This study provides data on changes in the functional status of older patients that are associated with acute hospitalization. Seventy-one patients over the age of 74 admitted to the medical service of Stanford University Hospital between February and May 1987 received functional assessments covering seven domains: mobility, transfer, toileting, incontinence, feeding, grooming, and mental status. Assessments were obtained by report from the patient's caregiver (or the patient when he or she lived alone) for 2 weeks before admission; from the patient's nurse on day 2 of hospitalization and on the day before discharge; and again from the caregiver (or patient) 1 week after discharge. The sample had a mean age of 84, covered 37 Diagnostic Related Groups, and had a median length of stay of 8 days. Between baseline and day 2, statistically significant deteriorations occurred for the overall functional score and for the individual scores for mobility, transfer, toileting, feeding, and grooming. None of these scores improved significantly by discharge. In the case of mobility, 65% of the patients experienced a decline in score between baseline and day 2. Between day 2 and discharge, 67% showed no improvement, and another 10% deteriorated further. These data suggest that older patients may experience a burden of new and worsened functional impairment during hospitalization that improves at a much slower rate than the acute illness. An awareness of delayed functional recovery should influence discharge planning for older patients. Greater efforts to prevent functional decline in the hospitalized older patient may be warranted.

IntroductionAboriginal and Torres Strait Islander peoples are Australia’s first peoples and have been connected to the land for ≥65 000 years. Their enduring cultures and values are considered critical to health and wellbeing, alongside physical, psychological and social factors. We currently lack large-scale data that adequately represent the experiences of Aboriginal and Torres Strait Islander people; the absence of evidence on cultural practice and expression is particularly striking, given its foundational importance to wellbeing.Method and analysisMayi Kuwayu: The National Study of Aboriginal and Torres Strait Islander Wellbeing (Mayi Kuwayu Study) will be a large-scale, national longitudinal study of Aboriginal and Torres Strait Islander adults, with linkage to health-related administrative records. The baseline survey was developed through extensive community consultation, and includes items on: cultural practice and expression, sociodemographic factors, health and wellbeing, health behaviours, experiences and environments, and family support and connection. The baseline survey will be mailed to 200 000 Aboriginal and Torres Strait Islander adults (≥16 years), yielding an estimated 16 000–40 000 participants, supplemented through face-to-face recruitment. Follow-up surveys will be conducted every 3–5 years, or as funding allows. The Mayi Kuwayu Study will contribute to filling key evidence gaps, including quantifying the contribution of cultural factors to wellbeing, alongside standard elements of health and risk.Ethics and disseminationThis study has received approval from national Human Research Ethics Committees, and from State and Territory committees, including relevant Aboriginal and Torres Strait Islander organisations. The study was developed and is conducted in partnership with Aboriginal and Torres Strait Islander organisations across states and territories. It will provide an enduring and shared infrastructure to underpin programme and policy development, based on measures and values important to Aboriginal and Torres Strait Islander peoples. Approved researchers can access confidentialised data and disseminate findings according to study data access and governance protocols.

National surveillance data indicate marked differences between Indigenous and other Australians in the prevalence of many sexually transmitted infections (STIs). Young Indigenous people bear a particularly high burden of these infections. A collaboration of university researchers, Indigenous health workers and young Indigenous people conducted 45 field interviews to examine how young Indigenous Australians keep themselves healthy and protected against STIs. Our findings emphasise the complexity of health behaviours, where individuals are rarely always 'risky' or always 'safe', as well as subtle gender differences in health practices. Preventive strategies employed by the young people were contingent on beliefs and knowledge about sexual partners, the type of relationship, the context of the sexual encounter, and access to condoms. Tangible strengths identified by our study should be celebrated and bolstered to enhance young Indigenous people's ability to protect themselves against adverse health outcomes and enhance their resilience against STIs. Focusing on strengths helps to counter the deficit model of health commonly deployed in Indigenous health research and draws attention to health issues facing young Indigenous people and their communities, without reinforcing negative stereotypes or focusing solely on individual risk behaviour. We provide concrete recommendations for health promotion and education.

The U.S. Geological Survey, Multi Hazards Demonstration Project (MHDP) uses hazards science to improve resiliency of communities to natural disasters including earthquakes, tsunamis, wildfires, landslides, floods and coastal erosion. The project engages emergency planners, businesses, universities, government agencies, and others in preparing for major natural disasters. The project also helps to set research goals and provides decision-making information for loss reduction and improved resiliency. The first public product of the MHDP was the ShakeOut Earthquake Scenario published in May 2008. This detailed depiction of a hypothetical magnitude 7.8 earthquake on the San Andreas Fault in southern California served as the centerpiece of the largest earthquake drill in United States history, involving over 5,000 emergency responders and the participation of over 5.5 million citizens. This document summarizes the next major public project for MHDP, a winter storm scenario called ARkStorm (for Atmospheric River 1,000). Experts have designed a large, scientifically realistic meteorological event followed by an examination of the secondary hazards (for example, landslides and flooding), physical damages to the built environment, and social and economic consequences. The hypothetical storm depicted here would strike the U.S. West Coast and be similar to the intense California winter storms of 1861 and 1862 that left the central valley of California impassible. The storm is estimated to produce precipitation that in many places exceeds levels only experienced on average once every 500 to 1,000 years. Extensive flooding results. In many cases flooding overwhelms the state's flood-protection system, which is typically designed to resist 100-to 200-year runoffs. The Central Valley experiences hypothetical flooding 300 miles long and 20 or more miles wide. Serious flooding also occurs in Orange County, Los Angeles County, San Diego, the San Francisco Bay area, and other coastal communities. Windspeeds in some places reach 125 miles per hour, hurricaneforce winds. Across wider areas of the state, winds reach 60 miles per hour. Hundreds of landslides damage roads, highways, and homes. Property damage exceeds $300 billion, most from flooding. Demand surge (an increase in labor rates and other repair costs after major natural disasters) could increase property losses by 20 percent. Agricultural losses and other costs to repair lifelines, dewater (drain) flooded islands, and repair damage from landslides, brings the total direct property loss to nearly $400 billion, of which $20 to $30 billion would be recoverable through public and commercial insurance. Power, water, sewer, and other lifelines experience damage that takes weeks or months to restore. Flooding evacuation could involve 1.5 million residents in the inland region and delta counties. Business interruption costs reach $325 billion in addition to the $400 billion property repair costs, meaning that an ARkStorm could cost on the order of $725 billion, which is nearly 3 ti...