Accelerated surgery versus standard care in hip fracture (HIP ATTACK): an international, randomised, controlled trial

© 2020 Elsevier Ltd Background: 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. Methods: 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). Findings: 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\u3c0·0001). 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). Interpretation: 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. Funding: Canadian Institutes of Health Research

Rationale and design of the HIP fracture Accelerated surgical TreaTment And Care tracK (HIP ATTACK) Trial : a protocol for an international randomised controlled trial evaluating early surgery for hip fracture patients

© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.Peer reviewedPublisher PD

Survey of the urban bell in the belfry of St. Trinity Church in Krosno

Urban is one of the three bells in the belfry of St. Trinity Church in Krosno. It is the largest one, with diameter equal to 1,535 mm and it is commonly considered as one of the largest historical bells in Poland. The total mass of all the three bells is close to 4,200 kilograms, so the dynamic actions produced by swinging have a great effect on the supporting structure and on the tower. However, the exact weight of the biggest bell isn't known, and for safety reasons it should be estimated in order to verify the real dynamic forces affecting the structure. The paper describes the method of Urban bell’s survey using terrestrial laser scanning and a total station as a task to estimate its weight by determining its volume

Screening and resonance enhancements of the

The $^{2}\text{H(d,~p)}^{3}\text{H}$ reaction cross-section has been measured for deuteron energies below 25 keV in a deuterized Zr target under improved ultra-high-vacuum conditions and controlled target surface contamination. The increase of reaction enhancement factors towards lower energies is much weaker than that determined before and can result not only from the electron screening effect but also from a suggested 0+ threshold resonance in 4He. The cross-section calculations performed within the T-matrix approximation enable to estimate a coherent resonance contribution and explain the observed energy dependence of the enhancement factors. Additionally, indications for the increase of the screening energies due to impurities at the target surface could be found

Initial results from the hotspot detection scheme for protection of plasma facing components in Wendelstein 7-X

One of the main aims of Wendelstein 7-X (W7-X), an advanced stellarator, is to investigate the quasi-steady state operation of magnetic confinement devices for nuclear fusion, for which power exhaust is an important issue. A dominant fraction of the energy leaving from the confined plasma region will be removed by 10 so-called island divertor units, which are designed to sustain a maximum heat flux of up to 10 MWm −2 . An essential prerequisite for the safe operation of a steady-state device is automatic detection of hot spots and other abnormal events. Simple temperature limits in infrared (IR) thermographic images will not be enough on their own, because of plasma-generated surface coatings and other effects summarized in the following. To protect divertor elements from overheating, and to monitor power deposition onto the divertor elements, near real-time hotspot detection algorithms for the analysis of carbon plasma facing components (PFCs) were implemented and tested in the GLADIS facility. One of the difficulties in hotspot detection in a carbon-based machine is the deposition of plasma impurities as layers with a reduced thermal connection to the underlying bulk material. We have developed and successfully tested a method to classify surface layers and benchmarked the performance of the method with the Tore Supra IR data operating with actively cooled carbon PFCs. The surface layers can be detected in a steady plasma discharge during the initial rise and decay in temperature when a strike line touches parts of the divertor or wall. It can also be detected by modulating electron cyclotron resonance heating (ECRH) input power. This feature allows detection of overheated areas while reducing false positives. For the recent operational campaign, inertially cooled test divertor units (TDU) were installed to prepare for steady-state operation with water-cooled divertor units. Automatic, near real-time detection of hot spots and identification of surface layers in the W7-X divertor are presented. Results are compared with a best fit estimate of the heat transmission coefficient α which is used to calculate heat flux onto the divertor in the presence of surface layers