Summary Background Reoperation rates are high after surgery for hip fractures. We investigated the effect of a sliding hip screw versus cancellous screws on the risk of reoperation and other key outcomes. Methods For this international, multicentre, allocation concealed randomised controlled trial, we enrolled patients aged 50 years or older with a low-energy hip fracture requiring fracture fixation from 81 clinical centres in eight countries. Patients were assigned by minimisation with a centralised computer system to receive a single large-diameter screw with a side-plate (sliding hip screw) or the present standard of care, multiple small-diameter cancellous screws. Surgeons and patients were not blinded but the data analyst, while doing the analyses, remained blinded to treatment groups. The primary outcome was hip reoperation within 24 months after initial surgery to promote fracture healing, relieve pain, treat infection, or improve function. Analyses followed the intention-to-treat principle. This study was registered with ClinicalTrials.gov, number NCT00761813. Findings Between March 3, 2008, and March 31, 2014, we randomly assigned 1108 patients to receive a sliding hip screw (n=557) or cancellous screws (n=551). Reoperations within 24 months did not differ by type of surgical fixation in those included in the primary analysis: 107 (20%) of 542 patients in the sliding hip screw group versus 117 (22%) of 537 patients in the cancellous screws group (hazard ratio [HR] 0.83, 95% CI 0.63–1.09; p=0.18). Avascular necrosis was more common in the sliding hip screw group than in the cancellous screws group (50 patients [9%] vs 28 patients [5%]; HR 1.91, 1.06–3.44; p=0.0319). However, no significant difference was found between the number of medically related adverse events between groups (p=0.82; appendix); these events included pulmonary embolism (two patients [<1%] vs four [1%] patients; p=0.41) and sepsis (seven [1%] vs six [1%]; p=0.79). Interpretation In terms of reoperation rates the sliding hip screw shows no advantage, but some groups of patients (smokers and those with displaced or base of neck fractures) might do better with a sliding hip screw than with cancellous screws. Funding National Institutes of Health, Canadian Institutes of Health Research, Stichting NutsOhra, Netherlands Organisation for Health Research and Development, Physicians’ Services Incorporated.

Seattle City Council and University of Washington Royalty Research Fund.

The increase in data from police-worn body cameras can illuminate formerly opaque practices. This article discusses using audiovisual big data from police-worn body cameras, citizen recordings, and other sources to address blind spots in police oversight. Based on body camera policies in America's largest cities, it discusses two possible roadblocks: (1) data retention and deletion, and (2) limits on use for evaluation and discipline. Although recordings are retained for criminal prosecutions, retention for oversight and accountability is overlooked or is contentious. Some departments have no policy on videos concerning civil suits against the police. The retention time for nonevidentiary recordings is also much shorter. Some policies limit their use for evaluation and discipline. Transactional myopia-seeing at the case rather than the systemic level-leads to a focus on specific footage for particular cases, rather than the potential of aggregated body camera big data to reveal important systemic information and to prevent the escalation of problems.

Highlights Federal restrictions have impacted funding for firearm-related research. We know little about the funding landscape for this research in the health sciences. A smaller proportion of articles reported funding in 2019 compared to 2000. Despite an increase in volume of publications, funding limitations still exist.