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:We randomised 2970 patients from 69 hospitals in 17 countries. Patients with a hip fracture that required surgery and were ≥45 years of age were eligible. Patients were randomly assigned to accelerated surgery (goal of surgery within 6 hours of diagnosis; 1487 patients) or standard care (1483 patients). The co-primary outcomes were 1.) mortality, and 2.) a composite of major complications (i.e., mortality and non-fatal myocardial infarction, stroke, venous thromboembolism, sepsis, pneumonia, life-threatening bleeding, and major bleeding) at 90 days after randomisation. Outcome adjudicators were masked to treatment allocation, and patients were analysed according to the intention-to-treat principle; ClinicalTrials.gov, NCT02027896. Findings:The median time from hip fracture diagnosis to surgery was 6 hours (interquartile range [IQR] 4-9) in the accelerated-surgery group and 24 hours (IQR 10-42) in the standard-care group, p<0.0001. Death occurred in 140 patients (9%) assigned to accelerated surgery and 154 patients (10%) assigned to standard care; hazard ratio (HR) 0.91, 95% CI 0.72-1.14; absolute risk reduction (ARR) 1%, 95% CI -1-3%; p=0.40. The primary composite outcome occurred in 321 patients (22%) randomised to accelerated surgery and 331 patients (22%) randomised to standard care; HR 0.97, 95% CI 0.83-1.13; ARR 1%, 95% CI -2-3%; 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 to standard care.

Patagonian lakes are one of the most unexplored aquatic environments on Earth, and little is known about their thermo-hydrodynamics and current trophic state. Meanwhile, increasing urbanization and industrialization in their catchments compromise their health. Here, we investigate Lake Llanquihue, one of the Earth's great freshwater bodies in Northern Patagonia, Chile. Still considered a pristine environment, Llanquihue has experienced recent contamination events along its littoral, whose impacts remain unknown. In response, public and private agencies have started to develop tailor-made monitoring plans to survey water quality. However, without comprehensive knowledge of the lake's functioning, it is impossible to determine the fate and effects of contaminants in the water body. Here, we characterize via numerical simulations the basin-scale hydrodynamics of Lake Llanquihue, crucial information for diagnosing the transport of dissolved and suspended matter within its basin. Aiming to delimit the regions impacted by contaminated discharges, we pose a fundamental question that applies to any lake: What is the physical connectivity between two zones of interest within a lake? To address this question, we introduce a framework that characterizes the preferential pathways and quantifies the timescale tracers take to stream from one zone to another within an aquatic system. This framework is applied to investigate the physical connectivity among the main urban and rural settlements connected to the littoral zone of Lake Llanquihue. Our results show that the physical connectivity between long-distance littoral regions is primarily controlled by a time-persistent, large-scale gyre and seasonal mesoscale gyres. The above information will enable lake managers to monitor the health of the water basin, identify and notify potential risk zones impacted by polluted effluents, and advance toward a more sustainable relationship with Lake Llanquihue.

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