals had no sequelae. Comorbidity rose substantially with age and in absolute terms from 1990 to 2013. Incidence of acute sequelae were predominantly infectious diseases and short-term injuries, with over 2 billion cases of upper respiratory infections and diarrhoeal disease episodes in 2013, with the notable exception of tooth pain due to permanent caries with more than 200 million incident cases in 2013. Conversely, leading chronic sequelae were largely attributable to non-communicable diseases, with prevalence estimates for asymptomatic permanent caries and tension-type headache of 2·4 billion and 1·6 billion, respectively. The distribution of the number of sequelae in populations varied widely across regions, with an expected relation between age and disease prevalence. YLDs for both sexes increased from 537·6 million in 1990 to 764·8 million in 2013 due to population growth and ageing, whereas the age-standardised rate decreased little from 114·87 per 1000 people to 110·31 per 1000 people between 1990 and 2013. Leading causes of YLDs included low back pain and major depressive disorder among the top ten causes of YLDs in every country. YLD rates per person, by major cause groups, indicated the main drivers of increases were due to musculoskeletal, mental, and substance use disorders, neurological disorders, and chronic respiratory diseases; however HIV/AIDS was a notable driver of increasing YLDs in sub-Saharan Africa. Also, the proportion of disability-adjusted life years due to YLDs increased globally from 21·1% in 1990 to 31·2% in 2013. Ageing of the world's population is leading to a substantial increase in the numbers of individuals with sequelae of diseases and injuries. Rates of YLDs are declining much more slowly than mortality rates. The non-fatal dimensions of disease and injury will require more and more attention from health systems. The transition to non-fatal outcomes as the dominant source of burden of disease is occurring rapidly outside of sub-Saharan Africa. Our results can guide future health initiatives through examination of epidemiological trends and a better understanding of variation across countries. Bill & Melinda Gates Foundation.