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Accelerated surgery; Acute kidney injury; Hip fracture Cirugía acelerada; Lesión renal aguda; Fractura de cadera Cirurgia accelerada; Lesions renals agudes; Fractura de maluc Introduction: Inflammation, dehydration, hypotension and bleeding may all contribute to the development of acute kidney injury (AKI). Accelerated surgery after a hip fracture can decrease the exposure time to such contributors and may reduce the risk of AKI. Methods and analysis: Hip fracture Accelerated surgical TreaTment And Care tracK (HIP ATTACK) is a multicentre, international, parallel-group randomised controlled trial (RCT). Patients who suffer a hip fracture are randomly allocated to either accelerated medical assessment and surgical repair with a goal of surgery within 6 hours of diagnosis or standard care where a repair typically occurs 24 to 48 hours after diagnosis. The primary outcome of this substudy is the development of AKI within 7 days of randomisation. We anticipate at least 1998 patients will participate in this substudy. Ethics and dissemination: We obtained ethics approval for additional serum creatinine recordings in consecutive patients enrolled at 70 participating centres. All patients provide consent before randomisation. We anticipate reporting substudy results by 2021. Trial registration number: NCT02027896; Pre-results. This work was supported by the following grants: Canadian Institute of Health and Research (CIHR) Foundation Award, CIHR’s Strategy for Patient Oriented Research (SPOR), through the Ontario SPOR Support Unit, which is supported by the CIHR and the Province of Ontario, as well as the Ontario Ministry of Health and Long-Term Care, and a grant from Smith & Nephew to recruit 300 patients in Spain. Grants to support this substudy were provided by the Department of Medicine at Western University. Dr Devereaux was supported by a Tier 1 Canada Research Chair in Perioperative Medicine. Dr Amit Garg was supported by the Dr Adam Linton Chair in Kidney Health Analytics and a CIHR Clinician Investigator Award.

Liposomes have been on the market as drug delivery systems for over 25 years. Their success comes from the ability to carry toxic drug molecules to the appropriate site of action through passive accumulation, thus reducing their severe side effects. However, the need for enhanced circulation time and site and time-specific drug delivery turned research focus on other systems, such as polymers. In this context, novel composites that combine the flexibility of polymeric nanosystems with the properties of liposomes gained a lot of interest. In the present work a mixed/chimeric liposomal system, composed of phospholipids and block copolymers, was developed and evaluated in regards with its feasibility as a drug delivery system. These innovative nano-platforms combine advantages from both classes of biomaterials. Thermal analysis was performed in order to offers an insight into the interactions between these materials and consequently into their physicochemical characteristics. In addition, colloidal stability was assessed by monitoring z-potential and size distribution over time. Finally, their suitability as carriers for biomedical applications was evaluated by carrying out in vitro toxicity studies. © 2019 Informa UK Limited, trading as Taylor & Francis Group.

BACKGROUND: Among adults undergoing contemporary noncardiac surgery, little is known about the frequency and timing of death and the associations between perioperative complications and mortality. We aimed to establish the frequency and timing of death and its association with perioperative complications. METHODS: We conducted a prospective cohort study of patients aged 45 years and older who underwent inpatient noncardiac surgery at 28 centres in 14 countries. We monitored patients for complications until 30 days after surgery and determined the relation between these complications and 30-day mortality using a Cox proportional hazards model. RESULTS: We included 40 004 patients. Of those, 715 patients (1.8%) died within 30 days of surgery. Five deaths (0.7%) occurred in the operating room, 500 deaths (69.9%) occurred after surgery during the index admission to hospital and 210 deaths (29.4%) occurred after discharge from the hospital. Eight complications were independently associated with 30-day mortality. The 3 complications with the largest attributable fractions (AF; i.e., potential proportion of deaths attributable to these complications) were major bleeding (6238 patients, 15.6%; adjusted hazard ratio [HR] 2.6, 95% confidence interval [CI] 2.2–3.1; AF 17.0%); myocardial injury after noncardiac surgery [MINS] (5191 patients, 13.0%; adjusted HR 2.2, 95% CI 1.9–2.6; AF 15.9%); and sepsis (1783 patients, 4.5%; adjusted HR 5.6, 95% CI 4.6–6.8; AF 12.0%). INTERPRETATION: Among adults undergoing noncardiac surgery, 99.3% of deaths occurred after the procedure and 44.9% of deaths were associated with 3 complications: major bleeding, MINS and sepsis. Given these findings, focusing on the prevention, early identification and management of these 3 complications holds promise for reducing perioperative mortality. Study registration:ClinicalTrials.gov, no. NCT00512109.

BACKGROUND: There is substantial variability in the perioperative administration of aspirin in patients undergoing noncardiac surgery, both among patients who are already on an aspirin regimen and among those who are not. METHODS: Using a 2-by-2 factorial trial design, we randomly assigned 10,010 patients who were preparing to undergo noncardiac surgery and were at risk for vascular complications to receive aspirin or placebo and clonidine or placebo. The results of the aspirin trial are reported here. The patients were stratified according to whether they had not been taking aspirin before the study (initiation stratum, with 5628 patients) or they were already on an aspirin regimen (continuation stratum, with 4382 patients). Patients started taking aspirin (at a dose of 200 mg) or placebo just before surgery and continued it daily (at a dose of 100 mg) for 30 days in the initiation stratum and for 7 days in the continuation stratum, after which patients resumed their regular aspirin regimen. The primary outcome was a composite of death or nonfatal myocardial infarction at 30 days. RESULTS: The primary outcome occurred in 351 of 4998 patients (7.0%) in the aspirin group and in 355 of 5012 patients (7.1%) in the placebo group (hazard ratio in the aspirin group, 0.99; 95% confidence interval [CI], 0.86 to 1.15; P = 0.92). Major bleeding was more common in the aspirin group than in the placebo group (230 patients [4.6%] vs. 188 patients [3.8%]; hazard ratio, 1.23; 95% CI, 1.01, to 1.49; P = 0.04). The primary and secondary outcome results were similar in the two aspirin strata. CONCLUSIONS: Administration of aspirin before surgery and throughout the early postsurgical period had no significant effect on the rate of a composite of death or nonfatal myocardial infarction but increased the risk of major bleeding. (Funded by the Canadian Institutes of Health Research and others; POISE-2 ClinicalTrials.gov number, NCT01082874.) Copyright © 2014 Massachusetts Medical Society.

Background: Marked activation of the sympathetic nervous system occurs during and after noncardiac surgery. Low-dose clonidine, which blunts central sympathetic outflow, may prevent perioperative myocardial infarction and death without inducing hemodynamic instability. Methods: We performed a blinded, randomized trial with a 2-by-2 factorial design to allow separate evaluation of low-dose clonidine versus placebo and low-dose aspirin versus placebo in patients with, or at risk for, atherosclerotic disease who were undergoing noncardiac surgery. A total of 10,010 patients at 135 centers in 23 countries were enrolled. For the comparison of clonidine with placebo, patients were randomly assigned to receive clonidine (0.2 mg per day) or placebo just before surgery, with the study drug continued until 72 hours after surgery. The primary outcome was a composite of death or nonfatal myocardial infarction at 30 days. Results: Clonidine, as compared with placebo, did not reduce the number of primary-outcome events (367 and 339, respectively; hazard ratio with clonidine, 1.08; 95% confidence interval [CI], 0.93 to 1.26; P=0.29). Myocardial infarction occurred in 329 patients (6.6%) assigned to clonidine and in 295 patients (5.9%) assigned to placebo (hazard ratio, 1.11; 95% CI, 0.95 to 1.30; P=0.18). Significantly more patients in the clonidine group than in the placebo group had clinically important hypotension (2385 patients [47.6%] vs. 1854 patients [37.1%]; hazard ratio 1.32; 95% CI, 1.24 to 1.40; P

A PARAMOUNT CONCEPT The following article, authored by Mathis Wackernagel et al, illustrates the Ecological Footprint concept developed by William Rees and Mathis Wackernagel (1996). This is a fundamental concept to measure sustainability and the unequal use of land resources on the planet. The Ecological Footprint is mentioned many times in this book in different chapters, showing its importance. For this reason it is believed that the inclusion of this paper as a preface to this handbook will not only enhance the reader’s understanding of the concept but will also aid in understanding further chapters. Nolberto Munier Editor THE ECOLOGICAL FOOTPRINT OF CITIES AND REGIONS: COMPARING RESOURCE* AVAILABILITY WITH RESOURCE DEMAND By Mathis Wackernagel, Justin Kitzes, Dan Moran, Steven Goldfinger and Mary Thomas SUMMARY: Cities and regions depend on resources and ecological services from distant ecosystems. The well-being of city and region residents is affected by both the health and availability of these ecosystems, especially in today’s ecologically strained world.* Reprinted by permission of Sage Publications Ltd. from: Wackernagel, Mathis et al,“The ecological footprint of cities and regions: comparing resource availability with resource demand”, Environment and Urbanization, Vol. 18, No. 1, in press.(© Sage Publications Ltd., 2006). 1© Sage Publications, 2006 2 Preface The management of a city or region’s resource metabolism, including the natural capital that supports these flows, is becoming increasingly a central concern to cities and regions that want to succeed.

The state of abandonment which historical districts have experienced from the second post-war period is rooted in the inadequacy of urban services, the lower level of accessibility, the lack of green urban areas and the shift of economic activities in the suburbs. Urban regeneration, since the mid-1990s, has been promoted to enhance and improve these areas by considering their vocations and opportunities. It has the aim to protect and renew existing heritage, as well as intervene in multiple dimensions of urban systems. Given this multidimensional nature, we considered walkability as a driver of the quality and attractiveness of urban areas. Throughout the redevelopment of pedestrian paths, it is possible to enhance the connectivity among houses, services, public facilities and green spaces, valuing built heritage and promoting active and sustainable mobility, synonymous with wellbeing and social inclusion. Numerous studies demonstrated how active mobility measures improve health conditions, citizens’ and city users’ opportunities, and even safety perception and attractiveness of historic city centers. This study aims to deepen the role of active mobility measures in the definition of accessibility and the redevelopment of historical districts characterized by economic and social marginality, furthermore analyzing the competitive spill-over. To this end, we identified and classified in a matrix active mobility measures, resulting from the study and comparison of the latest strategies and best practices, related to physical, economic, social and functional features of historic districts. Finally, the study proposes the application to a material case, Pizzofalcone, a significant area of the city of Naples, due to the lack of integration with the rest of the historic city center, despite its centrality, and the economic and social marginality despite the historical and architectural value of urban fabric, landscape and cultural heritage.

Cities accessible in 15 minutes represent a new possibility for reorganizing the urban system (times, spaces and activities) to try to respond to many current challenges, including ageing populations, energy saving and, more recently, Covid-19. A renewed concept of urban accessibility, together with the redefinition of public spaces and "soft" ways of moving (pedestrian and cycle) to reach neighbourhood services, represent a starting point not only from which to face new challenges but also to rediscover the sense of community, especially at the neighbourhood scale. The 15-minute city draws its origins from the concept of the "neighbourhood unit", developed in 1923 in a competition for the city of Chicago, to define compact residential neighbourhoods where the proximity between services and homes contributed to set out the identity character of that part of the city and to create "the sense of belonging" of a community to a place. The events of the last year strongly re-propose experimentation with this approach, also following the proposal by the mayor of Paris, Anne Hidalgo, aimed at giving a new face to Paris starting from the creation of extensive pedestrian green areas on the large boulevards that are now crossed by the cars and, therefore, to allow the inhabitants to reach, by walking, essential urban services within the 15-minute threshold. Other cities, such as New York and Milan, have also begun to work to make their neighbourhoods, especially peripheral ones, accessible in 15 minutes on foot or by bicycle, without neglecting the goal of transforming these neighbourhoods into attractive places for social gathering for local communities. In this perspective, the research work aims at identifying the urban characteristics that define a 15-minute city, starting from the cities that are launching this experimentation. Among the urban characteristics, the geomorphological, physical (concerning both the spaces and the paths, such as the geometry of the pedestrian and cycle networks), functional (distribution and location of services), socio-economic (of the population) and settlement ones are taken into consideration. According to the weights of the variables identified as significant, the work defines different areas accessible in 15 minutes based on users’ willingness to walk and the geomorphological, physical, settlement and functional characteristics identified in each urban area. The work is carried out in selected districts of the city of Naples which, due to their demographic, morphological and settlement characteristics, make them a significant area of experimentation.

Pavement skid resistance is one of determining road features that contributes to traffic safety. Several influencing factors govern the skid resistance, amongst which the pavement surface texture is the one that could be designed and controlled by the pavement engineers. Pavement surface texture is classified into four categories, where microtexture and macrotexture level affect the pavement skid resistance. Microtexture contributes to skid resistance at low traffic speed, while macrotexture governs skid resistance at high speed. Macrotexture is a result of asphalt mixture properties, mostly the aggregate gradation, maximum aggregate size, binder and air voids content. Macrotexture is usually measured using different volumetric or optical devices, and the measuring results are expressed as texture depth or profile depth values. Several studies showed that macrotexture level can be correlated to pavement skid resistance performance. Previously conducted small-scale case study performed on road network in City of Rijeka analyzed the influence of pavement surface renewal treatment on macrotexture values increase and its influence on skid resistance values. In this paper, an analysis of measured macrotexture and skid resistance values is shown for a greater set of data. The measurements were conducted on selected highway section in Croatia, using laser profilometer for macrotexture determination and surface friction trailer for skid resistance determination. Both pavement surface performance indicators – Mean profile depth (MPD) for the macrotexture and longitudinal friction coefficient (LFC) for the skid resistance were measured before and after the renewal treatment in order to determine the influence of the renewal treatment on the surface performance improvement. The measured values were then correlated, showing that skid resistance is connected to the level of pavement surface macrotexture.

Keratin (Ker) protein regenerated from readily available and low-cost wastes (e.g. raw wool, feathers and textile by-products) is a promising natural polymer for tissue engineering and drug delivery. Nevertheless, while showing good bioactivity and great drug carrier properties, keratin lacks of suitable mechanical characteristics. To overcome this drawback, keratin was blended with poly(butylene succinate) (PBS), a biodegradable and biocompatible polyester able to confer mechanical integrity to the keratin based materials. Despite the poor compatibility at the molecular level between keratin and PBS, their 50-50 blends were successfully electrospun into manageable mats, made of randomly oriented nanofibers with mean diameter of 290 nm. Along with mechanical properties, PBS improves also the thermal stability of the keratin based nanofibrous mats. On the other hand, compared to PBS-only electrospun mats, the presence of keratin improves both swelling ability and biodegradability and amplifies the capacity of diclofenac release as well as fibroblast proliferation of the blend mat.