Hip Fracture - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

HIP

FRACTURE A 3-IN-1 MEDICAL REFERENCE Medical Dictionary Bibliography & Annotated Research Guide TO I NTERNET

R EFERENCES

HIP

FRACTURE A M EDICAL D ICTIONARY , B IBLIOGRAPHY , AND A NNOTATED R ESEARCH G UIDE TO I NTERNET R E FERENCES

J AMES N. P ARKER , M.D. AND P HILIP M. P ARKER , P H .D., E DITORS

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ICON Health Publications ICON Group International, Inc. 4370 La Jolla Village Drive, 4th Floor San Diego, CA 92122 USA Copyright 2004 by ICON Group International, Inc. Copyright 2004 by ICON Group International, Inc. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. Printed in the United States of America. Last digit indicates print number: 10 9 8 7 6 4 5 3 2 1

Publisher, Health Care: Philip Parker, Ph.D. Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher's note: The ideas, procedures, and suggestions contained in this book are not intended for the diagnosis or treatment of a health problem. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised to always check product information (package inserts) for changes and new information regarding dosage and contraindications before prescribing any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960Hip Fracture: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References / James N. Parker and Philip M. Parker, editors p. cm. Includes bibliographical references, glossary, and index. ISBN: 0-497-00544-1 1. Hip Fracture-Popular works. I. Title.

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Disclaimer This publication is not intended to be used for the diagnosis or treatment of a health problem. It is sold with the understanding that the publisher, editors, and authors are not engaging in the rendering of medical, psychological, financial, legal, or other professional services. References to any entity, product, service, or source of information that may be contained in this publication should not be considered an endorsement, either direct or implied, by the publisher, editors, or authors. ICON Group International, Inc., the editors, and the authors are not responsible for the content of any Web pages or publications referenced in this publication.

Copyright Notice If a physician wishes to copy limited passages from this book for patient use, this right is automatically granted without written permission from ICON Group International, Inc. (ICON Group). However, all of ICON Group publications have copyrights. With exception to the above, copying our publications in whole or in part, for whatever reason, is a violation of copyright laws and can lead to penalties and fines. Should you want to copy tables, graphs, or other materials, please contact us to request permission (E-mail: [email protected]). ICON Group often grants permission for very limited reproduction of our publications for internal use, press releases, and academic research. Such reproduction requires confirmed permission from ICON Group International, Inc. The disclaimer above must accompany all reproductions, in whole or in part, of this book.

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Acknowledgements The collective knowledge generated from academic and applied research summarized in various references has been critical in the creation of this book which is best viewed as a comprehensive compilation and collection of information prepared by various official agencies which produce publications on hip fracture. Books in this series draw from various agencies and institutions associated with the United States Department of Health and Human Services, and in particular, the Office of the Secretary of Health and Human Services (OS), the Administration for Children and Families (ACF), the Administration on Aging (AOA), the Agency for Healthcare Research and Quality (AHRQ), the Agency for Toxic Substances and Disease Registry (ATSDR), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the Healthcare Financing Administration (HCFA), the Health Resources and Services Administration (HRSA), the Indian Health Service (IHS), the institutions of the National Institutes of Health (NIH), the Program Support Center (PSC), and the Substance Abuse and Mental Health Services Administration (SAMHSA). In addition to these sources, information gathered from the National Library of Medicine, the United States Patent Office, the European Union, and their related organizations has been invaluable in the creation of this book. Some of the work represented was financially supported by the Research and Development Committee at INSEAD. This support is gratefully acknowledged. Finally, special thanks are owed to Tiffany Freeman for her excellent editorial support.

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About the Editors James N. Parker, M.D. Dr. James N. Parker received his Bachelor of Science degree in Psychobiology from the University of California, Riverside and his M.D. from the University of California, San Diego. In addition to authoring numerous research publications, he has lectured at various academic institutions. Dr. Parker is the medical editor for health books by ICON Health Publications. Philip M. Parker, Ph.D. Philip M. Parker is the Eli Lilly Chair Professor of Innovation, Business and Society at INSEAD (Fontainebleau, France and Singapore). Dr. Parker has also been Professor at the University of California, San Diego and has taught courses at Harvard University, the Hong Kong University of Science and Technology, the Massachusetts Institute of Technology, Stanford University, and UCLA. Dr. Parker is the associate editor for ICON Health Publications.

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About ICON Health Publications To discover more about ICON Health Publications, simply check with your preferred online booksellers, including Barnes&Noble.com and Amazon.com which currently carry all of our titles. Or, feel free to contact us directly for bulk purchases or institutional discounts: ICON Group International, Inc. 4370 La Jolla Village Drive, Fourth Floor San Diego, CA 92122 USA Fax: 858-546-4341 Web site: www.icongrouponline.com/health

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Table of Contents FORWARD .......................................................................................................................................... 1 CHAPTER 1. STUDIES ON HIP FRACTURE .......................................................................................... 3 Overview........................................................................................................................................ 3 The Combined Health Information Database................................................................................. 3 Federally Funded Research on Hip Fracture.................................................................................. 5 E-Journals: PubMed Central ....................................................................................................... 57 The National Library of Medicine: PubMed ................................................................................ 58 CHAPTER 2. NUTRITION AND HIP FRACTURE .............................................................................. 103 Overview.................................................................................................................................... 103 Finding Nutrition Studies on Hip Fracture .............................................................................. 103 Federal Resources on Nutrition ................................................................................................. 106 Additional Web Resources ......................................................................................................... 107 CHAPTER 3. ALTERNATIVE MEDICINE AND HIP FRACTURE ........................................................ 109 Overview.................................................................................................................................... 109 National Center for Complementary and Alternative Medicine................................................ 109 Additional Web Resources ......................................................................................................... 115 General References ..................................................................................................................... 116 CHAPTER 4. DISSERTATIONS ON HIP FRACTURE .......................................................................... 117 Overview.................................................................................................................................... 117 Dissertations on Hip Fracture ................................................................................................... 117 Keeping Current ........................................................................................................................ 117 CHAPTER 5. PATENTS ON HIP FRACTURE..................................................................................... 119 Overview.................................................................................................................................... 119 Patents on Hip Fracture............................................................................................................. 119 Patent Applications on Hip Fracture......................................................................................... 124 Keeping Current ........................................................................................................................ 128 CHAPTER 6. BOOKS ON HIP FRACTURE ........................................................................................ 131 Overview.................................................................................................................................... 131 Book Summaries: Online Booksellers......................................................................................... 131 CHAPTER 7. PERIODICALS AND NEWS ON HIP FRACTURE .......................................................... 133 Overview.................................................................................................................................... 133 News Services and Press Releases.............................................................................................. 133 Newsletters on Hip Fracture...................................................................................................... 136 Newsletter Articles .................................................................................................................... 137 Academic Periodicals covering Hip Fracture............................................................................. 137 CHAPTER 8. RESEARCHING MEDICATIONS .................................................................................. 139 Overview.................................................................................................................................... 139 U.S. Pharmacopeia..................................................................................................................... 139 Commercial Databases ............................................................................................................... 140 APPENDIX A. PHYSICIAN RESOURCES .......................................................................................... 143 Overview.................................................................................................................................... 143 NIH Guidelines.......................................................................................................................... 143 NIH Databases........................................................................................................................... 145 Other Commercial Databases..................................................................................................... 147 APPENDIX B. PATIENT RESOURCES ............................................................................................... 149 Overview.................................................................................................................................... 149 Patient Guideline Sources.......................................................................................................... 149 Finding Associations.................................................................................................................. 152 APPENDIX C. FINDING MEDICAL LIBRARIES ................................................................................ 155 Overview.................................................................................................................................... 155 Preparation................................................................................................................................. 155

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Finding a Local Medical Library................................................................................................ 155 Medical Libraries in the U.S. and Canada ................................................................................. 155 ONLINE GLOSSARIES................................................................................................................ 161 Online Dictionary Directories ................................................................................................... 161 HIP FRACTURE DICTIONARY ................................................................................................. 163 INDEX .............................................................................................................................................. 211

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FORWARD In March 2001, the National Institutes of Health issued the following warning: "The number of Web sites offering health-related resources grows every day. Many sites provide valuable information, while others may have information that is unreliable or misleading."1 Furthermore, because of the rapid increase in Internet-based information, many hours can be wasted searching, selecting, and printing. Since only the smallest fraction of information dealing with hip fracture is indexed in search engines, such as www.google.com or others, a non-systematic approach to Internet research can be not only time consuming, but also incomplete. This book was created for medical professionals, students, and members of the general public who want to know as much as possible about hip fracture, using the most advanced research tools available and spending the least amount of time doing so. In addition to offering a structured and comprehensive bibliography, the pages that follow will tell you where and how to find reliable information covering virtually all topics related to hip fracture, from the essentials to the most advanced areas of research. Public, academic, government, and peer-reviewed research studies are emphasized. Various abstracts are reproduced to give you some of the latest official information available to date on hip fracture. Abundant guidance is given on how to obtain free-of-charge primary research results via the Internet. While this book focuses on the field of medicine, when some sources provide access to non-medical information relating to hip fracture, these are noted in the text. E-book and electronic versions of this book are fully interactive with each of the Internet sites mentioned (clicking on a hyperlink automatically opens your browser to the site indicated). If you are using the hard copy version of this book, you can access a cited Web site by typing the provided Web address directly into your Internet browser. You may find it useful to refer to synonyms or related terms when accessing these Internet databases. NOTE: At the time of publication, the Web addresses were functional. However, some links may fail due to URL address changes, which is a common occurrence on the Internet. For readers unfamiliar with the Internet, detailed instructions are offered on how to access electronic resources. For readers unfamiliar with medical terminology, a comprehensive glossary is provided. For readers without access to Internet resources, a directory of medical libraries, that have or can locate references cited here, is given. We hope these resources will prove useful to the widest possible audience seeking information on hip fracture. The Editors

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From the NIH, National Cancer Institute (NCI): http://www.cancer.gov/cancerinfo/ten-things-to-know.

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CHAPTER 1. STUDIES ON HIP FRACTURE Overview In this chapter, we will show you how to locate peer-reviewed references and studies on hip fracture.

The Combined Health Information Database The Combined Health Information Database summarizes studies across numerous federal agencies. To limit your investigation to research studies and hip fracture, you will need to use the advanced search options. First, go to http://chid.nih.gov/index.html. From there, select the “Detailed Search” option (or go directly to that page with the following hyperlink: http://chid.nih.gov/detail/detail.html). The trick in extracting studies is found in the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Journal Article.” At the top of the search form, select the number of records you would like to see (we recommend 100) and check the box to display “whole records.” We recommend that you type “hip fracture” (or synonyms) into the “For these words:” box. Consider using the option “anywhere in record” to make your search as broad as possible. If you want to limit the search to only a particular field, such as the title of the journal, then select this option in the “Search in these fields” drop box. The following is what you can expect from this type of search: •

Risk of Hip Fracture Among Dialysis and Renal Transplant Recipients Source: JAMA. Journal of the American Medical Association. 288(23): 3014-3018. December 18, 2002. Summary: Renal failure places people at particularly high risk of hip fracture. However, the possible differential impact of dialysis and renal (kidney) transplantation on this risk is not well understood. This article reports on a study undertaken to determine if patients who receive kidney transplants are at greater risk of hip fracture compared with those who continue to undergo dialysis. The data is from a cohort study of 101,039 patients with end stage renal disease (ESRD) placed on the renal transplant waiting list in the United States between January 1990 and December 1999. Among the patients included in this analysis, 971 hip fractures were observed during the followup period of 314,767 person-years. The incidence rate of hip fracture in patients receiving dialysis

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was 2.9 per 1000 patients per year compared with 3.3 hip fractures per 1000 patients per year in those who had previously received a renal transplant. Initially, the relative risk of hip fracture associated with transplantation was 1.34 fold greater when compared with dialysis, but then decreased by 1 percent per month until the estimated risk became equal for dialysis and transplant recipients approximately 630 days after transplantation. Among transplant recipients, risk of fracture was relatively higher in persons with a prolonged period of dialysis before transplantation. 1 figure. 3 tables. 26 references. •

Type 1 and Type 2 Diabetes and Incident Hip Fractures in Postmenopausal Women Source: Diabetes Care. 24(7): 1192-1197. July 2001. Contact: Available from American Diabetes Association. 1701 North Beauregard Street, Alexandria, VA 22311. (800) 232-3472. Website: www.diabetes.org. Summary: This article describes a study that examined whether postmenopausal women with diabetes experienced a higher incidence of hip fracture than women without diabetes. The study sample consisted of 32,089 postmenopausal women residing in Iowa who were surveyed by mail in 1986 and followed for 11 years. Diabetes status and other potential risk factors were assessed by questionnaire at baseline. Incidence of hip fracture was ascertained by follow up questionnaires. Over 306,900 person years of follow up, 490 hip fractures were identified, for an incidence rate of 1.6 per 1,000 person years. After adjustment for age, smoking status, estrogen use, body mass index, and waist to hip ratio, women with type 1 diabetes were 12.25 times more likely to report an incident hip fracture than women without diabetes. Women with type 2 diabetes had a 1.70 fold higher risk of incident hip fracture than women without diabetes. Longer duration of type 2 diabetes was associated with higher incidence, as was use of insulin or oral diabetes medications in women with type 2 diabetes. Furthermore, women who were initially free of diabetes but in whom diabetes developed had a relative risk of hip fracture of 1.60 compared with women who never had diabetes. The article concludes that postmenopausal women who have diabetes or in whom diabetes develops are at higher risk for hip fracture than postmenopausal women without diabetes. Strategies to prevent osteoporosis or falling may be especially warranted in women with diabetes. 2 tables. 31 references. (AA-M).

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Risk Factors for Hospital-Acquired Incontinence in Elderly Female Hip Fracture Patients Source: Journal of Gerontology. 57A(10): M672-M677. 2002. Summary: This article reports on a study undertaken to estimate the incidence of, and identify risk factors for, urinary incontinence in female hip fracture patients. The study was a secondary analysis of data abstracted from medical records in hospitals in Pennsylvania, Texas, New Jersey, and Virginia. The study included women aged 60 years and older who were admitted to one of the study hospitals with hip fracture. Data from 6,516 women were analyzed. Of these, 21 percent (n = 1,365) became incontinent during hospitalization. After adjusting for confounders (i.e., age, race, malnutrition, comorbidity, and severity of illness), admission from a nursing home or other long-term care facility, confusion, use of a wheelchair or device for walking, and prefracture dependence on others for ambulation significantly increased the odds of developing incontinence during hospitalization. The authors conclude that certain easilyidentifiable patient characteristics place female hip fracture patients at high risk of incontinence. Interventions to increase staff awareness of this vulnerable population

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need to be tested to minimize the incidence of hospital-acquired incontinence. 1 figure. 3 tables. 26 references. •

Randomised, Clinically Controlled Trial of Intensive Geriatric Rehabilitation in Patients With Hip Fracture: Subgroup Analysis of Patients With Dementia Source: BMJ. British Medical Journal. 321: 1107-1111. November 4, 2000. Summary: This journal article describes a study that investigated the effectiveness of intensive geriatric rehabilitation in people with mild to moderate dementia who had surgery for hip fracture. Participants were 243 people over age 64 years who lived independently and were admitted to the hospital with a hip fracture. Patients were evaluated to determine cognitive status. Following surgery, patients in the intervention group were referred to the geriatric ward, while the remaining patients were discharged to local hospitals. The study measured their length of hospital stay, place of residence at three months and one year after surgery, and mortality. The median length of hospital stays was significantly shorter in the intervention group. Three months following surgery, patients with mild dementia in the intervention group were as successful as people without dementia in returning to independent living. Severity of cognitive impairment related to less successful return to independent living and higher mortality. The researchers concluded that older people with mild to moderate dementia and hip fracture can return to community living if they receive active geriatric rehabilitation. 3 tables, 34 references.

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Rehabilitation Following Hip Fracture in Patients With Alzheimer's Disease and Related Disorders Source: American Journal of Alzheimers Disease. p. 209-211. September-October 1997. Summary: This journal article describes the rehabilitation outcomes of 19 patients with hip fractures admitted to a long-term care facility dedicated to caring for people with Alzheimer's disease and related disorders (ADRD). The patients ranged in age from 80 to 90 years, and most were female; all but one had surgery. The patients received physical therapy for 1 to 24 weeks. The physical therapy program included upper and lower extremity strengthening, balance training, transfer training, and gait training with and without assistive devices. At discharge, all 17 patients who survived were able to ambulate at least 100 feet with or without assistive devices. Some required assistance for safety due to decreased judgment and cognition, four were able to ambulate totally independently ad lib, and five needed supervision only. At followup several months later, most of the patients were still ambulatory at the same level as that at discharge. The authors conclude that people with ADRD who sustain hip fractures can be successfully rehabilitated with sufficient time and effort. 16 references. (AA-M).

Federally Funded Research on Hip Fracture The U.S. Government supports a variety of research studies relating to hip fracture. These studies are tracked by the Office of Extramural Research at the National Institutes of Health.2 CRISP (Computerized Retrieval of Information on Scientific Projects) is a searchable 2

Healthcare projects are funded by the National Institutes of Health (NIH), Substance Abuse and Mental Health Services (SAMHSA), Health Resources and Services Administration (HRSA), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH).

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database of federally funded biomedical research projects conducted at universities, hospitals, and other institutions. Search the CRISP Web site at http://crisp.cit.nih.gov/crisp/crisp_query.generate_screen. You will have the option to perform targeted searches by various criteria, including geography, date, and topics related to hip fracture. For most of the studies, the agencies reporting into CRISP provide summaries or abstracts. As opposed to clinical trial research using patients, many federally funded studies use animals or simulated models to explore hip fracture. The following is typical of the type of information found when searching the CRISP database for hip fracture: •

Project Title: A LOW-COST FALL MONITOR FOR GERIATRIC SUBJECTS Principal Investigator & Institution: Parker, B Eugene.; Barron Associates, Inc. 1410 Sachem Place Charlottesville, Va 22901 Timing: Fiscal Year 2003; Project Start 01-OCT-2000; Project End 31-AUG-2005 Summary: (provided by applicant): Falls are a leading cause of disability and even death in the elderly. A method is needed by which to identify elderly persons who frequently experience falls or near falls (e.g., slips, stumbles, etc.). There are presently no tools to objectively record such events and their characteristics (e.g., kinematics) in independentliving, assisted-living, or nursing-home environments. A device that could be used to discreetly count fall frequency and record the characteristics of fall events - while still permitting free and unrestricted body movement - would be invaluable in understanding why elderly people fall. Such a device could also serve as a research tool, enabling a better understanding of risk factors associated with falls and near falls. A method for characterizing fall dynamics (e.g., impact velocity and orientation, fall direction, impact energy) would assist in identifying elderly persons at high risk for hip fracture. Hip fractures, for example, have been associated with high impact energy sideways falls in which the subject lands on their hip. Under the proposed Phase II SBIR effort, Barron Associates, Inc. and its subcontractors, the University of Kansas Center for Research and the University of Virginia Division of General Medicine, Geriatrics & Palliative Care, propose to develop and demonstrate the Wear And Forget Ambulatory Recorder for Elderly Residents (WAFARER), a wireless system to detect, archive, characterize, and "reconstruct," through PC-based graphical reenactment, fall and nearfall events in the elderly with the goals of understanding and preventing fall-related injuries and their sequelae. Three-dimensional animation of pelvic motions during fall and near-fall events will facilitate their interpretation by senior-care facility physicians, nurses, and others. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: A NEW SYSTEM FOR ULTRASONIC BONE ASSESSMENT Principal Investigator & Institution: Kaufman, Jonathan J.; President & Ceo; Cyberlogic, Inc. 611 Broadway, Ste 707 New York, Ny 10012 Timing: Fiscal Year 2002; Project Start 01-NOV-1997; Project End 31-AUG-2004 Summary: (provided by applicant): The long-term objective of this research is to establish ultrasound as a safe, effective, and non-invasive method for assessing fracture risk, an important component in clinical management of osteoporosis. Osteoporosis afflicts over 20 million people in the U.S., responsible for more than 275,000 hip fractures annually. Currently, the primary means for assessment relies on densitometric

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techniques. These methods subject the patient to ionizing radiation, are relatively expensive, and do not always provide good estimates of bone strength. Ultrasound offers several potential advantages. It is non-ionizing and relatively inexpensive. Moreover, since ultrasound is a mechanical wave and interacts with bone in a fundamentally different manner than electromagnetic radiation, it may be able to provide more accurate estimates of bone strength compared with current densitometric methods. The goal of this research is to significantly improve the effectiveness of current ultrasonic bone assessment techniques by demonstrating the feasibility of a new ultrasonic system to assess bone. The system employs a novel parametric signal processing approach which is ideally suited for analog and real-time implementation. Thus this research may enable less expensive and easier to use ultrasound devices, which are also less sensitive to various experimental artifacts. The specific aims are to measure a set of new ultrasonic parameters and compare them with presently used features, namely BUA and ultrasound velocity, in calcaneal bone samples. A comparison will be made of their respective capabilities to estimate bone density and bone strength. This comparison will include cost, ease of use, and accuracy and precision of the bone density and bone strength estimates. PROPOSED COMMERCIAL APPLICATION: Osteoporosis is a major health concern in the United States, afflicting over 20 million people, and whose incidence is increasing as the average age of the U.S. population increases. An effective, relatively inexpensive and safe technique such as ultrasound for assessing osteoporosis would be an extremely emportant benefit to the patient population, and represents an enormous commercial opportunity. Ultrasound's importance will grow as various new pharmacologic agents are approved for treatment, thus requiring periodic assessments of efficacy. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: ACTIVITY GAIT AND EFFICACY (AGE) IN ORDER WOMEN Principal Investigator & Institution: Mcauley, Edward; Professor; Kinesiology; University of Illinois Urbana-Champaign Henry Administration Bldg Champaign, Il 61820 Timing: Fiscal Year 2004; Project Start 01-SEP-2001; Project End 31-JUL-2006 Summary: (provided by applicant): Osteoporosis is a major public health issue. Being African-American affords some protection from osteoporotic fracture primarily due to bone dependent factors such as a higher bone mass, density and shorter hip axis length; however, pilot data from our laboratory also suggests a racial difference in bone independent fracture risk factors including gait, balance and social cognitive factors such as fear of falling. However, to our knowledge, no research has studied the interrelationship between bone dependent and independent fracture risk factors in an older racially diverse sample of postmenopausal women. Additionally, little research has prospectively examined the relation between and among bone dependent and independent risk factors in black and white postmenopausal women. This is important work because black women are among the fastest growing segment of the population and alarming evidence suggests that although fewer black women sustain osteoporotic fractures, they have nearly a three-times greater likelihood of death due to complications from hip fracture. Thus, the primary purpose of this prospective study is to combine physiological bone health outcomes (bone mass, density and ultrasound attenuation), physical activity patterns, and balance and gait abilities with social cognitive outcomes including self-efficacy and expectations, to further elucidate the causes of this racial discrepancy in fracture rate. Secondarily, racial differences in body composition determinants (i.e. fat and fat-free mass) of bone health will be explored at

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baseline and in a prospective fashion. Per the parent grant design (1R01AG02011801A1), a large sample of older (60 - 80 yrs) white (N = 150) and black (N = 150) women will be recruited with outcomes assessed at baseline, 1 year and 2 years. Bone and body composition will be assessed by dual energy X-ray absorptiometry (DXA). Additionally, quantitative ultrasound (QUS) will be used as an index of bone quality. This research has high public health priority because bone dependent and independent factors that influence the risk of osteoporotic fracture risk must be understood to implement effective programs for public health agendas and programs, specifically with regards to racial differences thereby optimizing programming for all individuals. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: ADVANCE REHABILITATION RESEARCH TRAINING PROJECT Principal Investigator & Institution: Rodgers, Mary M.; Professor and Chair; Physical Therapy; University of Maryland Balt Prof School Baltimore, Md 21201 Timing: Fiscal Year 2003; Project Start 20-JUN-2003; Project End 30-APR-2008 Summary: (provided by applicant): Societal demand for high quality rehabilitationrelated research relevant to chronic diseases and disabilities is increasing with the aging of the population in the United States. The objective of the proposed Advanced Rehabilitation Research Training Program (ARRTP) is to provide trainees with academic and research preparation in fields pertinent to the emerging discipline of physical rehabilitation science (PRS). The existing UMB-PRS program, which will be augmented by this ARRTP, offers predoctoral students and post-doctoral fellows an educational curriculum and laboratory experiences with an emphasis in one of five academic subdisciplines or concentration areas: applied anatomy and cell biology, rehabilitation biomechanics, epidemiology, neuromotor control/plasticity, and rehabilitation physiology. Trainees are subsequently afforded research development opportunities in areas where participating faculty have ongoing externally funded collaborations. These areas include stroke, spinal cord injury, hip fracture, rheumatological/immunological diseases and developmental disorders. The training program features rigorous academic and research requirements that are individually tailored to develop scientists that are capable of becoming independent investigators. It is expected that graduates and fellows will be capable of drawing on the skills and informational bases of their chosen sub-discipline to expand overall knowledge related to the mechanisms and epidemiology of physical disability and rehabilitation. Additional opportunities for collaborative research across campus are available through established training programs in neurology, geriatrics, pediatrics, epidemiology and rheumatology. The strengths of the proposed ARRTP are (1) strong institutional and school support, (2) an interdisciplinary faculty, (3) ongoing interdisciplinary research in suitable fields, and (4) well-equipped laboratories. The didactic portion of the program includes course work designed to develop competence in foundational sciences, analytical methodologies, and a substantive concentration area through formal lectures, independent study, research seminars, journal clubs, and regular training in the ethical conduct of research. The training program is designed to enable trainees to (1) master a core curriculum in foundational biophysical sciences and scientific methodologies, (2) become knowledgeable about fundamental rehabilitative and psychosocial processes related to disability, (3) become expert in at least one substantive area relevant to the reversal of impairment and functional decline in a disabled population, (4) learn to contribute to a research team under the supervision of a primary mentor expert in a disability-specific field with appropriate mentorship by secondary and associate experts in rehabilitation

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research, and (5) demonstrate the capacity to conduct independent, original research related to rehabilitation. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: ANALYSIS OF INJURY AVOIDANCE STRATEGIES DURING FALLS Principal Investigator & Institution: Lotz, Jeffrey Charles.; Professor; Orthopaedic Surgery; University of California San Francisco 500 Parnassus Ave San Francisco, Ca 941222747 Timing: Fiscal Year 2002; Project Start 20-SEP-2000; Project End 31-AUG-2004 Summary: At least 280,000 hip fractures occur annually in the U.S., at an estimated cost of $9 billion. While over 90% of these are caused by falls, only about 2% of all falls result in hip fracture. Considerable evidence now exists that the most important determinants of hip fracture risk during a fall are the body's impact velocity and configuration (and in particular, whether contact occurs to the hip region). Accordingly, protective responses for reducing impact velocity, and the likelihood for direct impact to the hip, strongly influence fracture risk. Improved understanding of the nature of such responses, and how these are affected by age-related declines in neuromuscular variables, would enhance our ability to develop exercise- based strategies for hip fracture prevention. Based on the results of epidemiological and biomechanical studies, we hypothesize that two protective responses central to safe landing during a fall are (a) absorbing energy in the lower extremity muscles during the descent phase of the fall, and (b) braking the fall with the outstretched hands. We also hypothesize, based on epidemiological evidence, that the efficacy of these responses associate with strength, flexibility, and reaction time. To test these hypotheses, we will address four aims. Aim 1 is to test whether use of the above protective responses influences young females' ability to avoid impact to the hip, and reduce the impact velocity of the body during falls onto a soft gymnasium mat. Aim 2 is to test whether ancillary measures of balance and lower extremity flexibility and reaction time associate with young and elderly subjects' ability to absorb energy in their lower extremity muscles, and reduce impact velocity when descending from standing to sitting. Aim 3 is to test whether balance and upper extremity strength, flexibility, and reaction time associate with young and elderly subjects' ability to quickly contact an impact surface with the outstretched hands, and absorb energy in the upper extremity muscles during simulated falls. Finally, Aim 4 is to develop and validate complementary mathematical models of falling, and use these to determine how specific impairments (or exercise-induced enhancements) in muscle strength, joint flexibility. Finally, Aim 4 is to develop and validate complementary mathematical models of falling, and use these to determine how specific impairments (or exercise-induced enhancements) in muscle strength, joint flexibility, and reaction time affect fall protective responses and fall severity. By identifying the biomechanical and neuromuscular variables which govern safe landing during a fall, these studies should lead to novel and effective interventions for reducing hip fractures in the elderly. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: BBA EFFECTS ON GEOGRAPHIC VARIATION IN POST-ACUTE CARE Principal Investigator & Institution: Lin, Wen-Chieh; Family and Community Medicine; University of Missouri Columbia 310 Jesse Hall Columbia, Mo 65211 Timing: Fiscal Year 2003; Project Start 01-SEP-2003; Project End 31-AUG-2004

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Summary: (Provided by Applicant): In response to the rapid growth in payments for post-acute care (PAC) services, Congress enacted Medicare reforms as part of the Balanced Budget Act of 1997 (BBA) for each PAC service. The reforms mandated a series of separate case-mix adjusted prospective payment systems, each with its own implementation timeline. In addition to the overall effects, the BBA's effects on PAC use varied substantially across geographic areas. For example, in the case of skilled nursing facility use from 1998 to 2000, the average change relative to 1996 for stroke patients was 2.7%.at the national level, but it ranged from -12% to 24% across regions (the nine United States Census Bureau divisions). This varied response raises concerns that the hospital discharge process may be driven by payment policy rather than by clinical needs and individual preferences. Furthermore, varied changes in PAC use across regions might lead to untoward consequences, such as early hospital readmission. As efforts continue to reform PAC services and payment systems, it is essential that policymakers understand how different payment mechanisms associate with geographic variation in PAC use. The proposed study seeks to: 1) analyze geographic variation in PAC use before and after the BBA changes; 2) explore whether utilization and cost have shifted among PAC settings and whether early hospital readmission has increased; and 3) investigate how the contributions of patient, hospital, and market area characteristics in explaining PAC use differ between pre- and post-BBA periods. We will analyze the Center for Medicare & Medicaid Services' 5% sample of Medicare claims data from 1996 to 2000 to study the initial effect of the BBA changes on geographic variation in PAC use. We will focus on six diseases associated with high PAC use: stroke, hip procedure, hip fracture, chronic obstructive pulmonary disease, pneumonia, and congestive heart failure. The selected diseases provide a contrast between rehabilitative and medical conditions. The stability, the degree, and the association of geographic variation in PAC use before and after the BBA changes will be examined. Shifts in utilization and costs will be presented as correlations between changes in PAC use, hospital length of stay, and early hospital readmission. Finally, we will estimate multinomial logit models to explore changes in contribution to explain PAC use by patient, hospital, and market area characteristics after the BBA changes. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CHARACTERISTICS OF T CELL RECEPTORS Principal Investigator & Institution: Marrack, Philippa C.; Investigator; National Jewish Medical & Res Ctr and Research Center Denver, Co 80206 Timing: Fiscal Year 2003; Project Start 01-MAY-1982; Project End 30-APR-2006 Summary: T cells bearing alphabeta T cell receptors react with antigen in the form of peptides bound to major histocompatibility complex proteins (MHC). This reaction is crucial to the ability of T cells to orchestrate destruction of invading organisms. It is also involved in graft rejection and in T cell attacks on the tissues of their own host in autoimmune disease. Several aspects of T cell reaction with MHC are not understood. The projects in this application will study two of these aspects. The first set of experiments will study the ways in which T cells are selected to react with peptides bond to MHC in the thymus. A major focus of these experiments will be the role of the peptides bound to MHC. Mice will be created in which a single peptide is firmly bound to an MHC protein, and the ability of this MHC/single peptide combination to select T cells studied. The second set of experiments will investigate the relationship between T cell receptors and MHC. It is thought that the two sets of proteins may have an intrinsic affinity for each other. Experiments proposed here will try to find out if this is so. T cells

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from the MHV/single peptide mice, which are very reactive with MHC proteins, will be used to study the phenomenon. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CLAUDE D. PEPPER OLDER AMERICANS INDEPENDENCE CENTER (O* Principal Investigator & Institution: Goldberg, Andrew P.; Professor; Medicine; University of Maryland Balt Prof School Baltimore, Md 21201 Timing: Fiscal Year 2002; Project Start 15-JUL-1994; Project End 30-JUN-2006 Summary: (provided by the applicant): The mission of the University of Maryland, Baltimore (UM)-OAIC is to conduct mechanistic and outcome-based research in exercise rehabilitation and provide research training in gerontology and geriatrics that will improve lifestyle and functionality for millions of older disabled Americans. The research focus is on older patients who are chronically disabled by hemiparetic stroke, a major complication of arteriosclerotic cardiovascular disease (CVD) which affects greater than 750,000 Americans annually. These patients have reduced ambulatory capacity and functionality, impaired IADL performance, gait dysfunction and a multitude of comorbidities, which worsen their quality of life and increase their utilization of the healthcare system. While our focus is on hemiparetic stroke, the UMOAIC also collaborates with and provides infrastructure support for research on peripheral arterial occlusive disease, hip fracture and other disabling conditions where there are institutional strengths. Exercise rehabilitation is the consistent theme in the UM-OAIC that provides cohesiveness for the research training, the research resources cores, education, dissemination, and clinical care. The intervention development studies (IDS) examine the effects of task-oriented treadmill exercise in patients with lower extremity hemiparesis (IDS-1) and upper extremity training with auditory cueing in patients with upper extremity paresis (IDS-2) on: 1) functional mobility and ambulation, motor control and strength, V02 peak, and free living daily activity; 2) central (neural) and peripheral (muscle) mechanisms underlying these functional responses using functional magnetic resonance imaging (fMRI) and transcranial magnetic stimulation (TMS) to assess neural plasticity; 3) muscle biopsies with histochemical and biochemical analyses to determine conditioning; and 4) long-term functionality and psychosocial status in hemiparetic stroke patients. These and other studies of disabling conditions utilize RRCs in 1) epidemiology research and recruitment; 2) neuromuscular mechanisms and function performance; and 3) physiology that are blinded to patient randomization for measuring outcomes. The biostatistics RRC provides data management and analysis, and maintains confidentiality and records for the safety monitoring board. OAIC leadership and advisory committees 1) guide and review accomplishments of the RCT?s on hemiparetic stroke, 2) train young investigators in mechanistic, functional, and psychosocial research examining physiologic as well as cellular adaptations to exercise and outcomes research, 3) promote collaboration of UMB and Johns Hopkins faculty in interdisciplinary aging research and research training, and 4) disseminate OAIC findings to the public and health professionals. OAIC leaders have institutional support for interdisciplinary aging research that supports a cadre of gerontologists to achieve the interdisciplinary research goals of the OAIC. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: CORE--CLINICAL/APPLIED PHYSIOLOGY Principal Investigator & Institution: Katzel, Leslie I.; Associate Professor; University of Maryland Balt Prof School Baltimore, Md 21201

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Timing: Fiscal Year 2002 Summary: (provided by the applicant) The clinical/applied physiology core (RRC-C) will be directed by Leslie l. Katzel, MD, Ph.D. with Andrew R. Coggan, Ph.D., Andrew W. Gardner, Ph.D. and Alice Ryan Ph.D. as core investigators. The specific aims of RRCC are: 1) to perform cardiovascular screening (treadmill exercise testing) of research patients entering IDS 1 and 2, and in the pilot and junior faculty projects that require these measurements; 2) to provide standardized and quality controlled measures of: A) peak aerobic capacity (V02 peak); B) walking economy; C) functional performance; D) physical activity; and E) body composition in patients enrolled in IDS1 and 2, and in other OAIC projects; 3) To determine the effects of exercise training on skeletal muscle histochemistry in stroke patients (IDS1), and in other OAIC patients undergoing exercise rehabilitation; 4) To provide standardized and quality controlled measures of fibrinolysis and other CAD risk factors;5) To train young investigators in geriatrics and gerontology in the performance of applied exercise physiology and metabolism research relevant to the mission of the Pepper Center (collaborative project with RDC); 6) To provide an educational and consultative resource for all investigators interested in aging and exercise at UMB; and 7)To assist other funded NIH and VA investigators in the evaluation of the cardiovascular and metabolic effects of exercise rehabilitation in older patients with CAD risk factors, hip fracture and peripheral arterial disease. The RRC-C will provide a framework to evaluate patients during their exercise rehabilitation interventions of the OAIC. The performance of standardized measures of cardiovascular function, muscle characteristics, body composition, physical activity, and cardiac risk factors in the RRC-C, rather than in the individuals studies improves the accuracy and efficiency of the measurements through the use of personnel trained in the performance of these procedures, and allows the strict maintenance of blinding as critical outcomes measurers are tested. It also eliminates duplicate equipment. Centralization of these measurements should increase the intraclass correlation coefficients of the measurements, decrease the coefficient of variation, enhance data entry, data management and oversight to assure the integrity of the data, and its subsequent analysis by the biostatistics core (RRC-D). The collection of physiologic data and its integration with data collected in the projects and other cores enable comprehensive, multidisciplinary examinations of physiologic factors associated with exercise-induced changes in functional performance, gait biomechanics and quality of life in stroke. The RRC-C will also collaborate with RDC to develop the research skills of junior faculty interested in clinical research and gerontology. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CORE--FUNCTIONAL PERFORMANCE AND NEUROMUSCULAR MECHANISM Principal Investigator & Institution: Smith, Gerald V.; University of Maryland Balt Prof School Baltimore, Md 21201 Timing: Fiscal Year 2002 Summary: (provided by the applicant) The Functional Performance and Neuromuscular Mechanisms Core (RRC-B) provides support for research conducted in University of Maryland, Baltimore (UMB) OAIC studies. The RRC-B enhances Pepper Center goals by applying: 1) instrumented and standardized measures of gait, balance and motor control to measure functional performance changes, and 2) non-invasive brain stimulation and functional imaging methodologies to measure central nervous system (CNS) adaptations to exercise in patients with chronic stroke. RRC-B aims are to: 1. Support the research in the IDSs, selected RDC junior faculty pilot studies, and promote other aging-

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related research at UMB by providing quantitative and standardized measures of gait, balance, strength and motor control; 2. Investigate the effects of repetitive bilateral UE and LE task-oriented training on CNS motor control in hemiparetic stroke patients using novel non-invasive transcranial magnetic stimulation (TMS) and functional magnetic resonance imaging (fMRI). In collaboration with RRC-C studies of muscle mass and metabolism, this will identify the central and peripheral neuromuscular adaptations with treadmill training in IDS-1; 3. Train young investigators, RDC-OAIC awardees, and clinicians in the conduct of human performance and applied neurophysiological research relevant to the mission of the Pepper Center, and the fields of gerontology, neurology, and physical rehabilitation sciences; 4. Provide an educational and consultative resource for UMB investigators interested in pursuing research in aging and neurological rehabilitation; 5. Assist NIH and/or VA-funded investigators at UMB in the performance of rehabilitation research, particularly exercise rehabilitation studies in hip fracture and cortical excitability (RDC pilots, NSA and VA-CDA, NIH R37 MERIT), revascularized PAOD (R01), personal status monitoring of physical activity (VA MERIT) and other relevant rehabilitation research; and 6. Further inter-institutional collaborations in stroke and other rehabilitation research among investigators at UMB, Johns Hopkins University (JHU), the Human Cortical Physiology Section at the National Institutes of Health, Sinai Hospitals and other Pepper Centers. Conduct of laboratorybased and standardized measures of functional performance, cortical and peripheral neuromuscular adaptations in the RRC-B improves the accuracy of these assessments, allows strict maintenance of blinding as critical mechanistic outcomes are determined. and eliminates duplication of expensive testing equipment. Centralization of major mechanistic questions relevant to the IDS-1, IDS-2 and the RDC pilot studies into one core ensures the integrity of the methodologies and analysis. Collection of functional and neurophysiologic data by RRC-B investigators, and subsequent integration with data collected in IDS projects and research resources cores enables a comprehensive, multi-disciplinary examination of mechanistic factors associated with exercise rehabilitation in stroke. The RRC-B provides goal directed organization to precisely identify neuromuscular and cortical mechanisms of functional performance leading to adaptive modes of recovery after stroke and other disabling medical conditions in older populations. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CORE--MEDICAL Principal Investigator & Institution: Williams-Russo, Pamela; Weill Medical College of Cornell Univ New York, Ny 10021 Timing: Fiscal Year 2002 Summary: Geriatric depression is rarely found without at least some medical comorbidity and/or impatient in physical functioning. Not only do these conditions complicate the study of geriatric depression, but evidence from the Developing CRC suggests that they are important indicators of heterogeneity in late life mood disorders and contribute to their outcomes; for example in depressed CRC subjects, medical burden predicts chronicity of depression and delayed recovery is associated with increased mortality. The Medical Core is newly added to the CRC and developed from collaborative relationships between investigators in the Departments of Psychiatry and Internal Medicine at Cornell. Addition of the Medical Core uniquely contributes to the CRC's investigation of heterogeneity of late life mood disorders by rigorous and extensive study of medical illness, functional impairment and depression course and outcome. The Medical Core expands the CRC's resource by providing: 1. funded

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medical investigators with extensive experience conducting longitudinal studies of comorbidity in medical setting patients and having central roles in the CRC; 2. access to a large population of elderly medical patients accustomed to receiving care in a research environment; 3. training and supervision in the administration of carefully selected instruments to assess longitudinal variation in medical morbidity and functional performance; (4) investigations of depression in post-operative depression in subjects enrolled in funded longitudinal studies of coronary bypass surgery and hip fracture repair. The Medical Core will work with the Clinical Core in screening and recruiting elderly patients from primary care settings for assessments and longitudinal follow-up, including subjects with major depression (N=50), minor depression (N=50) and nondepressed. These patients will contribute to the overall CRC database, yielding a sample of depressed elderly subjects ranging widely in severity and type of medical comorbidity and functional status, and followed longitudinally with extensive clinical, neuropsychological and psychosocial ratings. As part of its mission, the Medical Core will take advantage of these data to test cross-core hypotheses concerning the reciprocal relationships of depression and medical illness over time. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CORE--RECRUITMENT AND EPIDEMIOLOGY Principal Investigator & Institution: Kittner, Steven J.; Professor; University of Maryland Balt Prof School Baltimore, Md 21201 Timing: Fiscal Year 2002 Summary: (provided by the applicant) The potential impact of the IDS-1 and IDS-2 stroke interventions and disability among Americans is enormous, and large-scale trials will be needed to test methods designed to maximize independence. The implementation of these trials will require information regarding the generalizability of findings and the potential personal and societal effects of those interventions. RRC-A is designed both to meet the needs of current UM-OAIC projects and to lay the groundwork for future trials. The specific aims of RRC-A are: 1. Support centralized recruitment and evaluation of factors affecting recruitment. 2. Implement interviewbased measures of outcomes, including basic and instrumental activities of daily living, quality of life, and caregiver burden, as well as potential modifiers of that outcome, including comorbidities, mood, cognitive function, social support, and exercise perception. 3.Develop an innovative approach to modeling the potential health care cost savings of interventions that lead to changes in functional status. There is a compelling rationale for including these services in a core rather than in individual projects. Centralized recruitment of stroke patients for both IDS studies is more efficient, allows study of the determinants of recruitment, and can provide strategic consultation regarding recruitment to other studies of chronic disease in older Americans. Centralized performance of interview-based measures will facilitate training, quality control, standardization, and precision of measurements. The inclusion of a healthservices component in this core makes this expertise available not only to the IDS studies, but also to R01 -funded studies of exercise interventions in peripheral vascular disease and hip fracture patients. The RRC-A will also contribute actively to training young geriatrics and gerontology investigators in epidemiology and health-services research, and will provide resources for the conduct of junior-faculty and pilot studies. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: CALCITONIN

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Principal Investigator & Institution: Kopecek, Jindrich N.; Distinguished Professor and Chairman; Pharmaceutics and Pharmaceutl Chem; University of Utah Salt Lake City, Ut 84102 Timing: Fiscal Year 2002; Project Start 01-APR-1995; Project End 31-DEC-2003 Summary: Osteoporosis is a major cause of morbidity and mortality in postmenopausal women. In an United States, an estimated 13% to 18% of women have osteoporosis. The financial burden is substantial, with an estimated yearly cost of $10 billion in the United States alone. The lifetime risk for osteoporotic fractures in Caucasian women 50 years of age is about 30-40%. Between 13-19% of postmenopausal women who have a hip fracture die within the following year. We propose to use a combination of human calcitonin (hCT) and polymer-bound cathepsin K inhibitor (CKI) as a novel treatment of osteoporosis. The rationales for hCT use in osteoporosis therapy are the stimulation of osteoblasts, specific inhibition of bone resorption by osteoclasts, and prevention of fusion of osteoclast precursors. Clinical studies have shown that a significant gain in bone mass can be achieved by administration of CT. An osteoclast-specific cysteine proteinase, cathepsin K, plays a specialized role in the resorption of organic bone matrix. It was shown that cathepsin K inhibitors (CKI) are effective in reducing osteoclastmediated bone resorption both in vitro and in vivo. The binding of CKI to a macromolecular carrier will change the mechanism of CKI internalization by osteoclasts from diffusion (CKI) to endocytosis (polymer-bound CKI). Consequently, the polymerbound CKI will localize in the sealed zones of the ruffled border (resorption lacuna), i.e. exactly in the place where bone resorption mediated by cathepsin K occurs. We hypothesize that the combination of the actions of hCT and CKI will produce cures which cannot be achieved with hCT or CKI alone. Establishing an oral delivery system for hCT and CKI is of great importance because it is expected that for treatment of chronic disorders in non-life threatening situations, such as postmenopausal osteoporosis, parenteral administration will lead to poor patient compliance and thus restricted utility. hCT is an excellent candidate for the development of alternate delivery routes due to its size and wide therapeutic index. The size of CKIs will be modified with semitelechelic poly[(N-2- hydroxypropyl)methacrylamide] (ST-PHPMA) chains to achieve comparable hydrodynamic volumes of CT and of the ST-PHPMA-CK conjugate, which will simplify the design of the delivery system and have beneficial biological consequences. Novel hydrogels were designed in the first period of research; they contain azoaromatic crosslinks, susceptible to degradation by bacterial enzymes in the colon and hydrolyzable side-chains, which control the kinetics of swelling in the small intestine. The structure and properties of biodegradable hydrogels will be optimized. A new macromolecular CKI will be synthesized. Its efficacy will be evaluated in an osteoclast culture in vitro as well as on an animal model in vivo. The effect of combination therapy will be compared with individual therapies. The bioavailability of hCT and ST-PHPMA-CKI conjugates in rabbits and dogs using hydrogel based delivery devices and a penetration enhancer will be determined. The efficacy and biocompatibility of an hCT and CKI delivery device in an animal model of osteoporosis will be studied. Based on in vivo animal data criteria will be studied. Based on in vivo animal data criteria will be established for the design of an oral hCT and CKI delivery system for the treatment of postmenopausal osteoporosis. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: DEPRESSION TREATMENT IN MEDICALLY REHABILITATING ELDERLY Principal Investigator & Institution: Lenze, Eric J.; Psychiatry; University of Pittsburgh at Pittsburgh 350 Thackeray Hall Pittsburgh, Pa 15260 Timing: Fiscal Year 2002; Project Start 01-SEP-2001; Project End 31-AUG-2006 Summary: (provided by applicant): This application requests a Mentored PatientOriented Research Career Development Award (K23). The candidate is a geriatric psychiatrist and postdoctoral research fellow at the University of Pittsburgh who proposes to develop research skills for geriatric psychiatry research in medical rehabilitation settings. Funding of this award would provide time and resources necessary for him to develop into an independent investigator capable of conducting depression intervention studies in elderly patients undergoing rehabilitation after disabling medical events such as hip fracture. Studies of elders undergoing rehabilitation suggest that depression is associated with poorer outcomes and an increased likelihood of permanent disability and institutionalization. Therefore, it would be of tremendous public health benefit to determine the most efficacious interventions for late-life depression in the medical rehabilitation setting. However, little such intervention research has been done, in part because not enough is known about depression in this setting, and in part due the difficulty of carrying out psychiatric Intervention studies in this setting. To perform such research, the candidate will develop skills in the areas of psychiatric assessment of patients in medical settings, design of intervention trials, measurement of rehabilitation outcomes, and data management and biostatistical analysis. Proposed research consists of a longitudinal descriptive study characterizing late-life depression in medical rehabilitation settings, leading to a pilot intervention study assessing effects of depression treatment on rehabilitation outcomes. The proposed activities will take place in the NIMH-funded Intervention Research Center for Late Life Mood Disorders, directed by the candidate's sponsor, in the Department of Psychiatry at the University of Pittsburgh. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: DETERMINANTS OF RECOVERY FOLLOWING HIP FRACTURE Principal Investigator & Institution: Magaziner, Jay S.; Professor; Epidemiology and Prev Medicine; University of Maryland Balt Prof School Baltimore, Md 21201 Timing: Fiscal Year 2002; Project Start 01-SEP-2001; Project End 31-AUG-2005 Summary: Hip fracture is a major public health problem. Results from our previous work demonstrate a 4.6 percent loss of femoral neck bone mineral density (BMD) during the year following a hip fracture; this dramatic loss in BMD is accompanied by notable changes in markers of bone metabolism. The parent project to the proposed ancillary study is a randomized controlled trial of a home-based exercise program intended to minimize losses in BMD, muscle and function following a hip fracture. The proposed ancillary study will evaluate markers of bone metabolism and selected regulating hormones in hip fracture patients who are participating in this intervention study in order to gain a better understanding of the mechanism by which exercise affects bone health during the year following a hip fracture. These markers and hormones also will be evaluated over a one year period in a matched group of non-fracture controls to establish expected levels and changes in markers of bone metabolism among a frail group of older persons who also have low BMD. The primary aims of the proposed study are: 1) to evaluate the role of exercise on bone metabolism following hip fracture by comparing bone metabolism during the year after hip fracture in patients

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randomized to a home-based exercise intervention with patients assigned to usual care, and 2) to separate the effects of hip fracture on bone metabolism from those of aging in similar persons with low BMD by comparing bone metabolism in hip fracture patients receiving usual care with bone metabolism in a matched group of non-fracture controls. These issues will be addressed using data from 170 female hip fracture patients age 65 plus (100 enrolled in the parent study, and an additional 70 hip fracture patients to be recruited for this ancillary study), and 85 age- and mobility-matched non- fracture controls with BMD Less than 0.82g/cm2. Patients are randomized to a year-long, homebased exercise program to begin when post-acute therapy ends, or usual care. As part of the parent study, 100 patients are having BMD measured during their hospital stay, and again at 2, 6, and 12 months, and blood samples for these 100 patients are being taken, processed, and stored. For the ancillary study, this protocol will be extended to include 70 additional hip fracture patients and 85 non- fracture controls, the latter of which will be measured at point of enrollment and 12 months later. For this ancillary study, all blood samples (i.e., those collected on 100 patients in the parent study and those collected on 70 patients and 85 non- fracture controls in the ancillary study) will be assayed to determine levels of four markers of bone metabolism and three regulating hormones. Information of this type will be useful developing interventions to improve bone health and maximize recovery. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: EARLY DETECTION OF FALLS WITH MULTIDIMENSIONAL SENSORS Principal Investigator & Institution: Xue, Shuwan; Integrated Biomedical Systems 17 Lida Dr Essex Junction, Vt 05452 Timing: Fiscal Year 2003; Project Start 01-JUL-2003; Project End 29-FEB-2004 Summary: (provided by applicant): The long-term objective of the project is to develop and commercialize an intelligent fall detector which can detect a fall in its early phase, well before the individual's hip, arm or head hit the ground Unlike any existing fall detectors which detect the fall after the impact, the new detector will be able to trigger a protective mechanism, e g and inflatable hip pads (and/or wrist pads, head pad) to protect the person from injuries due to the fall. The first application of the intelligent fall detection technology will be the Smart HipSaver This device includes the fall detector and the airbag-like inflatable hip pads which are concealed in comfortable and aesthetically appealing underpants The system will provide the elderly and others who are at the risk of falls with the protection against hip fracture, while affording them the freedom to extend their daily activities outside the specially designed hospital or nursing home rooms, such as the smart room, or rooms with dually stiff floor. The system will be expected to receive much higher user acceptance than the existing hip protectors because the inflatable underpants can be made to look and feel much like regular underpants when not inflated. The key to this system is the intelligent fall detector The goals for the fall detector are 1) The detector must be highly reliable in detecting actual falls, 2) the detector must detect a fall in its early phase, and leave sufficient time for any protective mechanisms to be put in place, 3) the detector should not give false alarms during the user's normal activities. In this proposed study (SBIR Phase I) the feasibility of the fall detector will be investigated with an integrated multidimensional sensor, which includes three linear accelerometers, and three angular rate sensors The fundamental requirements of the sensor, data acquisition and computational hardware and software, and most importantly the multi-dimensional event space discrimination algorithms of fall detection will be determined

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Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: EFFECT OF LEG STRENGTHENING EXERCISE AFTER HIP FRACTURE Principal Investigator & Institution: Mangione, Kathleen K.; Physical Therapy; Arcadia University 450 S Easton Rd Glenside, Pa 19038 Timing: Fiscal Year 2003; Project Start 01-JAN-2003; Project End 31-DEC-2004 Summary: (provided by applicant): Hip fracture is a common medical problem that can drastically change the quality of life for the elderly person. More than 300,000 older people are expected to fracture a hip each year at an estimated cost of 5 billion dollars. Interventions have not been identified that successfully return a majority of persons to their prefracture level of function following hip fracture. Muscle weakness, loss of balance and decreased physical endurance remain. These impairments are associated with slowed gait speed, decreased independence in ambulation, and inability to perform simple activities of daily living. Therefore, despite the improvements in medical care, functional recovery has not occurred. The purpose of this study is to examine the effectiveness of high intensity strengthening exercise used in the home setting for patients who sustain hip fracture. Intervention will begin six months after fracture to ensure healing of bone and soft tissue. Strengthening exercises will be performed twice a week for ten weeks and will be directed to the lower extremity muscles because of their role in gait and transfers. A control group will receive placebo intervention to the same muscle groups. Outcomes will be compared between groups after the intervention and one year after fracture. Effectiveness will be assessed using an impairment measure (quadriceps muscle force production), a functional limitation measure (gait speed), and a disability measure (self-reported physical function). Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: EFFECT OF THEAPEUTIC TOUCH ON BONE FORMATION IN POSTMENOPAUSAL WOMEN AFTER WRIST Principal Investigator & Institution: Prestwood, Karen M.; Assistant Professor and Associate Direct; University of Connecticut Sch of Med/Dnt Bb20, Mc 2806 Farmington, Ct 060302806 Timing: Fiscal Year 2002; Project Start 01-JUL-2001; Project End 30-JUN-2002 Summary: (provided by applicant): Therapeutic touch is a contemporary interpretation of several ancient healing arts developed in the 1970?s by Dolores Krieger, PhD, RN and Dora Kunz, a well known healer. Therapeutic touch is the probably the best researched form of biofield or energy medicine and has been shown to be effective in a wide variety of diseases. Osteoporosis is a common disease in older adults that may result in increased disability or mortality, especially in women or men with spine or hip fractures. Over 50% of women who fracture a hip do not return to pre-fracture function and those with vertebral fractures frequently suffer from chronic pain and associated disability. Anecdotal experiences and unpublished data suggest that therapeutic touch may speed fracture healing and functional recovery after fracture, although this has not been well studied. If therapeutic touch is beneficial to fracture recovery then its use might become an important part of fracture treatment. Serum and urine biochemical markers have been used in the diagnosis and to monitor treatment in metabolic bone disease for many years. Individual markers reflect bone resorption and bone formation and these measures have been shown to be associated with more invasive and cumbersome measures of bone remodeling. Although studies evaluating the use of

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markers after fracture are not well controlled, they suggest that bone formation decreases immediately after fracture then gradually increases and finally returns to the normal range at 6 months to 1 year after fracture. Persons with slower healing fractures have a more gradual rise and more prolonged increase in bone formation markers over time. To begin to examine the overall hypothesis that therapeutic touch may affect fracture healing, we propose to first look at the effect of therapeutic touch on markers of bone formation (and resorption) over time in women who have suffered a recent wrist fracture. We hypothesize that therapeutic touch will prevent the immediate decrease and will result in a more rapid rise and a faster return to normal values of markers of bone formation after fracture, compared to sham therapeutic touch. We will examine the effect of 3 different therapeutic touch treatment courses (or doses) on bone formation and hypothesize that any of the doses of therapeutic touch that we are testing will alter bone formation after fracture, compared to sham therapeutic touch, but that women who receive the highest dose will have the greatest response. We also hypothesize that stimulation of bone formation by therapeutic touch will be associated with altered levels of insulin-like growth factor I and binding protein 3. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: EFFECTS OF SOMATOKINE IN MYOTONIC DYSTROPHY TYPE 1 Principal Investigator & Institution: Moxley, Richard T.; Professor; University of Rochester Orpa - Rc Box 270140 Rochester, Ny 14627 Timing: Fiscal Year 2003; Project Start 30-SEP-2003; Project End 31-MAY-2008 Summary: These phase 1 studies examine a possible new treatment for myotonic dystrophy type1 (DM1), the most common form of adult muscular dystrophy. At present no treatment exists to reverse its progressive wasting and weakness. Low levels of testosterone and growth hormone, as well as insulin resistance, appear to contribute to the muscle loss, but therapeutic trials to reverse these hormonal abnormalities have failed to produce significant improvement. A previous trial of insulin-like growth factor1 [IGF1] has offered promise. Treatment with rhlGF1 increased strength, protein synthesis, and insulin action in 7 patients but side effects caused 2 to drop out. A new, better tolerated, longer acting, preparation of rhlGF1, is now available from INSMED. It is SomatoKine, rhlGF1 in complex with recombinant human IGF binding protein 3, and it will be used in this proposal. Preliminary studies show it is safe and well tolerated in healthy adults, diabetics, and older women treated after hip fracture. We will evaluate SomatoKine in DM1. The aim of this proposal is to evaluate the safety and feasibility of daily subcutaneous injections of SomatoKine for treatment of muscle wasting and weakness by performing two sequential studies, each involving 15 patients with DM1: 1st) An initial 24-Week Dose Escalation Study of SomatoKine [0.5, 1.0, and 2.0 mg/kg, with each dose given daily for 8 weeks] to identify an "optimal dose" based upon the side effects, drug levels, and efficacy [dual energy x-ray absorptiometry (DEXA); quantitative myometry; manual muscle strength testing] observed at each dose; 2nd) A subsequent 24-Week study of SomatoKine using an "Optimal Dose" to demonstrate its safety and feasibility as a daily treatment for a six month period. In addition, we will search for evidence of altered signaling along the intracellular pathway for IGF1 by measuring phosphorylation of p70S6K in needle muscle biopsy specimens obtained from 10 DM1 patients in the 24-Week "Optimal Dose" SomatoKine Study and from 10 age-gender matched normal volunteers who will receive SomatoKine for only two days. Specimens will be obtained from vastus lateralis muscle before and after two days of "optimal dose" treatment. These studies will test our hypothesis that supraphysiologic levels of IGF1 are safe and well tolerated and provide preliminary data regarding

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efficacy (reversal of muscle wasting and weakness.) If the results of this project prove promising, we plan to carry out a larger, multi-center, phase 2, controlled trial of SomatoKine. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: ENDOSTEAL BONE VOLUME REGULATION AND OSTEOPOROSIS Principal Investigator & Institution: Mohan, Subburaman; Research Professor; Loma Linda Veterans Assn/Research Educ C/O Research Service (151) Loma Linda, Ca 92357 Timing: Fiscal Year 2002; Project Start 01-AUG-1981; Project End 30-JUN-2007 Summary: (provided by applicant): The long-term goal of this project is to identify the molecular mechanisms responsible fur the pathogenesis of senile osteoporosis. Because impaired bone formation (BF) is a major contributor to this disease, and because of the importance of the IGF system in the regulation of BF, our studies have focused towards identifying the role of individual IGF system components in the regulation of BE. In this regard, studies during the past grant period have revealed that: (1) IGF binding protein5 (BP-5) could increase BE via a mechanism independent of IGFs (i.e. BP-5 is a growth factor); and (2) BP-5 could function as a physiologic regulator of BF, and that low serum BP-5 could play a pathogenic role in hip fracture patients. In order to define the role of BP-5 as a BE regulator, we need to understand the molecular mechanisms controlling the level of BP-5 and the molecular pathways involved in BP-5 action in bone. To this end, we have made two exciting and pivotal discoveries which form the basis for the continuation studies proposed in this application: (1) ADAM-9 (A Disintegrin And Metalloprotease) is an BP-5 protease in osteoblasts (OBs); and (2) FHL2 (Four and a Half LIM Domain) interacts with BP-5 in OBs. ADAM-9 and FHL2 are newly discovered proteins and relatively little is known about any aspects of these proteins in bone. Studies proposed in Specific Aim 1 deal with the role of ADAM-9 in OBs and these studies are based on the hypothesis that degradation of BP-5 by ADAM-9 is a key control mechanism in regulating BP-5 concentrations in the conditioned medium (and perhaps serum) and, thereby, osteoblast proliferation/differentiation. To this end, we will express recombinant ADAM-9 and test whether purified recombinant ADAM-9 cleaves BP-5 but not other IGFBPs. To evaluate if ADAM-9 is the predominant BP-5 protease, we will perform immunodepletion experiments with antibodies specific to ADAM-9 in the conditioned medium of human OBs. To determine if ADAM-9 is regulated, we will test the effect of osteoregulatory agents, known to modulate BP-5 proteolysis, on synthesis and activity of ADAM-9. To evaluate the functional role of ADAM-9, we will modulate expression of ADAM-9 in human OBs by transgenic approaches using MLV vectors and determine the consequence of changes in ADAM-9 expression on BP-5 proteolysis and BF parameters in vitro. Studies proposed in Specific Aim 2 deal with the role of FHL2 in OBs, and these studies are based on the hypothesis that FHL2 interacts with BP-5 and mediates IGF-independent actions of BP-5 in OBs. To test if BP-5 binds to FHL2 and shuttles it to the nucleus, we will over-express wildtype/nuclear localization sequence mutated BP-5 along with FHL2 fused to different fluorescent proteins and use a fluorescent energy transfer technique to monitor interactions between FHL2 and BP-5. To evaluate the significance of BP-5 interaction with FHL2, we will test the effects of BP-5 on bone formation parameters in mice lacking functional FHL2. We will also evaluate the BP-5 functional pathway by applying the ProteinChip Arrayer to determine if the complex of BP-5/FHL2 binds to other proteins in the nucleus of OBs. Successful completion of the proposed studies will provide information on the molecular pathways involved in the regulation of the BF process, which will eventually lead to better understanding the pathogenesis of why some

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people have impaired BF during aging, and suggest treatment options to correct BF deficiency in those patients. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: ESTROGEN REGULATION OF OSTEOCLASTOGENESIS IN OLDER MEN Principal Investigator & Institution: Taxel, Pamela; Medicine; University of Connecticut Sch of Med/Dnt Bb20, Mc 2806 Farmington, Ct 060302806 Timing: Fiscal Year 2003; Project Start 01-JUL-2003; Project End 30-JUN-2005 Summary: This R03 proposal is in response to Research Objective #17, entitled Basic Underlying Mechanisms of Musculoskeletal Aging. Male osteoporosis and hip fractures, primarily diseases of older men, have been poorly studied until recently. While there are numerous factors that cause osteoporosis and determine fracture risk, decreases in gonadal steroids with aging are known to influence bone metabolism in both men and women. Recent evidence has demonstrated the importance of estrogen (E2) in male bone health. E2 exerts a variety of important physiological effects, which are mediated via two estrogen receptors found in adult bone, although the mechanisms by which they interact is not well understood. In preliminary work we have found that ovariectomy in mice is rapidly followed by an increase in the ability of bone marrow cells to differentiate into osteoclasts, the cells that mediate bone resorption. This finding suggests that E2 regulates the ability of hematopoietic precursor cells to differentiate into osteoclasts, a process that has not been adequately examined. The studies of this proposal represents a collaboration between basic and clinical researchers who wish to determine if human bone marrow cells from older men respond to E2 in a manner similar to that which we have demonstrated in our murine model. Since increased rates of bone resorption appear to be the earliest known effects of estrogen withdrawal on the human skeleton, a better understanding of this process may lead to more effective therapies for the treatment of osteoporosis in both men and women. A unique model in which to better understand the role of E2 in men is that of men undergoing hormonal suppression with LHRH agonists for locally advanced prostate cancer. This therapy leads to hypogonadism, with both low testosterone (T) and E2 levels within a few weeks. Since E2 therapy has been previously used to achieve medical castration, adding back E2 in these men is acceptable and allows the study of the mechanisms of E2 action on bone without the simultaneous influence of T. As the mechanisms of E2 action on male bone metabolism are better understood, it should be possible to analyze these interactions more precisely and develop more specific interventions based on a better understanding of these interactions. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: EVALUATION OF OSTEOPOROSIS PREVENTION IN THE ELDERLY Principal Investigator & Institution: Tosteson, Anna N A.; Associate Professor; Community and Family Medicine; Dartmouth College 11 Rope Ferry Rd. #6210 Hanover, Nh 03755 Timing: Fiscal Year 2002; Project Start 05-JAN-1995; Project End 31-AUG-2007 Summary: (provided by applicant): The broad objective of this research proposal is to improve the health of elderly men and women by identifying more effective osteoporosis prevention and treatment strategies. Osteoporosis disproportionately affects the elderly and is associated with fractures that result in disability, death, and a large expenditure of health care resources. A growing number of interventions are

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available to prevent, diagnose, and treat osteoporosis. Cost-effective use of most such interventions requires selective targeting of high-risk populations, yet our previous research documents significant variation in clinical outcomes, cost, and intervention acceptance even among those at highest risk. Thus, the public health benefit of these interventions has yet to be fully realized. We hypothesize that this shortfall stems from multiple patient, provider and health system factors whose contribution to treatment and outcome variation is not yet understood. The proposed extension of AG 12262 entails four aims that will provide new information concerning variation in osteoporosis treatment and outcome. First, through surveys of patients and their healthcare providers, we will identify opportunities to improve intervention among elderly persons who have sustained a fracture; and will characterize correlates of long-term treatment continuation. Second, we will extend our study of fracture outcomes to a national sample to identify the patient, provider and health system attributes that contribute to variation in cost and adverse health outcomes. Third, we will develop a discrete state/event microsimulation model incorporating data from the first two aims to assess the cost-effectiveness of alternative osteoporosis interventions. This aim will also provide guidance to those planning future osteoporosis outcome studies through analyses addressing the correspondence between preference-based health outcomes measures and an osteoporosis-targeted health status instrument. Fourth, we will study the use of the microsimulation model as a tool for synthesizing evidence in patientcentered osteoporosis decision aids. Our proposed research will provide results useful in guiding both osteoporosis-related health policy and patient-centered decision making. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: EXERCISE--ADJUNCT THERAPY TO ESTROGEN IN OLDER WOMEN Principal Investigator & Institution: Dalsky, Gail; University of Connecticut Sch of Med/Dnt Bb20, Mc 2806 Farmington, Ct 060302806 Timing: Fiscal Year 2002 Summary: The central theme of this intervention development study is that regular exercise should be an adjunct therapy for older women to reduce the incidence of hip fracture. One out of every three white women 85 years and older are likely to experience a hip fracture, which leads to a loss of independence and a lower functional capacity. The primary approach for hip fracture prevention has been replacement estrogen. The long- range goal of implementing exercise as an adjunct therapy is to extend the time of first hip fracture by 5-10 years, resulting in a potential 30-50% reduction in hip fracture. The purpose of this intervention development study is to study the effects of participation in a three- year home-based exercise regimen for 105 women 65-78 years of age on risk factors related to bone and falling. An unique aspect of this study is that the volunteers will be long-term users of estrogen replacement therapy who have femoral neck bone mass >1 SD below the young adult level. The primary hypothesis to be tested is that women aged 65-78 years who are current users of estrogen replacement therapy and have low femoral neck bone mineral density will maintain sufficient compliance and retention in a 3 year home-based aerobic exercise and resistance training program to reduce risk factors regarding bone quantity and quality for osteoporosis, and falls. The specific aims to test this hypothesis are: 1) To evaluate the effectiveness of 3 year homebased exercise intervention on bone mass and geometric properties of the proximal femur. 2) To evaluate the effectiveness of home-based exercise intervention to improve formation relative to resorption, as evaluated by biochemical markers of bone

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metabolism. 3) To evaluate the effectiveness of home-based exercise intervention on risk factors for falls (balance, muscular strength and endurance, gait, lean body mass). A multivariate repeated measures factorial analyses of variance will be done to determine changes in the outcome measures as influenced by the determinants of bone mass. This proposal will establish an exercise regimen that may be implemented as an adjunct therapy to estrogen in older women to preserve or improve bone strength to delay the onset of first hip fracture. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: FALL BIOMECHANICS AND HIP FRACTURE RISK Principal Investigator & Institution: Hayes, Wilson C.; Professor; Exercise and Sport Sciences; Oregon State University Corvallis, or 973391086 Timing: Fiscal Year 2002; Project Start 01-FEB-1994; Project End 31-MAY-2005 Summary: (Verbatim from the application) Falls and fall-related injuries are the most serious, common costly medical problems facing the elderly. In the US each year there are about 30 millions falls, or about 1 per second, among 10 million fallers. In addition, of the approximately 300,000 hip fractures that occur each year, over 90% are associated with falls. We have shown previously that falls to the side with impact on the hip are associated with more than 20-fold increase in the risk of hip fractures (compared to a 3fold increase in risk associated with reduced bone density). Thus, when screening for interventions and fracture prevention programs (pharmaceutical agents, trochanter padding or exercise), it is far less cost effective and efficient from a public health perspective to attempt to identify the 10 million elderly who will fall each year (which can now be done using relatively simple field tests) than it is to focus on the 500,000 to 600,000 elderly subjects who will fall to the side (for which comparable validated tests are not yet available). The aims of this competitive renewal application are focused on this goal. During the previous funding period, we completed the goals of Aim 1: Dynamics of Side Falls, demonstrating that slow gait speed and the postural disturbances of slipping or fainting are associated with falls to the side and impact on the hip. We have also developed the first available multi‑segment, whole body model for falling and showed it to be a powerful tool for studying the biodynamics of falling to the side. For our previous Aim 2: Side Fall Risk Index, we completed both the development and refinement phases of the proposed index, demonstrating that a linear combination of tandem gait, hip abduction strength, step velocity asymmetry from the quick-step test, and sway variables while standing in a semi-tandem position could be used to distinguish elderly subjects who fell to the side from those who fell in all other directions. Under our new proposed Aim 1: Validation of Side Fall Risk Index (SFRI), we will determine whether the Side Fall Risk Index we have developed during the previous funding period can be used prospectively to identify elderly subjects who will fall to the side. As an extension of our previous work on the dynamics of side falls, under Aim 2: Gait Variability as a Predictor of Side Falls we will analyze the ground pressure time histories of elderly fallers ambulating on an instrumented mat. We will apply modern signal analysis theory to the ground pressure time histories. Using chaos theory and fractal analysis and noting that cardiovascular and neuromuscular pathologies are characterized by increased regularity of heartbeat and gait, respectively, we will determine if gait parameters determined from ground pressure time histories can be used to identify frail elderly subjects who fall to the side. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: FOCUS Principal Investigator & Institution: Carson, Jeffrey L.; Richard C. Reynolds Professor of Medicin; Medicine; Univ of Med/Dent Nj-R W Johnson Med Sch Robert Wood Johnson Medical Sch Piscataway, Nj 088545635 Timing: Fiscal Year 2003; Project Start 01-SEP-2003; Project End 31-AUG-2008 Summary: (provided by applicant); Red blood cell transfusions are an extremely common medical intervention in both the United States and worldwide; over 11 million units are transfused in the United States. Between 60% and 70% of all blood is transfused in the surgical setting. Despite the common use of red blood cell transfusions, the threshold for transfusion has not been adequately evaluated and is very controversial. A decade ago the standard of care was to administer a peri-operative transfusion whenever the hemoglobin (Hgb) level fell below 10 g/dl (the "10/30 rule"). Concerns about the safety of blood, especially with respect to HIV and hepatitis, and the absence of data to support a 10 g/dl threshold led to current standard of care today to administer blood transfusions based on the presence of symptoms and not a specific Hgb/hematocrit level. However, there are no randomized clinical trials in surgical patients that have tested the efficacy and safety of withholding blood until the patient develops symptoms or the "10/30" approach to transfusion. Patients with underlying cardiovascular disease are at greatest risk of adverse effects from reduced Hgb levels. We propose to conduct a multi-center randomized trial to test if a more aggressive transfusion strategy that maintains postoperative Hgb levels above 10 g/dl improves patient outcome as compared to a more conservative strategy that withholds blood transfusion until the patient develops symptoms of anemia. Eligible patients for the trial will have undergone surgical repair for a hip fracture and have a postoperative Hgb level below 10 g/dl within three days of surgery. Only patients with cardiovascular disease will be entered into the study. Patients will be randomized to one of the two transfusion strategies. The 10 g/dl threshold strategy will use enough red blood cell units to maintain Hgb levels at or above 10 g/dl through hospital discharge. Symptomatic transfusion strategy patients will receive red blood cell transfusions for symptoms of anemia, although transfusion is also permitted but not required if the Hgb level falls below 8 g/dl. Outcomes will include functional recovery (primary outcome: ability to walk ten feet across a room without human assistance at 60-days postrandomization), long-term survival, nursing home placement, and postoperative complications (death in hospital or within 30 days, pneumonia, myocardial infarction, thromboembolism, stroke, delirium). We will randomize 2,600 patients from 25 centers over a 3.5-year period. This will allow us to detect a 16% relative risk reduction in the loss of ability to walk independently with power about 0.90. A pilot study in 84 patients demonstrated the feasibility of the study. Ambulation at 60 days is known to be highly predictive of ultimate functional outcome as well as of mortality at one year. Because inability to walk again has such important implications for quality office, and because, unfortunately, it is a common problem, it far outweighs the remote chance of viral infection or other complications from transfusion in these elderly patients. Also, this study will measure the frequency and 95% confidence intervals of the medical errors that are important in this patient population and are poorly documented in the literature. The medical errors that will be measured are: transfusion errors (blood transfusion to the wrong patient, mislabeling of samples for type and cross match, use of whole blood instead of packed red cells), failure to use thromboembolism prophylaxis, incorrect antibiotic prophylaxis, wrong site surgery and femoral shaft fracture. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: FOCUS DATA COORDINATING CENTER Principal Investigator & Institution: Terrin, Michael L.; President; Maryland Medical Research Institute, Inc 600 Wyndhurst Ave Baltimore, Md 21210 Timing: Fiscal Year 2003; Project Start 10-JUL-2003; Project End 30-JUN-2008 Summary: (FROM THE APPLICATION): Over 11 million units are transfused in the United States. Despite the common use of red blood cell transfusions, the threshold for transfusion has not been adequately evaluated. A decade ago the standard of care was to administer a peri-operative transfusion whenever the hemoglobin level fell below 10 g/dl (the "10/30 rule"). Concerns about the safety of blood, especially with respect to HIV and hepatitis, and the absence of data to support a 10 g/dl threshold led to current standard of care to administer blood transfusions based on the presence of symptoms and not a specific hemoglobin/hematocrit level. However, there are no randomized clinical trials in surgical patients that have tested the efficacy and safety of withholding blood until the patient develops symptoms or the 10/30 approach to transfusion and limited evidence for patients with underlying cardiovascular disease are at greatest risk of adverse effects from reduced hemoglobin levels. We propose to conduct a multicenter randomized trial to test if a more aggressive transfusion strategy that maintains postoperative hemoglobin levels above 10 g/dl improves patient outcome as compared to a more conservative strategy that withholds blood transfusion until the patient develops symptoms of anemia. Patients eligible for the trial will have undergone surgical repair for a hip fracture and have a postoperative hemoglobin level below 10 g/dl within three days of surgery. Only patients with cardiovascular disease will be entered into the study. Symptomatic transfusion strategy patients will receive red blood cell transfusions for symptoms of anemia, although transfusion is also permitted but not required if the hemoglobin level falls below 8 g/dl. Outcomes will include functional recovery (primary outcome: ability to walk ten feet across a room without human assistance at 60-days post-randomization), long-term survival, nursing home placement, and postoperative complications (death in hospital or within 30 days, pneumonia, myocardial infarction, thromboembolism, stroke). We will randomize 2,600 patients over a 3.5-year period to detect a reduction in the loss of ability to walk independently from 43% to 36% (16% relative risk reduction) with power about 0.90. Also, this study will measure the frequency and 95% confidence intervals of the medical errors that are important in this patient population. The medical errors that will be measured are: transfusion errors (blood transfusion to the wrong patient, mislabeling of samples for type and cross match, use of whole blood instead of packed red cells), failure to use thromboembolism prophylaxis, incorrect antibiotic prophylaxis, wrong site surgery, and femoral shaft fracture. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: GENETIC ANALYSIS OF HIP FRAGILITY Principal Investigator & Institution: Turner, Charles H.; Professor; Orthopaedic Surgery; Indiana Univ-Purdue Univ at Indianapolis 620 Union Drive, Room 618 Indianapolis, in 462025167 Timing: Fiscal Year 2003; Project Start 04-APR-2003; Project End 31-MAR-2008 Summary: (provided by applicant): Genetic influences account for the majority of the population variance in bone mineral density and bone fragility. Considering that hip fracture is the most expensive of osteoporotic fractures, both in terms of health care cost and in human costs (i.e., morbidity and mortality), there should be considerable interest in an animal model for studying genetic influences on hip fragility. We recently

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identified two strains of rats, Copenhagen 2331 (COP) and DA, which have considerable variation in the biomechanical properties of their femoral necks. We propose to use these rat strains to identify genes responsible for the variation in hip fragility. We will test three hypotheses: (1) COP and DA rats reach peak femoral neck strength and bone mass at six months of age. Our goal is to determine genetic influences on the biomechanical properties and bone structure at an age when femoral neck strength is at its peak. Sprague-Dawley rats achieve peak bone mass and strength within a window of 5-9 months of age. Presumably, COP and DA strains follow similar skeletal growth curves. We will measure femoral biomechanical properties, geometry and microstructure in rats ranging from 2 to 10 months of age to determine the age associated with peak values; (2) chromosomal regions harboring genes that regulate femoral neck strength and microstructure can be determined for rats. COP and DA progenitor rats will be mated and their F1 hybrid offspring intercrossed to create an F2 population containing 500-600 individuals. These rats will be phenotyped based upon femoral neck biomechanical, geometrical and microstructural measurements. Quantitative trait loci (QTL) analyses will be performed to identify the genetic loci influencing variation phenotypes. We anticipate that these analyses will identify several QTLs containing genes that influence femoral neck fragility; and (3) femoral shaft and neck fragility are regulated, at least in part, by different genetic loci. The COP x DA F2 population will be further characterized for bone fragility at the femoral midshaft QTL analyses will be performed to identify the genetic loci contributing to the variation in the phenotypes. We anticipate that these analyses will identify some QTLs previously linked to femoral neck fragility in Aim 2, as well as novel QTLs specifically influencing femoral shaft phenotypes. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: GENETIC REGULATION OF IGF-I IN PEAK BONE DENSITY OF MICE Principal Investigator & Institution: Rosen, Clifford J.; Director; Jackson Laboratory 600 Main St Bar Harbor, Me 04609 Timing: Fiscal Year 2002; Project Start 22-JUL-1998; Project End 31-MAY-2005 Summary: Insulin-like growth factor- I (IGF-I) is a ubiquitously expressed 7.5 kDa polypedtide that circulate in relatively high concentrations. In bone, IGF-I is secreted by osteoblasts, and is stored in the matrix bound to IGF binding proteins (IGFBPs). Skeletal IGF-I promotes osteoblast differentiation, increasing collagen biosynthesis and mildly enhancing bone cell mitogenesis. Reduced serum IGF-I concentrations have been linked to lower skeletal levels of this peptide, future risk of hip fracture, histomorphometric indices of bone formation, bone mineral density, and a poly-morphism in the IGF-I gene. Hence serum IGF-I has been considered an intermediate skeletal phenotype. In the first three years of our proposal, using inbred strains of mice have established: 1) serum IGF-I is a heritable polygenic train; 2) three major non-growth hormone dependent quantitative trait loci (QTLs) and one interactive QTL influence the serum IGF-I phenotype; 3) two IGF-I QTLs associate with major skeletal phenotypes (BMD and femoral length); 4) one QTL contains the IGF-I gene and the interactive QTL maps in close proximity to the IGFBP-3 gene; 5) congenic mice carrying one of these major QTLs exhibit reduced serum IGF-I and a major skeletal phenotype; and 6) osteoblasts from high serum IGF-I mice (C3H/HeJ) show a sixfold up-regulation in IGF-I exon 1 promoter mRNA compared to the low serum IGF-I mice (C57BL/6). These data suggest that IGF-I is important for the acquisition of BMD and optimal strength. In this proposal we hypothesize that serum IGF-I genes are also major determinants of skeletal IGF-I

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expression. Our goals are to fine map these IGF-I regulatory genes and to understand how these genes affect osteoblast function and bone morphology. We propose three specific aims: 1) to delineate the genes for serum IGF-I by fine mapping and assessing nested congenics for changes in BMD and strength; 2) to determine the role of IGFBPs in modulating skeletal IGF-I by studying osteoblast expression and secretion of IGFBPs and by phenotype 'rescue' of newly developed congenics through targeted over expression of skeletal IGF-I; and 3) to determine the molecular mechanisms responsible for interstrain differences in skeletal IGF-I expression. These experiments will provide tremendous insight into the cellular regulation of the IGFs and IGFBPs, an important first stem towards understanding the role of IGF-I in osteoporosis and other chronic disease wherein tissue specific IGF-I activity may have a major pathophysiologic component. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: GENETICS OF BONE LOSS AND BONE STRENGTH IN MEN AND WOMEN Principal Investigator & Institution: Peacock, Munro; Professor; Indiana Univ-Purdue Univ at Indianapolis 620 Union Drive, Room 618 Indianapolis, in 462025167 Timing: Fiscal Year 2002 Summary: Osteoporotic fracture is due to age-related reduction in bone strength. Bone strength comprises bone mineral density, structure, quality and turnover, all of which are highly heritable. The most serious osteoporotic fracture occurs at the hip. Reduction in hip bone strength is due to a combination of low peak bone mass and age-related bone loss. Heritability of bone mass at the hip is high, but heritability of bone loss at the hip has not been studied. Women have lower bone strength and higher incidence of hip fracture than men. In men, heritability of bone strength has not been firmly established. Heritability of bone strength has been measured in 760 pairs of sisters, and a 10 cM genome screen has identified several chromosomal loci influencing bone strength. Two hypotheses will now be tested: 1. The rate of bone loss at the hip in women is genetically determined. This will be tested by remeasuring hip bone mass in 500 pairs of sisters in our current study and, if heritable, perform linkage analysis using genotypic already generated. 2. The genetic effect on bone strength in men is similar to that in women, but certain loci are sex specific. This will be tested by measuring bone strength in 700 pairs of brothers, comparing heritabilities to those in our 760 of sisters, and performing a genome screen to identify loci influencing bone strength in men. Three major goals in understanding the genetic basis of bone strength will be achieved: 1) establish if the rate of bone loss at the hip in women has a genetic component, and if so, localize the genes that underlie the loss; 2) establish heritabilities of bone strength in men and compare these with those established in women; 3) enrich our database for fine mapping bonestrength genes and establish if certain loci are sex specific. This information will lead to a much better understanding of the causes of osteoporotic hip fracture and of the difference in incidence between men and women and, ultimately, to new therapeutic and preventative treatments. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: GROWTH HORMONE W EXERCISE STRENGTH IN 60+ YR OLD MEN & WOMEN?

INCREASE

MUSCLE

Principal Investigator & Institution: Zachwieja, Jj; Washington University Lindell and Skinker Blvd St. Louis, Mo 63130

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Timing: Fiscal Year 2002 Summary: Advancing age is associated with a reduction in skeletal muscle protein and muscle force production capabilities; a syndrome referred to as sarcopenia. This process occurs in healthy, normal aging, but is accelerated by physical inactivity, degenerative or other disease conditions. Incorporation of 13C-leucine into skeletal muscle protein, as measured by isotope dilution mass spectrometry, provides a measure of muscle protein synthesis. Decreased muscle mass and strength are associated with an increased risk of falling, and therefore, increased risk for hip fracture. Reduced muscle strength with aging can also result in physical disability and frailty, a loss of independent function, and contributes to escalating health care costs. The biological consequences of advancing age and the progressive decline in physical activity with age contribute to sarcopenia. Exercise training programs have the potential to improve overall fitness, muscle force generation, and imp rove quali ty of life. The physiological and functional benefits of increased muscular activity have been reported, even into the 9th decade of life (1). Thus, human skeletal muscle protein maintains the ability to respond to an exercise-induced increase in contractile activity throughout. The ability to adapt may be limited by other biological processes. Circulating concentrations and the pulsatile release patterns of several hormones that regulate metabolism are reduced with age. By virtue of their anabolic actions on body proteins, low serum growth hormone (GH), testosterone, dehydroepiandrosterone (DHEA), and perhaps estrogen, along with reduced insulin action, have all been implicated as mediators of the muscle protein wasting aging. We review the efficacy of recombinant human growth hormone (rhGH) replacement therapy and resistance exercise training to enhance muscle protein mass and contractile force output in elderly (62+ yr old) men and women. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: HEALTH CONCORDANCE IN OLDER MEXICAN AMERICAN COUPLES Principal Investigator & Institution: Peek, Mary K.; Preventive Medicine and Community Health; University of Texas Medical Br Galveston 301 University Blvd Galveston, Tx 77555 Timing: Fiscal Year 2003; Project Start 01-JUL-2003; Project End 30-JUN-2006 Summary: (provided by applicant): Individuals who are married tend to have lower mortality, morbidity, and better mental health. The potential protective effect of marriage on both physical and mental health is of particular importance to older couples as the number of older married adults rises and mortality rates continue to decrease. However, there is very little information on the connection between the health statuses of older married couples. The similarity between health of spouses, or "concordance" can be of particular importance if the deterioration in the health of one spouse is associated with the deterioration in the health of the other spouse. One way to address concordance is to examine the connection between one spouse's health events and the other spouse's health outcomes. To address the association between spouses' health more extensively, we intend to examine the potential influence of physical functioning and health events in one spouse on the health of the other spouse over a 2-5 year time period in older Mexican American adults. The specific aims of the study are: (1) to examine the relationship between the presence of major health events (myocardial infarction, stroke, cancer, and hip fracture) in one spouse and depressive symptoms and lower body mobility of the other spouse; (2) to assess the connection between physical functioning (e.g., I/ADL disability) in one spouse and depressive symptoms and lower body mobility of the other spouse; and (3) to investigate the association of mortality of

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one spouse with depressive symptoms and lower body mobility of the other spouse. As a secondary aim, we will explore the possibility that social support and acculturation modify the relationship between spouses' health statuses in older Mexican Americans. We will be examining these specific aims in 553 married couples from the ongoing Hispanic Established Populations for Epidemiologic Studies of the Elderly (H-EPESE). One of the benefits of examining concordance in spouses' health in older Mexican Americans lies in their health profiles (mortality rates similar to older White adults but higher rates of certain diseases and disability). Structural equation modeling will be used for model estimation on three waves of data (1993-94 -1998/9.) Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: HIP OSTEOPOROSIS

RADIOGRAPHS:

NOVEL

METHOD

TO

DIAGNOSE

Principal Investigator & Institution: Arnaud, Claude D.; Professor Emeritus; Imaging Therapeutics, Inc. 1720 S Amphlett Blvd, St 240 San Mateo, Ca 94402 Timing: Fiscal Year 2003; Project Start 01-SEP-2003; Project End 28-FEB-2004 Summary: (provided by applicant): This Small Business Innovation Research Phase I project is designed to develop techniques for the diagnosis of osteoporosis and for assessing fracture risk by quantifying trabecular structural elements in hip x-rays. Osteoporosis is a public health threat for 44 million women in the United States alone. The inability to identify persons at risk for the disease is a major impediment in dealing with this epidemic. In fact, less than 30% of persons with osteoporosis are aware that they have it. This is due to the high cost and resulting small installed base of commercially available osteoporosis testing systems. Imaging Therapeutics Inc. proposes to develop technology for low-cost bone structural analyses by linking readily available x-ray equipment to novel image analysis algorithms. While measurements of bone mineral density (BMD) are easy to perform and are helpful in determining when to intervene therapeutically, low BMD accounts for only a portion of fracture risk. Progressive disruption of trabecular structure contributes the better part of the remainder of that risk. The aims of this proposal are: 1) To develop new image processing techniques for automated measurement of 2D-trabecular bone structural elements in hip radiographs. 2) To determine the influence of x-ray beam angulation, soft-tissue attenuation and radiographic technique on radiographic measurements of bone structure. 3) To determine the clinical validity of those 2 D measurements in vitro by a) comparing them, in cores of cadaver proximal femora, to similar measurements made using 3D micro CT and b) determining if they correlate significantly with biomechanical failure loads and stiffness. 4) To directly apply the technology developed in Phase I of this proposal to a series of clinical trials that will be developed for Phase II to prove the clinical utility of that technology in the diagnosis of osteoporosis and prediction of osteoporotic fracture. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: HOSPTIAL STAFFING, PHYSICAL RESTRAINT & PATIENT OUTCOMES Principal Investigator & Institution: Sullivan-Marx, Eileen; None; University of Pennsylvania 3451 Walnut Street Philadelphia, Pa 19104 Timing: Fiscal Year 2002; Project Start 01-SEP-2000; Project End 31-AUG-2004 Summary: The use of physical restraints with frail older adults is associated with increased risk for serious injuries and accidental death, as well as contributing to

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negative patient outcomes. Yet, the use of physical restraints with frail older adults in hospitals persists. This study examines the impact of hospital organizational context and nurse staffing on restraint use and associated patient outcomes. Data on restraint use for hip fracture patients in hospital will be merged with American Hospital Association Annual Hospital Survey data on hospital characteristics and nurse staffing and extensive organizational data from surveys collected in several NINR-funded studies by Penn's Center for Health Outcomes and Policy Research. It is hypothesized that hospital nurse staffing and organization affect the rate of physical restraint use, and that such use is associated with poorer outcomes at discharge. My research to date has focused on patient characteristics associated with physical restraint. In order to achieve my long term goal to be an independent investigator in outcomes research regarding care of frail older adults. I need advanced training and mentoring in the requisite methodologies and analytic techniques used in the emerging field of outcomes research. With targeted training and conduct of this proposed study, I will gain a new research skill set in the design and analysis required to investigate the organization of nursing, manage large date sets, and analyze interactive effects of multiple variables on outcomes employing such methods as hierarchical linear modeling, censoring, and multiple imputation techniques. This proposed study is consistent with my goals to expand my clinical research into a new field of inquiry, nursing outcomes research, in which I have had no previous training or experience. My goal for this research career award are to: 1) gain a new research skill set in outcomes research, 2) extend my research program by examining the effects of hospital factors on physical restraint and other outcomes, 3) publish findings in peer- reviewed journals, 4) develop a proposal for extramural funding extending the scope of the study proposed here, and 5) establish interdisciplinary/collaborative relationships with experts in the field of outcomes research. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: IMPACT OF MEDICARE POLICIES ON UTILIZATION AND OUTCOMES. Principal Investigator & Institution: Fitzgerald, John D.; Medicine; University of California Los Angeles 10920 Wilshire Blvd., Suite 1200 Los Angeles, Ca 90024 Timing: Fiscal Year 2002; Project Start 16-JUL-2002; Project End 30-JUN-2006 Summary: (provided by applicant): The candidate is a board-certified rheumatologist interested in applying the methodology of health economics to study fiscal policies that impact the care of patients suffering from arthritis and other rheumatic diseases. He is seeking external funding support so that he might have the protected time to avail himself of formal course studies, research time on the proposed project, and access to his mentors. He has a business background and is currently enrolled in the UCLA School of Public Health, Health Services Ph.D. degree program, with an emphasis on Health Economics. UCLA provides an excellent environment for the development of his career. The Department of Medicine provides formal support for its young investigators through the Scientific Training and Advanced Research program. UCLA has excellent health service researchers and health economists in the Schools of Public Health and Medicine. UCLA has a close working relationship with RAND and the RAND Graduate School. During the award, the candidate will take classes required to complete his Ph.D. degree. A portion of the proposed research will serve as his dissertation. He has enlisted a team of health economists, health service researchers, a rheumatologist and a statistician to teach him the skills he needs to complete the proposed research and to develop his career as an independent researcher with health economic and arthritis

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expertise. He has proposed to study the impact of the Balanced Budget Act expenditure cuts on post-acute care utilization and clinical outcomes on a 100% sample of Medicare patients who have undergone elective joint replacement surgery or surgical management of hip fracture. He has also proposed to examine managed care costshifting to the fee for service sector by studying managed care disenrollment prior to planned surgery (elective joint replacement) and disenrollment prior to unplanned surgery (hip fracture). Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: INCIDENCE OF LATE MACULAR DEGENERATION IN OLDER WOMEN Principal Investigator & Institution: Coleman, Anne L.; Assistant Professor; Jules Stein Eye Institute; University of California Los Angeles 10920 Wilshire Blvd., Suite 1200 Los Angeles, Ca 90024 Timing: Fiscal Year 2002; Project Start 15-AUG-2002; Project End 31-JUL-2007 Summary: (Applicant's Abstract) Age-related macular degeneration is the number one cause of irreversible blindness in the United States and is more prevalent in older, Caucasian women. Although there have been several studies on the incidence of ARM, none of these studies has been able to provide accurate estimates on the incidence of late ARM and/or the progression of ARM in the oldest old, those individuals over 80 years of age, because of the limited sample sizes in these studies in this age group. The population in the Study of Osteoporotic Fractures (SOF) is an appropriate cohort in which to evaluate the incidence of late ARM and the progression of ARM, because the mean age of the women at the re-examination will be 84.4 years of age and the sample is mainly Caucasian. The proposed research study aims to determine the incidence of late ARM, the rate of progression of ARM, and the association of specific risk factors such as diabetes mellitus and prior cataract surgery with late ARM and the progression of ARM in elderly women. In addition, it aims to determine the trajectory of visual decline in older women over a 14- year period. Secondarily, it aims to determine the impact of late ARM on vision-targeted health-related quality of life and to determine whether or not an association exists between the progression of ARM and the risk of falling and hip/non-spine fractures. In 1997 to 1998 (Visit 6), 5482 women had an eye examination that consisted of a medical and ocular history, nine questions from the National Eye Institute Visual Function Questionnaire (NEI-VFQ), and measurements of visual acuity, contrast sensitivity, peripheral vision with automated perimetry, intraocular pressure, and uncorrected refractive error. These women also had a refraction and imaging of their lenses and fundi of both eyes through dilated pupils. Approximately 4.5% of these women have photographically validated late ARM, 41.5% have early ARM, and 54% have no ARM or hard drusen only. In the proposed re-examination, we will update their medical and ocular history and ask them the nine questions from the NEIVFQ. In addition, visual acuity and contrast sensitivity will be re-measured. Fundus photographs of both eyes through dilated pupils will be obtained. These photographs and the relevant photographs from 1997 to 1998 will be graded for ARM with the Wisconsin Age-Related Maculopathy Grading System (WARMGS) in a masked fashion so that the readers do not know which film is from which visit. The University of Wisconsin will also grade the fundus photographs on 30% of the eyes with ARM and 10% of the total sample. This will allow the identification of women in SOF who have had progression of their ARM and developed late ARM since 1997 and 1998. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: INDEPENDENT SCIENTIST AWARD Principal Investigator & Institution: Ottenbacher, Kenneth; Associate Director; Sealy Center on Aging; University of Texas Medical Br Galveston 301 University Blvd Galveston, Tx 77555 Timing: Fiscal Year 2003; Project Start 01-MAY-2003; Project End 30-APR-2008 Summary: (provided by applicant): The candidate (Kenneth J. Ottenbacher) holds a faculty position at the University of Texas Medical Branch (UTMB) in Galveston, Texas, that involves several administrative roles including: Vice Dean in the School of Allied Health Sciences, Director of the Division of Rehabilitation Sciences, and Associate Director of the Sealy Center on Aging. The K02-Award will allow Dr. Ottenbacher to reduce his administrative responsibilities and focus additional time on research. K02 funding will permit him to expand his examination of the disablement process in older adults. His current research is funded by grants from the National Institute on Aging and, more recently, the American Heart Association. Specifically, Dr. Ottenbacher will systematically explore the relationship between functional status and two components of the disablement process associated with quality of life - patient satisfaction and participation in community and social/personal activities (as defined in the World Health Organization's, International Classification of Functioning, Disability and Health). The immediate goals for the K02 include: 1) reduce administrative responsibilities to a less than 25% time commitment, 2) increase publication rate by 20% per year for the next four years, and 3) increase amount of externally funded grant dollars by 100% by end of K02-award. These goals will be accomplished by permanent resignation of his administrative role as Vice Dean in the School of Allied Health Sciences and reassignment of other responsibilities, including transferring management of a Health Services Resources Administration training grant, for which he is currently PI, to another faculty member. These changes will allow Dr. Ottenbacher to devote a minimum of 75% time to research and achieve his long term goals of establishing a program of externally funded research supported by multiple R01 type grants that contributes to the understanding of older adults with disabilities. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: MECHANISMS

INTESTINAL

CALCIUM

ABSORPTION:

MOLECULAR

Principal Investigator & Institution: Fleet, James C.; Associate Professor; Foods and Nutrition; Purdue University West Lafayette West Lafayette, in 479072040 Timing: Fiscal Year 2004; Project Start 15-SEP-1997; Project End 30-JUN-2008 Summary: (provided by applicant): The control of intestinal calcium absorption is important for human health in two ways. First, the risk of osteoporotic hip fracture is higher in women with low calcium absorption efficiency and this may be due to ageassociated calcium malabsorption or intestinal resistance to 1,25(OH)2 vitamin D3 (1,25(OH)2 D, the primary regulator of intestinal calcium absorption). Second, a significant barrier to the use of vitamin D analogs as pro-differentiating agents in cancer treatment is that they stimulate intestinal calcium absorption and cause hypercalcemia. Our long-term objective is to clarify the mechanisms used by 1,25(OH)2 D to promote calcium absorption and to utilize this information to improve calcium absorption in people with low fractional calcium absorption and to aid in the design of vitamin D analogs that can be used as non-calcemic cancer therapeutics. New research shows that 1,25(OH)2 D rapidly activates second messenger and kinases pathways including the MAP kinases and their upstream activators; inhibition of these kinases blunts 1,25(OH)2

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D-mediated gene transcription indicating the classical and non-classical vitamin D signaling pathways interact. The goal of the proposed research is to determine how the 1,25(OH)2 D-mediated transcriptional activation of intestinal calcium absorption is influenced by the basal or induced activity of the MAP kinases ERK1 and 2. The specific aims of this project are to: (1) Identify the nVDR-mediated genomic pathways controlling intestinal calcium absorption that are modulated by 1,25(OH)2-induced activation of ERK1 and 2, and (2) Establish the protein-protein interactions necessary for 1,25(OH)2 D-mediated gene expression that are promoted by 1,25(OH)2 D-induced ERK1 and 2 activity. We will accomplish these aims by studying the effect of 1,25(OH)2 D in a well-characterized cell culture model (Caco-2 cells) and in the small intestine of mice. Biological actions of 1,25(OH)2 D will be studied in the presence of activators and inhibitors of protein kinases (pharmacologic inhibitors, dominant negative kinases) and the rapid actions of vitamin D (vitamin D analogs), nVDR action and function will be studied with cellular imaging, reporter genes, multi-hybrid assays, and chromatin immunoprecipitation (CHIP) assays. Elucidating the mechanism of this vitamin D signal pathway cross-talk will provide the foundation for controlled modulation of intestinal calcium absorption, e.g. when vitamin D resistance associated with aging or estrogen deficiency is present. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: LEAD EFFECTS ON SKELETAL STEM CELLS AND FRAC Principal Investigator & Institution: Schwarz, Edward M.; Associate Professor; University of Rochester Orpa - Rc Box 270140 Rochester, Ny 14627 Timing: Fiscal Year 2002; Project Start 01-JUL-2002; Project End 30-JUN-2006 Summary: (provided by the applicant): The unifying hypothesis of this Program Project is that Pb exposure causes osteoporosis, which at the cellular level is known to be the result of an imbalance between bone resorption and bone formation. This condition is also associated with defective skeletal repair, which represents a significant component of the disease, as it has been shown that ~24% of osteoporosis patients that sustain a hip fracture die from associated complications. Critical data in support of this theory are that animals feed Pb in their diet become osteoporotic. At present the mechanism of this Pb-induced osteoporosis and the effects of Pb on fracture healing are unknown. This project will test the hypotheses that 1) Pb-induced osteoporosis is caused by preferential inhibitory effects on bone stem cells (osteoblast >>osteoclast progenitors) and 2) this inhibition has significant effects on skeletal repair (fracture healing). To test this the investigators will utilize two different Pb exposure regimens: Chronic Pb exposure (adult mice continually fed Pb in their drinking water) and osteoporosis-induced exposure (adolescent mice are exposed to Pb during development to incorporate Pb into their bones following 2 month of a Pb free diet, to clear the systemic Pb, the mice are overiectomized to commence the osteoporosis-induced exposure). Utilizing these exposures regimens with the dosing of 0,200 or 500ppm of Pb in their drinking water, to achieve a blood Pb concentration of (<5, 15, and 40ug/dl respectively), the investigators will evaluate the effects of Pb on bone stem cells (Aim 1) and fracture healing (Aim 2). The effects of Pb exposure on osteoblast progenitor cells will be analyzed in nodule formation, alkaline phosphatase, and gene expression assays on primary bone marrow cells from mice. Effects on osteoclast progenitor cells will be evaluated in splenocyte CFU-M colony and osteoclastogenesis (TRAP) assays to determine osteoclast precursor frequency; and bone wafer resorption assays to evaluate effects on osteoclast activity. The effects of Pb exposure on fracture healing will be evaluated utilizing a stabilized

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tibia fracture model with quantitative radiology and histomorphometry at various time points after fracture. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: LOCUS OF CARE & PRESSURE ULCERS AFTER HIP FRACTURE Principal Investigator & Institution: Baumgarten, Mona; Associate Professor; Epidemiology and Prev Medicine; University of Maryland Balt Prof School Baltimore, Md 21201 Timing: Fiscal Year 2002; Project Start 30-SEP-2001; Project End 31-AUG-2005 Summary: (Taken from the application): There have been enormous changes in the care of hip fracture patients in recent years, including improved surgical techniques, earlier surgical repair, and earlier postoperative weight bearing. Since the advent of prospective payment to hospitals, the length of hospital stay for hip fracture has decreased dramatically and there has been a large increase in the variety of postacute care settings to which patients are discharged. Yet, nothing is known about the impact of these changes in locus of care on patient outcomes. Our goal is to study one such outcome (pressure ulcers) among elderly hip surgery patients in the current health care environment. The specific aims of this study are to estimate the incidence of pressure ulcers among elderly patients who have undergone surgical repair for hip fracture; to compare care settings (e.g., acute care hospital, onsite subacute unit, rehabilitation facility, nursing home, home) with respect to the incidence of pressure ulcers and with respect to use of pressure ulcer prevention measures; to assess the relationship between the incidence of pressure ulcers and certain characteristics of the early postfracture period (e.g., length of time waiting before transport to hospital; length of stay in the Emergency Department); and to develop a predictive model relating patient characteristics and characteristics of the postfracture period to individual patients risk of pressure ulcers. To achieve the research aims, a prospective cohort study will be carried out in eight hospitals that are part of the Baltimore Hip Studies network. The cohort will be made up of 1,240 eligible, consenting patients aged 60 years or more who undergo surgical repair of hip fracture. All patients will undergo a full-body skin inspection on admission and on alternating postoperative days, up to the 21 St postoperative day. If the patient is discharged home or to a postacute setting in the course of the follow-up period, the skin exam will be performed in the new setting. Additional data will be obtained by interview and chart review. The incidence of pressure ulcers per person-day of follow-up will be estimated overall and separately for each type of care setting. Discrete time proportional hazards models will be used to identify risk factors that are associated with increased pressure ulcer rates and to develop a statistical model for predicting patients individual risks. Pressure ulcers represent a significant problem both in terms of patient suffering and cost of care. By identifying settings, characteristics of the postfracture period, and patient characteristics that are associated with especially high risk, the proposed study will provide information for clinical practice, health care planning, and the development of future clinical trials. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: LONGITUDINAL CHANGES IN HIP GEOMETRY AND SKELETAL MUSCLE Principal Investigator & Institution: Chen, Zhao; Assistant Professor; Epidemiology and Biostatistics; University of Arizona P O Box 3308 Tucson, Az 857223308 Timing: Fiscal Year 2003; Project Start 15-AUG-2003; Project End 30-JUN-2008

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Summary: (provided by applicant) This study will be conducted among a large multiethnic cohort (N = 11,432) from the nationwide Women's Health Initiative (WHI), which includes an observational study and three clinic trials. The age range of this cohort is between 50-79 years at the baseline, and it has multiple minority groups: 1583 black, 739 Hispanic and 149 Native American women. The maximal follow-up time of this cohort will be 9 years by 2005. Dual-energy x-ray absorptiometry (DXA) is used to measure bone mineral density (BMD) and body composition. The randomized clinical trials and longitudinal nature of the WHI study provide a unique opportunity to investigate: 1) treatment effects of hormone replacement therapy (HRT) and calcium and vitamin D supplementation on hip structural geometry; 2) longitudinal changes in skeletal muscle mass as a factor in hip fragility; and 3) ethnic differences of mean and rates of changes in hip geometry and muscle mass. Special computer software will be used for analyzing hip scans by dual-energy x-ray absorptiometry (DXA). Crosssectional area, subperiosteal width, estimated endocortical diameter, estimated mean cortical thickness, buckling ratio and section modulus at the femoral neck, at the intertrochanteric and the femoral shaft regions will be assessed. MRI scans will be used as references to calibrate total, appendicular and leg skeletal muscle measurements from DXA subregion analyses. Prevalence rates of sarcopenia (low muscle mass) among each age and ethnic group will be studied. Random Effects Models will be used to analyze the longitudinal data. This proposed study is not funded by the WHI program. Recourses that the WHI will provide include DXA scans, fall and fracture data, and information on covariates. Since the majority of data collection work has been or will be done by the WHI, we will be able to cost effectively test multiple important scientific hypotheses in this study. The novel approaches in this ancillary study will enhance scientific contributions of the WHI program. The significance of the proposed study is that it may demonstrate the utility of bone structural analysis in addition to bone mass measurements for understanding ethnic differences in fracture risk and/or for assessing the effect of pharmacologic therapy (i.e. HRT) on bone health. Furthermore, if the muscle variables are found to be a strong determinant of bone structure in the proximal femur and the risk of fall, then it may be important to develop interventions to increase muscle mass in this region to prevent hip fracture. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: MEASUREMENT OF THICKNESS/DENSITY OF THE PROXIMAL FEMUR Principal Investigator & Institution: Prevrhal, Sven; Radiology; University of California San Francisco 500 Parnassus Ave San Francisco, Ca 941222747 Timing: Fiscal Year 2003; Project Start 01-APR-2000; Project End 31-MAR-2005 Summary: (Taken from the application): Hip fracture is one of the most severe implication of Osteoporosis, a disease affecting millions of elderly people world-wide. The clinically established method to predict a person's hip fracture risk, bone densitometry, cannot separately measure the status of trabecular and cortical bone but only reports overall bone density. There is evidence that both compartments individually contribute to bone strength but are differently affected by aging or osteoporotic changes and therapeutic regimens. This research effort will approach the following questions: Can the density and the thickness of cortical bone in the proximal femur be measured accurately with volumetric Quantitative Computed Tomography (vQCT)? Does the knowledge of these parameters aid in predicting mechanical integrity in addition to standard bone densitometry? To what extent is the technique applicable in vivo? To assess the accuracy of vQCT, a comparison to Micro-CT is planned. Micro-CT

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Hip Fracture

is a Computed Tomography technique on microscopic level (the spatial resolution is 25 mm for the instrument being used) and has recently been extended to scan whole proximal femora. It can therefore be used as a gold standard to evaluate vQCT. Out of a total of 25 excised cadaveric proximal femora from elderly women who did not have diseases known to affect bone, 5 will be scanned with vQCT and Micro-CT. The analysis tools, which will comprise segmentation of the cortical wall and local measurement of cortical bone mineral density and thickness, will be applied to both data sets. The other 20 specimens will be subjected to vQCT, standard bone densitometry and mechanical testing. During the latter, bone elasticity and ultimate failure load will be recorded. The gathered data will allow to estimate the relative contribution of the cortical thickness and density to mechanical integrity and to locate the most sensitive regions of the cortex. The question of whether a vQCT scan of cortical bone can add information to standard bone densitometry can also be answered. The third part of the study will focus on clinical feasibility of vQCT of cortical bone. Its specific aim is reducing the radiation exposure by limiting the CT scan volume and decreasing the amount of radiation used. By analyzing the impact of the consequential increase of image noise and loss of spatial resolution on the measurability of cortical density and thickness optimal CT imaging parameters will be derived. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: MINORITY PREDOCTORAL FELLOWSHIP PROGRAM Principal Investigator & Institution: Yim-Chiplis, Paula K.; None; Johns Hopkins University 3400 N Charles St Baltimore, Md 21218 Timing: Fiscal Year 2003; Project Start 16-FEB-2003; Project End 15-FEB-2005 Summary: (provided by applicant): Maintaining postural balance is crucial to mobility. Mobility disability is predictive of more severe disablement, including falls, hip fractures, recurrent hospitalizations and institutionalization. Approximately half of persons 65 years or older report a fall annually and $10 billion is spent for the care of hip fractures each year. An important national health goal is to "help individuals of all ages increase life expectancy and improve their quality of life." Identifying modifiable health factors that can delay the onset or decrease the slope of functional decline relating to balance is of key importance. The purpose of this study is to determine the association of knee extensor strength, body composition, and physical activity with balance in healthy adults. This study is a substudy of a NASA/National Institute on Aging (NIA) study. Specific questions are: 1). Is there a difference between same-age gender groups in balance? 2). Will knee strength predict balance after accounting for body composition and physical activity? 3). Do knee extensor strength, body composition and physical activity decrease the association of age with balance? 4). Does physical activity have an independent contribution to balance? Using a cross-sectional design, 180 healthy men and women from 20-90 years of age belonging to the Baltimore Longitudinal Study of Aging (BLSA) will undergo evaluations of balance using the modified "Equitest"; knee muscle strength using the "KinCom" dynamometer; body composition using dualenergy x-ray absorptiometry (DEXA) scanning; and physical activity assessment using a questionnaire. Results using sequential regression analysis, ANOVA, and ANCOVA will determine the importance of these health factors throughout the lifespan. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: MULTIAXIAL STRENGTH BEHAVIOR OF HUMAN TRABECULAR BONE Principal Investigator & Institution: Keaveny, Tony M.; Professor; Mechanical Engineering; University of California Berkeley Berkeley, Ca 947205940 Timing: Fiscal Year 2002; Project Start 01-AUG-1996; Project End 31-JAN-2004 Summary: In this grant, we continue to investigate the multiaxial failure behavior of human trabecular bone. The clinical motivation is to improve mechanistic understanding of osteoporotic hip fractures. So far, we have described the failure behavior of trabecular bone for the human proximal femur, tibia, and vertebral body (n=214, each with a high-resolution three-dimensional reconstruction) for habitual type loading. We found that the strains at which the bone fails are relatively independent of volume fraction, but can differ across sites. The difference between tensile and compressive failure strains is greater in the higher density bone of the femoral neck. These results suggest that micro-structural bending of individual trabeculae dominates failure mechanisms at low density, but becomes less important at high density. Our work on axial-shear mutliaxial testing demonstrated that engineering type multiaxial failure criteria-expressed in units of strain-can predict the experimental behavior very well despite variations in volume fraction and anatomic site, with mean errors between experiment and criterion of less than 1 percent. These findings provide the foundation for more advanced research on multiaxial failure behavior. Given the difficulty of performing the requisite multiaxial experiments on relatively scarce human tissue, we propose to combine sophisticated computer simulations of the micro-mechanical failure mechanisms of trabecular bone with selected multiaxial experiments to develop a complete multiaxial failure criterion for femoral (neck and trochanter) trabecular bone. Specifically, we hypothesize that multiaxial failure of femoral trabecular bone is determined by critical strain levels and is independent of volume fraction. Highresolution micro-mechanical computer models, using 3D images obtained to date, will be used to simulate multiaxial behavior. These models will be first calibrated against our existing experimental data and then used to predict a wide variety of states of multiaxial failure. The predictions will be validated by new multiaxial experiments (n=100). The validated criterion will then be analyzed for a dependence on volume fraction. To address clinical significance, we also hypothesize that this multiaxial behavior is an independent determinant of whole bone femoral strength. To test this, anatomically detailed finite element models will be developed of the whole proximal femur using computed tomography and magnetic resonance scans. Simulations will be done with and without inclusion of the multiaxial failure criterion, and these predictions will be compared against experimental data for 20 cadaver bones. This work should provide substantial insight into mechanisms of whole bone and trabecular bone failure under traumatic conditions. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: NIA DEVELOPMENT AWARD PAIN AND DELIRIUM IN HIP FRACTURE Principal Investigator & Institution: Morrison, Sean; Medicine; Mount Sinai School of Medicine of Nyu of New York University New York, Ny 10029 Timing: Fiscal Year 2002; Project Start 01-JUL-1998; Project End 30-JUN-2003 Summary: Dr. Morrison's interest in quality of life issues at the end-of-life has led him to focus on palliative care and geriatrics. Merging these two areas, his clinical and research work suggest that pain symptoms tend to be overlooked in patients presenting with

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dementia/delirium. Dr. Morrison's long-term objectives are to promote understanding of this issue and to enhance the quality of life of older patients through improved pain and symptom management. The overall objective of the research project is to examine the management of pain in hip fracture patients and the inter-related problem of delirium. The specific aims are to: determine the incidence and prevalence of pain and delirium in patients with hip fracture; describe the management of pain and delirium; identify risk factors for the development of delirium and for inadequate pain management; examine the relationship between delirium and pain on select patient outcome variables; and develop strategies and interventions to improve the management of delirium and pain. Patients entering the Mount Sinai Health System presenting with a hip fracture will be studied. All patients will be assessed daily through the fifth hospital or third full post-operative day and thereafter every other day through the ninth hospital day for the severity of their pain and for delirium. Information will be collected on specific processes of care that are used during the treatment course of these patients with particular attention to those processes that could lead to the development of pain or delirium and those directed at the management of these two conditions by concurrently following the course of the patients and by reviewing medical records. Patients will be followed longitudinally through their hospitalization and at 2 and 6 months with assessments of pain, functional status, morbidity, and mortality. In the final half of the five year project, the data collected from the initial phase of this proposal will be used to plan and test two interventions at the Mount Sinai Hospital. The first intervention will be directed at improving pain management. The second intervention will be randomized controlled trial evaluating the pharmacologic management of delirium. Dr. Morrison will engage in a number of educational activities in order to enhance his research and statistical analysis skills. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: NURSING INTERVENTIONS & OUTCOMES IN 3 OLDER POPULATIONS Principal Investigator & Institution: Titler, Marita G.; Director of Research, Quality; None; University of Iowa Iowa City, Ia 52242 Timing: Fiscal Year 2002; Project Start 01-JUL-2001; Project End 31-MAR-2005 Summary: (provided by applicant): As competition for health care services increase, understanding the relationships among interventions and patient outcomes is essential. Nursing interventions are not accounted for in standardized coding schemas, and, thus, are rarely included in outcomes effectiveness studies that use large electronic data sets. The recent implementation of standardized classification systems of nursing interventions, such as the Nursing Interventions Classification (NIC), now makes it possible to describe the contributions of nursing care to patient outcomes. Research in this area has been limited due to availability of clinical data repositories that include nursing care variables. The site for this proposed study, the University of Iowa Hospitals and Clinics (UIHC), has a large electronic database of nursing interventions accumulated over 3 years that can be accessed and linked, at the individual patient level, to other clinical and operational data. The purpose of this 4-year exploratory study is to evaluate a methodological approach for conducting nursing outcomes effectiveness research using existing clinical and operational data that reside in several electronic data repositories in a large academic medical center. Specific variables will be identified and examined in three elderly patient groups: DRG 127 - Heart Failure and Shock, DRG 209 Major Joint and Limb Reattachment Procedures of the Lower Extremity (Hip Fracture), and those who are recipients of the nursing intervention Fall Prevention. The process

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and results of this study will be used to formulate a guideline for investigators on the construction and use of a nursing effectiveness research database built from electronic data repositories. The study's four aims are to: Identify the most frequently used nursing diagnoses, nursing interventions, pharmacological treatments, and medical treatments for the hospitalized elderly with DRG 127 or 209, and for those who receive the NIC intervention of Fall Prevention. Describe the relationships among patient characteristics, patient clinical conditions (nursing diagnoses, medical diagnoses, severity of illness), treatments (nursing interventions, medical treatments, pharmacological treatments), characteristics of nursing units, and outcomes of hospitalized elderly patients (DRG 127; DRG 209, Fall Prevention) using a cross sectional, retrospective design. Compare the cost of acute care for patients a) who receive of the nursing treatment Fall Prevention with those who do not receive this nursing intervention, b) who receive the most frequently used nursing treatment for heart failure (DRG 127) with those who do not receive this intervention, and c) who receive the most frequently used nursing treatment for hip fracture (DRG 209) with those who do not receive this intervention. Develop a guideline for construction and use of a nursing effectiveness research database built from electronic data repositories. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: OSTEOPOROSIS CANDIDATE GENES: IN SILICO AIDED DISCOVERY Principal Investigator & Institution: Ardlie, Kristin G.; Genomics Collaborative, Inc. 99 Erie St Cambridge, Ma 02139 Timing: Fiscal Year 2003; Project Start 30-SEP-2003; Project End 30-SEP-2004 Summary: (provided by applicant): Our understanding of the gene interactions that underlie molecular pathogenesis is expanding rapidly, yet despite continuing technical advances in the area, genetic studies of common diseases remain costly and time consuming. Initial linkage and/or genome scan studies are rarely definitive, and require further focused genetic follow-up and/or validation studies often on additional patient cohorts. Current solutions include sample pooling to defray the considerable genotyping costs of whole genome studies, or reduced and selective focal candidate gene approaches. The success of the latter, however, depends on knowledge of the disease and pathways, which is growing but still limited. Our goal is to determine whether simulating the biological pathways of putative candidate genes prior to testing those candidates, can enable us to more accurately target higher-likelihood candidates and reduce both the cost and time involved in identifying the genes associated with disease, as well as to define the likely role of these targets in a future diagnostic or therapeutic setting. We will test this in a genetic study of Osteoporosis aimed at identifying the gene(s) underlying the observed linkage to chromosome 1p36. Osteoporosis is a disease of reduced bone mineral density (BMD) that is associated with increased risk of bone fracture and for which the treatment and care of hip fractures exceeds $9 billion annually. Numerous twin and family studies have shown that as much as 80% of the individual risk in BMD is under genetic control. Moreover the genetic basis of the disease is likely to be polygenic, involving multiple gene products implicated in both bone modeling (growth) and remodeling (loss and gain). Our goals in this phase of the study are 1) to evaluate all genes in the linkage region 1p36 in a novel biological modeling and simulation platform, "BoneFusion", for their impact and importance in bone remodeling, 2) to genotype SNPs in the genes identified as high value candidates in order to identifying associations between the gene candidates and osteoporosis, and test the model, and 3) to further use the BoneFusion computer

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Hip Fracture

simulation to define the potential of any genes showing strong association with the disease, as a therapeutic target and/or diagnostic marker. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: OUTCOMES ASSOCIATED WITH ANTIEPILEPTIC DRUGS IN ELDERLY Principal Investigator & Institution: Garrard, Judith M.; Professor; University of Minnesota Twin Cities 200 Oak Street Se Minneapolis, Mn 554552070 Timing: Fiscal Year 2002; Project Start 30-SEP-2002; Project End 31-AUG-2003 Summary: Elderly people (age 65 years and older) are the most rapidly growing segment of the US population and the incidence of epilepsy is greatest in this age group. Little information is available about the use or outcomes associated with antiepileptic drugs (AEDs) by these vulnerable persons. We will examine pattems of AED use and associated outcomes among nursing home (NH) and community based elderly. For the proposed research, we have available two large electronic data sets: (1) the Beverly Enterprises Inc. centralized records (the Minimum Data Set and physicians' orders) for two calendar years (1999, 2000) for all residents (N~140,000 for two years) living in 501 NHs in 31 states, and (2) the Health Care Financing Administration's (HCFA) integration of the Medicare Current Beneficiaries Survey with Medicare claims files (N~12,000 elderly per year) for 7 calendar years. Both of these data sets have been used in part during the current project (1997-2002) by the same multidisciplinary team that will be working in the proposed project. We have a thorough working knowledge of the complexities of these data sets and the richness of information they contain. In our current research, we found a prevalence of 7.7% for AED use by NH admissions. Significant covadates with AED use at admission were epilepsy/seizure, bipolar depression, age group, and cognitive performance. During the first 3 months following admission, an additional 2.7% people were initiated on AEDs. Epilepsy/seizure indication was present in 5.8% of all admissions and an additional 1.47% of the followup cohort during the first 3 months. Specific aims of the proposed project are: (1) outcomes associated with any AED use by eldedy, (2) pharmacoepidemiology, characteristics, and outcomes associated with CBZ, PHT and VPA, and (3) the pharmacoepidemiology of other specific AEDs. Patient outcomes will be captured through incidence events, while AED use can be tracked continuously over time. Multivariate-modeling techniques will be used, controlling for demographics, comorbidities, and regional effects. Other P50 teams are studying the elimination kinetics of AEDs, and we will use this knowledge to develop age, gender and co-medication specific estimated total and unbound concentrations for NH residents. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: PHYSIOLOGY POPULATION

OF

BONE

METABOLISM

IN

AN

AGING

Principal Investigator & Institution: Khosla, Sundeep; Professor of Medicine and Research Chair; Mayo Clinic Coll of Medicine, Rochester 200 1St St Sw Rochester, Mn 55905 Timing: Fiscal Year 2004; Project Start 01-JUL-1997; Project End 30-JUN-2009 Summary: (provided by applicant): This is a competitive renewal application for funding of years 21 to 25 of P01 AG04875, "Physiology of Bone Metabolism in an Aging Population." Osteoporosis is an enormous public health problem. Recent estimates indicate that about 44 million US women and men aged 50 years and older have

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osteoporosis or low bone mass, resulting in 1.5 million fractures per year, including 300,000 hip fractures, 700,000 spine fractures, 250,000 forearm fractures, and 250,000 fractures at other sites. While traditionally considered a disease of women, men also develop osteoporosis. Thus, at age 50, the lifetime risk of an osteoporotic fracture in women is 40%, and the comparable figure for men is 13%. Given the scope of this problem and the projected increase in the prevalence of this disease as the population ages, rational approaches to prevention and treatment depend critically on gaining a better understanding the pathogenesis of this disorder, as well as assessing its impact in the community. Work over the previous funding cycle has now identified estrogen (E) deficiency as a key factor in the development of age-related bone loss not only in women, but also in men; hence, a theme common to all projects is E regulation of bone metabolism. As in the past, the major strength of our group is to bring together diverse disciplines into synergistic interactions, and the present application spans the spectrum from population-based epidemiology studies, intensive studies in the clinical research center, animal studies using novel mouse knock out models, and basic molecular studies using state-of-the-art proteomics technology. This is accomplished through five Projects and an Administrative and Biostatistics Core: Project 1, "Pathophysiology of Osteoporosis in Aging Men" and Project 2, "Pathophysiology of Osteoporosis in Aging Women" utilize intensive studies in the clinical research center in men and women, respectively; Project 3, "Risk Factors for Hip Fractures Among the Elderly" utilizes the resources of the Rochester Epidemiology Project in population-based epidemiology studies; Project 4, "Estrogen Receptor Coactivators and Bone Metabolism" focuses on novel mouse knock out models with defects in E action; and Project 5, "Actions of Estrogen Receptor Coregulators in Osteoblasts" proposes to dissect E action in bone cells at a molecular level. Collectively, these studies strive to provide a comprehensive assessment of the pathogenesis and clinical impact of this important disorder. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PHYSIOLOGY OF MALE REPRODUCTIVE HORMONES IN AGING Principal Investigator & Institution: Fox, Christopher R.; Center for Res in Reproduction; University of Virginia Charlottesville Box 400195 Charlottesville, Va 22904 Timing: Fiscal Year 2002; Project Start 01-JUL-2002; Project End 30-JUN-2003 Summary: Testosterone concentrations decline by 1-2% annually as men age, and free testosterone concentrations decline even more rapidly (3-4% per year). Lower serum testosterone concentrations have been associated with important health consequences, including reduced bone mineral density, increased risk of hip fracture, loss of muscle mass, decreased libido and fertility, and increased cardiovascular disease. HYPOTHESIS I will test whether glucocorticoids mediate down- regulation of urea transporter proteins by altering transcription. Specific Aim 1 will test whether glucocorticoids down-regulate UT-A and/or UT-B protein or mRNA expression. Specific Aim 2 will determine the element mediating glucocorticoid-induced suppression of urea transporter promoter activity. HYPOTHESIS II will test whether chronic lithium administration down-regulates urea transporter protein(s) by increasing glucocorticoids. Specific Aim 3 will test whether adrenalectomy prevents long-term down-regulation of urea transporter protein(s) in lithium-treated rats. Specific Aim 4 will test whether elevated lithium levels perturb urea transporter phosphorylation or function in rat inner medulla or in EcR-293 cells that have been stably transfected with a specific urea transporter isoform. HYPOTHESIS III will test whether urea transporter proteins are down- regulated during aldosterone-escape. Specific Aim 5 will test whether mineralocorticoids down-regulate UT-A and/or UT-B protein or mRNA expression.

42

Hip Fracture

Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PILOT AND FEASIBILITY STUDY--RISK OF HIP FRACTURE IN HISPANIC MEN Principal Investigator & Institution: Lauderdale, Diane S.; University of Chicago 5801 S Ellis Ave Chicago, Il 60637 Timing: Fiscal Year 2002 Summary: This abstract is not available. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: POPULATION AGING, MEDICAL COSTS, AND VALUE OF TECHNOLOGY Principal Investigator & Institution: Cutler, David M.; Professor; National Bureau of Economic Research Cambridge, Ma 02138 Timing: Fiscal Year 2002; Project Start 01-MAY-1999; Project End 30-APR-2004 Summary: This abstract is not available. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: PREVENTION OF FUNCTIONAL DISABILITY IN AT RISK ELDERS Principal Investigator & Institution: Gill, Thomas M.; Associate Professor; Internal Medicine; Yale University 47 College Street, Suite 203 New Haven, Ct 065208047 Timing: Fiscal Year 2002; Project Start 01-JAN-1998; Project End 31-DEC-2002 Summary: (Adapted from applicant's abstract). According to the applicant intervention strategies to date have focused largely on the restoration of function among disabled elderly persons in the context of rehabilitation after an acute medical event, such as a stroke or hip fracture. There have been few attempts to develop strategies aimed at "prehabilitation" (PREHAB), which is the prevention of functional dependence and decline among persons who have not sustained an acute illness or injury. The overall objective of this project is to test the efficacy of a home-based PREHAB strategy to prevent functional decline in a high-risk group of physically impaired, communityliving elderly persons who do not have severe memory loss or impaired orientation. Community-living persons, over 75 years will be screened for eligibility during nonurgent clinic visits at two large primary care sites. After comprehensive home assessment, 160 physically impaired elders will be randomized, using a blocked design that is stratified by clinic site, severity of physical impairment, and age to receive either the control group strategy (EDUCATE), a 6-month education program covering several content areas in general health practices and health promotion, or a home-based intervention strategy (PREHAB) -- which is a 6-month training program of physical therapy, to include muscle strengthening, joint range of motion, foot care, and balance, gait, transfer, and stair training, plus functional therapy to include training and instruction in safe and effective performance of the task needed to complete ADLs and selected IADLs, provision of appropriate adaptive equipment, and environmental modifications. Functional assessments will be completed in all participants at baseline and at six and twelve months by trained staff who will be kept unaware of group assignments. The specific aims of the project are 1) to determine whether the homebased PREHAB strategy is superior to the EDUCATE strategy in preventing decline in ADL-IADL function, and in decreasing the use of formal and informal care, including home care and nursing home care; 2) if the PREHAB strategy proves successful to

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43

identify the predictors of response to the intervention and to determine whether its benefit is mediated, as hypothesized, by improvements in both physical capability and functional self-efficacy. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PROPOXYPHENE USE IN THE AGED: PREDICTORS AND OUTCOMES Principal Investigator & Institution: Kamal-Bahl, Sachin; Pharmaceutical Health Services Research; University of Maryland Balt Prof School Baltimore, Md 21201 Timing: Fiscal Year 2003; Project Start 15-APR-2003; Project End 14-JUL-2004 Summary: (provided by the applicant): Over the past two decades, studies have documented a high prevalence of potentially inappropriate drug use among the elderly. Inappropriate drug use is defined in several ways; the most widely accepted explicit criteria are those developed by Beers (1997). Propoxyphene, an opiate analgesic, is one such inappropriate medication identified by the Beers' criteria. Its use is associated with such adverse effects as sedation and dependence, and it has no efficacy advantages over other analgesics. The CNS-related side effects with propoxyphene use may increase the likelihood of falls and, hence, of fall-related fractures in the elderly. Despite this, propoxyphene is the most prevalent among all inappropriate drugs used by the elderly according to a recent study by AHRQ. Prior research of propoxyphene use in the elderly is limited in several important respects. For example, no studies have examined the persistence or frequency of its use. None has systematically studied the factors associated with its use. Additionally, specific indications for which propoxyphene is still being prescribed have not been examined. Only two studies have assessed the risk of hip fractures with propoxyphene use; both used non-U.S. databases and have several limitations. This study aims to: (1) estimate the prevalence and persistence of propoxyphene use among community-dwelling aged; (2) determine the factors associated with propoxyphene use in the community-dwelling aged; and (3) establish whether propoxyphene use is associated with an increased risk of fractures in the aged. Data from the 1993-1999 Medicare Current Beneficiary Survey (MCBS) and the 1999 and 2000 MarketScan Datasets will be used. National-level annual prevalence estimates of propoxyphene use by community-dwelling aged Medicare beneficiaries will be made using 1993-1999 MCBS. A logistic regression will be estimated to identify specific patient, physician and drug plan characteristics associated with propoxyphene use. The MarketScan Dataset will be used to study proximate pain conditions for which propoxyphene is prescribed. A prospective cohort study design will be used with Cox regression analysis to estimate the increase in risk of fractures with propoxyphene use in the MarketScan Dataset. Determination of factors associated with propoxyphene use will help identify potential targets and design interventions to reduce its use. An establishment of an increased risk of fractures will strengthen the case for interventions to reduce propoxyphene use in the aged. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: RACE DIFFERENCES IN HIP STRENGTH, DENSITY AND GEOMETRY Principal Investigator & Institution: Lang, Thomas F.; Associate Professor; Radiology; University of California San Francisco 500 Parnassus Ave San Francisco, Ca 941222747 Timing: Fiscal Year 2002; Project Start 01-APR-2001; Project End 31-MAR-2005

44

Hip Fracture

Summary: (Verbatim from the Applicant): In the clinical setting, areal bone mineral density (BMD) measurements by dual x-ray absorptiometry (DXA) estimate hip fracture risk by providing a surrogate measure for proximal femoral strength. Because DXA is a planar imaging modality, it has potentially important limitations. First, DXA quantifies integral bone mass and density, whereas the influence of the cortical and trabecular compartments on mechanical strength may exceed their contributions to the integral bone mass. Second, DXA BMD measurements scale with bone size; larger bones appear to be denser. The overall goal of our study is to understand how the projectional nature of DXA imaging affects its ability to depict proximal femoral strength in two populations with known differences in hip fracture rates, volumetric BMID, bone size and cortical thickness. To achieve this goal, we will carry out a study in vivo comparing proximal femoral strength, compartmental BMD and geometry in 400 elderly Caucasian and African-American women. To estimate femoral strength, we will image the subjects with volumetric quantitative computed tomography (vQCT) of the proximal femur and construct finite element (FE) models using the vQCT scans. We will calculate proximal femoral failure load (FL) by loading these models to failure with forces simulating a fall to the side with impact on the posterolateral aspect of the greater trochanter and a joint reaction force simulating a spontaneous fracture. In order to determine the relationship between DXA BMD and FL in these two race groups, we will acquire DXA hip scans in all of the subjects. To determine the relationship between FL, compartmental BMD and 3-D bone geometry, we will analyze the vQCT scans with a computer algorithm, which extracts measures of trabecular/cortical BMD and cross-sectional geometry. By determining the 3-D geometric and/or BMD factors which result in greater proximal femoral bone strength and understanding how these measures are modified by planar projection, we will gain considerable insight into the performance of DXA, the principal technique used to estimate proximal femoral strength and therefore, hip fracture risk. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: REDUCING BENZODIAZEPINES AND HIP FRACTURE IN THE ELDERLY Principal Investigator & Institution: Soumerai, Stephen B.; Ambulatory Care & Prevention; Harvard University (Medical School) Medical School Campus Boston, Ma 02115 Timing: Fiscal Year 2002; Project Start 01-MAY-2002; Project End 30-SEP-2004 Summary: (provided by applicant): Benzodiazepines (BZDs) are important, effective and widely used medications for treating anxiety, panic, sleep, seizure, and bipolar disorders. Epidemiological studies to date have produced conflicting data about hip fracture risk associated with BZD use by the elderly. This study provides a unique opportunity to compare an epidemiological assessment of the BZD-hip fracture relationship with results based on the effects of a statewide natural experiment that resulted in a sudden, sustained reduction in BZD use. The overall aim of this study is to determine whether BZDs are associated with increased hip fracture incidence in the elderly and, if so, which characteristics of BZD use are most likely to increase the risk. The proposed investigation will use a classical epidemiological design (Phase I) and a unique longitudinal, controlled, intervention-based (quasi-experimental) design (Phase II). The study populations will consist of elderly New York (NY) and New Jersey (NJ) Medicaid enrollees between October 1987 and December 1990. Phase I, an open cohort study of more than 50,000 elderly NJ Medicaid recipients, will estimate the magnitude and significance of the BZD-hip fracture association overall and in specific risk groups. Most importantly, Phase II will test whether a NY policy that dramatically reduced BZD

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45

use also decreased hip fracture incidence (overall and in specific risk groups). On January 1, 1989, New York implemented a triplicate prescription program, a potent barrier to BZD prescribing, that resulted in a sudden, sustained decrease of over 50 percent in BZD use in most patient groups, including the elderly. The Phase II survival analyses of this natural experiment will compare changes in hip fracture incidence associated with the dramatic decline in BZD use in NY (intervention state) with changes in NJ (control state) where BZD use remained constant during the study period (total N=14,000). Medicaid and Medicare data provide reliable, valid, person-specific measures of demographics, medication and health services use over time, including hip fracture occurrence. The proposed study will provide important data on the association between BZDs, used by more than 20 percent of the elderly, and hip fractures, a major cause of morbidity and mortality. Phase II analyses will also contribute a novel method for evaluating health outcomes of changes in medication use in large populations. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: REHABILITATION AND FUNCTION RECOVERY AFTER HIP FRACTURE Principal Investigator & Institution: Young, Yuchi; Assistant Professor; Health Policy and Management; Johns Hopkins University 3400 N Charles St Baltimore, Md 21218 Timing: Fiscal Year 2002; Project Start 15-MAY-1999; Project End 30-APR-2004 Summary: (adapted from Investigator's abstract) The broad, long-term objectives of this proposal are to understand the effects of post-acute rehabilitation and to improve functional independence among older hip fracture patients. The specific aims are: (1) To conduct an epidemiologic study of the pattern of use of post-acute rehabilitation facilities and the factors associated with choice of rehabilitation locations where patients receive their prescribed post-acute rehabilitation; (2) To examine the factors associated with the short-term and long-term effect of post-acute rehabilitation on functional recovery. The dose response effect of the amount of post acute rehabilitation on functional score will be tested adjusting for patient characteristics and other potential cofounders; (3) To examine the factors associated with Medicare payment incurred due to hip fracture in both the acute and post- acute care setting and to calculate the costeffectiveness ratio. Hip fracture, a major problem of persons ages 65 and over, causes significant mortality, morbidity, and functional impairment. The loss of functional independence imposes a heavy burden on individuals, caregivers, and requires costly long-term care. Rehabilitation, as a tertiary prevention, is intended to restore prefracture autonomy and functional independence. Previous studies have examined functional recovery among elderly hip fracture patients' who received interventions mostly in inpatient rehabilitation settings. Few studies have examined the effectiveness of post acute rehabilitation on functional outcome in multiple settings (inpatient, outpatient or subacute rehabilitation settings) and take into account the intensity and quantity of rehabilitation services received. The proposed study will use a longitudinal cohort design prospectively to collect and analyze demographic, medical, and psychosocial impacts of post acute rehabilitation on functional outcome and cost. Subjects will be a sample of 300 community- dwelling elders with unilateral hip fracture, who have had a surgical repair (internal fixation, hemiarthroplasty, or total hip replacement), and received prescribed post acute rehabilitations in any one of the predetermined inpatient, outpatient, or subacute rehabilitation facilities. The longitudinal data on demographic, medical, psychosocial characteristics and functional status will be collected through repeated interview surveys and Medicare claims data. The intent is that the results of this study will provide epidemiologic data on choice and utilization of post acute

46

Hip Fracture

rehabilitation settings, and information on the effectiveness of post acute rehabilitation on functional recovery and cost incurred. Findings will be useful for developing intervention programs to improve functional independence among elderly hip fracture patients. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: REHABILITATION FOR STROKE AND HIP FRACTURE Principal Investigator & Institution: Munin, Michael C.; Physical Medicine and Rehabilitation; University of Pittsburgh at Pittsburgh 350 Thackeray Hall Pittsburgh, Pa 15260 Timing: Fiscal Year 2002; Project Start 26-SEP-2002; Project End 31-AUG-2004 Summary: (provided by applicant): Hip fracture is one of the leading healthcare problems requiring rehabilitation services in older Americans. Three models of rehabilitation treatment are available for patients recovering from hip fracture that include acute inpatient rehabilitation (AR), nursing home rehabilitation (NHR) and home care rehabilitation (HCR). These settings differ based on the timing, duration and intensity of services provided. No prior randomized study has been performed to determine the optimum rehabilitation treatment to improve the rate of functional recovery and return home to the community for patients with hip fracture. This planning grant will complete work in the following key domains during the two-year grant cycle to perform a randomized controlled trial (1) coordinating facilities to assist subject recruitment using state of the art bioinformatics systems within the University of Pittsburgh Medical Center Health System; (2) performing focus interviews to better understand patient, family, physician and therapist values concerning the randomization process; (3) determining the best method to risk stratify patients to different treatment settings that include random assignment to a home rehabilitation arm; (4) refining physical and occupational therapy algorithms using similar treatment goals at each location; (5) incorporating outcomes that are validated, objective and reliable measures of self-reported function and observed physical performance; and (6) standardizing data measurements in all rehabilitation environments through the implementation of quality control procedures. Co-investigators from the RAND Corporation will refine methods for data analysis using their extensive expertise in outcome assessment. At the end of this two-year planning grant, the investigators expect to be well positioned to perform a randomized controlled trial. Primary hypotheses will test whether AR subjects have higher function and a lower percentage of extended care facility placements than patients receiving NHR or HCR. Using novel methodology developed by the research team, secondary hypotheses will evaluate the relationship of functional outcomes and intensity of therapy to level of participation in therapy and physical activity measured by an activity monitor. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: SUBSIDENCE

REMOTELY

QUERIED

SENSOR

OF

FEMORAL

IMPLANT

Principal Investigator & Institution: Arms, Steven W.; President; Microstrain, Inc. 294 N Winooski Ave Burlington, Vt 05401 Timing: Fiscal Year 2002; Project Start 15-SEP-2002; Project End 28-FEB-2004 Summary: (provided by applicant): Over 250,000 hip replacements are inserted annually in the U.S.A., with aseptic loosening the greatest source of long-term failure. Since femoral component subsidence measured on plain radiographs (accuracy 2-3

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millimeters) is not typically evident before five years, lengthy follow-up is required to determine whether a new design reduces failure rates, and thereby widens patient indications and reduces complicated revision operations. Radiostereometry (RSA) sensitively (100-500 micrometers) tracks implant position. It is arguably the gold standard for detecting the early excessive subsidence shown to be a reliable predictor of ultimate clinical failure. However, implementation of RSA requires custom components and complex radiographic equipment, and is not widely available. We propose to develop an implantable, non-contacting sensing plug, to be inserted just distal to the tip of a femoral stem. External RF powering and embedded digital telemetry remotely query the plug to resolve subsidence to less than 100 micrometers, allowing the hallmark early subsidence (and thereby poor designs) to be detected within the first two years. Recoverable implant motion can be monitored real time (update rates of 200 Hz). The implanted microelectronics will include non-volatile memory and bi-directional wireless communications, allowing the plug to measure and maintain a record of subsidence over time. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: RISK FACTORS FOR HIP FRACTURES AMONG THE ELDERLY Principal Investigator & Institution: Melton, Joseph L.; Mayo Clinic Coll of Medicine, Rochester 200 1St St Sw Rochester, Mn 55905 Timing: Fiscal Year 2002 Summary: This project complements studies of pathophysiology by addressing fractures, the principle clinical manifestation of osteoporosis. Through the unique data resources of the Rochester Epidemiology Project, we can identify large inception cohorts of Rochester and/or Olmsted County, Minnesota., residents with specific medical and surgical conditions and conduct a series of retrospective (=historical) cohort studies to estimate the long-term risk of age-related fractures associated with secondary osteoporosis, an important contributor to bone loss in the elderly. Secondary, osteoporosis is an important area of research because new therapies are being developed for affected men and older women who are not candidates for estrogen replacement. We previously determined the risk of fracture among cohorts with diabetes mellitus, hyperparathryoidism, thyroidectomy, gastrectomy, pernicious anemia, oophorectomy, urolithiasis, anticoagulant therapy, anorexia nervosa, dementia, parkinsonism, epilepsy, poliomyelitis, rheumatoid arthritis, ankylosing spondylitis and breast cancer. We now proposed to extend this work by quantifying the fracture risk associated with conditions that might impair peak bone mass (endometriosis, infertility), induce hypogonadism (orchiectomy), disturb extraskeletal bone metabolism in the kidney (chronic renal failure) and gut (inflammatory bowel disease) or cause a generalized increase in bone resorbing cytokine (multiple myeloma). Each condition represents a natural experiment with respect to the pathogenesis of osteoporosis, several of which parallel the concerns of other projects. These will be the first assessments of fracture risk among cohorts of unselected patients from the community, and the results should be more valid and more precise than any previous estimates. Our overall goal is to develop new information that will lead to effective strategies for preventing osteoporosis-related fractures among the elderly. This project contributes by demonstrating the public health importance of specific risk factors and, by identifying high risk groups within each cohort, allowing future control programs to be designed and conducted more efficiently. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Hip Fracture

Project Title: STRUCTURAL ANALYSIS OF DEXA SCANS: OSTEOPOROSIS STUDIES Principal Investigator & Institution: Beck, Thomas J.; Associate Professor; Radiology; Johns Hopkins University 3400 N Charles St Baltimore, Md 21218 Timing: Fiscal Year 2002; Project Start 01-JUL-1998; Project End 31-MAR-2004 Summary: This abstract is not available. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: STUDY OF OSTEOPOROTIC FRACTURES Principal Investigator & Institution: Ensrud, Kristine E.; Associate Professor; Epidemiology; University of Minnesota Twin Cities 200 Oak Street Se Minneapolis, Mn 554552070 Timing: Fiscal Year 2002; Project Start 01-FEB-1986; Project End 31-JUL-2006 Summary: (provided by applicant): The Study of Osteoporotic Fractures (SOF) is a multi-center longitudinal study in a cohort of 9,704 older women. SOF has comprehensive data about risk factors for osteoporosis and other diseases, along with an archive of serum, buffy coat and urine specimens. Data from SOF have served for: (1) developing osteoporosis guidelines, (2) estimating the cost-effectiveness of screening for osteoporosis, and (3) planning trials of osteoporosis therapies. They propose to renew SOF to sustain this unique resource and to pursue several new hypotheses. Osteoporosis is a chronic disease and prevention of fractures must be considered over the very longterm, not just the 3-5 year duration of most studies in the field. As the study of osteoporosis and aging with the longest (nearly 15 years) follow-up, SOF will provide the foundation for describing ways to identify people at greatest risk of osteoporosis and fractures decades in advance. They envision a new generation of clinical guidelines based on long-term prediction of risk of fractures and disability. Because they have enriched the cohort with African-American women, SOF will also provide unique information on risk factors for osteoporosis and non-spine fractures in older African American women. SOF was the first study to show a link between low BMD and risk of stroke and this has helped to fuel the interest and new investigations about the links between arterial calcification and osteoporosis. If they demonstrate, and can begin to explain, the link between these two diseases, this may lead to screening tools and treatments that simultaneously decrease the risk of both of these disabling conditions. Preliminary results from SOF suggest that impaired sleep may be a major cause of fractures, disability and decline in cognition in older women. If the next phase of SOF confirms these relationships using more objective measures of insomnia and other sleep disorders, then this might change current clinical policies and practices toward more aggressive screening and better coverage for treatment of sleep disorders. Finally, the value of SOF could be magnified by recruiting other scientists to work on SOF data and samples. They propose to make the database easily accessible to investigators outside of SOF and assist them in making productive use of a database that represents one of the most comprehensive prospective sources of information about the health of older women. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: TAMOXIFEN EFFECTIVENESS

&

BREAST

49

CANCER--ACCEPTANCE/COST

Principal Investigator & Institution: Melnikow, Joy A.; Family and Community Medicine; University of California Davis Sponsored Programs, 118 Everson Hall Davis, Ca 956165200 Timing: Fiscal Year 2002; Project Start 01-APR-2000; Project End 31-MAR-2004 Summary: Risk reduction or prophylaxis of breast cancer with tamoxifen is a controversial intervention. The decision to take or recommend tamoxifen presents a range of potential outcomes and associated costs which must be considered in both individual and clinical policy decisions. Objectives: The primary objectives of this 3 year proposal are: (1) to evaluate women's acceptance and utilities for the outcomes of tamoxifen prophylaxis of breast cancer, (2) to evaluate the association of self-perceived breast cancer risk with preferences for tamoxifen prophylaxis compared to the association of calculated breast cancer risk using the NCI Gail breast cancer risk screening tool with preferences for tamoxifen prophylaxis and (3) to determine the marginal cost- effectiveness of tamoxifen prophylaxis for reduction of breast cancer mortality compared with annual screening by clinical breast exam and mammography. Methods: We will collect cross- sectional data from interviews with 300 women as well as perform secondary analyses on pre-existing data. Utilities and patient preferences will be collected from interviews with 300 women potentially eligible for tamoxifen prophylaxis, as identified through use of the NCI Gail breast cancer risk screening tool. Because low income minority women have been largely excluded from clinical trials examining tamoxifen prophylaxis, particular efforts will be made to recruit African American and Latina women participating in California's Breast Cancer Early Detection Program for assessment of these parameters. Costs will be derived from Medicare average allowed charges and average wholesale prices for outpatient medications. Model probabilities will be determined when possible from a systematic review of the literature, relying primarily on recent published results from randomized trials and a large meta-analysis for relative risks of tamoxifen related outcomes, and population based data or large cohort studies for estimating baseline risks. When probabilities are not available from the medical literature, expert opinion will be solicited from a panel using a modified Delphi process. Outcomes will include breast cancer, endometrial cancer, venous thromboembolism, stroke, hip fracture, cataracts, and bothersome side effects. The cost-effectiveness analysis will be based on modifications of a previously developed Markov process model. One way and two way, sensitivity analyses and Monte Carlo analysis will be conducted. Expected results: Findings from this project will enhance understanding of women's decisionmaking about tamoxifen prophylaxis, identify key parameters influencing cost effectiveness of tamoxifen prophylaxis, and provide perspective on the marginal cost effectiveness of tamoxifen compared with other preventive interventions, outside the context of randomized controlled trials. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: TESTING REHABILITATION

A

FUNCTIONAL

APPROACH

TO

SUBACUTE

Principal Investigator & Institution: Nelson, David L.; Occupational Therapy; Medical College of Ohio at Toledo Research & Grants Admin. Toledo, Oh 436145804 Timing: Fiscal Year 2002; Project Start 01-FEB-2002; Project End 31-JAN-2004 Summary: (provided by applicant): The proposed project is part of an ongoing program of research to develop evidence-based practice for occupational therapy and physical

50

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therapy in subacute rehabilitation. Two distinct approaches to therapy are routinely practiced: (a) a functional approach involving participation in daily living tasks; and (b) a rote exercise approach whereby the patient is instructed to follow exercise protocols. In the proposed project, these two approaches will be compared in subacute rehabilitation patients with hip fracture. Subacute rehabilitation is a neglected site for research, even though it is one of the most common settings for therapy practice. Hip fracture, frequently occurring in frail elderly persons with multiple health problems, is one of the most important diagnoses in this setting. The two specific aims are to determine if there is a difference between the functional approach to rehabilitation and the rote exercise approach to rehabilitation in terms of improvement in (a) the motor abilities required for daily living tasks, and (b) self-reported physical health status. The design is a randomized trial (pretest-posttest design) with blind assessment of outcomes. The final sample size of 104 provides adequate power. The two dependent variables are derived from the Assessment of Motor and Process Skills and the SF-36. Protocols for the two interventions include specifications for each intervention as well as lists of daily living tasks or exercises appropriate to each intervention. Pre-training and ongoing training of interventionists emphasizes equivalent attention and balance across conditions while preventing inadvertent contamination across conditions. Intervention fidelity will be tested by an independent, blind reviewer of clinical notes. Each specific aim will be tested by analysis of covariance, with the pretest as a covariate and with other relevant covariates including co-morbidities, cognitive status, hours of therapy, age, and gender. Alpha will be set at.05 for a two-tailed test. The proposed project follows logically from a smaller project funded by the American Occupational Therapy Foundation, and leads logically to a multi-site clinical trial of these two commonly used but untested approaches to rehabilitation. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: TESTING THE EXERCISE PLUS PROGRAM FOLLOWING HIP FRACTURE Principal Investigator & Institution: Resnick, Barbara M.; None; University of Maryland Balt Prof School Baltimore, Md 21201 Timing: Fiscal Year 2002; Project Start 30-SEP-1999; Project End 30-JUN-2005 Summary: (Adapted from Investigator's Abstract) Hip fracture is a major public health problem. More than 50% of patients do not return to pre-fracture functional levels one year post fracture. Recovery following hip fracture has been shown to be greatly improved by rehabilitation services and exercise. In older adults, regular exercise prevents disease, decreases the risk of falling, reduces disability, improves sleep, and enhances mood and general well-being. Specifically for older adults post hip fracture, exercise can improve mobility (speed and weight-bearing ability), strength, functional performance, and prevent future falls. Unfortunately, the majority of older adults do not exercise regularly, and approximately 50% of those who begin exercise programs drop out by six months. The major aim of this study is to test the effectiveness of a home delivered self-efficacy based intervention, the Exercise Plus Program, on increasing exercise behavior in older adults post hip fracture. Participants will be randomly assigned to one of the four groups defined by the 2 X 2 design: (1) Exercise Trainer component which includes regular home visits by an exercise trainer to implement an exercise program with patients; (2) Plus Component only which includes motivational interventions but without an exercise trainer to exercise with; (3) the full Exercise Plus program which includes the Plus Component (motivational interventions) and the Exercise Trainer component; or (4) routine care. Five acute care facilities participating in

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the Baltimore Hip Studies will be used to recruit participants. A total of 240 (60 per group) older adults will be included in the study. Baseline testing will be done in the acute care setting, and the intervention implemented in the home setting when traditional inpatient rehabilitation services are completed. Efficacy expectations related to exercise, exercise behavior, activity, functional performance, health status, pain, mood, fear of falling, falls, and injuries related to falls will be measured at baseline, and then at two, six, and twelve months post hip fracture. The primary outcomes will be efficacy expectations, exercise behavior, and activity; secondary outcomes will focus on the benefits of exercise (such as improved function). Generalized estimating equations will be used to perform the analyses with both binary and continuous outcome measures as dependent variables. The investigators state that this study will contribute to the understanding of what interventions improve exercise behavior in the older adult post hip fracture, and add to the current base of knowledge regarding the benefits of exercise in frail older persons. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: TESTOSTERONE FOR PREVENTION OF FRACTURE IN MEN Principal Investigator & Institution: Kenny, Anne M.; Assistant Professor; Medicine; University of Connecticut Sch of Med/Dnt Bb20, Mc 2806 Farmington, Ct 060302806 Timing: Fiscal Year 2002; Project Start 30-SEP-2001; Project End 30-JUN-2006 Summary: (verbatim from application) Attention to osteoporosis has largely emphasized women's health, and little attention has focused on the diagnosis and prevention of osteoporotic fractures in men. And yet the disease is also an important problem in men. Tesosterone levels decline with advancing age, and severe testosterone deficiency is associated with low bone mass and fracture. Several epidemiologic studies suggest that low testosterone is associated with low bone mass in older men, but this finding is not consistent. Men with hip fracture are found to be testosterone deficient more often than control subjects. Among men over age 70 with testosterone levels below young normal range, we found differences in bioavailable testosterone accounted for 20 percent of the variance in femoral next bone mineral density (FN BMD) values. Based on these data, testosterone supplementation may be important for bone health in older men. We will test the hypothesis that testosterone supplementation can decrease the risk of subsequent vertebral and non-vertebral fractures in older men with recent hip fracture. We will also evaluate the effects of testosterone on general health and wellbeing in this group. The specific aims of the proposed study will be to determine the effect of testosterone supplementation on vertebral and non-vertebral fractures incidence in men, age 60 years and older, who have sustained a recent hip fracture. Two hundred men, age 60 years and older, who have sustained a hip fracture following mild to moderate trauma (such as a fall from a standing height in the previous 2-6 months) will be randomly assigned to receive either long-acting testosterone or placebo injections in a double-blind study. We will ascertain new, non vertebral fracture incidence by structured questionnaire and follow-up radiographic confirmation every 6 months for 36 months, as well as vertebral fracture rates with baseline lateral spine films and yearly follow-up lateral spine films. In addition, bone mineral density (BMD) of the proximal femur, lumbar spine, distal radius and total body by dual x-ray absorptiometry (DXA) will be performed at baseline and yearly for 3 years to assess changes in BMD. In addition, we will determine the effect of testosterone on general health, including physical and cognitive function, cardiovascular risk, body composition and prostate parameters. Various physical and cognitive measures will be assessed, cardiovascular risk will be assessed by lipid profile and body composition from the whole body DXA

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and prostate parameters will include prostate specific antigen levels, American Urologic Association Prostate Symptom Score and digital rectal examination of the prostate. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: TESTOSTERONE THERAPY AFTER HIP FRACTURE IN ELDERLY WOMEN Principal Investigator & Institution: Binder, Ellen F.; Associate Professor; Internal Medicine; Washington University Lindell and Skinker Blvd St. Louis, Mo 63130 Timing: Fiscal Year 2004; Project Start 01-JUN-2004; Project End 31-MAY-2006 Summary: provided by applicant): Hip fractures are common among elderly women and can have a devastating impact on their ability to remain independent. A significant functional decline following a hip fracture has been documented, and many patients have persistent strength and mobility deficits that impair their capacity for independent function. Such individuals are at high risk for continued supportive services, recurrent injury, and institutionalization. High-risk patients include those with deficits in skeletal muscle strength during the post fracture period. Age-associated androgen deficiency contributes to deficits in muscle mass and strength that are common in this patient population. The role of testosterone therapy for improving deficits in muscle mass, strength, and functional capacity in the frail elderly is unclear, particularly for elderly women. There is insufficient information regarding tolerability of testosterone therapy, and the appropriate medication dosage and target serum testosterone levels necessary to induces changes in skeletal muscle mass and functional measures in elderly women with physical frailty due to muscle weakness. The goals of this project are to conduct a randomized, double-blinded, placebo-controlled prospective study to determine the feasibility, tolerability, and safety of 6 months of testosterone therapy in community dwelling, physically frail, elderly female hip fracture patients. Twenty-seven female hip fracture patients will be enrolled, using objective criteria for testosterone deficiency and frailty. We plan to evaluate two dosages of testosterone, administered as a 0.5% topical gel: a physiologic replacement dosage, and a supraphysiologic dosage. We plan to carefully monitor testosterone levels, side effects, biochemical parameters, and factors related to compliance with therapy. We plan to obtain preliminary information regarding the changes in measurements of muscle strength, total score on an Objective Physical Performance Test, total lean body mass by dual energy x-ray absorptiometry (DEXA), thigh cross-sectional areas by magnetic resonance imaging (MRI), and selfreported performance of activities of daily living, and quality of life. These data will be used to develop a full-scale proposal to test the long-term hypothesis that testosterone therapy combined with exercise training can improve physical function after a hip fracture. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: THE 3 COHORT STUDY OF HIP FRACTURE FUNCTIONAL OUTCOMES Principal Investigator & Institution: Siu, Albert L.; Professor; Medicine; Mount Sinai School of Medicine of Nyu of New York University New York, Ny 10029 Timing: Fiscal Year 2003; Project Start 30-SEP-2003; Project End 31-AUG-2006 Summary: (provided by applicant): Hip fractures are an important cause of mortality and functional dependence among older adults and approximately 340,000 hip fractures occur annually in this country. The proposed project brings together 3 cohorts of 2819 patients with hip fracture to create the largest dataset of hip fracture patients with

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follow-up information on functional outcomes. This dataset will be used to address 2 important topics in hip fracture research: a) the characterization of patient subgroups that could be targeted for future clinical interventions, and b) the role of early surgical intervention. The specific aims are: a) to combine the Mount Sinai, Baltimore, and Hospital for Joint Disease hip fracture cohorts to produce a dataset with information on patient characteristics, pre-fracture function, process of inpatient care, and longitudinal follow-up on function and other outcomes; b) to better characterize the mortality and functional outcomes of subgroups of hip fracture patients; c) to test how pre-fracture function, patient characteristics, and co-morbid conditions affect functional outcomes for patients as a whole and for major subgroups; and d) to test the impact of early surgery for patients with hip fracture. Our research methods include: a) assembling the dataset and creating and testing common definitions of study variables from the 3 cohorts; b) using cluster analysis to identify clinically important subgroups and to examine differences in mortality and functional outcomes among the subgroups; and c) analyzing the determinants of mortality and functional outcome, including the effect of early surgery. In the course of doing this, we will extend the methodological work on a) how mortality can be incorporated into analyses of functional outcome and b) how observational data can be analyzed to assess the effectiveness of interventions that are not likely to be evaluated in randomized trials. These 2 latter topics are critical issues to a series of other clinical topics in aging. The methodologies we propose to develop and test has wide applicability to other clinical problems of aging where functional status is an important outcome and mortality is also high. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: THE CAUSES OF HEALTH CARE INTENSITY Principal Investigator & Institution: Skinner, Jonathan S.; Professor; Dartmouth College 11 Rope Ferry Rd. #6210 Hanover, Nh 03755 Timing: Fiscal Year 2002 Summary: (provided by applicant): Wide variations in Medicare spending per capita are observed across geographic regions. In 1996, age, sex and race adjusted spending for traditional (fee-for-service) Medicare in the Miami region was $7,783, compared to the $3,700 spent in the Minneapolis region. Little is known about the causes of such differences; are they the consequence of patient preferences, market structure, physician beliefs, the availability of health care resources, or some combination of all factors? To better understand the dimensions and implications of health care intensity, we intend to: 1. Characterize health care intensity at the level of regions or hospitals using the clinically rich data available from population-based Medicare administrative files. We will develop models that allow us to examine dynamic associations among components of health care intensity, particularly for patient suffering from chronic disease and near the end of life. 2. Determine whether preferences of patients are aligned with the intensity and mix of care that they get. We test this hypothesis by comparing the stated preferences of patients in the telephone survey with the intensity and nature of care that they receive. We will consider whether education, race, or other factors makes it more likely that patients get what they say they want. 3. Study the role of patient preferences, physician beliefs, and the structure of the health care market in explaining differences in intensity across regions or hospitals. We seek to explain why Miami spends twice as much in Medicare expenditures as Minneapolis; is it because patients want the extra care, because of a larger share of for-profit hospitals, the importance of managed care in Minneapolis, or physician beliefs about appropriate treatment? 4. Explore how

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preferences evolve over time. Do patient preferences gradually evolve towards the characteristics of the region in which people receive their care? Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: THE CONSEQUENCES OF HEALTH CARE INTENSITY Principal Investigator & Institution: Fisher, Elliott S.; Professor of Medicine; Dartmouth College 11 Rope Ferry Rd. #6210 Hanover, Nh 03755 Timing: Fiscal Year 2002 Summary: (provided by applicant): There appear to be differences in the way that medicine is provided across region. This project addresses the consequences of regional differences in health care intensity for health, functioning, and well-being more generally. Knowing the answer to these questions is important, because it will allow us to judge whether elderly Americans in high expenditure regions value the additional care they are receiving. In particular, the goals of this project are to 1. Study the impact of variations in health care intensity on survival by carrying out longitudinal cohort studies of three chronic disease cohorts, i.e., myocardial infarction, hip fracture and colon cancer. 2. Examine the impact of variations in intensity on function, well-being and disease-specific quality of life using longitudinal cohort studies in three groups sampled from the Medicare population: the Medicare Current Beneficiary Survey (MCBS), for whom we have measures of self-assessed health and physical function, the proposed Core Survey, for whom we have measures of well-being in physical wellbeing and mental well being, and men in regions that were early and later adopters of a more intensive approach to the detection and treatment of prostate cancer. 3. Explore how intensity is valued in different regions. We will use data from the Core Telephone Survey to determine patient preferences for specific treatments and determine the degree to which high or low intensity regions improve the health and functioning of patients with different preferences. We will use in-person interviews in three regions (Florida, Oregon, and Sun City, Arizona) to determine how Medicare enrollees in these communities value major dimensions of intensity and whether those values reflect community treatment patterns. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: TIMING AND INTENSITY OF STRENGTHENING AFTER HIP FRACTURE Principal Investigator & Institution: Craik, Rebecca L.; Professor and Chair; Physical Therapy; Arcadia University 450 S Easton Rd Glenside, Pa 19038 Timing: Fiscal Year 2002; Project Start 26-SEP-2002; Project End 31-AUG-2004 Summary: (provided by applicant): Despite dramatic improvements in medical management of hip fracture, we have been unsuccessful in reducing the significant residual disability that remains in older persons post-fracture. The burgeoning economic cost of this seemingly simple condition and the burden of care borne by caregivers and society are predicted to escalate. Systematic investigations of promising interventions are needed. The interventions should be specific to the deficits that impede recovery, i.e., muscle mass and strength, should be of the correct intensity and be introduced at the most appropriate time to achieve the most beneficial outcome. This planning grant will be used to refine a future trial, a home-based exercise program. The investigators propose to evaluate the intensity and timing of an exercise program to reduce the level of disability post-hip fracture. This planning effort will be used to design a randomized controlled trial (RCT) to compare two different intensities of lower extremity exercise

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delivered at different times post-fracture to a sham, attention control group. In this future trial the investigators plan to include a broader range of patients with hip fracture than has been included in previous studies instead of focusing only on individuals with the best chance for recovery. They also will document aspects of current rehabilitation care, and identify the factors that predict success of this intervention. The planning project brings together a dynamic group of investigators expert in studying hip fracture outcomes and clinical methodologies. The investigative team consists of experts in hip fracture outcomes, clinical methodologies, and physical intervention required to design and lead a randomized controlled trial of an exercise program following hip fracture. Specific aims of the present application for a planning and development grant are to (1) refine the study design of the future trial; (2) prepare detailed protocols for successful enrollment of subjects in the future trial; (3) establish reliable procedures to ensure treatment adherence; (4) prepare detailed protocols to enable meaningful outcome assessment in the future trial; and (5) develop the future trial budget. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: TROCHANTERIC PADDING TO PREVENT HIP FRACTURES Principal Investigator & Institution: Kiel, Douglas P.; Associate Professor; Hebrew Rehabilitation Center for Aged 1200 Centre St, Roslindale Boston, Ma 02131 Timing: Fiscal Year 2002; Project Start 30-SEP-2001; Project End 31-AUG-2006 Summary: (provided by applicant) As measured by their frequency, influence on quality of life and economic cost, hip fractures are a public health problem of crisis proportions. Studies suggest that hip fractures may be prevented by the use of protective trochanteric padding, although some of those studies were small, had potential biases introduced by randomizing nursing homes or nursing home units, and used energy shunting pads. Fractures may still occur beneath such pads, and compliance has been variable because these pads were not particularly easy to wear or comfortable. We plan to conduct a randomized controlled trial of an energy absorbing and distributing, trochanteric padding system to reduce the incidence of hip fractures in 546 NH residents followed for an average of three years. To carry out this trial, a Coordinating Center (Maryland Medical Research Institute in Baltimore) will work with three clinical centers in Boston, Baltimore, and St. Louis that will each recruit 10-14 NHs and 182 NH residents to participate; residents will be replaced as they drop out during the follow up period. This sample size accounts for an effect size of 50 percent, and compliance rate of 50 percent. Each subject will be given a set of protective underwear containing a single pocket and hip pad so that each resident becomes his/her own control. The side to be protected is based on the randomization of facilities to be either "right" or "left-sided" such that the final sample will consist of an approximately equal number of residents with protection on the right as on the left hip. Using an intent to treat analysis, we will compare hip fracture incidence in padded and unpadded hips. The secondary aim will be to identify patient and facility factors contributing to non-adherence with the use of hip protectors. This will be the largest clinical trial of this biomechanically tested, energy absorbing and distributing hip protector ever conducted in the United States. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: VITAMIN D SUPPLEMENTATION IN POSTMENOPAUSAL WOMEN Principal Investigator & Institution: Aloia, John F.; Winthrop-University Hospital 259 1St St Mineola, Ny 11501

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Timing: Fiscal Year 2002; Project Start 15-SEP-1998; Project End 31-JUL-2004 Summary: (Adapted from the Applicant's Abstract): The long-term goal of this project is to develop strategies for the prevention of osteoporotic fractures in black women. Most studies have excluded black women because of the mistaken belief that osteoporosis is not a major health problem in this population. It is true that black women have a higher bone density, protective anatomic geometry of the femur, and a larger muscle mass compared to white women. Nonetheless, the incidence of hip fracture in black women is as great as 40% of that in white women. As the black population ages, osteoporosis will become even a greater health problem for this ethnic minority. Black women have lower levels of calcidiol and higher levels of parathyroid hormone (PTH) than white women. Since black women have lower indices of bone turnover, they also appear to have a relative resistance to the effect of PTH. Dietary supplementation with vitamin D3 has been shown to safely reduce bone loss and prevent hip fractures in postmenopausal white women. The strategy of vitamin D3 supplementation to prevent osteoporosis is even more cogent in black postmenopausal women compared to white women because (a) they have lower calcidiol levels, (b) they have evidence of secondary hyperparathyroidism, (c) the long-term effects and risks of hormonal replacement therapy have not been evaluated in black women, and (d) because of their higher bone mass, low risk strategies are more appropriate. There are less black women with osteoporosis at menopause, so that a modest reduction in bone loss could have a great impact on prevention of osteoporosis. The specific aim of this project is to determine if daily dietary supplementation with 800 IU (20 ug) of vitamin D3 will reduce bone loss in postmenopausal black women. A secondary aim is to evaluate the changes in the vitamin D-endocrine system and indices of bone turnover that result from long term vitamin D3 augmentation. A positive response would provide a safe, inexpensive and acceptable strategy for prevention of osteoporotic fractures in black women. If this randomized clinical trial demonstrates a positive effect on prevention of bone loss, a large scale multi-centered trial with fracture prevention as an endpoint will have merit. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: WHI SEX HORMONE & GENETIC RISK FACTORS FOR HIP FRACTURE Principal Investigator & Institution: Cummings, Steven R.; California Pacific Med CtrPacific Camp 2200 Webster Street, Suite 514 San Francisco, Ca 94115 Timing: Fiscal Year 2003; Project Start 24-SEP-2003; Project End 31-MAR-2006 Summary: (provided by applicant): In the United States, many hip fractures occur each year, causing significant disability and premature deaths. Cases of hip fractures cost an estimated $7 billion annually. Several etiologic factors are implicated in fracture risk including hormonal, metabolic, and genetic contributions. We propose to examine promising hormonal and genetic markers for hip fracture risk; this is a major objective of the Women's Health Initiative Observation Study (WHI-OS), a prospective study of over 93,000 postmenopausal women. Among WHI-OS participants, we will investigate whether low levels (especially very low levels) of estradiol, high levels of steroid hormone binding globulin, and low levels of insulin like growth factor 1 increase the risk of hip fracture. Recent studies also have identified promising polymorphisms in several candidate genes related to bone metabolism that may substantially affect hip fracture risk. We will test whether candidate polymorphisms in the following genes contribute to hip fracture risk: APOE, estrogen receptor alpha-l, transforming growth factor-beta and collagen type 1 alpha 1, and LDL receptor-related protein 5. Recent data support the functional role of these polymorphisms in the maintenance of bone mass

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and metabolism, suggesting that they may contribute to osteoporotic fracture risk. Identifying such hormonal and genetic markers for increased fracture risk ultimately may provide insight into treatment methods, at risk populations that could benefit from preventive measures, and new hypotheses about the pathophysiologic mechanisms for increased fracture risk. Among eligible WHI-OS participants aged 55-79 years at baseline, we will use a nested case-control study design to identify 400 cases of first hip fracture and 400 age-, ethnicity-, and center-matched controls for this study. This study will use previously collected baseline data and stored specimens in WHI-OS, including existing baseline serum and buffy coat samples and documentation/adjudication of hip fracture events. WHl data include comprehensive measurements of potential confounders and effect modifiers that will be considered in the analyses. The proposed study is a very efficient approach to understanding the etiologies of hip fracture. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

E-Journals: PubMed Central3 PubMed Central (PMC) is a digital archive of life sciences journal literature developed and managed by the National Center for Biotechnology Information (NCBI) at the U.S. National Library of Medicine (NLM).4 Access to this growing archive of e-journals is free and unrestricted.5 To search, go to http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Pmc, and type “hip fracture” (or synonyms) into the search box. This search gives you access to full-text articles. The following is a sample of items found for hip fracture in the PubMed Central database: •

Benzodiazepines and hip fractures in elderly people: case-control study. by Pierfitte C, Macouillard G, Thicoipe M, Chaslerie A, Pehourcq F, Aissou M, Martinez B, Lagnaoui R, Fourrier A, Begaud B, Dangoumau J, Moore N.; 2001 Mar 24; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=30096

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Does early surgical repair of hip fractures improve patient outcomes? by Bhandari M.; 2004 Jul 20; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=450359

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Effect on hip fractures of increased use of hip protectors in nursing homes: cluster randomised controlled trial. by Meyer G, Warnke A, Bender R, Muhlhauser I.; 2003 Jan 11; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=139934

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Quality of life related to fear of falling and hip fracture in older women: a time trade off study. by Salkeld G, Cameron ID, Cumming RG, Easter S, Seymour J, Kurrle SE, Quine S.; 2000 Feb 5; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=27279

3 4

Adapted from the National Library of Medicine: http://www.pubmedcentral.nih.gov/about/intro.html.

With PubMed Central, NCBI is taking the lead in preservation and maintenance of open access to electronic literature, just as NLM has done for decades with printed biomedical literature. PubMed Central aims to become a world-class library of the digital age. 5 The value of PubMed Central, in addition to its role as an archive, lies in the availability of data from diverse sources stored in a common format in a single repository. Many journals already have online publishing operations, and there is a growing tendency to publish material online only, to the exclusion of print.

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Serum undercarboxylated osteocalcin is a marker of the risk of hip fracture in elderly women. by Szulc P, Chapuy MC, Meunier PJ, Delmas PD.; 1993 Apr; http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobt ype=pdf&artid=288157

The National Library of Medicine: PubMed One of the quickest and most comprehensive ways to find academic studies in both English and other languages is to use PubMed, maintained by the National Library of Medicine.6 The advantage of PubMed over previously mentioned sources is that it covers a greater number of domestic and foreign references. It is also free to use. If the publisher has a Web site that offers full text of its journals, PubMed will provide links to that site, as well as to sites offering other related data. User registration, a subscription fee, or some other type of fee may be required to access the full text of articles in some journals. To generate your own bibliography of studies dealing with hip fracture, simply go to the PubMed Web site at http://www.ncbi.nlm.nih.gov/pubmed. Type “hip fracture” (or synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for hip fracture (hyperlinks lead to article summaries): •

A comparative study of rehabilitation outcomes of elderly hip fracture patients: the advantage of a comprehensive orthogeriatric approach. Author(s): Adunsky A, Lusky A, Arad M, Heruti RJ. Source: The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences. 2003 June; 58(6): 542-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12807926

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A cost-minimisation study of alternative discharge policies after hip fracture repair. Author(s): Polder JJ, van Balen R, Steyerberg EW, Cools HJ, Habbema JD. Source: Health Economics. 2003 February; 12(2): 87-100. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12563657

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A method for assessment of the shape of the proximal femur and its relationship to osteoporotic hip fracture. Author(s): Gregory JS, Testi D, Stewart A, Undrill PE, Reid DM, Aspden RM. Source: Osteoporosis International : a Journal Established As Result of Cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the Usa. 2004 January; 15(1): 5-11. Epub 2003 November 07. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14605797

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PubMed was developed by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine (NLM) at the National Institutes of Health (NIH). The PubMed database was developed in conjunction with publishers of biomedical literature as a search tool for accessing literature citations and linking to full-text journal articles at Web sites of participating publishers. Publishers that participate in PubMed supply NLM with their citations electronically prior to or at the time of publication.

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•

A randomised trial of weight-bearing versus non-weight-bearing exercise for improving physical ability in inpatients after hip fracture. Author(s): Sherrington C, Lord SR, Herbert RD. Source: The Australian Journal of Physiotherapy. 2003; 49(1): 15-22. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12600250

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A randomized controlled trial of weight-bearing versus non-weight-bearing exercise for improving physical ability after usual care for hip fracture. Author(s): Sherrington C, Lord SR, Herbert RD. Source: Archives of Physical Medicine and Rehabilitation. 2004 May; 85(5): 710-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15129393

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A randomized trial of laypersons' perception of the benefit of osteoporosis therapy: number needed to treat versus postponement of hip fracture. Author(s): Christensen PM, Brosen K, Brixen K, Andersen M, Kristiansen IS. Source: Clinical Therapeutics. 2003 October; 25(10): 2575-85. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14667958

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A randomized, controlled comparison of home versus institutional rehabilitation of patients with hip fracture. Author(s): Kuisma R. Source: Clinical Rehabilitation. 2002 August; 16(5): 553-61. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12194626

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Acceptability and compliance with hip protectors in community-dwelling women at high risk of hip fracture. Author(s): Patel S, Ogunremi L, Chinappen U. Source: Rheumatology (Oxford, England). 2003 June; 42(6): 769-72. Epub 2003 February 28. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12730537

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Acute pain treatment for older adults hospitalized with hip fracture: current nursing practices and perceived barriers. Author(s): Titler MG, Herr K, Schilling ML, Marsh JL, Xie XJ, Ardery G, Clarke WR, Everett LQ. Source: Applied Nursing Research : Anr. 2003 November; 16(4): 211-27. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14608555

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Adverse effects of depression and cognitive impairment on rehabilitation participation and recovery from hip fracture. Author(s): Lenze EJ, Munin MC, Dew MA, Rogers JC, Seligman K, Mulsant BH, Reynolds CF 3rd. Source: International Journal of Geriatric Psychiatry. 2004 May; 19(5): 472-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15156549

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An evaluation of footwear worn at the time of fall-related hip fracture. Author(s): Sherrington C, Menz HB. Source: Age and Ageing. 2003 May; 32(3): 310-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12720618

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Another approach to hip fracture prevention. Author(s): Pearson AG. Source: Postgraduate Medicine. 2003 December; 114(6): 8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14689718

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Antibiotic prophylaxis in hip fracture surgery: a metaanalysis. Author(s): Southwell-Keely JP, Russo RR, March L, Cumming R, Cameron I, Brnabic AJ. Source: Clinical Orthopaedics and Related Research. 2004 February; (419): 179-84. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15021151

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Arthroplasty in the treatment of subcapital hip fracture. Author(s): Sorbie C. Source: Orthopedics. 2003 March; 26(3): 337-41; Quiz 342-3. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12650332

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Assessing the risk of hip fracture in older people. Author(s): Beynon J. Source: Nursing Older People. 2002 July-August; 14(5): 29-30. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12138576

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Association between bone loss and promoter polymorphism in the IL-6 gene in elderly Japanese women with hip fracture. Author(s): Feng D, Ishibashi H, Yamamoto S, Hosoi T, Orimo H, Machida T, Koshihara Y. Source: Journal of Bone and Mineral Metabolism. 2003; 21(4): 225-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12811627

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Association of timing of surgery for hip fracture and patient outcomes. Author(s): Orosz GM, Magaziner J, Hannan EL, Morrison RS, Koval K, Gilbert M, McLaughlin M, Halm EA, Wang JJ, Litke A, Silberzweig SB, Siu AL. Source: Jama : the Journal of the American Medical Association. 2004 April 14; 291(14): 1738-43. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15082701

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Author's reply to criticism of study on benzodiazepines and risk of hip fracture. Author(s): Moore N. Source: Bmj (Clinical Research Ed.). 2001 September 29; 323(7315): 752-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11576987

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Balance function and fall-related efficacy in patients with newly operated hip fracture. Author(s): Ingemarsson AH, Frandin K, Hellstrom K, Rundgren A. Source: Clinical Rehabilitation. 2000 October; 14(5): 497-505. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11043875

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Barriers and solutions to osteoporosis care in patients with a hip fracture. Author(s): Kaufman JD, Bolander ME, Bunta AD, Edwards BJ, Fitzpatrick LA, Simonelli C. Source: The Journal of Bone and Joint Surgery. American Volume. 2003 September; 85A(9): 1837-43. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12954849

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Basicervical fracture--a rare type of hip fracture. Author(s): Saarenpaa I, Partanen J, Jalovaara P. Source: Archives of Orthopaedic and Trauma Surgery. 2002 March; 122(2): 69-72. Epub 2001 September 07. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11880905

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Beneficial effect of etidronate therapy in immobilized hip fracture patients. Author(s): Sato Y, Kanoko T, Yasuda H, Satoh K, Iwamoto J. Source: American Journal of Physical Medicine & Rehabilitation / Association of Academic Physiatrists. 2004 April; 83(4): 298-303. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15024332

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Biochemical bone markers and bone density in hip fracture patients: weak correlation in 106 women. Author(s): Hedstrom M, Svensson J, Dalen N. Source: Acta Orthopaedica Scandinavica. 2000 August; 71(4): 409-13. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11028892

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Biomechanical factors and failure of transcervical hip fracture repair. Author(s): Spangler L, Cummings P, Tencer AF, Mueller BA, Mock C. Source: Injury. 2001 April; 32(3): 223-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11240299

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Bipolar hemiartroplasty in the treatment of hip fracture: are special centres necessary for the optimal outcome? Author(s): Sarvilinna R, Pajamaki J, Sovelius R, Puolakka T, Huhtala H, Jarvinen M. Source: Scand J Surg. 2002; 91(2): 182-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12164520

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Blood transfusion requirements in elderly hip fracture patients. Author(s): Adunsky A, Lichtenstein A, Mizrahi E, Arad M, Heim M. Source: Archives of Gerontology and Geriatrics. 2003 January-February; 36(1): 75-81. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12849101

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Body composition and hip fracture type in elderly women. Author(s): Di Monaco M, Vallero F, Di Monaco R, Mautino F, Cavanna A. Source: Clinical Rheumatology. 2004 February; 23(1): 6-10. Epub 2003 October 17. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14749973

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Body size and hip fracture risk. Swedish Hip Fracture Study Group. Author(s): Farahmand BY, Michaelsson K, Baron JA, Persson PG, Ljunghall S. Source: Epidemiology (Cambridge, Mass.). 2000 March; 11(2): 214-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11021622

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Bone densitometry is not a good predictor of hip fracture. Author(s): Dequeker J, Luyten FP. Source: Bmj (Clinical Research Ed.). 2001 October 6; 323(7316): 797-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11642251

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Bone densitometry is not a good predictor of hip fracture. Author(s): Wilkin TJ, Devendra D. Source: Bmj (Clinical Research Ed.). 2001 October 6; 323(7316): 795-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11588087

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Bone mass and subsequent risk of hip fracture. Author(s): Huang Z, Himes JH. Source: Epidemiology (Cambridge, Mass.). 1997 March; 8(2): 192-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9229213

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Bone mineral content of the spine and proximal femur in female patients with hip fracture. Author(s): Soghikian GW, Boden SA, Labropoulos PA. Source: Orthopedics. 1994 October; 17(10): 917-21. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7824394

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Bone mineral density 6 years after a hip fracture: a prospective, longitudinal study. Author(s): Dirschl DR, Piedrahita L, Henderson RC. Source: Bone. 2000 January; 26(1): 95-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10617162

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Bone mineral density, hip axis length and risk of hip fracture in men: results from the Cornwall Hip Fracture Study. Author(s): Pande I, O'Neill TW, Pritchard C, Scott DL, Woolf AD. Source: Osteoporosis International : a Journal Established As Result of Cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the Usa. 2000; 11(10): 866-70. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11199191

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Bone mineral normative data in Malmo, Sweden. Comparison with reference data and hip fracture incidence in other ethnic groups. Author(s): Karlsson MK, Gardsell P, Johnell O, Nilsson BE, Akesson K, Obrant KJ. Source: Acta Orthopaedica Scandinavica. 1993 April; 64(2): 168-72. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8498178

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Bone remodeling at the endocortical surface of the human femoral neck: a mechanism for regional cortical thinning in cases of hip fracture. Author(s): Power J, Loveridge N, Lyon A, Rushton N, Parker M, Reeve J. Source: Journal of Bone and Mineral Research : the Official Journal of the American Society for Bone and Mineral Research. 2003 October; 18(10): 1775-80. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14584887

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Brief postoperative delirium in hip fracture patients affects functional outcome at three months. Author(s): Zakriya K, Sieber FE, Christmas C, Wenz JF Sr, Franckowiak S. Source: Anesthesia and Analgesia. 2004 June; 98(6): 1798-802, Table of Contents. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15155351

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Broader strategies for hip fracture prevention. Author(s): Fisher A, Davis M, Budge M. Source: The American Journal of Medicine. 2004 July 15; 117(2): 137-8; Author Reply 138. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15234653

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Case study of hip fracture in an older person. Author(s): Hayes KS, Steinke EE, Heilman A. Source: Journal of the American Academy of Nurse Practitioners. 2003 October; 15(10): 450-7. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14606134

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Changes in biochemical markers of bone metabolism and BMD during the first year after a hip fracture. Author(s): Hedstrom M, Sjoberg K, Svensson J, Brosjo E, Dalen N. Source: Acta Orthopaedica Scandinavica. 2001 June; 72(3): 248-51. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11480599

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Changes in bone and calcium metabolism following hip fracture in elderly patients. Author(s): Sato Y, Kaji M, Higuchi F, Yanagida I, Oishi K, Oizumi K. Source: Osteoporosis International : a Journal Established As Result of Cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the Usa. 2001; 12(6): 445-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11446559

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Changes in functional status attributable to hip fracture: a comparison of hip fracture patients to community-dwelling aged. Author(s): Magaziner J, Fredman L, Hawkes W, Hebel JR, Zimmerman S, Orwig DL, Wehren L. Source: American Journal of Epidemiology. 2003 June 1; 157(11): 1023-31. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12777366

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Changes in quality of life among elderly patients with hip fracture in Taiwan. Author(s): Shyu YI, Chen MC, Liang J, Lu JF, Wu CC, Su JY. Source: Osteoporosis International : a Journal Established As Result of Cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the Usa. 2004 February; 15(2): 95-102. Epub 2003 November 07. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14605800

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Characteristics of lifetime factors, bone metabolism, and bone mineral density in patients with hip fracture. Author(s): Partanen J, Heikkinen J, Jamsa T, Jalovaara P. Source: Journal of Bone and Mineral Metabolism. 2002; 20(6): 367-75. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12434165

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Chronic renal failure in hip fracture patients. Author(s): Casey M, Walsh B. Source: Osteoporosis International : a Journal Established As Result of Cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the Usa. 2004 May; 15(5): 420; Author Reply 421. Epub 2004 March 30. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15052378

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Clinically relevant behaviors in elderly hip fracture inpatients. Author(s): Dorra HH, Lenze EJ, Kim Y, Mulsant BH, Munin MC, Dew MA, Reynolds CF 3rd. Source: International Journal of Psychiatry in Medicine. 2002; 32(3): 249-59. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12489700

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Cognitive impairment in hip fracture patients: timing of detection and longitudinal follow-up. Author(s): Gruber-Baldini AL, Zimmerman S, Morrison RS, Grattan LM, Hebel JR, Dolan MM, Hawkes W, Magaziner J. Source: Journal of the American Geriatrics Society. 2003 September; 51(9): 1227-36. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12919234

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Colles fracture, spine fracture, and subsequent risk of hip fracture in men and women. A meta-analysis. Author(s): Haentjens P, Autier P, Collins J, Velkeniers B, Vanderschueren D, Boonen S. Source: The Journal of Bone and Joint Surgery. American Volume. 2003 October; 85A(10): 1936-43. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14563801

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Combination of bone mineral density and upper femur geometry improves the prediction of hip fracture. Author(s): Pulkkinen P, Partanen J, Jalovaara P, Jamsa T. Source: Osteoporosis International : a Journal Established As Result of Cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the Usa. 2004 April; 15(4): 274-80. Epub 2004 February 03. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14760516

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Combined paravertebral lumbar plexus and parasacral sciatic nerve block for reduction of hip fracture in a patient with severe aortic stenosis. Author(s): Ho AM, Karmakar MK. Source: Canadian Journal of Anaesthesia = Journal Canadien D'anesthesie. 2002 November; 49(9): 946-50. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12419722

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Comments on the specificity of functional mobility measures in older adults after hip fracture. Author(s): Gans BM. Source: American Journal of Physical Medicine & Rehabilitation / Association of Academic Physiatrists. 2003 October; 82(10): 775. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14508408

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Comparison of biochemical markers of bone turnover and bone mineral density between hip fracture and vertebral fracture. Author(s): Takahashi M, Naitou K, Ohishi T, Nagano A. Source: Journal of Clinical Densitometry : the Official Journal of the International Society for Clinical Densitometry. 2003 Fall; 6(3): 211-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14514989

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Continuity of care and health decline associated with a hip fracture. Author(s): Cree M, Yang Q, Sclater A, Johnson D, Carriere KC. Source: Journal of Aging and Health. 2002 August; 14(3): 385-98. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12146513

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Continuous intra-articular patient-controlled analgesia in a cancer patient with a pathological hip fracture. A case report. Author(s): Shabat S, Stern A, Kollender Y, Nyska M. Source: Acta Orthop Belg. 2001 June; 67(3): 304-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11486698

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Corticosteroid use and risk of hip fracture: a population-based case-control study in Denmark. Author(s): Vestergaard P, Olsen ML, Paaske Johnsen S, Rejnmark L, Sorensen HT, Mosekilde L. Source: Journal of Internal Medicine. 2003 November; 254(5): 486-93. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14535971

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Cost analysis of fondaparinux versus enoxaparin as venous thromboembolism prophylaxis in hip fracture surgery. Author(s): Wade WE, Spruill WJ, Leslie RB. Source: American Journal of Therapeutics. 2004 May-June; 11(3): 194-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15133534

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Cost analysis of hip fracture treatment among the elderly for the public health services: a 1-year prospective study in 106 consecutive patients. Author(s): Nurmi I, Narinen A, Luthje P, Tanninen S. Source: Archives of Orthopaedic and Trauma Surgery. 2003 December; 123(10): 551-4. Epub 2003 September 12. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=13680273

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Cost-effectiveness of preventing hip fracture in the general female population. Author(s): Kanis JA, Dawson A, Oden A, Johnell O, de Laet C, Jonsson B. Source: Osteoporosis International : a Journal Established As Result of Cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the Usa. 2001; 12(5): 356-61. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11444082

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Declines in physical functioning attributable to hip fracture among older people: a follow-up study of case-control participants. Author(s): Norton R, Butler M, Robinson E, Lee-Joe T, Campbell AJ. Source: Disability and Rehabilitation. 2000 May 20; 22(8): 345-51. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10896094

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Deep vein thrombosis following hip fracture and prevalence of hyperhomocysteinaemia in the elderly. Author(s): Lim YW, Chong KC, Chong I, Low CO, See HF, Lam KS. Source: Ann Acad Med Singapore. 2004 March; 33(2): 235-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15098640

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Delirium after hip fracture: to be or not to be? Author(s): Inouye SK. Source: Journal of the American Geriatrics Society. 2001 May; 49(5): 678-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11380767

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Delirium is independently associated with poor functional recovery after hip fracture. Author(s): Marcantonio ER, Flacker JM, Michaels M, Resnick NM. Source: Journal of the American Geriatrics Society. 2000 June; 48(6): 618-24. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10855596

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Delirium on hospital admission in aged hip fracture patients: prediction of mortality and 2-year functional outcomes. Author(s): Dolan MM, Hawkes WG, Zimmerman SI, Morrison RS, Gruber-Baldini AL, Hebel JR, Magaziner J. Source: The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences. 2000 September; 55(9): M527-34. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10995051

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Delirium severity and psychomotor types: their relationship with outcomes after hip fracture repair. Author(s): Marcantonio E, Ta T, Duthie E, Resnick NM. Source: Journal of the American Geriatrics Society. 2002 May; 50(5): 850-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12028171

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Dementia does not significantly affect complications and functional gain in elderly patients operated on for intracapsular hip fracture. Author(s): Beloosesky Y, Grinblat J, Epelboym B, Hendel D. Source: Archives of Orthopaedic and Trauma Surgery. 2001 May; 121(5): 257-60. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11409554

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Deterioration in quality of life following hip fracture: a prospective study. Author(s): Randell AG, Nguyen TV, Bhalerao N, Silverman SL, Sambrook PN, Eisman JA. Source: Osteoporosis International : a Journal Established As Result of Cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the Usa. 2000; 11(5): 460-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10912850

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Diabetes mellitus as a risk factor for hip fracture in mexican american older adults. Author(s): Ottenbacher KJ, Ostir GV, Peek MK, Goodwin JS, Markides KS. Source: The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences. 2002 October; 57(10): M648-53. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12242318

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Difference in mortality after hip fracture is associated with postdischarge prescription of antithrombotic prophylaxis: a case-control study. Author(s): Grion AM, Gallo U, Bano F, Ragazzi M, Cestrone A, Orsini A, Salomoni M, Gaion RM, Pengo V. Source: Clinical and Applied Thrombosis/Hemostasis : Official Journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis. 2002 April; 8(2): 143-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12121055

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Discrimination of proximal hip fracture by quantitative ultrasound measurement at the radius. Author(s): Pluskiewicz W, Drozdzowska B. Source: Osteoporosis International : a Journal Established As Result of Cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the Usa. 2002 March; 13(3): 265; Author Reply 265. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11991448

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Discrimination of proximal hip fracture by quantitative ultrasound measurement at the radius. Author(s): Weiss M, Ben-Shlomo A, Hagag P, Ish-Shalom S. Source: Osteoporosis International : a Journal Established As Result of Cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the Usa. 2000; 11(5): 411-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10912843

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Disparity in health services and outcomes for persons with hip fracture and lower extremity joint replacement. Author(s): Ottenbacher KJ, Smith PM, Illig SB, Linn RT, Gonzales VA, Ostir GV, Granger CV. Source: Medical Care. 2003 February; 41(2): 232-41. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12555051

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Documentation of delirium in elderly patients with hip fracture. Author(s): Milisen K, Foreman MD, Wouters B, Driesen R, Godderis J, Abraham IL, Broos PL. Source: Journal of Gerontological Nursing. 2002 November; 28(11): 23-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12465199

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Does a hip protector reduce the risk of hip fracture in frail elderly patients? Author(s): Markova T, Schwartz K. Source: The Journal of Family Practice. 2001 March; 50(3): 259. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11252220

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Does blood transfusion increase the risk of infection after hip fracture? Author(s): Koval KJ, Rosenberg AD, Zuckerman JD, Aharonoff GB, Skovron ML, Bernstein RL, Su E, Chakka M. Source: Journal of Orthopaedic Trauma. 1997 May; 11(4): 260-5; Discussion 265-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9258823

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Dual X-ray absorptiometry of hip, heel ultrasound, and densitometry of fingers can discriminate male patients with hip fracture from control subjects: a comparison of four different methods. Author(s): Pluskiewicz W, Drozdzowska B, Boron A. Source: Journal of Clinical Densitometry : the Official Journal of the International Society for Clinical Densitometry. 2003 Fall; 6(3): 305. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14571916

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Dual X-ray absorptiometry of hip, heel ultrasound, and densitometry of fingers can discriminate male patients with hip fracture from control subjects: a comparison of four different methods. Author(s): Ekman A, Michaelsson K, Petren-Mallmin M, Ljunghall S, Mallmin H. Source: Journal of Clinical Densitometry : the Official Journal of the International Society for Clinical Densitometry. 2002 Spring; 5(1): 79-85. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11940732

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Duration of prophylaxis against venous thromboembolism with fondaparinux after hip fracture surgery: a multicenter, randomized, placebo-controlled, double-blind study. Author(s): Eriksson BI, Lassen MR; PENTasaccharide in HIp-FRActure Surgery Plus Investigators. Source: Archives of Internal Medicine. 2003 June 9; 163(11): 1337-42. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12796070

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DXA of the hip and heel ultrasound but not densitometry of the fingers can discriminate female hip fracture patients from controls: a comparison between four different methods. Author(s): Ekman A, Michaelsson K, Petren-Mallmin M, Ljunghall S, Mallmin H. Source: Osteoporosis International : a Journal Established As Result of Cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the Usa. 2001; 12(3): 185-91. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11315236

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Early discharge and home rehabilitation after hip fracture achieves functional improvements: a randomized controlled trial. Author(s): Crotty M, Whitehead CH, Gray S, Finucane PM. Source: Clinical Rehabilitation. 2002 June; 16(4): 406-13. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12061475

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Early discharge of hip fracture patients from hospital: transfer of costs from hospital to nursing home. Author(s): van Balen R, Steyerberg EW, Cools HJ, Polder JJ, Habbema JD. Source: Acta Orthopaedica Scandinavica. 2002 October; 73(5): 491-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12440489

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Early individualized postoperative occupational therapy training in 100 patients improves ADL after hip fracture: a randomized trial. Author(s): Hagsten B, Svensson O, Gardulf A. Source: Acta Orthopaedica Scandinavica. 2004 April; 75(2): 177-83. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15180233

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Effect of a video intervention on functional recovery following hip replacement and hip fracture repair. Author(s): Tappen RM, Whitehead D, Folden SL, Hall R. Source: Rehabilitation Nursing : the Official Journal of the Association of Rehabilitation Nurses. 2003 September-October; 28(5): 148-53. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14521003

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Effect of birth cohort on risk of hip fracture: age-specific incidence rates in the Framingham Study. Author(s): Samelson EJ, Zhang Y, Kiel DP, Hannan MT, Felson DT. Source: American Journal of Public Health. 2002 May; 92(5): 858-62. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11988460

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Effect of hip fracture on mortality in elderly women: the EPIDOS prospective study. Author(s): Empana JP, Dargent-Molina P, Breart G; EPIDOS Group. Source: Journal of the American Geriatrics Society. 2004 May; 52(5): 685-90. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15086646

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Effect of home care service levels on health outcomes in hip fracture patients in Alberta. Author(s): Cree MW, Juby AG, Carriere KC. Source: Healthc Q. 2004; 7(2): 49-53, 2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15088332

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Effect of hospitalist consultation on treatment of osteoporosis in hip fracture patients. Author(s): Jachna CM, Whittle J, Lukert B, Graves L, Bhargava T. Source: Osteoporosis International : a Journal Established As Result of Cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the Usa. 2003 August; 14(8): 665-71. Epub 2003 July 18. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12879218

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Effect of postoperative delirium on outcome after hip fracture. Author(s): Edelstein DM, Aharonoff GB, Karp A, Capla EL, Zuckerman JD, Koval KJ. Source: Clinical Orthopaedics and Related Research. 2004 May; (422): 195-200. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15187857

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Effect of rehabilitation on hip and knee proprioception in older adults after hip fracture: a pilot study. Author(s): Mendelsohn ME, Overend TJ, Petrella RJ. Source: American Journal of Physical Medicine & Rehabilitation / Association of Academic Physiatrists. 2004 August; 83(8): 624-32. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15277964

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Effects of blood transfusion on clinical and functional outcomes in patients with hip fracture. Author(s): Halm EA, Wang JJ, Boockvar K, Penrod J, Silberzweig SB, Magaziner J, Koval KJ, Siu AL. Source: Transfusion. 2003 October; 43(10): 1358-65. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14507265

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Efficacy of a specially designed hip protector for hip fracture prevention and compliance with use in elderly Hong Kong Chinese. Author(s): Woo J, Sum C, Yiu HH, Ip K, Chung L, Ho L. Source: Clinical Rehabilitation. 2003 March; 17(2): 203-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12625661

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Estimating hip fracture morbidity, mortality and costs. Author(s): Braithwaite RS, Col NF, Wong JB. Source: Journal of the American Geriatrics Society. 2003 March; 51(3): 364-70. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12588580

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Evaluation of a hip fracture risk score for assessing elderly women: the Melton Osteoporotic Fracture (MOF) study. Author(s): McGrother CW, Donaldson MM, Clayton D, Abrams KR, Clarke M. Source: Osteoporosis International : a Journal Established As Result of Cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the Usa. 2002 January; 13(1): 89-96. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11883411

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Evaluation of osteoporosis treatment in seniors after hip fracture. Author(s): Juby AG, De Geus-Wenceslau CM. Source: Osteoporosis International : a Journal Established As Result of Cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the Usa. 2002 March; 13(3): 205-10. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11991439

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Excess mortality or institutionalization after hip fracture: men are at greater risk than women. Author(s): Fransen M, Woodward M, Norton R, Robinson E, Butler M, Campbell AJ. Source: Journal of the American Geriatrics Society. 2002 April; 50(4): 685-90. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11982669

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Exposure to tricyclic and selective serotonin reuptake inhibitor antidepressants and the risk of hip fracture. Author(s): Hubbard R, Farrington P, Smith C, Smeeth L, Tattersfield A. Source: American Journal of Epidemiology. 2003 July 1; 158(1): 77-84. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12835289

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External hip protectors and risk of hip fracture. Author(s): Cummings P, Weiss NS. Source: Jama : the Journal of the American Medical Association. 2003 August 20; 290(7): 884; Author Reply 884-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12928456

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External hip protectors and risk of hip fracture. Author(s): Bulat T, Quigley P. Source: Jama : the Journal of the American Medical Association. 2003 August 20; 290(7): 883; Author Reply 884-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12928455

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External hip protectors and risk of hip fracture. Author(s): Honkanen LA. Source: Jama : the Journal of the American Medical Association. 2003 August 20; 290(7): 883-4; Author Reply 884-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12928454

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Factors predicting 12-month outcome of elderly patients admitted with hip fracture to an acute care hospital. Author(s): Kaehrle P, Maljanian R, Bohannon RW, Horowitz S. Source: Outcomes Management for Nursing Practice. 2001 July-September; 5(3): 121-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11898672

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Factors related to activity limitations in a group of Cuban Americans before and after hip fracture. Author(s): Kirk-Sanchez NJ. Source: Physical Therapy. 2004 May; 84(5): 408-18. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15113274

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Factors related to occurrence of hip fracture during a fall on the hip. Author(s): Willig R, Luukinen H, Jalovaara P. Source: Public Health. 2003 January; 117(1): 25-30. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12802901

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Falls in community-dwelling older persons followinig hip fracture: impact on selfefficacy, balance and handicap. Author(s): Whitehead C, Miller M, Crotty M. Source: Clinical Rehabilitation. 2003 December; 17(8): 899-906. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14682563

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Fear of falling, falls efficacy, and health outcomes in older people following hip fracture. Author(s): McKee KJ, Orbell S, Austin CA, Bettridge R, Liddle BJ, Morgan K, Radley K. Source: Disability and Rehabilitation. 2002 April 15; 24(6): 327-33. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12017466

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Femur bone mineral density is independently associated with functional recovery after hip fracture in elderly women. Author(s): Di Monaco M, Di Monaco R, Mautino F, Cavanna A. Source: Archives of Physical Medicine and Rehabilitation. 2002 December; 83(12): 171520. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12474175

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FIM after hip fracture: is telephone administration valid and sensitive to change? Author(s): Petrella RJ, Overend T, Chesworth B. Source: American Journal of Physical Medicine & Rehabilitation / Association of Academic Physiatrists. 2002 September; 81(9): 639-44. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12172514

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Fondaparinux and prolonged thromboprophylaxis after hip fracture surgery. Author(s): Nurmohamed MT. Source: Archives of Internal Medicine. 2003 December 8-22; 163(22): 2789; Author Reply 2790. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14662637

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Frailty and the biochemical effects of recombinant human growth hormone in women after surgery for hip fracture. Author(s): Yeo AL, Levy D, Martin FC, Sonksen P, Sturgess I, Wheeler MM, Young A. Source: Growth Hormone & Igf Research : Official Journal of the Growth Hormone Research Society and the International Igf Research Society. 2003 December; 13(6): 36170. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14624771

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Frequency and impact of active clinical issues and new impairments on hospital discharge in patients with hip fracture. Author(s): Halm EA, Magaziner J, Hannan EL, Wang JJ, Silberzweig SB, Boockvar K, Orosz GM, McLaughlin MA, Koval KJ, Siu AL. Source: Archives of Internal Medicine. 2003 January 13; 163(1): 108-13. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12523924

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Functional dependence after hip fracture. Author(s): Cree M, Carriere KC, Soskolne CL, Suarez-Almazor M. Source: American Journal of Physical Medicine & Rehabilitation / Association of Academic Physiatrists. 2001 October; 80(10): 736-43. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11562555

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Functional gain of hip fracture patients in different cognitive and functional groups. Author(s): Beloosesky Y, Grinblat J, Epelboym B, Weiss A, Grosman B, Hendel D. Source: Clinical Rehabilitation. 2002 May; 16(3): 321-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12017519

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Functional mobility measures in older adults after hip fracture. Author(s): Granger CV, Tesio L, Linn RT. Source: American Journal of Physical Medicine & Rehabilitation / Association of Academic Physiatrists. 2003 November; 82(11): 901-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14566160

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Functional outcome after hip fracture. A 1-year prospective outcome study of 275 patients. Author(s): Rosell PA, Parker MJ. Source: Injury. 2003 July; 34(7): 529-32. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12832181

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Functional outcome and quality of life following hip fracture in elderly women: a prospective controlled study. Author(s): Boonen S, Autier P, Barette M, Vanderschueren D, Lips P, Haentjens P. Source: Osteoporosis International : a Journal Established As Result of Cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the Usa. 2004 February; 15(2): 87-94. Epub 2003 November 07. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14605799

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Functional recovery after hip fracture: six months' follow-up of patients in a multidisciplinary rehabilitation program. Author(s): Dai YT, Huang GS, Yang RS, Tsauo JY, Yang LH. Source: J Formos Med Assoc. 2002 December; 101(12): 846-53. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12632818

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Functional recovery among elderly people one year after hip fracture surgery. Author(s): Lin PC, Chang SY. Source: The Journal of Nursing Research : Jnr. 2004 March; 12(1): 72-82. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15136965

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Functional recovery and length of stay after hip fracture in patients taking corticosteroids. Author(s): Di Monaco M, Vallero F, Di Monaco R, Mautino F, Cavanna A. Source: American Journal of Physical Medicine & Rehabilitation / Association of Academic Physiatrists. 2004 August; 83(8): 633-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15277965

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Functional recovery and length of stay after hip fracture in patients with neurologic impairment. Author(s): Di Monaco M, Vallero F, Di Monaco R, Mautino F, Cavanna A. Source: American Journal of Physical Medicine & Rehabilitation / Association of Academic Physiatrists. 2003 February; 82(2): 143-8; Quiz 149-51, 157. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12544761

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Functional status in older women following hip fracture. Author(s): Curry LC, Hogstel MO, Davis GC. Source: Journal of Advanced Nursing. 2003 May; 42(4): 347-54. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12752879

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Gender differences in mortality after hip fracture: the role of infection. Author(s): Wehren LE, Hawkes WG, Orwig DL, Hebel JR, Zimmerman SI, Magaziner J. Source: Journal of Bone and Mineral Research : the Official Journal of the American Society for Bone and Mineral Research. 2003 December; 18(12): 2231-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14672359

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General versus regional anaesthesia for hip fracture surgery. Author(s): Eger EI 2nd. Source: British Journal of Anaesthesia. 2000 September; 85(3): 492. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11103200

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General versus regional anaesthesia for hip fracture surgery: a meta-analysis of randomized trials. Author(s): Urwin SC, Parker MJ, Griffiths R. Source: British Journal of Anaesthesia. 2000 April; 84(4): 450-5. Erratum In: Br J Anaesth 2002 Apr; 88(4): 619. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10823094

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Geometric characteristics of the proximal femur and hip fracture risk. Author(s): Geusens P. Source: Osteoporosis International : a Journal Established As Result of Cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the Usa. 1996; 6 Suppl 3: 27-30. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8931043

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Geometry of proximal femur in the prediction of hip fracture in osteoporotic women. Author(s): Gnudi S, Ripamonti C, Gualtieri G, Malavolta N. Source: The British Journal of Radiology. 1999 August; 72(860): 729-33. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10624337

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Growing knowledge about hip fracture in older people. Author(s): Qureshi A, Gwyn Seymour D. Source: Age and Ageing. 2003 January; 32(1): 8-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12540341

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Health-related quality of life after hip fracture in the elderly community-dwelling. Author(s): Jongjit J, Komsopapong L, Songjakkaew P, Kongsakon R. Source: Southeast Asian J Trop Med Public Health. 2003 September; 34(3): 670-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15115149

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Height and lower extremity length as predictors of hip fracture: results of the NHANES I Epidemiologic Follow-up Study. Author(s): Opotowsky AR, Su BW, Bilezikian JP. Source: Journal of Bone and Mineral Research : the Official Journal of the American Society for Bone and Mineral Research. 2003 September; 18(9): 1674-81. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12968677

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Higher Hb level is associated with better early functional recovery after hip fracture repair. Author(s): Lawrence VA, Silverstein JH, Cornell JE, Pederson T, Noveck H, Carson JL. Source: Transfusion. 2003 December; 43(12): 1717-22. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14641869

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Hip arthroplasty after extracapsular hip fracture: a matched pair cohort analysis. Author(s): Lyman JR, Kelley SS, Lachiewicz PF. Source: J Surg Orthop Adv. 2004 Spring; 13(1): 38-41. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15055494

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Hip fracture discrimination study: QUS of the radius and the calcaneum. Author(s): Hans D, Genton L, Allaoua S, Pichard C, Slosman DO. Source: Journal of Clinical Densitometry : the Official Journal of the International Society for Clinical Densitometry. 2003 Summer; 6(2): 163-72. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12794239

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Hip fracture in elderly patients: outcomes for function, quality of life, and type of residence. Author(s): van Balen R, Steyerberg EW, Polder JJ, Ribbers TL, Habbema JD, Cools HJ. Source: Clinical Orthopaedics and Related Research. 2001 September; (390): 232-43. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11550871

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Hip fracture in the immobile patient. Author(s): Hay D, Parker MJ. Source: The Journal of Bone and Joint Surgery. British Volume. 2003 September; 85(7): 1037-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14516042

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Hip fracture incidence in central norway: a followup study. Author(s): Finsen V, Johnsen LG, Trano G, Hansen B, Sneve KS. Source: Clinical Orthopaedics and Related Research. 2004 February; (419): 173-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15021150

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Hip fracture mortality and morbidity--can we do better? Author(s): Davidson CW, Merrilees MJ, Wilkinson TJ, McKie JS, Gilchrist NL. Source: N Z Med J. 2001 July 27; 114(1136): 329-32. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11548098

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Hip fracture patients have more vertebral deformities than subjects in populationbased studies. Author(s): Hasserius R, Johnell O, Nilsson BE, Thorngren KG, Jonsson K, Mellstrom D, Redlund-Johnell I, Karlsson MK. Source: Bone. 2003 February; 32(2): 180-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12633790

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Hip fracture prevention. Drug therapies and lifestyle modifications that can reduce risk. Author(s): Fiechtner JJ. Source: Postgraduate Medicine. 2003 September; 114(3): 22-8, 32. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14503398

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Hip fracture prevention: cost-effective strategies. Author(s): Vestergaard P, Rejnmark L, Mosekilde L. Source: Pharmacoeconomics. 2001; 19(5 Pt 1): 449-68. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11465306

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Hip fracture research results related to home care. Author(s): Neal LJ. Source: Caring. 2001 August; 20(8): 42-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11499216

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Hip fracture risk assessment using composite indices of femoral neck strength: the Rancho Bernardo study. Author(s): Karlamangla AS, Barrett-Connor E, Young J, Greendale GA. Source: Osteoporosis International : a Journal Established As Result of Cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the Usa. 2004 January; 15(1): 62-70. Epub 2003 November 07. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14605798

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Hip fracture treatment: outcome and socio-economic aspects. A one-year survey in a Belgian University Hospital. Author(s): Scheerlinck T, Opdeweegh L, Vaes P, Opdecam P. Source: Acta Orthop Belg. 2003 April; 69(2): 145-56. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12769015

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Hip fracture. Author(s): Sprauve D. Source: Nursing. 2003 November; 33(11): 88. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14597821

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Hip fracture. Author(s): Gillespie W. Source: Clin Evid. 2002 December; (8): 1126-48. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12603934

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Homocysteine as a predictive factor for hip fracture in older persons. Author(s): McLean RR, Jacques PF, Selhub J, Tucker KL, Samelson EJ, Broe KE, Hannan MT, Cupples LA, Kiel DP. Source: The New England Journal of Medicine. 2004 May 13; 350(20): 2042-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15141042

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Hospital readmission of persons with hip fracture following medical rehabilitation. Author(s): Ottenbacher KJ, Smith PM, Illig SB, Peek MK, Fiedler RC, Granger CV. Source: Archives of Gerontology and Geriatrics. 2003 January-February; 36(1): 15-22. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12849095

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How well are community-living women treated for osteoporosis after hip fracture? Author(s): Bellantonio S, Fortinsky R, Prestwood K. Source: Journal of the American Geriatrics Society. 2001 September; 49(9): 1197-204. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11559379

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Implant-related fractures of the femur following hip fracture surgery. Author(s): Robinson CM, Adams CI, Craig M, Doward W, Clarke MC, Auld J. Source: The Journal of Bone and Joint Surgery. American Volume. 2002 July; 84-A(7): 1116-22. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12107309

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Implementing guidance on hip fracture: advice is misleading. Author(s): Ions GK. Source: Bmj (Clinical Research Ed.). 2004 June 26; 328(7455): 1568; Author Reply 1568. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15217893

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Improvement in the undertreatment of osteoporosis following hip fracture. Author(s): Gardner MJ, Flik KR, Mooar P, Lane JM. Source: The Journal of Bone and Joint Surgery. American Volume. 2002 August; 84-A(8): 1342-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12177263

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Improvements in pain relief, handling time and pressure ulcers through internal audits of hip fracture patients. Author(s): Hommel A, Ulander K, Thorngren KG. Source: Scandinavian Journal of Caring Sciences. 2003 March; 17(1): 78-83. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12581299

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Improvements in the prevention of postoperative venous thromboembolism in hip fracture patients. Author(s): Eriksson BI. Source: Orthopedics. 2003 August; 26(8 Suppl): S851-8. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12934740

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Incidence of hip fracture in Chiang Mai. Author(s): Phadungkiat S, Chariyalertsak S, Rajatanavin R, Chiengthong K, Suriyawongpaisal P, Woratanarat P. Source: J Med Assoc Thai. 2002 May; 85(5): 565-71. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12188386

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Incidence of hip fracture in New South Wales: are our efforts having an effect? Author(s): Boufous S, Finch CF, Lord SR. Source: The Medical Journal of Australia. 2004 June 21; 180(12): 623-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15200359

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Influence of preoperative medical status and delay to surgery on death following a hip fracture. Author(s): Stoddart J, Horne G, Devane P. Source: Anz Journal of Surgery. 2002 June; 72(6): 405-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12121158

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Influence of reproductive factors on hip fracture risk in Chinese women. Author(s): Huo D, Lauderdale DS, Li L. Source: Osteoporosis International : a Journal Established As Result of Cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the Usa. 2003 August; 14(8): 694-700. Epub 2003 July 19. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12879222

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Inhaled corticosteroids and hip fracture: a population-based case-control study. Author(s): Hubbard RB, Smith CJ, Smeeth L, Harrison TW, Tattersfield AE. Source: American Journal of Respiratory and Critical Care Medicine. 2002 December 15; 166(12 Pt 1): 1563-6. Epub 2002 September 25. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12406825

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Inhaled corticosteroids and hip fracture: disease or drugs? Author(s): van Staa TP, Leufkens HG, Cooper C. Source: American Journal of Respiratory and Critical Care Medicine. 2003 July 1; 168(1): 128; Author Reply 129. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12826596

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Inhaled or systemic corticosteroids and the risk of hospitalization for hip fracture among elderly women. Author(s): Lau E, Mamdani M, Tu K. Source: The American Journal of Medicine. 2003 February 1; 114(2): 142-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12586235

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Intensive geriatric rehabilitation of hip fracture patients: a randomized, controlled trial. Author(s): Huusko TM, Karppi P, Avikainen V, Kautiainen H, Sulkava R. Source: Acta Orthopaedica Scandinavica. 2002 August; 73(4): 425-31. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12358116

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Intentional and unintentional weight loss increase bone loss and hip fracture risk in older women. Author(s): Ensrud KE, Ewing SK, Stone KL, Cauley JA, Bowman PJ, Cummings SR; Study of Osteoporotic Fractures Research Group. Source: Journal of the American Geriatrics Society. 2003 December; 51(12): 1740-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14687352

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Interdisciplinary inpatient care for elderly people with hip fracture: a randomized controlled trial. Author(s): Naglie G, Tansey C, Kirkland JL, Ogilvie-Harris DJ, Detsky AS, Etchells E, Tomlinson G, O'Rourke K, Goldlist B. Source: Cmaj : Canadian Medical Association Journal = Journal De L'association Medicale Canadienne. 2002 July 9; 167(1): 25-32. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12137074

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International variations in hip fracture probabilities: implications for risk assessment. Author(s): Kanis JA, Johnell O, De Laet C, Jonsson B, Oden A, Ogelsby AK. Source: Journal of Bone and Mineral Research : the Official Journal of the American Society for Bone and Mineral Research. 2002 July; 17(7): 1237-44. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12096837

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Intracapsular hip fracture and the region-specific loss of cortical bone: analysis by peripheral quantitative computed tomography. Author(s): Crabtree N, Loveridge N, Parker M, Rushton N, Power J, Bell KL, Beck TJ, Reeve J. Source: Journal of Bone and Mineral Research : the Official Journal of the American Society for Bone and Mineral Research. 2001 July; 16(7): 1318-28. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11450708

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Is physical activity protective against hip fracture in frail older people? Author(s): Norton R, Galgali G, Campbell AJ, Reid IR, Robinson E, Butler M, Gray H. Source: Age and Ageing. 2001 May; 30(3): 262-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11443030

Studies

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Is time since hip fracture influencing the discrimination between fractured and nonfractured subjects as assessed at the calcaneum by three technologically different quantitative ultrasound devices? Author(s): Hans D, Allaoua S, Genton L, Delmi M, Vuagnat H, Rizzoli R, TahintziZawadynski S, Perron C, Pichard C, Slosman DO. Source: Calcified Tissue International. 2002 December; 71(6): 485-92. Epub 2002 September 18. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12232682

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Issues of methodology, standardization and metabolite recognition for 25hydroxyvitamin D when comparing the DiaSorin radioimmunoassay and the Nichols Advantage automated chemiluminescence protein-binding assay in hip fracture cases. Author(s): Glendenning P, Noble JM, Taranto M, Musk AA, McGuiness M, Goldswain PR, Fraser WD, Vasikaran SD. Source: Annals of Clinical Biochemistry. 2003 September; 40(Pt 5): 546-51. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14503993

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Joint proprioception in the elderly with and without hip fracture. Author(s): Ishii Y, Terajima K, Terashima S, Matsueda M. Source: Journal of Orthopaedic Trauma. 2000 November; 14(8): 542-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11149499

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Just a hip fracture? Author(s): Calle P. Source: European Journal of Emergency Medicine : Official Journal of the European Society for Emergency Medicine. 1998 December; 5(4): 481-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9919457

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Knee extensor and flexor strength in elderly women after recent hip fracture: assessment by the Cybex 6000 dynamometer of intra-rater inter-test reliability. Author(s): Madsen OR, Lauridsen UB. Source: Scandinavian Journal of Rehabilitation Medicine. 1995 December; 27(4): 219-26. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8650506

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Laboratory evaluation of hip fracture fixation devices. Author(s): Jazrawi LM, DeWal H, Kummer FJ, Koval KJ. Source: Bull Hosp Jt Dis. 2001-2002; 60(3-4): 114-23. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12102397

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Lack of diagnosis and treatment of osteoporosis in men and women after hip fracture. Author(s): Follin SL, Black JN, McDermott MT. Source: Pharmacotherapy. 2003 February; 23(2): 190-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12587808

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Lack of opioid administration in older hip fracture patients (CE). Author(s): Ardery G, Herr K, Hannon BJ, Titler MG. Source: Geriatric Nursing (New York, N.Y.). 2003 November-December; 24(6): 353-60. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14694324

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Late symptoms after hip fracture with displacement of the lesser trochanter--a case report. Author(s): Nielsen KD, Dammen I. Source: Acta Orthopaedica Scandinavica. 2003 August; 74(4): 500-1. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14521306

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Latrogenic arterial trauma associated with hip fracture treatment. Author(s): Storm RK, Sing AK, de Graaf EJ, Tetteroo GW. Source: The Journal of Trauma. 2000 May; 48(5): 957-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10823545

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Leisure-time physical activity levels and changes in relation to risk of hip fracture in men and women. Author(s): Hoidrup S, Sorensen TI, Stroger U, Lauritzen JB, Schroll M, Gronbaek M. Source: American Journal of Epidemiology. 2001 July 1; 154(1): 60-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11427405

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Length of hip axis and rate of hip fracture. Author(s): Todd C. Source: Bmj (Clinical Research Ed.). 1995 February 11; 310(6976): 401. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7866233

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Lessons for search strategies from a systematic review, in The Cochrane Library, of nutritional supplementation trials in patients after hip fracture. Author(s): Avenell A, Handoll HH, Grant AM. Source: The American Journal of Clinical Nutrition. 2001 March; 73(3): 505-10. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11237924

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Lifetime occupational physical activity and risk of hip fracture in women. Author(s): Jaglal SB, Kreiger N, Darlington GA. Source: Annals of Epidemiology. 1995 July; 5(4): 321-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8520716

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Limited magnetic resonance imaging (MRI) and the occult hip fracture. Author(s): Lim KB, Eng AK, Chng SM, Tan AG, Thoo FL, Low CO. Source: Ann Acad Med Singapore. 2002 September; 31(5): 607-10. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12395646

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Lipid-lowering agents and the risk of hip fracture in a Medicaid population. Author(s): Ray WA, Daugherty JR, Griffin MR. Source: Injury Prevention : Journal of the International Society for Child and Adolescent Injury Prevention. 2002 December; 8(4): 276-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12460961

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Longer femoral necks in the young: a predictor of further increases in hip fracture incidence? Author(s): Reid IR, Chin K, Evans MC, Cundy T. Source: N Z Med J. 1996 June 28; 109(1024): 234-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8769033

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Long-term trends in hip fracture prevalence: the influence of hip fracture incidence and survival. Author(s): Melton LJ 3rd, Therneau TM, Larson DR. Source: Osteoporosis International : a Journal Established As Result of Cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the Usa. 1998; 8(1): 68-74. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9692080

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Loss of bone density and lean body mass after hip fracture. Author(s): Fox KM, Magaziner J, Hawkes WG, Yu-Yahiro J, Hebel JR, Zimmerman SI, Holder L, Michael R. Source: Osteoporosis International : a Journal Established As Result of Cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the Usa. 2000; 11(1): 31-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10663356

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Low fractional calcium absorption increases the risk for hip fracture in women with low calcium intake. Study of Osteoporotic Fractures Research Group. Author(s): Ensrud KE, Duong T, Cauley JA, Heaney RP, Wolf RL, Harris E, Cummings SR. Source: Annals of Internal Medicine. 2000 March 7; 132(5): 345-53. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10691584

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Low levels of serum ascorbic acid in elderly patients with hip fracture. Author(s): Falch JA, Mowe M, Bohmer T. Source: Scandinavian Journal of Clinical and Laboratory Investigation. 1998 May; 58(3): 225-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9670346

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Low prevalence of osteomalacia in elderly patients with hip fracture. Author(s): Compston JE, Vedi S, Croucher PI. Source: Age and Ageing. 1991 March; 20(2): 132-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2053503

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Low rate of compliance with ergocalciferol therapy in vitamin-D-deficient patients with hip fracture. Author(s): Noble JM, McGuiness M, Glendenning P. Source: The Medical Journal of Australia. 2002 September 2; 177(5): 280. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12197833

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Low risk of hip fracture among elderly breast cancer survivors. Author(s): Lamont EB, Lauderdale DS. Source: Annals of Epidemiology. 2003 November; 13(10): 698-703. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14599734

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Low-molecular-weight heparinoid orgaran is more effective than aspirin in the prevention of venous thromboembolism after surgery for hip fracture. Author(s): Gent M, Hirsh J, Ginsberg JS, Powers PJ, Levine MN, Geerts WH, Jay RM, Leclerc J, Neemeh JA, Turpie AG. Source: Circulation. 1996 January 1; 93(1): 80-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8616946

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Maternal height, childhood growth and risk of hip fracture in later life: a longitudinal study. Author(s): Cooper C, Eriksson JG, Forsen T, Osmond C, Tuomilehto J, Barker DJ. Source: Osteoporosis International : a Journal Established As Result of Cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the Usa. 2001; 12(8): 623-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11580075

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Measuring recovery after a hip fracture using the SF-36 and Cummings scales. Author(s): Peterson MG, Allegrante JP, Cornell CN, MacKenzie CR, Robbins L, Horton R, Ganz SB, Augurt A. Source: Osteoporosis International : a Journal Established As Result of Cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the Usa. 2002; 13(4): 296-302. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12030544

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Medical complications and outcomes after hip fracture repair. Author(s): Lawrence VA, Hilsenbeck SG, Noveck H, Poses RM, Carson JL. Source: Archives of Internal Medicine. 2002 October 14; 162(18): 2053-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12374513

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Mobilisation strategies after hip fracture surgery in adults. Author(s): Handoll HH, Parker MJ, Sherrington C. Source: Cochrane Database Syst Rev. 2003; (1): Cd001704. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12535411

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Mobilisation strategies after hip fracture surgery in adults. Author(s): Parker MJ, Handoll HH, Dynan Y. Source: Cochrane Database Syst Rev. 2002; (2): Cd001704. Review. Update In: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12076418

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Modeling changes in health perception following hip fracture. Author(s): Cree M, Hayduk L, Soskolne CL, Suarez-Almazor M. Source: Quality of Life Research : an International Journal of Quality of Life Aspects of Treatment, Care and Rehabilitation. 2001; 10(8): 651-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11871586

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More comments on "Specificity of functional mobility measures in older adults after hip fracture: a pilot study". Author(s): Mendelsohn M, Petrella RJ. Source: American Journal of Physical Medicine & Rehabilitation / Association of Academic Physiatrists. 2003 December; 82(12): 979. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14627935

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Mortality and morbidity associated with osteoporosis drug treatment following hip fracture. Author(s): Cree MW, Juby AG, Carriere KC. Source: Osteoporosis International : a Journal Established As Result of Cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the Usa. 2003 September; 14(9): 722-7. Epub 2003 August 07. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12904833

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Mortality and morbidity in nonagenarian patients following hip fracture surgery. Author(s): Formiga F, Lopez-Soto A, Sacanella E, Coscojuela A, Suso S, Pujol R. Source: Gerontology. 2003 January-February; 49(1): 41-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12457049

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Mortality risk after hip fracture. Author(s): Richmond J, Aharonoff GB, Zuckerman JD, Koval KJ. Source: Journal of Orthopaedic Trauma. 2003 January; 17(1): 53-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12499968

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Mortality risk after hip fracture. 2003. Author(s): Richmond J, Aharonoff GB, Zuckerman JD, Koval KJ. Source: Journal of Orthopaedic Trauma. 2003 September; 17(8 Suppl): S2-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14696770

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Mortality, disability, and nursing home use for persons with and without hip fracture: a population-based study. Author(s): Leibson CL, Tosteson AN, Gabriel SE, Ransom JE, Melton LJ. Source: Journal of the American Geriatrics Society. 2002 October; 50(10): 1644-50. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12366617

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Mortality, functional status both important in assessing hip fracture care. Author(s): Rollins G. Source: Rep Med Guidel Outcomes Res. 2001 July 12; 12(14): 1-2, 5. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12214619

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National Consensus Conference on Improving the Continuum of Care for Patients with Hip Fracture. Author(s): Morris AH, Zuckerman JD; AAOS Council of Health Policy and Practice, USA. American Academy of Orthopaedic Surgeons. Source: The Journal of Bone and Joint Surgery. American Volume. 2002 April; 84-A(4): 670-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11940633

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Neuromuscular stimulation of the quadriceps muscle after hip fracture: a randomized controlled trial. Author(s): Lamb SE, Oldham JA, Morse RE, Evans JG. Source: Archives of Physical Medicine and Rehabilitation. 2002 August; 83(8): 1087-92. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12161829

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Novel concepts: emerging data and the role of extended prophylaxis following hip fracture surgery. Author(s): Dobesh PP. Source: American Journal of Health-System Pharmacy : Ajhp : Official Journal of the American Society of Health-System Pharmacists. 2003 November 15; 60(22 Suppl 7): S159. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14650862

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Nutritional state and functional capacity among elderly Swedish people with acute hip fracture. Author(s): Bachrach-Lindstrom MA, Ek AC, Unosson M. Source: Scandinavian Journal of Caring Sciences. 2000; 14(4): 268-74. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12035218

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Nutritional status in elderly female hip fracture patients: comparison with an agematched home living group attending day centres. Author(s): Lumbers M, New SA, Gibson S, Murphy MC. Source: The British Journal of Nutrition. 2001 June; 85(6): 733-40. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11430778

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Occurrence and incidence of the second hip fracture. Author(s): Schroder HM, Petersen KK, Erlandsen M. Source: Clinical Orthopaedics and Related Research. 1993 April; (289): 166-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8472408

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Orthopedic pitfalls in the ED: radiographically occult hip fracture. Author(s): Perron AD, Miller MD, Brady WJ. Source: The American Journal of Emergency Medicine. 2002 May; 20(3): 234-7. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11992346

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Osteocyte lacunar occupancy in the femoral neck cortex: an association with cortical remodeling in hip fracture cases and controls. Author(s): Power J, Noble BS, Loveridge N, Bell KL, Rushton N, Reeve J. Source: Calcified Tissue International. 2001 July; 69(1): 13-9. Epub 2001 June 12. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11685428

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Osteoporosis awareness: implications for improving the care of patients with hip fracture. Author(s): Kaufman JD. Source: The Journal of Bone and Joint Surgery. American Volume. 2002 April; 84-A(4): 683; Author Reply 683. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11940637

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Osteoporosis in men and women: a story about bone mineral density thresholds and hip fracture risk. Author(s): de Laet CE, van der Klift M, Hofman A, Pols HA. Source: Journal of Bone and Mineral Research : the Official Journal of the American Society for Bone and Mineral Research. 2002 December; 17(12): 2231-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12469917

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Outcome after hip fracture in individuals ninety years of age and older. 2001. Author(s): Shah MR, Aharonoff GB, Wolinsky P, Zuckerman JD, Koval KJ. Source: Journal of Orthopaedic Trauma. 2003 September; 17(8 Suppl): S6-11. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14696771

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Outcome following a second hip fracture. Author(s): Pearse EO, Redfern DJ, Sinha M, Edge AJ. Source: Injury. 2003 July; 34(7): 518-21. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12832178

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Outcome of hip fracture in older Irish women: a 2-year follow-up of subjects in a case-control study. Author(s): Kirke PN, Sutton M, Burke H, Daly L. Source: Injury. 2002 June; 33(5): 387-91. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12095716

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Outcome of medically unstable elderly patients admitted to a geriatric ward after hip fracture. Author(s): Beloosesky Y, Hendel D, Hershkovitz A, Skribnic G, Grinblat J. Source: Aging (Milano). 2001 April; 13(2): 78-84. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11405389

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Outcomes of hip fracture surgery in patients aged > or = 90 years. Author(s): Tanaka J, Tokimura F, Seki N. Source: Orthopedics. 2003 January; 26(1): 55-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12555835

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Patient and caregiver outcomes 12 months after home-based therapy for hip fracture: a randomized controlled trial. Author(s): Crotty M, Whitehead C, Miller M, Gray S. Source: Archives of Physical Medicine and Rehabilitation. 2003 August; 84(8): 1237-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12917867

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Patients' experiences of hip fracture. Author(s): Archibald G. Source: Journal of Advanced Nursing. 2003 November; 44(4): 385-92. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14651710

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Perioperative care of the patient with hip fracture. Author(s): Tammaro D, McGarry KA, Cyr MG. Source: Compr Ther. 2003 Winter; 29(4): 233-43. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14989045

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Posterior subcapsular cataract and hip fracture. Author(s): Endeshaw YW, Holland NW. Source: Journal of the American Geriatrics Society. 2004 April; 52(4): 650, Author Reply 650-1. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15066095

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Post-operative mortality related to waiting time for hip fracture surgery. Author(s): Casaletto JA, Gatt R. Source: Injury. 2004 February; 35(2): 114-20. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14736466

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Prediction of total and hip fracture risk in men and women by quantitative ultrasound of the calcaneus: EPIC-Norfolk prospective population study. Author(s): Khaw KT, Reeve J, Luben R, Bingham S, Welch A, Wareham N, Oakes S, Day N. Source: Lancet. 2004 January 17; 363(9404): 197-202. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14738792

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Predictors of bone loss after hip fracture. Author(s): Wehren LE, Hawkes WG, Hebel JR, Orwig D, Zimmerman SI, Fox KM, YuYahiro J, Magaziner J. Source: Osteoporosis International : a Journal Established As Result of Cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the Usa. 2004 February; 15(2): 125-31. Epub 2003 December 05. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14658032

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Preoperative saline versus gelatin for hip fracture patients; a randomized trial of 396 patients. Author(s): Parker MJ, Griffiths R, Boyle A. Source: British Journal of Anaesthesia. 2004 January; 92(1): 67-70. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14665555

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Prevention of hip fracture by external hip protectors: an intervention in 17 nursing homes in two municipalities in Norway. Author(s): Forsen L, Arstad C, Sandvig S, Schuller A, Roed U, Sogaard AJ. Source: Scandinavian Journal of Public Health. 2003; 31(4): 261-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15099031

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Quadriceps strength in women with a previous hip fracture: relationships to physical ability and bone mass. Author(s): Madsen OR, Lauridsen UB, Sorensen OH. Source: Scandinavian Journal of Rehabilitation Medicine. 2000 March; 32(1): 37-40. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10782940

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Quality improvement for patients with hip fracture: experience from a multi-site audit. Author(s): Freeman C, Todd C, Camilleri-Ferrante C, Laxton C, Murrell P, Palmer CR, Parker M, Payne B, Rushton N. Source: Quality & Safety in Health Care. 2002 September; 11(3): 239-45. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12486988

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Quality of care for hip fracture patients. Author(s): Strom B, Villadsen B. Source: Eur Qual Assur Netw Newsl. 1995 May 24-30; 9(35 Suppl Qa): 13-5. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9737898

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Quality of life after hip fracture: a comparison of four health status measures in 208 patients. Author(s): Van Balen R, Essink-Bot ML, Steyerberg E, Cools H, Habbema DF. Source: Disability and Rehabilitation. 2003 May 20; 25(10): 507-19. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12745962

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Quality of life in osteoporotic patients with hip fracture and without fracture. Author(s): Cvijetic S, Mestrovic T, Crkvenac A, Davila S, Korsic M. Source: Arh Hig Rada Toksikol. 2002 December; 53(4): 257-62. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12828126

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Quality of life related to fear of falling and hip fracture in older women: a time trade off study. Author(s): Salkeld G, Cameron ID, Cumming RG, Easter S, Seymour J, Kurrle SE, Quine S. Source: Bmj (Clinical Research Ed.). 2000 February 5; 320(7231): 341-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10657327

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Quantification of osteopenia in hip fracture patients. Author(s): Cornell CN, Schwartz S, Bansal M, Lane JM, Bullough P. Source: Journal of Orthopaedic Trauma. 1988; 2(3): 212-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3225706

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Quantitative ultrasound of the os calcis in postmenopausal women with spine and hip fracture. Author(s): Hadji P, Hars O, Gorke K, Emons G, Schulz KD. Source: Journal of Clinical Densitometry : the Official Journal of the International Society for Clinical Densitometry. 2000 Fall; 3(3): 233-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11090230

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Rapid loss of hip fracture protection after estrogen cessation: evidence from the National Osteoporosis Risk Assessment. Author(s): Yates J, Barrett-Connor E, Barlas S, Chen YT, Miller PD, Siris ES. Source: Obstetrics and Gynecology. 2004 March; 103(3): 440-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14990403

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Rehabilitation following hip fracture surgery: a comparative study of females and males. Author(s): Lieberman D, Lieberman D. Source: Disability and Rehabilitation. 2004 January 21; 26(2): 85-90. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14668144

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Rehabilitation outcome of elderly patients with hip fracture and cognitive impairment. Author(s): Rolland Y, Pillard F, Lauwers-Cances V, Busquere F, Vellas B, Lafont C. Source: Disability and Rehabilitation. 2004 April 8; 26(7): 425-31. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15204479

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Responding to Meyer et al. Factors associated with mortality after hip fracture. Osteoporos Int 2000; 11:228-32. Author(s): Wehren LE, Hebel R, Hawkes W, Magaziner J, Fox KM, Zimmerman SI. Source: Osteoporosis International : a Journal Established As Result of Cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the Usa. 2001; 12(6): 516-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11446569

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Retest reliability of dynamic balance during standing in older people after surgical treatment of hip fracture. Author(s): Dodd K, Hill K, Haas R, Luke C, Millard S. Source: Physiotherapy Research International : the Journal for Researchers and Clinicians in Physical Therapy. 2003; 8(2): 93-100. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12879731

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Risk factors and characteristics of falls resulting in hip fracture in the elderly. Author(s): Aizen E, Dranker N, Swartzman R, Michalak R. Source: Isr Med Assoc J. 2003 May; 5(5): 333-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12811949

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Risk factors for hip fracture in skilled nursing facilities: who should be evaluated? Author(s): Colon-Emeric CS, Biggs DP, Schenck AP, Lyles KW. Source: Osteoporosis International : a Journal Established As Result of Cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the Usa. 2003 July; 14(6): 484-9. Epub 2003 April 25. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12730734

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Risk factors for pressure ulcers among elderly hip fracture patients. Author(s): Baumgarten M, Margolis D, Berlin JA, Strom BL, Garino J, Kagan SH, Kavesh W, Carson JL. Source: Wound Repair and Regeneration : Official Publication of the Wound Healing Society [and] the European Tissue Repair Society. 2003 March-April; 11(2): 96-103. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12631296

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Risk of hip fracture in protected and unprotected falls in nursing homes in Norway. Author(s): Forsen L, Sogaard AJ, Sandvig S, Schuller A, Roed U, Arstad C. Source: Injury Prevention : Journal of the International Society for Child and Adolescent Injury Prevention. 2004 February; 10(1): 16-20. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14760021

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Ruptured internal iliac artery aneurysm mimicking a hip fracture. Author(s): Ijaz S, Geroulakos G. Source: International Angiology : a Journal of the International Union of Angiology. 2001 June; 20(2): 187-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11533528

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Seasonal variation, hip fracture and vitamin D levels in Southern Tasmania. Author(s): Inderjeeth CA, Barrett T, Al-Lahham Y, Mulford J, Nicklason F, Reberger C. Source: N Z Med J. 2002 April 26; 115(1152): 183-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12044001

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Serum and urine markers of bone metabolism during the year after hip fracture. Author(s): Yu-Yahiro JA, Michael RH, Dubin NH, Fox KM, Sachs M, Hawkes WG, Hebel JR, Zimmerman SI, Shapiro J, Magaziner J. Source: Journal of the American Geriatrics Society. 2001 July; 49(7): 877-83. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11527478

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Serum undercarboxylated osteocalcin is a marker of the risk of hip fracture in elderly women. Author(s): Szulc P, Chapuy MC, Meunier PJ, Delmas PD. Source: The Journal of Clinical Investigation. 1993 April; 91(4): 1769-74. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8473517

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Severe acute respiratory syndrome (SARS) in a geriatric patient with a hip fracture. A case report. Author(s): Wong KC, Leung KS, Hui M. Source: The Journal of Bone and Joint Surgery. American Volume. 2003 July; 85-A(7): 1339-42. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12851360

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Sex and ethnic differences in hip fracture-related mortality in Texas, 1990 through 1998. Author(s): Orces CH, Lee S, Bradshaw B. Source: Tex Med. 2002 December; 98(12): 56-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12515249

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Some way to go for consistent implementation of guidance on hip fracture. Author(s): Bottle A, Jarman B, Aylin P, Taylor R. Source: Bmj (Clinical Research Ed.). 2004 May 8; 328(7448): 1097. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15130976

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Specificity of functional mobility measures in older adults after hip fracture: a pilot study. Author(s): Mendelsohn ME, Leidl DS, Overend TJ, Petrella RJ. Source: American Journal of Physical Medicine & Rehabilitation / Association of Academic Physiatrists. 2003 October; 82(10): 766-74. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14508407

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Strategies for the prevention of hip fracture. Author(s): Gourlay M, Richy F, Reginster JY. Source: The American Journal of Medicine. 2003 September; 115(4): 309-17. Review. Erratum In: Am J Med. 2003 October 15; 115(6): 509. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12967696

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Subcapital femoral neck fracture following open reduction and internal fixation of an intertrochanteric hip fracture using a sliding screw and side plate. Author(s): Malkani AL, Rand JA. Source: Orthop Rev. 1993 April; 22(4): 469-72. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8479792

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Survival and potential years of life lost after hip fracture in men and age-matched women. Author(s): Trombetti A, Herrmann F, Hoffmeyer P, Schurch MA, Bonjour JP, Rizzoli R. Source: Osteoporosis International : a Journal Established As Result of Cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the Usa. 2002 September; 13(9): 731-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12195537

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Technique for percutaneous insertion of intramedullary nail for intertrochanteric hip fracture. Author(s): Siddiqui SA, Rocco J, McKechnie A, Meyerson RI, Sands AK. Source: Am J Orthop. 2004 March; 33(3): 117-20; Discussion 120. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15074458

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The contribution of hip fracture to risk of subsequent fractures: data from two longitudinal studies. Author(s): Colon-Emeric C, Kuchibhatla M, Pieper C, Hawkes W, Fredman L, Magaziner J, Zimmerman S, Lyles KW. Source: Osteoporosis International : a Journal Established As Result of Cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the Usa. 2003 November; 14(11): 879-83. Epub 2003 October 03. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14530910

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The effects of MK-0677, an oral growth hormone secretagogue, in patients with hip fracture. Author(s): Bach MA, Rockwood K, Zetterberg C, Thamsborg G, Hebert R, Devogelaer JP, Christiansen JS, Rizzoli R, Ochsner JL, Beisaw N, Gluck O, Yu L, Schwab T, Farrington J, Taylor AM, Ng J, Fuh V; MK 0677 Hip Fracture Study Group. Source: Journal of the American Geriatrics Society. 2004 April; 52(4): 516-23. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15066065

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The management of osteoporosis following hip fracture: have we improved our care? Author(s): Bahl S, Coates PS, Greenspan SL. Source: Osteoporosis International : a Journal Established As Result of Cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the Usa. 2003 November; 14(11): 884-8. Epub 2003 October 16. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14569422

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The second hip fracture--an analysis of 84 elderly patients. Author(s): Fisher AA, Davis MW, Goh S, Smith PN. Source: Journal of Orthopaedic Trauma. 2004 April; 18(4): 256; Author Reply 256-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15087975

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The second hip fracture--an analysis of 84 elderly patients. Author(s): Shabat S, Gepstein R, Mann G, Kish B, Fredman B, Nyska M. Source: Journal of Orthopaedic Trauma. 2003 October; 17(9): 613-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14574188

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Thiazide diuretics and the risk for hip fracture. Author(s): Schoofs MW, van der Klift M, Hofman A, de Laet CE, Herings RM, Stijnen T, Pols HA, Stricker BH. Source: Annals of Internal Medicine. 2003 September 16; 139(6): 476-82. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=13679324

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Thromboprophylaxis practice patterns in hip fracture surgery patients: experience in Perth, Western Australia. Author(s): Wan S, Ting J, Olsen A, Croser J, Eikelboom JW. Source: Anz Journal of Surgery. 2003 October; 73(10): 826-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14525575

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Time to ambulation after hip fracture surgery: relation to hospitalization outcomes. Author(s): Kamel HK, Iqbal MA, Mogallapu R, Maas D, Hoffmann RG. Source: The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences. 2003 November; 58(11): 1042-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14630887

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Timing, intensity, and duration of rehabilitation for hip fracture and stroke: report of a workshop at the National Center for Medical Rehabilitation Research. Author(s): Weinrich M, Good DC, Reding M, Roth EJ, Cifu DX, Silver KH, Craik RL, Magaziner J, Terrin M, Schwartz M, Gerber L. Source: Neurorehabilitation and Neural Repair. 2004 March; 18(1): 12-28. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15035960

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Ultrasound velocity in the tibia in Japanese patients with hip fracture. Author(s): Muraki S, Yamamoto S, Kanai H. Source: Journal of Orthopaedic Science : Official Journal of the Japanese Orthopaedic Association. 2002; 7(6): 623-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12486464

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Undertreatment of osteoporosis following hip fracture. Author(s): Fisher AA, Davis MW, Smith PN. Source: The Journal of Bone and Joint Surgery. American Volume. 2003 July; 85-A(7): 1394-5; Author Reply 1395-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12851373

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Undertreatment of osteoporosis in men who have had a hip fracture. Author(s): Abraham A. Source: Archives of Internal Medicine. 2003 May 26; 163(10): 1236; Author Reply 1236-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12767962

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Undertreatment of osteoporosis in men with hip fracture. Author(s): Kiebzak GM, Beinart GA, Perser K, Ambrose CG, Siff SJ, Heggeness MH. Source: Archives of Internal Medicine. 2002 October 28; 162(19): 2217-22. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12390065

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Underutilization of pressure ulcer risk assessment in hip fracture patients. Author(s): Stotts NA, Deosaransingh K, Roll FJ, Newman J. Source: Adv Wound Care. 1998 January-February; 11(1): 32-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9729931

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Unipolar or bipolar prosthesis for the displaced intracapsular hip fracture? An unanswered question. Author(s): Gilbert MS, Capozzi J. Source: Clinical Orthopaedics and Related Research. 1998 August; (353): 81-5. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9728162

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Urinary incontinence in elderly patients with acute stroke and hip fracture. Author(s): Bird MR, Hii S, McCrory PR, Donnan GA. Source: The Medical Journal of Australia. 1997 October 20; 167(8): 415. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9364156

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Use of clinical risk factors in elderly women with low bone mineral density to identify women at higher risk of hip fracture: The EPIDOS prospective study. Author(s): Dargent-Molina P, Douchin MN, Cormier C, Meunier PJ, Breart G; EPIDOS Study Group. Source: Osteoporosis International : a Journal Established As Result of Cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the Usa. 2002 July; 13(7): 593-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12111021

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Use of human GH in elderly patients with accidental hip fracture. Author(s): Van der Lely AJ, Lamberts SW, Jauch KW, Swierstra BA, Hertlein H, Danielle De Vries D, Birkett MA, Bates PC, Blum WF, Attanasio AF. Source: European Journal of Endocrinology / European Federation of Endocrine Societies. 2000 November; 143(5): 585-92. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11078981

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Use of low potency estrogens does not reduce the risk of hip fracture. Author(s): Michaelsson K, Baron JA, Farahmand BY, Ljunghall S. Source: Bone. 2002 April; 30(4): 613-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11934654

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Variations in hip fracture hospitalization rates among different race/ethnicity groups in New York City. Author(s): Fang J, Freeman R, Jeganathan R, Alderman MH. Source: Ethn Dis. 2004 Spring; 14(2): 280-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15132215

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Variations in nursing home discharge rates for urban and rural nursing facility residents with hip fracture. Author(s): Coburn AF, Bolda EJ, Keith RG. Source: The Journal of Rural Health : Official Journal of the American Rural Health Association and the National Rural Health Care Association. 2003 Spring; 19(2): 148-55. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12696851

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Venous thromboembolism after hip fracture surgery in a patient with haemophilia B and factor V Arg506Gln (factor V Leiden). Author(s): Pruthi RK, Heit JA, Green MM, Emiliusen LM, Nichols WL, Wilke JL, Gastineau DA. Source: Haemophilia : the Official Journal of the World Federation of Hemophilia. 2000 November; 6(6): 631-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11122387

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Visual factors should be assessed in older people presenting with falls or hip fracture. Author(s): Abdelhafiz AH, Austin CA. Source: Age and Ageing. 2003 January; 32(1): 26-30. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12540344

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Visual impairment and risk of hip fracture. Author(s): Ivers RQ, Norton R, Cumming RG, Butler M, Campbell AJ. Source: American Journal of Epidemiology. 2000 October 1; 152(7): 633-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11032158

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Visual risk factors for hip fracture in older people. Author(s): Ivers RQ, Cumming RG, Mitchell P, Simpson JM, Peduto AJ. Source: Journal of the American Geriatrics Society. 2003 March; 51(3): 356-63. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12588579

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Vitamin D deficiency in women with hip fracture. Author(s): Lesser GT. Source: Jama : the Journal of the American Medical Association. 2000 March 15; 283(11): 1425-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10732930

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Vitamin D status and bone turnover in women with acute hip fracture. Author(s): Nuti R, Martini G, Valenti R, Gambera D, Gennari L, Salvadori S, Avanzati A. Source: Clinical Orthopaedics and Related Research. 2004 May; (422): 208-13. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15187859

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Volume kinetics of Ringer solution after surgery for hip fracture. Author(s): Svensen C, Ponzer S, Hahn RG. Source: Canadian Journal of Anaesthesia = Journal Canadien D'anesthesie. 1999 February; 46(2): 133-41. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10083993

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Volumetric bone density at the femoral neck as a common measure of hip fracture risk for men and women. Author(s): Center JR, Nguyen TV, Pocock NA, Eisman JA. Source: The Journal of Clinical Endocrinology and Metabolism. 2004 June; 89(6): 2776-82. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15181057

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Walking ability and activity level after hip fracture in the elderly--a follow-up. Author(s): Ingemarsson AH, Frandin K, Mellstrom D, Moller M. Source: Journal of Rehabilitation Medicine : Official Journal of the Uems European Board of Physical and Rehabilitation Medicine. 2003 March; 35(2): 76-83. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12691337

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Walking and leisure-time activity and risk of hip fracture in postmenopausal women. Author(s): Feskanich D, Willett W, Colditz G. Source: Jama : the Journal of the American Medical Association. 2002 November 13; 288(18): 2300-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12425707

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Warfarin responses in total joint and hip fracture patients. Author(s): Messieh M, Huang Z, Johnson LJ, Jobin S. Source: The Journal of Arthroplasty. 1999 September; 14(6): 724-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10512445

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Warfarin therapy and risk of hip fracture among elderly patients. Author(s): Mamdani M, Upshur RE, Anderson G, Bartle BR, Laupacis A. Source: Pharmacotherapy. 2003 January; 23(1): 1-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12523455

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Weight loss from maximum body weight among middle-aged and older white women and the risk of hip fracture: the NHANES I epidemiologic follow-up study. Author(s): Langlois JA, Mussolino ME, Visser M, Looker AC, Harris T, Madans J. Source: Osteoporosis International : a Journal Established As Result of Cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the Usa. 2001; 12(9): 763-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11605743

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Weight variability, weight change and the incidence of hip fracture: a prospective study of 39,000 middle-aged Norwegians. Author(s): Meyer HE, Tverdal A, Selmer R. Source: Osteoporosis International : a Journal Established As Result of Cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the Usa. 1998; 8(4): 373-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10024908

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What is the role of timing in the surgical and rehabilitative care of communitydwelling older persons with acute hip fracture? Author(s): Hoenig H, Rubenstein LV, Sloane R, Horner R, Kahn K. Source: Archives of Internal Medicine. 1997 March 10; 157(5): 513-20. Erratum In: Arch Intern Med 1997 July 14; 157(13): 1444. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9066455

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Workshop on Hip Fracture Registries in Europe. Author(s): Langlois JA, Maggi S, Crepaldi G. Source: Aging (Milano). 2000 October; 12(5): 398-401. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11126528

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Worldwide incidence of hip fracture in elderly women: relation to consumption of animal and vegetable foods. Author(s): Cochrane Database Syst Rev. 2004;(1):CD001880 Source: The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences. 2000 October; 55(10): M585-92. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14973973

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World-wide projections for hip fracture. Author(s): Gullberg B, Johnell O, Kanis JA. Source: Osteoporosis International : a Journal Established As Result of Cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the Usa. 1997; 7(5): 407-13. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9425497

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Years of potential life lost after hip fracture among postmenopausal women. Author(s): Eiskjaer S, Ostgard SE, Jakobsen BW, Jensen J, Lucht U. Source: Acta Orthopaedica Scandinavica. 1992 June; 63(3): 293-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1609593

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CHAPTER 2. NUTRITION AND HIP FRACTURE Overview In this chapter, we will show you how to find studies dedicated specifically to nutrition and hip fracture.

Finding Nutrition Studies on Hip Fracture The National Institutes of Health’s Office of Dietary Supplements (ODS) offers a searchable bibliographic database called the IBIDS (International Bibliographic Information on Dietary Supplements; National Institutes of Health, Building 31, Room 1B29, 31 Center Drive, MSC 2086, Bethesda, Maryland 20892-2086, Tel: 301-435-2920, Fax: 301-480-1845, E-mail: [email protected]). The IBIDS contains over 460,000 scientific citations and summaries about dietary supplements and nutrition as well as references to published international, scientific literature on dietary supplements such as vitamins, minerals, and botanicals.7 The IBIDS includes references and citations to both human and animal research studies. As a service of the ODS, access to the IBIDS database is available free of charge at the following Web address: http://ods.od.nih.gov/databases/ibids.html. After entering the search area, you have three choices: (1) IBIDS Consumer Database, (2) Full IBIDS Database, or (3) Peer Reviewed Citations Only. Now that you have selected a database, click on the “Advanced” tab. An advanced search allows you to retrieve up to 100 fully explained references in a comprehensive format. Type “hip fracture” (or synonyms) into the search box, and click “Go.” To narrow the search, you can also select the “Title” field.

7 Adapted from http://ods.od.nih.gov. IBIDS is produced by the Office of Dietary Supplements (ODS) at the National Institutes of Health to assist the public, healthcare providers, educators, and researchers in locating credible, scientific information on dietary supplements. IBIDS was developed and will be maintained through an interagency partnership with the Food and Nutrition Information Center of the National Agricultural Library, U.S. Department of Agriculture.

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The following is a typical result when searching for recently indexed consumer information on hip fracture: •

How well you absorb calcium is important for limiting hip fracture risk. Author(s): Department of Foods and Nutrition, Purdue University, West Lafayette, IN 47906, USA. Source: Fleet, J Nutr-Revolume 2001 October; 59(10): 338-41 0029-6643

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Supplementation with vitamin D3 and calcium prevents hip fractures in elderly women. Source: Anonymous Nutr-Revolume 1993 June; 51(6): 183-5 0029-6643

The following information is typical of that found when using the “Full IBIDS Database” to search for “hip fracture” (or a synonym): •

Apolipoprotein E polymorphism: A new genetic marker of hip fracture risk--The Study of Osteoporotic Fractures. Author(s): Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pennsylvania 15261, USA. Source: Cauley, J A Zmuda, J M Yaffe, K Kuller, L H Ferrell, R E Wisniewski, S R Cummings, S R J-Bone-Miner-Res. 1999 July; 14(7): 1175-81 0884-0431

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Calcaneal ultrasonic measurements discriminate hip fracture independently of bone mass. Author(s): Department of Orthopedic Surgery, Indiana University School of Medicine, Indianapolis, USA. Source: Turner, C H Peacock, M Timmerman, L Neal, J M Johnson, C C Osteoporos-Int. 1995 March; 5(2): 130-5 0937-941X

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Calcium, dairy products, and the risk of hip fracture in women in northern Italy. Author(s): Istituto di Ricerche Farmacologiche Mario Negri, Universita di Milano, Milan, Italy. Source: Tavani, A Negri, E La Vecchia, C Epidemiology. 1995 September; 6(5): 554-7 1044-3983

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Clinical efficacy of aspirin and dextran for thromboprophylaxis in geriatric hip fracture patients. Author(s): Department of Orthopedic Surgery, Hospital for Joint Diseases, New York, New York. Source: Feldman, D S Zuckerman, J D Walters, I Sakales, S R J-Orthop-Trauma. 1993; 7(1): 1-5 0890-5339

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Combined calcium and vitamin D3 supplementation in elderly women: confirmation of reversal of secondary hyperparathyroidism and hip fracture risk: the Decalyos II study. Author(s): Hjpital Edouard Herriot, Lyon, France. [email protected] Source: Chapuy, M C Pamphile, R Paris, E Kempf, C Schlichting, M Arnaud, S Garnero, P Meunier, P J Osteoporos-Int. 2002 March; 13(3): 257-64 0937-941X

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Decreased broadband ultrasound attenuation of the calcaneus in women with fragility fracture. 85 Colles' and hip fracture cases versus 77 normal women. Author(s): Department of Orthopedics, University General Hospital, Heraklion, Crete, Greece. Source: Dretakis, E C Kontakis, G M Steriopoulos, C A Dretakis, C E Acta-OrthopScand. 1994 June; 65(3): 305-8 0001-6470

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Diet and hip fracture risk: a case-control study. Study Group of the Multiple Risk Survey on Swedish Women for Eating Assessment. Author(s): Department of Orthopaedics, Central Hospital, Vasteras, Sweden. Source: Michaelsson, K Holmberg, L Mallmin, H Sorensen, S Wolk, A Bergstrom, R Ljunghall, S Int-J-Epidemiol. 1995 August; 24(4): 771-82 0300-5771

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Dietary calcium and hip fracture risk: the NHANES I Epidemiologic Follow-Up Study. Author(s): Division of Health Examination Statistics, Centers for Disease Control, Hyattsville, MD 20782. Source: Looker, A C Harris, T B Madans, J H Sempos, C T Osteoporos-Int. 1993 July; 3(4): 177-84 0937-941X

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Effect of prefracture versus postfracture dietary assessment on hip fracture risk estimates. Author(s): Department of Orthopaedics, Central Hospital, 721 89 Vasteras, Sweden. The Study Group of the Multiple Risk Survey on Swedish Women for eating Assessment (MRS SWEA). Source: Michaelsson, K Holmberg, L Ljunghall, S Mallmin, H Persson, P G Wolk, A IntJ-Epidemiol. 1996 April; 25(2): 403-10 0300-5771

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Factors associated with hip fracture occurrence in old age. Implications in the postsurgical management. Author(s): Department of Internal Medicine, University Hospitals K.U. Leuven, Belgium. Source: Boonen, S Broos, P Haentjens, P Acta-Chir-Belg. 1999 August; 99(4): 185-9 00015458

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Incidence of hip fractures in osteoporotic women treated with sodium fluoride. Author(s): Mayo Clinic, Rochester, MN. Source: Riggs, B L Baylink, D J Kleerekoper, M Lane, J M Melton, L J 3rd Meunier, P J JBone-Miner-Res. 1987 April; 2(2): 123-6 0884-0431

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Increased incidence of hip fracture in osteoporotic women treated with sodium fluoride. Author(s): Creighton University, Omaha, NE 68131. Source: Hedlund, L R Gallagher, J C J-Bone-Miner-Res. 1989 April; 4(2): 223-5 0884-0431

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Influence of age and body mass on the effects of vitamin D on hip fracture risk. Author(s): Department of Community Health Science, Malmo General Hospital, Lund University, Sweden. Source: Ranstam, J Kanis, J A Osteoporos-Int. 1995; 5(6): 450-4 0937-941X

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Nutritional supplementation for hip fracture aftercare in the elderly. Author(s): Health Services Research Unit, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, Scotland, UK, AB25 2ZD. [email protected] Source: Avenell, A Handoll, H H Cochrane-Database-Syst-Revolume 2000; (4): CD001880 1469-493X

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Orgaran in hip fracture surgery. Author(s): Department of Surgery, Lund University, Malmo General Hospital, Sweden. Source: Bergqvist, D Haemostasis. 1992; 22(2): 104-8 0301-0147

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Polymorphisms of the VDR, ER and COLIA1 genes and osteoporotic hip fracture in elderly postmenopausal women. Author(s): Arthritis and Metabolic Bone Disease Research Unit, Division of Traumatology and Emergency Surgery, K.U. Leuven, Belgium.

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Source: Aerssens, J Dequeker, J Peeters, J Breemans, S Broos, P Boonen, S OsteoporosInt. 2000; 11(7): 583-91 0937-941X •

Postmenopausal hormone therapy and risk of cardiovascular disease and hip fracture in a cohort of Swedish women. Author(s): Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, MA 02115, USA. Source: Grodstein, F Stampfer, M J Falkeborn, M Naessen, T Persson, I Epidemiology. 1999 September; 10(5): 476-80 1044-3983

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Prevention of secondary hyperparathyroidism and hip fracture in elderly women with calcium and vitamin D3 supplements. Author(s): Department of Rhuematology & Bone Diseases, Edouard Herriot Hospital, Lyon, France. Source: Chapuy, M C Meunier, P J Osteoporos-Int. 1996; 6 Suppl 360-3 0937-941X

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Risk factors for hip fracture in a high incidence area: a case-control study from Oslo, Norway. Author(s): National Health Screening Service, University of Oslo, Norway. Source: Meyer, H E Henriksen, C Falch, J A Pedersen, J I Tverdal, A Osteoporos-Int. 1995; 5(4): 239-46 0937-941X

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Spontaneous hip fractures in fluoride-treated patients: potential causative factors. Author(s): Department of Endocrinology & Diabetes, Sir Charles Gairdner Hospital, Nedlands, Western Australia. Source: Gutteridge, D H Price, R I Kent, G N Prince, R L Michell, P A J-Bone-Miner-Res. 1990 March; 5 Suppl 1S205-15 0884-0431

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The prevalence of malnutrition in elderly hip fracture patients. Author(s): Older Persons Health, The Princess Margaret Hospital, Christchurch. [email protected] Source: Hanger, H C Smart, E J Merrilees, M J Frampton, C M N-Z-Med-J. 1999 Mar 26; 112(1084): 88-90 0028-8446

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Thromboprophylaxis in hip fracture surgery: a pilot study comparing danaparoid, enoxaparin and dalteparin. The TIFDED Study Group. Source: Anonymous Haemostasis. 1999 Nov-December; 29(6): 310-7 0301-0147

Federal Resources on Nutrition In addition to the IBIDS, the United States Department of Health and Human Services (HHS) and the United States Department of Agriculture (USDA) provide many sources of information on general nutrition and health. Recommended resources include: •

healthfinder®, HHS’s gateway to health information, including diet and nutrition: http://www.healthfinder.gov/scripts/SearchContext.asp?topic=238&page=0

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The United States Department of Agriculture’s Web site dedicated to nutrition information: www.nutrition.gov

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The Food and Drug Administration’s Web site for federal food safety information: www.foodsafety.gov

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The National Action Plan on Overweight and Obesity sponsored by the United States Surgeon General: http://www.surgeongeneral.gov/topics/obesity/

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The Center for Food Safety and Applied Nutrition has an Internet site sponsored by the Food and Drug Administration and the Department of Health and Human Services: http://vm.cfsan.fda.gov/

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Center for Nutrition Policy and Promotion sponsored by the United States Department of Agriculture: http://www.usda.gov/cnpp/

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Food and Nutrition Information Center, National Agricultural Library sponsored by the United States Department of Agriculture: http://www.nal.usda.gov/fnic/

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Food and Nutrition Service sponsored by the United States Department of Agriculture: http://www.fns.usda.gov/fns/

Additional Web Resources A number of additional Web sites offer encyclopedic information covering food and nutrition. The following is a representative sample: •

AOL: http://search.aol.com/cat.adp?id=174&layer=&from=subcats

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Family Village: http://www.familyvillage.wisc.edu/med_nutrition.html

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Google: http://directory.google.com/Top/Health/Nutrition/

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Healthnotes: http://www.healthnotes.com/

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Open Directory Project: http://dmoz.org/Health/Nutrition/

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Yahoo.com: http://dir.yahoo.com/Health/Nutrition/

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WebMDHealth: http://my.webmd.com/nutrition

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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html

The following is a specific Web list relating to hip fracture; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: •

Vitamins Vitamin A Source: Healthnotes, Inc.; www.healthnotes.com Vitamin A Source: Prima Communications, Inc.www.personalhealthzone.com Vitamin D Source: Healthnotes, Inc.; www.healthnotes.com Vitamin D Source: Prima Communications, Inc.www.personalhealthzone.com Vitamin D Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com

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Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,905,00.html Vitamin K Alternative names: Menadione, Menaphthone, Menaquinone, Phylloquinone Source: Integrative Medicine Communications; www.drkoop.com Vitamin K Source: Prima Communications, Inc.www.personalhealthzone.com •

Minerals Retinol Source: Integrative Medicine Communications; www.drkoop.com Vitamin A (Retinol) Source: Integrative Medicine Communications; www.drkoop.com

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Food and Diet Coffee Source: Healthnotes, Inc.; www.healthnotes.com Tea Source: Healthnotes, Inc.; www.healthnotes.com

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CHAPTER 3. ALTERNATIVE MEDICINE AND HIP FRACTURE Overview In this chapter, we will begin by introducing you to official information sources on complementary and alternative medicine (CAM) relating to hip fracture. At the conclusion of this chapter, we will provide additional sources.

National Center for Complementary and Alternative Medicine The National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health (http://nccam.nih.gov/) has created a link to the National Library of Medicine’s databases to facilitate research for articles that specifically relate to hip fracture and complementary medicine. To search the database, go to the following Web site: http://www.nlm.nih.gov/nccam/camonpubmed.html. Select “CAM on PubMed.” Enter “hip fracture” (or synonyms) into the search box. Click “Go.” The following references provide information on particular aspects of complementary and alternative medicine that are related to hip fracture: •

A case of femoral neck fracture in a patient with severe testosterone deficiency. Author(s): Ohishi T, Koide Y, Takahashi M, Oikawa M, Kushida K. Source: Journal of Bone and Mineral Metabolism. 1999; 17(1): 51-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10084402

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A comparison of hip fracture incidence among native Japanese, Japanese Americans, and American Caucasians. Author(s): Ross PD, Norimatsu H, Davis JW, Yano K, Wasnich RD, Fujiwara S, Hosoda Y, Melton LJ 3rd. Source: American Journal of Epidemiology. 1991 April 15; 133(8): 801-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2021147

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A randomised, controlled comparison of different calcium and vitamin D supplementation regimens in elderly women after hip fracture: The Nottingham Neck of Femur (NONOF) Study.

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Author(s): Harwood RH, Sahota O, Gaynor K, Masud T, Hosking DJ; The Nottingham Neck of Femur (NONOF) Study. Source: Age and Ageing. 2004 January; 33(1): 45-51. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14695863 •

A randomised, double-blind assessment of the effect of nutritional supplementation on the prevention of pressure ulcers in hip-fracture patients. Author(s): Houwing RH, Rozendaal M, Wouters-Wesseling W, Beulens JW, Buskens E, Haalboom JR. Source: Clinical Nutrition (Edinburgh, Lothian). 2003 August; 22(4): 401-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12880608

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A randomized controlled trial of osteopathic manipulative treatment following knee or hip arthroplasty. Author(s): Licciardone JC, Stoll ST, Cardarelli KM, Gamber RG, Swift JN Jr, Winn WB. Source: J Am Osteopath Assoc. 2004 May; 104(5): 193-202. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15176518

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A randomized controlled trial of vitamin D supplementation on preventing postmenopausal bone loss and modifying bone metabolism using identical twin pairs. Author(s): Hunter D, Major P, Arden N, Swaminathan R, Andrew T, MacGregor AJ, Keen R, Snieder H, Spector TD. Source: Journal of Bone and Mineral Research : the Official Journal of the American Society for Bone and Mineral Research. 2000 November; 15(11): 2276-83. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11092410

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A systematic review of protein and energy supplementation for hip fracture aftercare in older people. Author(s): Avenell A, Handoll HH. Source: European Journal of Clinical Nutrition. 2003 August; 57(8): 895-903. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12879083

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Abnormal bone and calcium metabolism in patients after stroke. Author(s): Sato Y. Source: Archives of Physical Medicine and Rehabilitation. 2000 January; 81(1): 117-21. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10638886

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Accuracy in the Outcomes and Assessment Information Set (OASIS): results of a video simulation. Author(s): Madigan EA, Tullai-McGuinness S, Fortinsky RH.

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Source: Research in Nursing & Health. 2003 August; 26(4): 273-83. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12884416 •

Adherence to vitamin d supplementation in elderly patients after hip fracture. Author(s): Segal E, Zinnman H, Raz B, Tamir A, Ish-Shalom S. Source: Journal of the American Geriatrics Society. 2004 March; 52(3): 474-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14962175

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Amelioration of hemiplegia-associated osteopenia more than 4 years after stroke by 1 alpha-hydroxyvitamin D3 and calcium supplementation. Author(s): Sato Y, Maruoka H, Oizumi K. Source: Stroke; a Journal of Cerebral Circulation. 1997 April; 28(4): 736-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9099188

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Amelioration of osteoporosis and hypovitaminosis D by sunlight exposure in stroke patients. Author(s): Sato Y, Metoki N, Iwamoto J, Satoh K. Source: Neurology. 2003 August 12; 61(3): 338-42. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12913194

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Calcium, vitamin D, milk consumption, and hip fractures: a prospective study among postmenopausal women. Author(s): Feskanich D, Willett WC, Colditz GA. Source: The American Journal of Clinical Nutrition. 2003 February; 77(2): 504-11. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12540414

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Calcium-vitamin D3 supplementation is cost-effective in hip fractures prevention. Author(s): Lilliu H, Pamphile R, Chapuy MC, Schulten J, Arlot M, Meunier PJ. Source: Maturitas. 2003 April 25; 44(4): 299-305. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12697371

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Care of the older adult following hip fracture. Author(s): Kain HB. Source: Holistic Nursing Practice. 2000 July; 14(4): 24-39. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12119649

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Clinical outcomes in transition program for older adults with hip fracture. Author(s): Simpson P. Source: Outcomes Management. 2002 April-June; 6(2): 86-92. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11949519

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Combined calcium and vitamin D3 supplementation in elderly women: confirmation of reversal of secondary hyperparathyroidism and hip fracture risk: the Decalyos II study. Author(s): Chapuy MC, Pamphile R, Paris E, Kempf C, Schlichting M, Arnaud S, Garnero P, Meunier PJ. Source: Osteoporosis International : a Journal Established As Result of Cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the Usa. 2002 March; 13(3): 257-64. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11991447

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Cross-cultural association between dietary animal protein and hip fracture: a hypothesis. Author(s): Abelow BJ, Holford TR, Insogna KL. Source: Calcified Tissue International. 1992 January; 50(1): 14-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1739864

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Dietary vitamin K intakes are associated with hip fracture but not with bone mineral density in elderly men and women. Author(s): Booth SL, Tucker KL, Chen H, Hannan MT, Gagnon DR, Cupples LA, Wilson PW, Ordovas J, Schaefer EJ, Dawson-Hughes B, Kiel DP. Source: The American Journal of Clinical Nutrition. 2000 May; 71(5): 1201-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10799384

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Hip fracture mortality and morbidity in Switzerland and Japan: a cross-cultural comparison. Author(s): Fujiwara NK, Marti B, Gutzwiller F. Source: Sozial- Und Praventivmedizin. 1993; 38(1): 8-14. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8451869

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Low fractional calcium absorption increases the risk for hip fracture in women with low calcium intake. Study of Osteoporotic Fractures Research Group. Author(s): Cochrane Database Syst Rev. 2001;(1):CD000227 Source: Annals of Internal Medicine. 2000 March 7; 132(5): 345-53. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11279685

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'Natural' healing of hip fractures in childhood. Author(s): Sferopoulos NK, Papavasiliou VA. Source: Injury. 1994 October; 25(8): 493-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7960063

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Nutritional supplementation for hip fracture aftercare in the elderly. Author(s): Avenell A, Handoll HH.

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Source: Cochrane Database Syst Rev. 2004; (1): Cd001880. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14973973 •

Nutritional supplementation for hip fracture aftercare in the elderly. Author(s): Avenell A, Handoll HH. Source: Cochrane Database Syst Rev. 2000; (4): Cd001880. Review. Update In: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11034731

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Nutritional supplementation for hip fracture aftercare in the elderly. Author(s): Avenell A, Handoll HH. Source: Cochrane Database Syst Rev. 2000; (2): Cd001880. Review. Update In: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10796450

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Nutritional supplementation of elderly hip fracture patients. A randomized, doubleblind, placebo-controlled trial. Author(s): Espaulella J, Guyer H, Diaz-Escriu F, Mellado-Navas JA, Castells M, Pladevall M. Source: Age and Ageing. 2000 September; 29(5): 425-31. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11108415

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Nutritional supplements after hip fracture: poor compliance limits effectiveness. Author(s): Bruce D, Laurance I, McGuiness M, Ridley M, Goldswain P. Source: Clinical Nutrition (Edinburgh, Lothian). 2003 October; 22(5): 497-500. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14512038

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Physical activity and risk factors for hip fractures in Thai women. Author(s): Boonyaratavej N, Suriyawongpaisal P, Takkinsatien A, Wanvarie S, Rajatanavin R, Apiyasawat P. Source: Osteoporosis International : a Journal Established As Result of Cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the Usa. 2001; 12(3): 244-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11315244

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Protein supplements after osteoporotic hip fracture. Author(s): Craig RM. Source: Annals of Internal Medicine. 1998 December 15; 129(12): 1076. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9867769

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Protein supplements after osteoporotic hip fracture. Author(s): Kelly KG.

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Source: Annals of Internal Medicine. 1998 December 15; 129(12): 1075-6; Author Reply 1076. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9867768 •

Protein supplements increase serum insulin-like growth factor-I levels and attenuate proximal femur bone loss in patients with recent hip fracture. A randomized, doubleblind, placebo-controlled trial. Author(s): Schurch MA, Rizzoli R, Slosman D, Vadas L, Vergnaud P, Bonjour JP. Source: Annals of Internal Medicine. 1998 May 15; 128(10): 801-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9599191

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Provision of high-protein supplement for patients recovering from hip fracture. Author(s): Neumann M, Friedmann J, Roy MA, Jensen GL. Source: Nutrition (Burbank, Los Angeles County, Calif.). 2004 May; 20(5): 415-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=15105027

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Rehabilitation of left femur subtrochanteric fracture in osteopetrosis -- a case report. Author(s): Yang BJ, Chen CF, Lien IN. Source: Taiwan Yi Xue Hui Za Zhi. 1980 December; 79(12): 1180-7. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6943297

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Supplemental calcium for the prevention of hip fracture: potential health-economic benefits. Author(s): Bendich A, Leader S, Muhuri P. Source: Clinical Therapeutics. 1999 June; 21(6): 1058-72. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10440627

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Treatment of neglected femoral neck fractures in young adults. Author(s): Huang CH. Source: Clinical Orthopaedics and Related Research. 1986 May; (206): 117-26. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3708964

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Vitamin A intake and hip fractures among postmenopausal women. Author(s): Feskanich D, Singh V, Willett WC, Colditz GA. Source: Jama : the Journal of the American Medical Association. 2002 January 2; 287(1): 47-54. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11754708

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Additional Web Resources A number of additional Web sites offer encyclopedic information covering CAM and related topics. The following is a representative sample: •

Alternative Medicine Foundation, Inc.: http://www.herbmed.org/

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AOL: http://search.aol.com/cat.adp?id=169&layer=&from=subcats

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Chinese Medicine: http://www.newcenturynutrition.com/

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drkoop.com: http://www.drkoop.com/InteractiveMedicine/IndexC.html

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Family Village: http://www.familyvillage.wisc.edu/med_altn.htm

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Google: http://directory.google.com/Top/Health/Alternative/

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Healthnotes: http://www.healthnotes.com/

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MedWebPlus: http://medwebplus.com/subject/Alternative_and_Complementary_Medicine

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Open Directory Project: http://dmoz.org/Health/Alternative/

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HealthGate: http://www.tnp.com/

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WebMDHealth: http://my.webmd.com/drugs_and_herbs

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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html

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Yahoo.com: http://dir.yahoo.com/Health/Alternative_Medicine/

The following is a specific Web list relating to hip fracture; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: •

General Overview Bone Loss Source: Integrative Medicine Communications; www.drkoop.com Kidney Stones Source: Healthnotes, Inc.; www.healthnotes.com Menopause Source: Integrative Medicine Communications; www.drkoop.com Osteoporosis Source: Healthnotes, Inc.; www.healthnotes.com Osteoporosis Source: Integrative Medicine Communications; www.drkoop.com Osteoporosis Source: Prima Communications, Inc.www.personalhealthzone.com

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Parkinson's Disease Source: Healthnotes, Inc.; www.healthnotes.com •

Herbs and Supplements Amino Acids Overview Source: Healthnotes, Inc.; www.healthnotes.com Menadione Source: Integrative Medicine Communications; www.drkoop.com Menaphthone Source: Integrative Medicine Communications; www.drkoop.com Menaquinone Source: Integrative Medicine Communications; www.drkoop.com Phylloquinone Source: Integrative Medicine Communications; www.drkoop.com

General References A good place to find general background information on CAM is the National Library of Medicine. It has prepared within the MEDLINEplus system an information topic page dedicated to complementary and alternative medicine. To access this page, go to the MEDLINEplus site at http://www.nlm.nih.gov/medlineplus/alternativemedicine.html. This Web site provides a general overview of various topics and can lead to a number of general sources.

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CHAPTER 4. DISSERTATIONS ON HIP FRACTURE Overview In this chapter, we will give you a bibliography on recent dissertations relating to hip fracture. We will also provide you with information on how to use the Internet to stay current on dissertations. IMPORTANT NOTE: When following the search strategy described below, you may discover non-medical dissertations that use the generic term “hip fracture” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on hip fracture, we have not necessarily excluded non-medical dissertations in this bibliography.

Dissertations on Hip Fracture ProQuest Digital Dissertations, the largest archive of academic dissertations available, is located at the following Web address: http://wwwlib.umi.com/dissertations. From this archive, we have compiled the following list covering dissertations devoted to hip fracture. You will see that the information provided includes the dissertation’s title, its author, and the institution with which the author is associated. The following covers recent dissertations found when using this search procedure: •

Preventing heel pressure ulcers in hip fracture patients by Bordner, Theda Ione, MSN from Gonzaga University, 2003, 66 pages http://wwwlib.umi.com/dissertations/fullcit/1414791

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The impact of hip fracture on the lives of older adults who return home: Individual perspectives by Davidson, Sylvia, MSc from University of Toronto (Canada), 2003, 134 pages http://wwwlib.umi.com/dissertations/fullcit/MQ84498

Keeping Current Ask the medical librarian at your library if it has full and unlimited access to the ProQuest Digital Dissertations database. From the library, you should be able to do more complete searches via http://wwwlib.umi.com/dissertations.

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CHAPTER 5. PATENTS ON HIP FRACTURE Overview Patents can be physical innovations (e.g. chemicals, pharmaceuticals, medical equipment) or processes (e.g. treatments or diagnostic procedures). The United States Patent and Trademark Office defines a patent as a grant of a property right to the inventor, issued by the Patent and Trademark Office.8 Patents, therefore, are intellectual property. For the United States, the term of a new patent is 20 years from the date when the patent application was filed. If the inventor wishes to receive economic benefits, it is likely that the invention will become commercially available within 20 years of the initial filing. It is important to understand, therefore, that an inventor’s patent does not indicate that a product or service is or will be commercially available. The patent implies only that the inventor has “the right to exclude others from making, using, offering for sale, or selling” the invention in the United States. While this relates to U.S. patents, similar rules govern foreign patents. In this chapter, we show you how to locate information on patents and their inventors. If you find a patent that is particularly interesting to you, contact the inventor or the assignee for further information. IMPORTANT NOTE: When following the search strategy described below, you may discover non-medical patents that use the generic term “hip fracture” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on hip fracture, we have not necessarily excluded non-medical patents in this bibliography.

Patents on Hip Fracture By performing a patent search focusing on hip fracture, you can obtain information such as the title of the invention, the names of the inventor(s), the assignee(s) or the company that owns or controls the patent, a short abstract that summarizes the patent, and a few excerpts from the description of the patent. The abstract of a patent tends to be more technical in nature, while the description is often written for the public. Full patent descriptions contain much more information than is presented here (e.g. claims, references, figures, diagrams, etc.). We will tell you how to obtain this information later in the chapter. The following is an 8Adapted

from the United States Patent and Trademark Office: http://www.uspto.gov/web/offices/pac/doc/general/whatis.htm.

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example of the type of information that you can expect to obtain from a patent search on hip fracture: •

Enhancement of return to independent living status with a growth hormone secretagogue Inventor(s): Bach; Mark (Scotch Plains, NJ), Fuh; Vivian (New York, NY), Ng; Jennifer (Short Hills, NJ), Taylor; Alice (Edison, NJ) Assignee(s): Merck & Co., Inc. (Rahway, NJ) Patent Number: 6,194,402 Date filed: August 31, 1999 Abstract: A growth hormone secretagogue is useful for enhancing the return of patients to independent living status following acute deconditioning such as that which may result from immobilization, surgery, or major injury such as hip fracture. Excerpt(s): Many patients who receive surgery or experience a major illness or injury require additional care and supervision following such surgery or illness. Patients who receive surgery or experience a major illness or injury such as hip fracture may have prolonged recovery times due to deconditioning, a bed-rest associated syndrome comprising, e.g.: decreased cardiac output, hypotension, muscular atrophy and acute muscle loss, and joint contractures (Hoenig and Rubenstein, Journal of the American Geriatrics Society, 39, 220-221. (1991)). In the elderly the loss of muscle mass and function as a result of illness or immobilization may be up to 5% per day at bedrest. Among the elderly in particular, deconditioning associated with acute illness is believed to lead to recovery times far in excess of that expected for the acute illness itself. In addition to prolonged recovery times, functional losses may result from deconditioning, the acute illness itself, and untoward effects of treatment. Although many functional losses are often reversible with activity and exercise interventions, recovery times may vary widely (Vorhies and Riley, Clinical Geriatric Medicine, 9, 745-763 (1993)). There are direct and indirect costs associated with both the acute illness and recovery periods. These costs may be considerable. As a result of their deconditioned physical state, patients who had once been able to live independently may require additional assistance and care. In particular, patients who had previously lived independently in a private home or apartment may find that following surgery or a major illness or injury they require the formal care provided by an assisted living center, a nursing home, a rehabilitation hospital/center, an acute care hospital or a chronic medical care center. This increase in the degree of care which is required by an individual following such deconditioning imposes increased financial costs. Moreover, such restrictions in their lifestyle may impose detrimental psychological impact with respect to the patient's self esteem and independence. Web site: http://www.delphion.com/details?pn=US06194402__

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Intramedullary rod for fracture fixation of femoral shaft independent of ipsilateral femoral neck fracture fixation Inventor(s): Latour, Jr.; Robert A. (Clemson, SC), Shuler; Thomas E. (Pittsburgh, PA) Assignee(s): Clemson University (Clemson, SC), Greenville Hospital System (Greenville, SC) Patent Number: 5,429,640 Date filed: November 27, 1992 Abstract: A femoral intramedullary rod has a thin or reduced proximal segment so as to provide room for the use of femoral hip screws. Use of the rod for femoral shaft fixation permits subsequent independent treatment of an ipsilateral femoral hip fracture as an isolated injury, regardless of whether initially detected. Different rod embodiments are formed by the omission of different proximal portions of the rod. It is in such portions that the femoral screws may be placed to set hip fractures. The rod is cannulated for installation over a guide wire. Internal rod threads, below the thin proximal segment in some embodiments, are used for initial installation of the rod with a driving member screwed into such threads. Without driving forces on the thin proximal segment, such segment can be made even thinner. Once the rod is seated, hip screws may be installed if there is a detected hip fracture. Subsequent to healing, the femoral screws and interlocking screws (if any) may be removed. A hollow reamer sized for clearance over the intramedullary rod may be placed down over the top of the rod to cut away any bony tissue ingrown into the proximal end. Thereafter, the rod is extracted with a suitable extraction device. Excerpt(s): The present invention relates in general to improved treatment for fractures of the femur and in particular concerns apparatus and methodology for the efficacious treatment of the highly problematic combination of a femoral shaft fracture with an ipsilateral femoral neck fracture (i.e., femoral hip region fracture). The femur or thigh bone is the largest and longest bone in the human skeleton. In general, it comprises two extremities connected by an elongated fairly cylindrical shaft. The upper or proximal extremity may be broadly regarded as constituting the hip region. Generally speaking, fracture injuries to the femoral shaft have been primarily treated (per current acceptable methods) with various intramedullary rods or nails. An intramedullary rod is an elongated member which is introduced to and resides in the marrow of the femur for the purpose of stabilizing the fractured femoral shaft. It is desired that stabilization take place in conjunction with anatomic reduction (i.e., proper reorientation of fractured elements to their original position, both relative to one another and relative to other adjacent anatomical features). As well known to those of ordinary skill in the art, installation of intramedullary rods often involves passage through the upper extremity or hip region, and in fact results in the proximal end of the rod occupying a significant portion of the hip portion of the femur. Web site: http://www.delphion.com/details?pn=US05429640__

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Mouse growth hormone secretagogue receptor Inventor(s): Howard; Andrew D. (Park Ridge, NJ), Jiang; Michael M. (Edison, NJ), McKee; Karen Kulju (Middletown, NJ), Smith; Roy G. (Houston, TX), Van der Ploeg; Leonardus H. T. (Scotch Plains, NJ), Zheng; Hui (Houston, TX) Assignee(s): Merck & Co., Inc. (Rahway, NJ) Patent Number: 6,682,908 Date filed: June 13, 2001 Abstract: A mouse growth hormone secretagogue receptor has been isolated, cloned and sequenced. This receptor is characteristic of the G-protein family of receptors. Mouse growth hormone secretagogue receptors may be used to screen and identify compoumds which bind to the mouse growth hormone secretagogue receptor. Such compounds may be used in the treatment of conditions which occur when there is a shortage of growth hormone, such as observed in growth hormone deficient children, elderly patients with musculoskeletal impairment and those recovering from hip fracture and osteoporosis. Targeted disruption of the mouse GHS-R gene may prove useful in elucidation of the mechanism of action and role of the growth hormone secretagogues in human and animal physiology. Excerpt(s): This invention relates to a newly identified receptor, the mouse growth hormone secretagogue receptor (mGHS-R), nucleic acids encoding this receptor; and to the use of a mGHS-R to identify growth hormone secretagogues and compounds that modulate mGHS-R function. Growth hormone secretagogues (GHSs) and secretagoguelike compounds, both peptide and non-peptide, bind to and exert their biological effects (i.e., release of growth hormone (GH)) through a G protein-coupled receptor (GPC-R) distinct from the receptors for growth hormone releasing hormone (GHRH) and somatostatin (SST) (Pong et al., 1996 Mol. Endocrin. 10:57-61). The molecular cloning of this growth hormone secretagogue receptor (GHS-R) capitalized on the pivotal observation that GHSs transduce their signal through activation of the phospholipase C pathway (Cheng et al., 1991 Endocrinology 129:3337-3342; Howard et al., 1996 Science 273:974-977). cDNA and genomic DNA cloning from human, swine, and rat showed that the GHS-R is a protein of 364/366 amino acids containing 7 putative alpha-helical transmembrane (TM) domains, a signature feature of GPC-Rs (Howard et al. 1996; McKee et al., 1997 Mol. Endocrin. 11:415-423). In all species evaluated, the GHS-R is encoded by a single highly-conserved gene containing one intron, placed at the Cterminal end of TM domain 5. The biology of the growth hormone secretagogues (GHSs) is still in a relatively early stage of development. Research is focused on identification of the GHS natural ligand system and understanding the role of the GHSR in brain regions (substantia nigra, dentate gyrus, hippocampus) other than those traditionally thought to be involved in GH secretion (Bennett et al. 1997; Guan et al. 1997). Web site: http://www.delphion.com/details?pn=US06682908__

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Polymer filled hip fracture fixation device Inventor(s): Lozier; Antony J. (Warsaw, IN), Stalcup; Gregory C. (Columbia City, IN) Assignee(s): Zimmer (Warsaw, IN) Patent Number: 6,447,514 Date filed: March 7, 2000

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Abstract: An orthopaedic implant includes a flexible bag; a structural support at least partially within the bag; and a hardened polymer within the bag. The orthopaedic implant is implanted within the bone by forming a cavity in the bone; inserting a flexible bag into the cavity; filling the bag with a polymer; and hardening the polymer. Excerpt(s): The present invention relates to orthopaedic implants, and, more particularly, to fracture fixation devices for femoral neck fractures. The present invention provides an orthopaedic implant and corresponding implanting method utilizing a porous flexible bag, one or more structural supports within the bag and a high strength polymer within the bag. The invention comprises, in one form thereof, an orthopaedic implant including a flexible bag; a structural support at least partially within the bag; and a hardened polymer within the bag. Web site: http://www.delphion.com/details?pn=US06447514__ •

Protector pad Inventor(s): Kummer; Frederick J. (Brooklyn, NY) Assignee(s): Hospital for Joint Diseases (New York, NY) Patent Number: 5,062,433 Date filed: January 16, 1990 Abstract: A protector to prevent hip fracture and/or bed-sores and/or protect a wound or wound area is formed from an outer load bearing member reinforced by internal ridges. The protector is dome shaped with structured ridges to form an internal dome or clearance for the region of desired protection. A soft inner sheet is attached for comfort. This structure has less bulk and weight than a solid pad. The outer shell formation distributes the load or pressure to the edges of the device, protecting the organ covered by the dome. The pad may have different internal ridge patterns to provide flexibility for user comfort. Excerpt(s): The present invention relates to pads or padded bandages particularly useful in covering and/or protecting the body from injury and/or covering and/or protecting an injury or wound on-the body. In particular the present invention is a light-in-weight and reduced-in-bulk pad useful particularly in the upper leg and hip area for preventing injury to the hip. It can also prevent sores from occurring and be used for protecting the upper leg and hip region where the individual using the padded bandage has been subjected to surgery on the hip or some wound in the upper leg and/or hip region. There are, in the United States alone, approximately 150,000 to 200,000 hip fractures each year. Many of the hip fractures require surgical procedures to properly align the fractured bone so as to promote proper healing. Surgery, especially hip surgery, normally results in a wound on the outside of the hip region, which is more often difficult to protect, especially when the patient becomes ambulatory. Protective pads have been designed to protect hip surgical wounds and other hip wound areas. Some of these are large domelike pads formed by a large, rigid outer shell. The size of the wound and/or wound area dictates the size of the protective pad to be used and as the size of the wound and/or wound area increases both the bulk and weight of the protective pad increase. The overall bulk of this type of hip region protective pad is objectionable, to the user of such pad, especially since the rigid shell forming it is not flexible. Web site: http://www.delphion.com/details?pn=US05062433__

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Patent Applications on Hip Fracture As of December 2000, U.S. patent applications are open to public viewing.9 Applications are patent requests which have yet to be granted. (The process to achieve a patent can take several years.) The following patent applications have been filed since December 2000 relating to hip fracture: •

Enhanced graphic features for computer assisted surgery system Inventor(s): Kienzle, Thomas C. III; (Lake Forest, IL) Correspondence: Bullwinkel Partners, LTD.; 19 South Lasalle ST.; Suite 1300; Chicago; IL; 60603; US Patent Application Number: 20020077540 Date filed: November 19, 2001 Abstract: A computer assisted surgery system with is enhanced graphics features is described for assisting a surgeon in orthopaedic procedures. A system is described for use in inserting multiple guide pins in hip fracture surgery using a single bore drill guide that has a graphical representation comprising its real trajectory and one or more virtual trajectories, the virtual trajectories representing potential positions of other guide pins to be placed during the procedure. Additionally, representations of inserted guide pins and virtual trajectories may be retained on the display at their inserted positions for use in aligning subsequent guide pins. A system is also described for orientation of an acetabular cup in a total hip replacement surgery. During cup insertion, the surgeon is provided with information regarding the orientation of the cup with respect to a pelvic reference frame that is based on accepted pelvic landmarks. The positions of each landmark is calculated by the system when a probe with a virtual tip, separate from its physical tip, is overlaid on the landmark in roughly orthogonal images of the pelvis. Excerpt(s): This invention relates to a computer assisted surgery system with enhanced graphics capabilities for use in inserting multiple screws into a hip fracture and orienting a total hip acetabular component. Fractures of the femoral neck, one kind of hip fracture, are a common injury of the elderly with over 150,000 such fractures occurring annually. The currently accepted treatment for mildly displaced femoral neck fractures is surgical fixation. In the procedure, three cannulated screws are inserted in the hip, from the lateral aspect of the femur, across the fracture site and into the femoral head. The initial step is the placement of three guide pins, over which the screws are inserted, in a characteristic triangular pattern. This is typically performed under fluoroscopic guidance, usually with the aid of a drill guide. Some surgeons prefer to use a drill guide with a single bore, but doing so may make it difficult to achieve the desired triangular spacing and optimum placement of the guide pins in the femoral neck. Other surgeons prefer a drill guide with multiple bores that are fixed in the proper triangular spacing, but this requires a larger incision and doesn't permit the surgeon much flexibility to modify the preset pattern. With either drill guide, it can be difficult to accurately predict the final guide pin placement. Further, the surgery requires a significant number of fluoroscopic images and x-ray exposure for the surgeon, patient and operating room staff. Fluoroscopic based image guided surgery systems can be of benefit in predicting the paths of the guide pins and in significantly reducing the amount of radiation exposure. Image guided systems such as those taught in U.S. Pat. Nos. 5,772,594 and 6,285,902, incorporated herein by reference, employ a computer and

9

This has been a common practice outside the United States prior to December 2000.

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a localizing device to track a drill or drill guide and superimpose a trajectory line on fluoroscopic images. U.S. Pat. No. 6,285,902 describes a system in which, preferably, orthopaedic surgical tools outfitted with infrared LEDs are tracked by an optical localizing device. The poses of these tools are determined and graphic representations of the tools are superimposed on standard intraoperative x-ray images. This allows the surgeon to view, in real time, the position of the tool or tools with respect to an imaged body part or another tool or tools. In the preferred embodiment, a drill guide outfitted with infrared LEDs is tracked and the trajectory of its bore is displayed on the x-ray image of the involved bone. This allows a surgeon to accurately predict the trajectory of a guide pin that passes through the bore of the drill guide. The surgeon can see the path each guide pin will take and can improve the accuracy and speed of insertion of the guide pin with only a minimum number of x-ray images. These systems, however, do not provide help in selecting paths that will lead to the desired triangular pattern with proper spacing between screws. On the other hand, a tracked drill guide with multiple bores may be used, but this requires a large incision and does not leave the surgeon with flexibility in the spacing or orientation (e.g., parallel vs. diverging) of the screws. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Fitted protective hip brief Inventor(s): Strobl, Frederick T.; (Wayzata, MN) Correspondence: John C. Reich; Merchant & Gould P.C.; P.O. Box 2903; Minneapolis; MN; 55402-0903; US Patent Application Number: 20020099346 Date filed: March 21, 2002 Abstract: A brief for padding a wearer's hips to reduce the risk of hip fracture. The brief comprises a front panel having first and second side edges and a rear panel having first and second side edges. The first side edge of the rear panel is connected to the first side edge of the front panel, and the second side edge of the rear panel is connected to the second side edge of the front panel, thereby forming first and second opening for receiving the wearer's legs. Shock-absorbing padding lines at least part of the rear panel. The shock-absorbing padding extends from a position proximal the first edge of the rear panel to a position proximal the second side edge of the rear panel and at least to a position between the two leg openings. Excerpt(s): The present invention is directed to a device for protecting a person's hip, and more particularly, to a fitted protective hip brief. Every year in the United States, about 250,000 people suffer from hip fractures. 90% of those people are over the age of 50. As the population of our country ages, the number of people suffering hip fractures is projected to double by the year 2040. Of people who suffer from a hip fracture, only 50-65% regain their previous level of mobility. Additionally, a study of 2624 patients showed that only 24% of people suffering from a hip fracture returned home after recovering a nursing home. An even more tragic result of hip fractures is that 14-36% of elderly patients die within one year after sustaining hip fracture. The majority of hip fractures are caused by trauma rather than weakening of the bone. When a person falls, or takes some other blow to the hip, kinetic energy from the impact is transmitted to the hip bone and causes a fracture. Various devices have been proposed to prevent hip fractures that result from such trauma, but none of these device have achieved any level of widespread acceptance. In fact, one study showed that as few as 24% of the people given hip protectors as part of the study had regularly worn the hip protectors. Possible

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reasons that so many people participating in the study failed to wear their hip protectors include poor difficulty of use, poor fit, and questionable efficacy. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Growth hormone secretagogue receptor family Inventor(s): Arena, Joseph P.; (Eagleville, PA), Cully, Doris F.; (Scotch Plains, NJ), Feighner, Scott D.; (Highlands, NJ), Howard, Andrew D.; (Park Ridge, NJ), Liberator, Paul A.; (Holmdel, NJ), Schaeffer, James M.; (Westfield, NJ), Van Der Ploeg, Leonardus H. T.; (Scotch Plains, NJ) Correspondence: Merck And CO Inc; P O Box 2000; Rahway; NJ; 070650907 Patent Application Number: 20030166144 Date filed: November 25, 2002 Abstract: Human, swine and rat growth hormone secretagogue receptors have been isolated, cloned and sequenced. Growth hormone secretagogue receptors are new members of the G-protein family of receptors. The growth hormone secretagogue receptors may be used to screen and identify compounds which bind to the growth hormone secretagogue receptor. Such compounds may be used in the treatment of conditions which occur when there is a shortage of growth hormone, such as observed in growth hormone deficient children, elderly patients with musculoskeletal impairment and recovering from hip fracture and osteoporosis. Excerpt(s): This invention relates to a new family of receptors, which includes the growth hormone secretagogue receptors (GHSRs) and growth hormone secretagoguerelated receptors (GHSRRs), nucleic acids encoding these receptors; and to the use of a GHSR to identify growth hormone secretagogues and compounds that modulate GHSR function. Growth hormone (GH) is an anabolic hormone capable of promoting linear growth, weight gain and whole body nitrogen retention. Classically, GH is thought to be released primarily from the somatotroph cells of the anterior pituitary under the coordinate regulation of two hypothalamic hormones, growth hormone releasing factor (GHRF or GRF) and somatostatin. Both GHRF stimulation and somatostatin inhibition of the release of GH occurs by the specific engagement of receptors on the cell membrane of the somatotroph. Recent evidence has been mounting which suggests that GH release is also stimulated by a group of short peptides, the growth hormone releasing peptides (GHRP; GHRP-6, GHRP-2 [hexarelin]) which are described, for example, in U.S. Pat. No. 4,411,890, PCT Patent Pub. No. WO 89/07110, PCT Patent Pub. No. WO 89/07111, PCT Patent Pub. No. WO 93/04081, and J. Endocrinol Invest., 15 (Suppl 4), 45 (1992). These peptides function by selectively binding to distinct somatotroph cell membrane receptor, the growth hormone secretagogue receptor(s) (GHSRs). A medicinal chemical approach has resulted in the design of several classes of orally-active, low molecular weight, non-peptidyl compounds which bind specifically to this receptor and result in the pulsatile release of GH. Such compounds possessing growth hormone secretagogue activity are disclosed, for example, in the following: U.S. Pat. Nos. 3,239,345; 4,036,979; 4,411,890; 5,206,235; 5,283,241; 5,284,841; 5,310,737; 5,317,017; 5,374,721; 5,430,144; 5,434,261; 5,438,136; 5,494,919; 5,494,920; 5,492,916; EPO Patent Pub. No. 0,144,230; EPO Patent Pub. No. 0,513,974; PCT Patent Pub. No. WO 94/07486; PCT Patent Pub. No. WO 94/08583; PCT Patent Pub. No. WO 94/11012; PCT Patent Pub. No. WO 94/13696; PCT Patent Pub. No. WO 94/19367; PCT Patent Pub. No. WO 95/03289; PCT Patent Pub. No. WO 95/03290; PCT Patent Pub. No. WO 95/09633; PCT Patent Pub. No. WO 95/11029; PCT Patent Pub. No. WO 95/12598; PCT Patent

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Pub. No. WO 95/13069; PCT Patent Pub. No. WO 95/14666; PCT Patent Pub. No. WO 95/16675; PCT Patent Pub. No. WO 95/16692; PCT Patent Pub. No. WO 95/17422; PCT Patent Pub. No. WO 95/17423; PCT Patent Pub. No. WO 95/34311; PCT Patent Pub. No. WO 96/02530; Science, 260, 1640-1643 (Jun. 11, 1993); Ann. Rep. Med. Chem., 28, 177-186 (1993); Bioorg. Med. Chem. Ltrs., 4(22), 2709-2714 (1994); and Proc. Natl. Acad. Sci. USA 92, 7001-7005 (July 1995). Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Method and apparatus for reducing femoral fractures Inventor(s): Dietzel, Steven E.; (Peru, IN), Lozier, Antony J.; (Warsaw, IN), Miller, Rick; (South Whitley, IN), Sisk, Billy N.; (Claypool, IN), Thelen, Sarah L.; (North Manchester, IN) Correspondence: Baker & Daniels; 111 E. Wayne Street; Suite 800; Fort Wayne; IN; 46802 Patent Application Number: 20030220641 Date filed: May 23, 2002 Abstract: An improved method and apparatus for reducing a hip fracture utilizing a minimally invasive procedure which does not require incision of the quadriceps. A femoral implant in accordance with the present invention achieves intramedullary fixation as well as fixation into the femoral head to allow for the compression needed for a femoral fracture to heal. To position the femoral implant of the present invention, an incision is made along the greater trochanter. Because the greater trochanter is not circumferentially covered with muscles, the incision can be made and the wound developed through the skin and fascia to expose the greater trochanter, without incising muscle, including, e.g., the quadriceps. After exposing the greater trochanter, novel instruments of the present invention are utilized to prepare a cavity in the femur extending from the greater trochanter into the femoral head and further extending from the greater trochanter into the intramedullary canal of the femur. After preparation of the femoral cavity, a femoral implant in accordance with the present invention is inserted into the aforementioned cavity in the femur. The femoral implant is thereafter secured in the femur, with portions of the implant extending into and being secured within the femoral head and portions of the implant extending into and being secured within the femoral shaft. Excerpt(s): The present invention relates to a method and apparatus for treating hip fractures, and, more particularly, to a method and apparatus for reducing femoral fractures utilizing a minimally invasive procedure. Current procedures utilized to reduce hip fractures generally utilize a side plate/hip screw combination, i.e., a bone plate affixed to a lateral aspect of the femur and having a hip screw operably connected thereto, with the hip screw extending into the femoral head. To properly implant a side plate hip screw, a surgeon must dissect an amount of muscle to expose the femur and operably attach the bone plate and hip screw. Typically, the side plate hip screw requires an incision of about 10-12 cm through the quadriceps to expose the femur. While this approach provides surgeons with an excellent view of the bone surface, the underlying damage to soft tissue, including muscle, e.g., the quadriceps can lengthen a patient's rehabilitation time after surgery. What is needed in the art is a method and apparatus for reducing a hip fracture without requiring incision of soft tissue, including, e.g., the quadriceps. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Multi-slot guide for bone-setting operation for a femoral neck fracture Inventor(s): Kawakami, Fujio; (Ube-shi, JP) Correspondence: Kubovcik & Kubovcik; Suite 710; 900 17th Street NW; Washington; DC; 20006 Patent Application Number: 20030236527 Date filed: June 24, 2002 Abstract: An object of the present invention is to provide a multi-slot guide for a femoral neck fracture bone-setting operation, by which a high level of fixation of, for example, a guide pin to a femoral head part can be obtained with no regard to the size of the femur.During a femoral neck fracture bone-setting operation, in the multi-slot guide 10 for the femoral neck fracture bone-setting operation, pin inserting slots a1, d1 and g1 are selected so as to form a triangle under the condition that each of them may be positioned in the site corresponding to the lateral cortical bone S. Then, the guide pins 13A to 13C are inserted from the base region of the femoral greater trochanter G through the locations having contacts with said lateral cortical bone S into the inner region of the femoral head H via respective pin inserting slots a1, d1 and g1. Consequently, the guide pins 13A to 13C and thus the screws 16A to 16C can be rigidly fixed to the upper region of the femur in match with the size of individual femur. Therefore, earlier application of the load to the affected site becomes possible. Excerpt(s): The present invention relates to a multi-slot guide for bone-setting operation for a femoral neck fracture, and specifically to a multi-slot guide used in the cannulated cancellous hip screw technique. In the operations taken on the femoral neck region for the fracture, in which serious displacement are often observed for the aged persons, a technique of replacing a head part of femur (hereafter, sometimes referred to as femoral head) separated from an upper region of the femur due to the fracture with an artificial femoral head has been frequently used, taking a dim view of the risk of false joint or femoral head necrosis. However, this technique has the following problems. That is, in this technique, bone marrow within the femur is seriously invaded, leading to a poor blood circulation within the bone marrow. Further, since this artificial femoral head has a limited lifetime, and therefore another operation will be necessary to change the artificial femoral head after a certain period has elapsed. This may cause another problem, rising of medical expenses. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

Keeping Current In order to stay informed about patents and patent applications dealing with hip fracture, you can access the U.S. Patent Office archive via the Internet at the following Web address: http://www.uspto.gov/patft/index.html. You will see two broad options: (1) Issued Patent, and (2) Published Applications. To see a list of issued patents, perform the following steps: Under “Issued Patents,” click “Quick Search.” Then, type “hip fracture” (or synonyms) into the “Term 1” box. After clicking on the search button, scroll down to see the various patents which have been granted to date on hip fracture.

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You can also use this procedure to view pending patent applications concerning hip fracture. Simply go back to http://www.uspto.gov/patft/index.html. Select “Quick Search” under “Published Applications.” Then proceed with the steps listed above.

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CHAPTER 6. BOOKS ON HIP FRACTURE Overview This chapter provides bibliographic book references relating to hip fracture. In addition to online booksellers such as www.amazon.com and www.bn.com, excellent sources for book titles on hip fracture include the Combined Health Information Database and the National Library of Medicine. Your local medical library also may have these titles available for loan.

Book Summaries: Online Booksellers Commercial Internet-based booksellers, such as Amazon.com and Barnes&Noble.com, offer summaries which have been supplied by each title’s publisher. Some summaries also include customer reviews. Your local bookseller may have access to in-house and commercial databases that index all published books (e.g. Books in Print). IMPORTANT NOTE: Online booksellers typically produce search results for medical and non-medical books. When searching for “hip fracture” at online booksellers’ Web sites, you may discover non-medical books that use the generic term “hip fracture” (or a synonym) in their titles. The following is indicative of the results you might find when searching for “hip fracture” (sorted alphabetically by title; follow the hyperlink to view more details at Amazon.com): •

Prevention of Falls and Hip Fractures in the Elderly; ISBN: 9994618903; http://www.amazon.com/exec/obidos/ASIN/9994618903/icongroupinterna

•

Some tranquilizers increase risk of hip fractures in older people (SuDoc HE 20.3038:T 68) by U.S. Dept of Health and Human Services; ISBN: B000104P1Y; http://www.amazon.com/exec/obidos/ASIN/B000104P1Y/icongroupinterna

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CHAPTER 7. PERIODICALS AND NEWS ON HIP FRACTURE Overview In this chapter, we suggest a number of news sources and present various periodicals that cover hip fracture.

News Services and Press Releases One of the simplest ways of tracking press releases on hip fracture is to search the news wires. In the following sample of sources, we will briefly describe how to access each service. These services only post recent news intended for public viewing. PR Newswire To access the PR Newswire archive, simply go to http://www.prnewswire.com/. Select your country. Type “hip fracture” (or synonyms) into the search box. You will automatically receive information on relevant news releases posted within the last 30 days. The search results are shown by order of relevance. Reuters Health The Reuters’ Medical News and Health eLine databases can be very useful in exploring news archives relating to hip fracture. While some of the listed articles are free to view, others are available for purchase for a nominal fee. To access this archive, go to http://www.reutershealth.com/en/index.html and search by “hip fracture” (or synonyms). The following was recently listed in this archive for hip fracture: •

Extended rehab after hip fracture can improve function Source: Reuters Health eLine Date: August 18, 2004

•

Extended outpatient rehab after hip fracture improves function, reduces disability Source: Reuters Medical News Date: August 18, 2004

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•

High and low vitamin A raise hip fracture risk Source: Reuters Health eLine Date: August 17, 2004

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High and low vitamin A levels increase hip fracture risk Source: Reuters Medical News Date: August 17, 2004

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Benzodiazepine use associated with hip fracture in elderly Source: Reuters Industry Breifing Date: August 05, 2004

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PT soon after hip fracture surgery improves mobility Source: Reuters Medical News Date: July 30, 2004

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Stopping estrogen therapy raises hip fracture risk Source: Reuters Health eLine Date: March 23, 2004

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Estrogen cessation might boost hip fracture risk Source: Reuters Medical News Date: March 23, 2004

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Thiazide diuretics may reduce hip fracture risk Source: Reuters Industry Breifing Date: September 15, 2003

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Childbirth cuts risk of hip fracture in old age Source: Reuters Medical News Date: April 25, 2003

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Clinical problems at discharge linked to adverse outcomes in hip fracture patients Source: Reuters Medical News Date: January 14, 2003

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Inhaled corticosteroid use increases the risk of hip fractures in older patients Source: Reuters Industry Breifing Date: January 01, 2003

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Transient rise in hip fracture risk noted after renal transplantation Source: Reuters Medical News Date: December 17, 2002

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Walking cuts hip fracture risk in older women Source: Reuters Health eLine Date: November 12, 2002

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Low vitamin K1 may contribute to hip fractures in women with Parkinson's disease Source: Reuters Medical News Date: February 04, 2002

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High dietary vitamin A intake linked to hip fractures in postmenopausal women Source: Reuters Medical News Date: January 01, 2002

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Risk of hip fracture may be determined before birth Source: Reuters Medical News Date: November 23, 2001

Periodicals and News

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Nulliparity may increase hip fracture risk Source: Reuters Medical News Date: October 16, 2001

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Even low-dose tranquilizers up hip fracture risk Source: Reuters Health eLine Date: June 26, 2001

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Orthopedic organizations convene over hip fracture epidemic Source: Reuters Medical News Date: May 04, 2001

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Current smoking increases risk of hip fracture in postmenopausal women Source: Reuters Medical News Date: April 18, 2001

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Benzodiazepine use not linked to hip fractures in elderly Source: Reuters Industry Breifing Date: March 27, 2001

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Irregular menstrual periods up hip fracture risk Source: Reuters Health eLine Date: March 02, 2001

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Menstrual irregularities increase hip fracture risk Source: Reuters Medical News Date: February 22, 2001

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Incidence of hip fracture in dialysis patients "alarmingly high" Source: Reuters Medical News Date: December 11, 2000

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Padded undergarments reduce hip fracture risk Source: Reuters Health eLine Date: November 22, 2000

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Low-dose oral prednisone linked to increased risk of hip fracture and cataracts Source: Reuters Medical News Date: October 24, 2000

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The NIH Within MEDLINEplus, the NIH has made an agreement with the New York Times Syndicate, the AP News Service, and Reuters to deliver news that can be browsed by the public. Search news releases at http://www.nlm.nih.gov/medlineplus/alphanews_a.html. MEDLINEplus allows you to browse across an alphabetical index. Or you can search by date at the following Web page: http://www.nlm.nih.gov/medlineplus/newsbydate.html. Often, news items are indexed by MEDLINEplus within its search engine. Business Wire Business Wire is similar to PR Newswire. To access this archive, simply go to http://www.businesswire.com/. You can scan the news by industry category or company name.

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Market Wire Market Wire is more focused on technology than the other wires. To browse the latest press releases by topic, such as alternative medicine, biotechnology, fitness, healthcare, legal, nutrition, and pharmaceuticals, access Market Wire’s Medical/Health channel at http://www.marketwire.com/mw/release_index?channel=MedicalHealth. Or simply go to Market Wire’s home page at http://www.marketwire.com/mw/home, type “hip fracture” (or synonyms) into the search box, and click on “Search News.” As this service is technology oriented, you may wish to use it when searching for press releases covering diagnostic procedures or tests. Search Engines Medical news is also available in the news sections of commercial Internet search engines. See the health news page at Yahoo (http://dir.yahoo.com/Health/News_and_Media/), or you can use this Web site’s general news search page at http://news.yahoo.com/. Type in “hip fracture” (or synonyms). If you know the name of a company that is relevant to hip fracture, you can go to any stock trading Web site (such as http://www.etrade.com/) and search for the company name there. News items across various news sources are reported on indicated hyperlinks. Google offers a similar service at http://news.google.com/. BBC Covering news from a more European perspective, the British Broadcasting Corporation (BBC) allows the public free access to their news archive located at http://www.bbc.co.uk/. Search by “hip fracture” (or synonyms).

Newsletters on Hip Fracture Find newsletters on hip fracture using the Combined Health Information Database (CHID). You will need to use the “Detailed Search” option. To access CHID, go to the following hyperlink: http://chid.nih.gov/detail/detail.html. Limit your search to “Newsletter” and “hip fracture.” Go to the bottom of the search page where “You may refine your search by.” Select the dates and language that you prefer. For the format option, select “Newsletter.” Type “hip fracture” (or synonyms) into the “For these words:” box. The following list was generated using the options described above: •

Alzheimer's Cooperative Newsletter Source: Eureka, CA: Alzheimer's Day Care Resource Center. 1985-. [8 p. average]. Contact: Alzheimer's Day Care Resource Center. Humboldt Senior Resource Center, 1910 California Street, Eureka, CA 95501. (707) 444-8254. PRICE: Free, donations accepted. Summary: This newsletter is published quarterly and is available free of charge to families of persons with Alzheimer's disease. It is produced by the Alzheimer's Day Care Resource Center in Eureka, California. The newsletter includes announcements about the Center's programs and special events as well as general information and advice for family caregivers. A typical issue may include articles about such topics as

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Medi-Cal waivers for family caregiving, the decision to establish a guardianship for an impaired relative, kitchen safety tips, new products for people with special dietary needs, and the risk of hip fracture in elderly women.

Newsletter Articles Use the Combined Health Information Database, and limit your search criteria to “newsletter articles.” Again, you will need to use the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. Go to the bottom of the search page where “You may refine your search by.” Select the dates and language that you prefer. For the format option, select “Newsletter Article.” Type “hip fracture” (or synonyms) into the “For these words:” box. You should check back periodically with this database as it is updated every three months. The following is a typical result when searching for newsletter articles on hip fracture: •

Falls and Alzheimer's Disease Source: Mount Sinai Medical Center Alzheimer's Disease Research Center. [Newsletter] p. 1-14. Autumn 1993. Contact: Alzheimer's Disease Research Center. Mount Sinai Medical Center. Box 1230, One Gustave Levy Place, New York, NY 10029-6574. PRICE: Free Subscription. Summary: Instability and falls are common problems of old age. One-third to one-half of the population 65 years old and older fall each year, often with serious consequences, and persons with Alzheimer's disease (AD) are not exempt from fall-related problems. Aside from behavioral problems, falls and the risk of injury are a major concern of family members of AD patients. The most serious results of falls among AD patients are premature death, hip fracture, and complications due to immobility related to injuries received in falls. The author addresses risk factors leading to falls, such as impaired physical functions, adverse medication effects, and specific cognitive and systemic effects inherent to AD. Further addressed are ways of modifying fall risk factors, first by medical evaluation to identify fall risk factors, followed by changing medication doses, exercising, changing footwear, and modifying the environment by removing obstacles or problematic furnishings and improving lighting. Special attention should be paid to bed and chair height, placement of bars for support, and providing non slip surfaces in bathrooms and near beds. Modifications should be done to provide a safe environment without making too many changes, as AD patients have difficulty learning new tasks, such as using bathtub grab bars.

Academic Periodicals covering Hip Fracture Numerous periodicals are currently indexed within the National Library of Medicine’s PubMed database that are known to publish articles relating to hip fracture. In addition to these sources, you can search for articles covering hip fracture that have been published by any of the periodicals listed in previous chapters. To find the latest studies published, go to http://www.ncbi.nlm.nih.gov/pubmed, type the name of the periodical into the search box, and click “Go.”

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If you want complete details about the historical contents of a journal, you can also visit the following Web site: http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi. Here, type in the name of the journal or its abbreviation, and you will receive an index of published articles. At http://locatorplus.gov/, you can retrieve more indexing information on medical periodicals (e.g. the name of the publisher). Select the button “Search LOCATORplus.” Then type in the name of the journal and select the advanced search option “Journal Title Search.”

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CHAPTER 8. RESEARCHING MEDICATIONS Overview While a number of hard copy or CD-ROM resources are available for researching medications, a more flexible method is to use Internet-based databases. Broadly speaking, there are two sources of information on approved medications: public sources and private sources. We will emphasize free-to-use public sources.

U.S. Pharmacopeia Because of historical investments by various organizations and the emergence of the Internet, it has become rather simple to learn about the medications recommended for hip fracture. One such source is the United States Pharmacopeia. In 1820, eleven physicians met in Washington, D.C. to establish the first compendium of standard drugs for the United States. They called this compendium the U.S. Pharmacopeia (USP). Today, the USP is a nonprofit organization consisting of 800 volunteer scientists, eleven elected officials, and 400 representatives of state associations and colleges of medicine and pharmacy. The USP is located in Rockville, Maryland, and its home page is located at http://www.usp.org/. The USP currently provides standards for over 3,700 medications. The resulting USP DI Advice for the Patient can be accessed through the National Library of Medicine of the National Institutes of Health. The database is partially derived from lists of federally approved medications in the Food and Drug Administration’s (FDA) Drug Approvals database, located at http://www.fda.gov/cder/da/da.htm. While the FDA database is rather large and difficult to navigate, the Phamacopeia is both user-friendly and free to use. It covers more than 9,000 prescription and over-the-counter medications. To access this database, simply type the following hyperlink into your Web browser: http://www.nlm.nih.gov/medlineplus/druginformation.html. To view examples of a given medication (brand names, category, description, preparation, proper use, precautions, side effects, etc.), simply follow the hyperlinks indicated within the United States Pharmacopeia (USP). Below, we have compiled a list of medications associated with hip fracture. If you would like more information on a particular medication, the provided hyperlinks will direct you to ample documentation (e.g. typical dosage, side effects, drug-interaction risks, etc.). The

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following drugs have been mentioned in the Pharmacopeia and other sources as being potentially applicable to hip fracture: Fondaparinux •

Systemic - U.S. Brands: Arixtra http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/500365.html

Commercial Databases In addition to the medications listed in the USP above, a number of commercial sites are available by subscription to physicians and their institutions. Or, you may be able to access these sources from your local medical library.

Mosby’s Drug Consult Mosby’s Drug Consult database (also available on CD-ROM and book format) covers 45,000 drug products including generics and international brands. It provides prescribing information, drug interactions, and patient information. Subscription information is available at the following hyperlink: http://www.mosbysdrugconsult.com/. PDRhealth The PDRhealth database is a free-to-use, drug information search engine that has been written for the public in layman’s terms. It contains FDA-approved drug information adapted from the Physicians’ Desk Reference (PDR) database. PDRhealth can be searched by brand name, generic name, or indication. It features multiple drug interactions reports. Search PDRhealth at http://www.pdrhealth.com/drug_info/index.html. Other Web Sites Drugs.com (www.drugs.com) reproduces the information in the Pharmacopeia as well as commercial information. You may also want to consider the Web site of the Medical Letter, Inc. (http://www.medletter.com/) which allows users to download articles on various drugs and therapeutics for a nominal fee. If you have any questions about a medical treatment, the FDA may have an office near you. Look for their number in the blue pages of the phone book. You can also contact the FDA through its toll-free number, 1-888-INFO-FDA (1-888-463-6332), or on the World Wide Web at www.fda.gov.

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APPENDICES

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APPENDIX A. PHYSICIAN RESOURCES Overview In this chapter, we focus on databases and Internet-based guidelines and information resources created or written for a professional audience.

NIH Guidelines Commonly referred to as “clinical” or “professional” guidelines, the National Institutes of Health publish physician guidelines for the most common diseases. Publications are available at the following by relevant Institute10: •

Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm

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National Institute of General Medical Sciences (NIGMS); fact sheets available at http://www.nigms.nih.gov/news/facts/

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National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines: http://www.nlm.nih.gov/medlineplus/healthtopics.html

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National Cancer Institute (NCI); guidelines available at http://www.cancer.gov/cancerinfo/list.aspx?viewid=5f35036e-5497-4d86-8c2c714a9f7c8d25

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National Eye Institute (NEI); guidelines available at http://www.nei.nih.gov/order/index.htm

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National Heart, Lung, and Blood Institute (NHLBI); guidelines available at http://www.nhlbi.nih.gov/guidelines/index.htm

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National Human Genome Research Institute (NHGRI); research available at http://www.genome.gov/page.cfm?pageID=10000375

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National Institute on Aging (NIA); guidelines available at http://www.nia.nih.gov/health/

10

These publications are typically written by one or more of the various NIH Institutes.

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•

National Institute on Alcohol Abuse and Alcoholism (NIAAA); guidelines available at http://www.niaaa.nih.gov/publications/publications.htm

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National Institute of Allergy and Infectious Diseases (NIAID); guidelines available at http://www.niaid.nih.gov/publications/

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National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS); fact sheets and guidelines available at http://www.niams.nih.gov/hi/index.htm

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National Institute of Child Health and Human Development (NICHD); guidelines available at http://www.nichd.nih.gov/publications/pubskey.cfm

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National Institute on Deafness and Other Communication Disorders (NIDCD); fact sheets and guidelines at http://www.nidcd.nih.gov/health/

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National Institute of Dental and Craniofacial Research (NIDCR); guidelines available at http://www.nidr.nih.gov/health/

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National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); guidelines available at http://www.niddk.nih.gov/health/health.htm

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National Institute on Drug Abuse (NIDA); guidelines available at http://www.nida.nih.gov/DrugAbuse.html

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National Institute of Environmental Health Sciences (NIEHS); environmental health information available at http://www.niehs.nih.gov/external/facts.htm

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National Institute of Mental Health (NIMH); guidelines available at http://www.nimh.nih.gov/practitioners/index.cfm

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National Institute of Neurological Disorders and Stroke (NINDS); neurological disorder information pages available at http://www.ninds.nih.gov/health_and_medical/disorder_index.htm

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National Institute of Nursing Research (NINR); publications on selected illnesses at http://www.nih.gov/ninr/news-info/publications.html

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National Institute of Biomedical Imaging and Bioengineering; general information at http://grants.nih.gov/grants/becon/becon_info.htm

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Center for Information Technology (CIT); referrals to other agencies based on keyword searches available at http://kb.nih.gov/www_query_main.asp

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National Center for Complementary and Alternative Medicine (NCCAM); health information available at http://nccam.nih.gov/health/

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National Center for Research Resources (NCRR); various information directories available at http://www.ncrr.nih.gov/publications.asp

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Office of Rare Diseases; various fact sheets available at http://rarediseases.info.nih.gov/html/resources/rep_pubs.html

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Centers for Disease Control and Prevention; various fact sheets on infectious diseases available at http://www.cdc.gov/publications.htm

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NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.11 Physician-oriented resources provide a wide variety of information related to the biomedical and health sciences, both past and present. The format of these resources varies. Searchable databases, bibliographic citations, full-text articles (when available), archival collections, and images are all available. The following are referenced by the National Library of Medicine:12 •

Bioethics: Access to published literature on the ethical, legal, and public policy issues surrounding healthcare and biomedical research. This information is provided in conjunction with the Kennedy Institute of Ethics located at Georgetown University, Washington, D.C.: http://www.nlm.nih.gov/databases/databases_bioethics.html

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HIV/AIDS Resources: Describes various links and databases dedicated to HIV/AIDS research: http://www.nlm.nih.gov/pubs/factsheets/aidsinfs.html

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NLM Online Exhibitions: Describes “Exhibitions in the History of Medicine”: http://www.nlm.nih.gov/exhibition/exhibition.html. Additional resources for historical scholarship in medicine: http://www.nlm.nih.gov/hmd/hmd.html

•

Biotechnology Information: Access to public databases. The National Center for Biotechnology Information conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information for the better understanding of molecular processes affecting human health and disease: http://www.ncbi.nlm.nih.gov/

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Population Information: The National Library of Medicine provides access to worldwide coverage of population, family planning, and related health issues, including family planning technology and programs, fertility, and population law and policy: http://www.nlm.nih.gov/databases/databases_population.html

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Cancer Information: Access to cancer-oriented databases: http://www.nlm.nih.gov/databases/databases_cancer.html

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Profiles in Science: Offering the archival collections of prominent twentieth-century biomedical scientists to the public through modern digital technology: http://www.profiles.nlm.nih.gov/

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Chemical Information: Provides links to various chemical databases and references: http://sis.nlm.nih.gov/Chem/ChemMain.html

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Clinical Alerts: Reports the release of findings from the NIH-funded clinical trials where such release could significantly affect morbidity and mortality: http://www.nlm.nih.gov/databases/alerts/clinical_alerts.html

•

Space Life Sciences: Provides links and information to space-based research (including NASA): http://www.nlm.nih.gov/databases/databases_space.html

•

MEDLINE: Bibliographic database covering the fields of medicine, nursing, dentistry, veterinary medicine, the healthcare system, and the pre-clinical sciences: http://www.nlm.nih.gov/databases/databases_medline.html

11

Remember, for the general public, the National Library of Medicine recommends the databases referenced in MEDLINEplus (http://medlineplus.gov/ or http://www.nlm.nih.gov/medlineplus/databases.html). 12 See http://www.nlm.nih.gov/databases/databases.html.

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•

Toxicology and Environmental Health Information (TOXNET): Databases covering toxicology and environmental health: http://sis.nlm.nih.gov/Tox/ToxMain.html

•

Visible Human Interface: Anatomically detailed, three-dimensional representations of normal male and female human bodies: http://www.nlm.nih.gov/research/visible/visible_human.html

The NLM Gateway13 The NLM (National Library of Medicine) Gateway is a Web-based system that lets users search simultaneously in multiple retrieval systems at the U.S. National Library of Medicine (NLM). It allows users of NLM services to initiate searches from one Web interface, providing one-stop searching for many of NLM’s information resources or databases.14 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “hip fracture” (or synonyms) into the search box and click “Search.” The results will be presented in a tabular form, indicating the number of references in each database category. Results Summary Category Journal Articles Books / Periodicals / Audio Visual Consumer Health Meeting Abstracts Other Collections Total

Items Found 11067 95 18 38 43 11261

HSTAT15 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.16 These documents include clinical practice guidelines, quickreference guides for clinicians, consumer health brochures, evidence reports and technology assessments from the Agency for Healthcare Research and Quality (AHRQ), as well as AHRQ’s Put Prevention Into Practice.17 Simply search by “hip fracture” (or synonyms) at the following Web site: http://text.nlm.nih.gov.

13

Adapted from NLM: http://gateway.nlm.nih.gov/gw/Cmd?Overview.x.

14

The NLM Gateway is currently being developed by the Lister Hill National Center for Biomedical Communications (LHNCBC) at the National Library of Medicine (NLM) of the National Institutes of Health (NIH). 15 Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html. 16 17

The HSTAT URL is http://hstat.nlm.nih.gov/.

Other important documents in HSTAT include: the National Institutes of Health (NIH) Consensus Conference Reports and Technology Assessment Reports; the HIV/AIDS Treatment Information Service (ATIS) resource documents; the Substance Abuse and Mental Health Services Administration's Center for Substance Abuse Treatment (SAMHSA/CSAT) Treatment Improvement Protocols (TIP) and Center for Substance Abuse Prevention (SAMHSA/CSAP) Prevention Enhancement Protocols System (PEPS); the Public Health Service (PHS) Preventive Services Task Force's Guide to Clinical Preventive Services; the independent, nonfederal Task Force on Community Services’ Guide to Community Preventive Services; and the Health Technology Advisory Committee (HTAC) of the Minnesota Health Care Commission (MHCC) health technology evaluations.

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Coffee Break: Tutorials for Biologists18 Coffee Break is a general healthcare site that takes a scientific view of the news and covers recent breakthroughs in biology that may one day assist physicians in developing treatments. Here you will find a collection of short reports on recent biological discoveries. Each report incorporates interactive tutorials that demonstrate how bioinformatics tools are used as a part of the research process. Currently, all Coffee Breaks are written by NCBI staff.19 Each report is about 400 words and is usually based on a discovery reported in one or more articles from recently published, peer-reviewed literature.20 This site has new articles every few weeks, so it can be considered an online magazine of sorts. It is intended for general background information. You can access the Coffee Break Web site at the following hyperlink: http://www.ncbi.nlm.nih.gov/Coffeebreak/.

Other Commercial Databases In addition to resources maintained by official agencies, other databases exist that are commercial ventures addressing medical professionals. Here are some examples that may interest you: •

CliniWeb International: Index and table of contents to selected clinical information on the Internet; see http://www.ohsu.edu/cliniweb/.

•

Medical World Search: Searches full text from thousands of selected medical sites on the Internet; see http://www.mwsearch.com/.

18 Adapted 19

from http://www.ncbi.nlm.nih.gov/Coffeebreak/Archive/FAQ.html.

The figure that accompanies each article is frequently supplied by an expert external to NCBI, in which case the source of the figure is cited. The result is an interactive tutorial that tells a biological story. 20 After a brief introduction that sets the work described into a broader context, the report focuses on how a molecular understanding can provide explanations of observed biology and lead to therapies for diseases. Each vignette is accompanied by a figure and hypertext links that lead to a series of pages that interactively show how NCBI tools and resources are used in the research process.

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APPENDIX B. PATIENT RESOURCES Overview Official agencies, as well as federally funded institutions supported by national grants, frequently publish a variety of guidelines written with the patient in mind. These are typically called “Fact Sheets” or “Guidelines.” They can take the form of a brochure, information kit, pamphlet, or flyer. Often they are only a few pages in length. Since new guidelines on hip fracture can appear at any moment and be published by a number of sources, the best approach to finding guidelines is to systematically scan the Internet-based services that post them.

Patient Guideline Sources The remainder of this chapter directs you to sources which either publish or can help you find additional guidelines on topics related to hip fracture. Due to space limitations, these sources are listed in a concise manner. Do not hesitate to consult the following sources by either using the Internet hyperlink provided, or, in cases where the contact information is provided, contacting the publisher or author directly. The National Institutes of Health The NIH gateway to patients is located at http://health.nih.gov/. From this site, you can search across various sources and institutes, a number of which are summarized below. Topic Pages: MEDLINEplus The National Library of Medicine has created a vast and patient-oriented healthcare information portal called MEDLINEplus. Within this Internet-based system are “health topic pages” which list links to available materials relevant to hip fracture. To access this system, log on to http://www.nlm.nih.gov/medlineplus/healthtopics.html. From there you can either search using the alphabetical index or browse by broad topic areas. Recently, MEDLINEplus listed the following when searched for “hip fracture”:

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Bursitis http://www.nlm.nih.gov/medlineplus/bursitis.html Falls http://www.nlm.nih.gov/medlineplus/falls.html Fractures http://www.nlm.nih.gov/medlineplus/fractures.html Hip Injuries and Disorders http://www.nlm.nih.gov/medlineplus/hipinjuriesanddisorders.html Leg Injuries and Disorders http://www.nlm.nih.gov/medlineplus/leginjuriesanddisorders.html Neck Disorders and Injuries http://www.nlm.nih.gov/medlineplus/neckdisordersandinjuries.html Osteoporosis http://www.nlm.nih.gov/medlineplus/osteoporosis.html Shoulder Injuries and Disorders http://www.nlm.nih.gov/medlineplus/shoulderinjuriesanddisorders.html Wrist and Arm Injuries and Disorders http://www.nlm.nih.gov/medlineplus/wristandarminjuriesanddisorders.html You may also choose to use the search utility provided by MEDLINEplus at the following Web address: http://www.nlm.nih.gov/medlineplus/. Simply type a keyword into the search box and click “Search.” This utility is similar to the NIH search utility, with the exception that it only includes materials that are linked within the MEDLINEplus system (mostly patient-oriented information). It also has the disadvantage of generating unstructured results. We recommend, therefore, that you use this method only if you have a very targeted search. The Combined Health Information Database (CHID) CHID Online is a reference tool that maintains a database directory of thousands of journal articles and patient education guidelines on hip fracture. CHID offers summaries that describe the guidelines available, including contact information and pricing. CHID’s general Web site is http://chid.nih.gov/. To search this database, go to http://chid.nih.gov/detail/detail.html. In particular, you can use the advanced search options to look up pamphlets, reports, brochures, and information kits. The following was recently posted in this archive: •

Don't Let a Fall Be Your Last Trip Source: Rosemont, IL: American Academy of Orthopaedic Surgeons. 199x. [4 p.]. Contact: Available from American Academy of Orthopaedic Surgeons. 6300 North River Road, Rosemont, IL 60018. (800) 346-AAOS or (847) 823-7186. Fax (847) 823-8125. Website: www.aos.org. PRICE: Single copy free. Summary: This brochure discusses the problem of falls in older people, emphasizing preventive measures. The brochure notes that falls can happen anytime and anywhere to people of any age, but most falls by people age 65 and older occur in the home during

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everyday activities. The number of falls and the severity of injury resulting from falls increases as people get older. The most common serious injuries are head injuries, wrist fractures, spine fractures, and hip fractures. The brochure first provides general facts about falls, and discusses the financial costs of falls among older people, and the role of osteoporosis in fractures. The fact sheet then lists suggestions for safety precautions in five areas of the home: stairs, bathroom, kitchen, living area, and bedroom. Also listed are suggestions for footwear that can help prevent falls. The last section of the brochure lists medical and personal risk factors that can increase problems with falling, including vision loss, hearing loss, and balance difficulties. The brochure concludes with a list of suggestions for what to do after a fall occurs. Colorful line drawings illustrate the brochure. The National Guideline Clearinghouse™ The National Guideline Clearinghouse™ offers hundreds of evidence-based clinical practice guidelines published in the United States and other countries. You can search this site located at http://www.guideline.gov/ by using the keyword “hip fracture” (or synonyms). The following was recently posted: •

Prevention and management of hip fracture in older people. A national clinical guideline Source: Scottish Intercollegiate Guidelines Network - National Government Agency [Non-U.S.]; 2002 January; 40 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3184&nbr=2410&a mp;string=hip+AND+fracture The NIH Search Utility

The NIH search utility allows you to search for documents on over 100 selected Web sites that comprise the NIH-WEB-SPACE. Each of these servers is “crawled” and indexed on an ongoing basis. Your search will produce a list of various documents, all of which will relate in some way to hip fracture. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively rare or specific disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html. Additional Web Sources A number of Web sites are available to the public that often link to government sites. These can also point you in the direction of essential information. The following is a representative sample: •

AOL: http://search.aol.com/cat.adp?id=168&layer=&from=subcats

•

Family Village: http://www.familyvillage.wisc.edu/specific.htm

•

Google: http://directory.google.com/Top/Health/Conditions_and_Diseases/

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•

Med Help International: http://www.medhelp.org/HealthTopics/A.html

•

Open Directory Project: http://dmoz.org/Health/Conditions_and_Diseases/

•

Yahoo.com: http://dir.yahoo.com/Health/Diseases_and_Conditions/

•

WebMDHealth: http://my.webmd.com/health_topics

Finding Associations There are several Internet directories that provide lists of medical associations with information on or resources relating to hip fracture. By consulting all of associations listed in this chapter, you will have nearly exhausted all sources for patient associations concerned with hip fracture. The National Health Information Center (NHIC) The National Health Information Center (NHIC) offers a free referral service to help people find organizations that provide information about hip fracture. For more information, see the NHIC’s Web site at http://www.health.gov/NHIC/ or contact an information specialist by calling 1-800-336-4797. Directory of Health Organizations The Directory of Health Organizations, provided by the National Library of Medicine Specialized Information Services, is a comprehensive source of information on associations. The Directory of Health Organizations database can be accessed via the Internet at http://www.sis.nlm.nih.gov/Dir/DirMain.html. It is composed of two parts: DIRLINE and Health Hotlines. The DIRLINE database comprises some 10,000 records of organizations, research centers, and government institutes and associations that primarily focus on health and biomedicine. To access DIRLINE directly, go to the following Web site: http://dirline.nlm.nih.gov/. Simply type in “hip fracture” (or a synonym), and you will receive information on all relevant organizations listed in the database. Health Hotlines directs you to toll-free numbers to over 300 organizations. You can access this database directly at http://www.sis.nlm.nih.gov/hotlines/. On this page, you are given the option to search by keyword or by browsing the subject list. When you have received your search results, click on the name of the organization for its description and contact information. The Combined Health Information Database Another comprehensive source of information on healthcare associations is the Combined Health Information Database. Using the “Detailed Search” option, you will need to limit your search to “Organizations” and “hip fracture”. Type the following hyperlink into your Web browser: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For

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publication date, select “All Years.” Then, select your preferred language and the format option “Organization Resource Sheet.” Type “hip fracture” (or synonyms) into the “For these words:” box. You should check back periodically with this database since it is updated every three months. The National Organization for Rare Disorders, Inc. The National Organization for Rare Disorders, Inc. has prepared a Web site that provides, at no charge, lists of associations organized by health topic. You can access this database at the following Web site: http://www.rarediseases.org/search/orgsearch.html. Type “hip fracture” (or a synonym) into the search box, and click “Submit Query.”

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APPENDIX C. FINDING MEDICAL LIBRARIES Overview In this Appendix, we show you how to quickly find a medical library in your area.

Preparation Your local public library and medical libraries have interlibrary loan programs with the National Library of Medicine (NLM), one of the largest medical collections in the world. According to the NLM, most of the literature in the general and historical collections of the National Library of Medicine is available on interlibrary loan to any library. If you would like to access NLM medical literature, then visit a library in your area that can request the publications for you.21

Finding a Local Medical Library The quickest method to locate medical libraries is to use the Internet-based directory published by the National Network of Libraries of Medicine (NN/LM). This network includes 4626 members and affiliates that provide many services to librarians, health professionals, and the public. To find a library in your area, simply visit http://nnlm.gov/members/adv.html or call 1-800-338-7657.

Medical Libraries in the U.S. and Canada In addition to the NN/LM, the National Library of Medicine (NLM) lists a number of libraries with reference facilities that are open to the public. The following is the NLM’s list and includes hyperlinks to each library’s Web site. These Web pages can provide information on hours of operation and other restrictions. The list below is a small sample of

21

Adapted from the NLM: http://www.nlm.nih.gov/psd/cas/interlibrary.html.

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libraries recommended by the National Library of Medicine (sorted alphabetically by name of the U.S. state or Canadian province where the library is located)22: •

Alabama: Health InfoNet of Jefferson County (Jefferson County Library Cooperative, Lister Hill Library of the Health Sciences), http://www.uab.edu/infonet/

•

Alabama: Richard M. Scrushy Library (American Sports Medicine Institute)

•

Arizona: Samaritan Regional Medical Center: The Learning Center (Samaritan Health System, Phoenix, Arizona), http://www.samaritan.edu/library/bannerlibs.htm

•

California: Kris Kelly Health Information Center (St. Joseph Health System, Humboldt), http://www.humboldt1.com/~kkhic/index.html

•

California: Community Health Library of Los Gatos, http://www.healthlib.org/orgresources.html

•

California: Consumer Health Program and Services (CHIPS) (County of Los Angeles Public Library, Los Angeles County Harbor-UCLA Medical Center Library) - Carson, CA, http://www.colapublib.org/services/chips.html

•

California: Gateway Health Library (Sutter Gould Medical Foundation)

•

California: Health Library (Stanford University Medical Center), http://wwwmed.stanford.edu/healthlibrary/

•

California: Patient Education Resource Center - Health Information and Resources (University of California, San Francisco), http://sfghdean.ucsf.edu/barnett/PERC/default.asp

•

California: Redwood Health Library (Petaluma Health Care District), http://www.phcd.org/rdwdlib.html

•

California: Los Gatos PlaneTree Health Library, http://planetreesanjose.org/

•

California: Sutter Resource Library (Sutter Hospitals Foundation, Sacramento), http://suttermedicalcenter.org/library/

•

California: Health Sciences Libraries (University of California, Davis), http://www.lib.ucdavis.edu/healthsci/

•

California: ValleyCare Health Library & Ryan Comer Cancer Resource Center (ValleyCare Health System, Pleasanton), http://gaelnet.stmarysca.edu/other.libs/gbal/east/vchl.html

•

California: Washington Community Health Resource Library (Fremont), http://www.healthlibrary.org/

•

Colorado: William V. Gervasini Memorial Library (Exempla Healthcare), http://www.saintjosephdenver.org/yourhealth/libraries/

•

Connecticut: Hartford Hospital Health Science Libraries (Hartford Hospital), http://www.harthosp.org/library/

•

Connecticut: Healthnet: Connecticut Consumer Health Information Center (University of Connecticut Health Center, Lyman Maynard Stowe Library), http://library.uchc.edu/departm/hnet/

22

Abstracted from http://www.nlm.nih.gov/medlineplus/libraries.html.

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•

Connecticut: Waterbury Hospital Health Center Library (Waterbury Hospital, Waterbury), http://www.waterburyhospital.com/library/consumer.shtml

•

Delaware: Consumer Health Library (Christiana Care Health System, Eugene du Pont Preventive Medicine & Rehabilitation Institute, Wilmington), http://www.christianacare.org/health_guide/health_guide_pmri_health_info.cfm

•

Delaware: Lewis B. Flinn Library (Delaware Academy of Medicine, Wilmington), http://www.delamed.org/chls.html

•

Georgia: Family Resource Library (Medical College of Georgia, Augusta), http://cmc.mcg.edu/kids_families/fam_resources/fam_res_lib/frl.htm

•

Georgia: Health Resource Center (Medical Center of Central Georgia, Macon), http://www.mccg.org/hrc/hrchome.asp

•

Hawaii: Hawaii Medical Library: Consumer Health Information Service (Hawaii Medical Library, Honolulu), http://hml.org/CHIS/

•

Idaho: DeArmond Consumer Health Library (Kootenai Medical Center, Coeur d’Alene), http://www.nicon.org/DeArmond/index.htm

•

Illinois: Health Learning Center of Northwestern Memorial Hospital (Chicago), http://www.nmh.org/health_info/hlc.html

•

Illinois: Medical Library (OSF Saint Francis Medical Center, Peoria), http://www.osfsaintfrancis.org/general/library/

•

Kentucky: Medical Library - Services for Patients, Families, Students & the Public (Central Baptist Hospital, Lexington), http://www.centralbap.com/education/community/library.cfm

•

Kentucky: University of Kentucky - Health Information Library (Chandler Medical Center, Lexington), http://www.mc.uky.edu/PatientEd/

•

Louisiana: Alton Ochsner Medical Foundation Library (Alton Ochsner Medical Foundation, New Orleans), http://www.ochsner.org/library/

•

Louisiana: Louisiana State University Health Sciences Center Medical LibraryShreveport, http://lib-sh.lsuhsc.edu/

•

Maine: Franklin Memorial Hospital Medical Library (Franklin Memorial Hospital, Farmington), http://www.fchn.org/fmh/lib.htm

•

Maine: Gerrish-True Health Sciences Library (Central Maine Medical Center, Lewiston), http://www.cmmc.org/library/library.html

•

Maine: Hadley Parrot Health Science Library (Eastern Maine Healthcare, Bangor), http://www.emh.org/hll/hpl/guide.htm

•

Maine: Maine Medical Center Library (Maine Medical Center, Portland), http://www.mmc.org/library/

•

Maine: Parkview Hospital (Brunswick), http://www.parkviewhospital.org/

•

Maine: Southern Maine Medical Center Health Sciences Library (Southern Maine Medical Center, Biddeford), http://www.smmc.org/services/service.php3?choice=10

•

Maine: Stephens Memorial Hospital’s Health Information Library (Western Maine Health, Norway), http://www.wmhcc.org/Library/

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•

Manitoba, Canada: Consumer & Patient Health Information Service (University of Manitoba Libraries), http://www.umanitoba.ca/libraries/units/health/reference/chis.html

•

Manitoba, Canada: J.W. Crane Memorial Library (Deer Lodge Centre, Winnipeg), http://www.deerlodge.mb.ca/crane_library/about.asp

•

Maryland: Health Information Center at the Wheaton Regional Library (Montgomery County, Dept. of Public Libraries, Wheaton Regional Library), http://www.mont.lib.md.us/healthinfo/hic.asp

•

Massachusetts: Baystate Medical Center Library (Baystate Health System), http://www.baystatehealth.com/1024/

•

Massachusetts: Boston University Medical Center Alumni Medical Library (Boston University Medical Center), http://med-libwww.bu.edu/library/lib.html

•

Massachusetts: Lowell General Hospital Health Sciences Library (Lowell General Hospital, Lowell), http://www.lowellgeneral.org/library/HomePageLinks/WWW.htm

•

Massachusetts: Paul E. Woodard Health Sciences Library (New England Baptist Hospital, Boston), http://www.nebh.org/health_lib.asp

•

Massachusetts: St. Luke’s Hospital Health Sciences Library (St. Luke’s Hospital, Southcoast Health System, New Bedford), http://www.southcoast.org/library/

•

Massachusetts: Treadwell Library Consumer Health Reference Center (Massachusetts General Hospital), http://www.mgh.harvard.edu/library/chrcindex.html

•

Massachusetts: UMass HealthNet (University of Massachusetts Medical School, Worchester), http://healthnet.umassmed.edu/

•

Michigan: Botsford General Hospital Library - Consumer Health (Botsford General Hospital, Library & Internet Services), http://www.botsfordlibrary.org/consumer.htm

•

Michigan: Helen DeRoy Medical Library (Providence Hospital and Medical Centers), http://www.providence-hospital.org/library/

•

Michigan: Marquette General Hospital - Consumer Health Library (Marquette General Hospital, Health Information Center), http://www.mgh.org/center.html

•

Michigan: Patient Education Resouce Center - University of Michigan Cancer Center (University of Michigan Comprehensive Cancer Center, Ann Arbor), http://www.cancer.med.umich.edu/learn/leares.htm

•

Michigan: Sladen Library & Center for Health Information Resources - Consumer Health Information (Detroit), http://www.henryford.com/body.cfm?id=39330

•

Montana: Center for Health Information (St. Patrick Hospital and Health Sciences Center, Missoula)

•

National: Consumer Health Library Directory (Medical Library Association, Consumer and Patient Health Information Section), http://caphis.mlanet.org/directory/index.html

•

National: National Network of Libraries of Medicine (National Library of Medicine) provides library services for health professionals in the United States who do not have access to a medical library, http://nnlm.gov/

•

National: NN/LM List of Libraries Serving the Public (National Network of Libraries of Medicine), http://nnlm.gov/members/

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•

Nevada: Health Science Library, West Charleston Library (Las Vegas-Clark County Library District, Las Vegas), http://www.lvccld.org/special_collections/medical/index.htm

•

New Hampshire: Dartmouth Biomedical Libraries (Dartmouth College Library, Hanover), http://www.dartmouth.edu/~biomed/resources.htmld/conshealth.htmld/

•

New Jersey: Consumer Health Library (Rahway Hospital, Rahway), http://www.rahwayhospital.com/library.htm

•

New Jersey: Dr. Walter Phillips Health Sciences Library (Englewood Hospital and Medical Center, Englewood), http://www.englewoodhospital.com/links/index.htm

•

New Jersey: Meland Foundation (Englewood Hospital and Medical Center, Englewood), http://www.geocities.com/ResearchTriangle/9360/

•

New York: Choices in Health Information (New York Public Library) - NLM Consumer Pilot Project participant, http://www.nypl.org/branch/health/links.html

•

New York: Health Information Center (Upstate Medical University, State University of New York, Syracuse), http://www.upstate.edu/library/hic/

•

New York: Health Sciences Library (Long Island Jewish Medical Center, New Hyde Park), http://www.lij.edu/library/library.html

•

New York: ViaHealth Medical Library (Rochester General Hospital), http://www.nyam.org/library/

•

Ohio: Consumer Health Library (Akron General Medical Center, Medical & Consumer Health Library), http://www.akrongeneral.org/hwlibrary.htm

•

Oklahoma: The Health Information Center at Saint Francis Hospital (Saint Francis Health System, Tulsa), http://www.sfh-tulsa.com/services/healthinfo.asp

•

Oregon: Planetree Health Resource Center (Mid-Columbia Medical Center, The Dalles), http://www.mcmc.net/phrc/

•

Pennsylvania: Community Health Information Library (Milton S. Hershey Medical Center, Hershey), http://www.hmc.psu.edu/commhealth/

•

Pennsylvania: Community Health Resource Library (Geisinger Medical Center, Danville), http://www.geisinger.edu/education/commlib.shtml

•

Pennsylvania: HealthInfo Library (Moses Taylor Hospital, Scranton), http://www.mth.org/healthwellness.html

•

Pennsylvania: Hopwood Library (University of Pittsburgh, Health Sciences Library System, Pittsburgh), http://www.hsls.pitt.edu/guides/chi/hopwood/index_html

•

Pennsylvania: Koop Community Health Information Center (College of Physicians of Philadelphia), http://www.collphyphil.org/kooppg1.shtml

•

Pennsylvania: Learning Resources Center - Medical Library (Susquehanna Health System, Williamsport), http://www.shscares.org/services/lrc/index.asp

•

Pennsylvania: Medical Library (UPMC Health System, Pittsburgh), http://www.upmc.edu/passavant/library.htm

•

Quebec, Canada: Medical Library (Montreal General Hospital), http://www.mghlib.mcgill.ca/

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•

South Dakota: Rapid City Regional Hospital Medical Library (Rapid City Regional Hospital), http://www.rcrh.org/Services/Library/Default.asp

•

Texas: Houston HealthWays (Houston Academy of Medicine-Texas Medical Center Library), http://hhw.library.tmc.edu/

•

Washington: Community Health Library (Kittitas Valley Community Hospital), http://www.kvch.com/

•

Washington: Southwest Washington Medical Center Library (Southwest Washington Medical Center, Vancouver), http://www.swmedicalcenter.com/body.cfm?id=72

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ONLINE GLOSSARIES The Internet provides access to a number of free-to-use medical dictionaries. The National Library of Medicine has compiled the following list of online dictionaries: •

ADAM Medical Encyclopedia (A.D.A.M., Inc.), comprehensive medical reference: http://www.nlm.nih.gov/medlineplus/encyclopedia.html

•

MedicineNet.com Medical Dictionary (MedicineNet, Inc.): http://www.medterms.com/Script/Main/hp.asp

•

Merriam-Webster Medical Dictionary (Inteli-Health, Inc.): http://www.intelihealth.com/IH/

•

Multilingual Glossary of Technical and Popular Medical Terms in Eight European Languages (European Commission) - Danish, Dutch, English, French, German, Italian, Portuguese, and Spanish: http://allserv.rug.ac.be/~rvdstich/eugloss/welcome.html

•

On-line Medical Dictionary (CancerWEB): http://cancerweb.ncl.ac.uk/omd/

•

Rare Diseases Terms (Office of Rare Diseases): http://ord.aspensys.com/asp/diseases/diseases.asp

•

Technology Glossary (National Library of Medicine) - Health Care Technology: http://www.nlm.nih.gov/nichsr/ta101/ta10108.htm

Beyond these, MEDLINEplus contains a very patient-friendly encyclopedia covering every aspect of medicine (licensed from A.D.A.M., Inc.). The ADAM Medical Encyclopedia can be accessed at http://www.nlm.nih.gov/medlineplus/encyclopedia.html. ADAM is also available on commercial Web sites such as drkoop.com (http://www.drkoop.com/) and Web MD (http://my.webmd.com/adam/asset/adam_disease_articles/a_to_z/a).

Online Dictionary Directories The following are additional online directories compiled by the National Library of Medicine, including a number of specialized medical dictionaries: •

Medical Dictionaries: Medical & Biological (World Health Organization): http://www.who.int/hlt/virtuallibrary/English/diction.htm#Medical

•

MEL-Michigan Electronic Library List of Online Health and Medical Dictionaries (Michigan Electronic Library): http://mel.lib.mi.us/health/health-dictionaries.html

•

Patient Education: Glossaries (DMOZ Open Directory Project): http://dmoz.org/Health/Education/Patient_Education/Glossaries/

•

Web of Online Dictionaries (Bucknell University): http://www.yourdictionary.com/diction5.html#medicine

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HIP FRACTURE DICTIONARY The definitions below are derived from official public sources, including the National Institutes of Health [NIH] and the European Union [EU]. Abdominal: Having to do with the abdomen, which is the part of the body between the chest and the hips that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs. [NIH] Abduction: Forcible pulling of a limb away from its natural position, a risk in road accidents and disasters; move outwards away from middle line. [NIH] Acculturation: Process of cultural change in which one group or members of a group assimilates various cultural patterns from another. [NIH] Activities of Daily Living: The performance of the basic activities of self care, such as dressing, ambulation, eating, etc., in rehabilitation. [NIH] Acuity: Clarity or clearness, especially of the vision. [EU] Adaptation: 1. The adjustment of an organism to its environment, or the process by which it enhances such fitness. 2. The normal ability of the eye to adjust itself to variations in the intensity of light; the adjustment to such variations. 3. The decline in the frequency of firing of a neuron, particularly of a receptor, under conditions of constant stimulation. 4. In dentistry, (a) the proper fitting of a denture, (b) the degree of proximity and interlocking of restorative material to a tooth preparation, (c) the exact adjustment of bands to teeth. 5. In microbiology, the adjustment of bacterial physiology to a new environment. [EU] Adjustment: The dynamic process wherein the thoughts, feelings, behavior, and biophysiological mechanisms of the individual continually change to adjust to the environment. [NIH] Adjuvant: A substance which aids another, such as an auxiliary remedy; in immunology, nonspecific stimulator (e.g., BCG vaccine) of the immune response. [EU] Adolescence: The period of life beginning with the appearance of secondary sex characteristics and terminating with the cessation of somatic growth. The years usually referred to as adolescence lie between 13 and 18 years of age. [NIH] Adrenal Cortex: The outer layer of the adrenal gland. It secretes mineralocorticoids, androgens, and glucocorticoids. [NIH] Adverse Effect: An unwanted side effect of treatment. [NIH] Aerobic: In biochemistry, reactions that need oxygen to happen or happen when oxygen is present. [NIH] Aerobic Exercise: A type of physical activity that includes walking, jogging, running, and dancing. Aerobic training improves the efficiency of the aerobic energy-producing systems that can improve cardiorespiratory endurance. [NIH] Affinity: 1. Inherent likeness or relationship. 2. A special attraction for a specific element, organ, or structure. 3. Chemical affinity; the force that binds atoms in molecules; the tendency of substances to combine by chemical reaction. 4. The strength of noncovalent chemical binding between two substances as measured by the dissociation constant of the complex. 5. In immunology, a thermodynamic expression of the strength of interaction between a single antigen-binding site and a single antigenic determinant (and thus of the stereochemical compatibility between them), most accurately applied to interactions among

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simple, uniform antigenic determinants such as haptens. Expressed as the association constant (K litres mole -1), which, owing to the heterogeneity of affinities in a population of antibody molecules of a given specificity, actually represents an average value (mean intrinsic association constant). 6. The reciprocal of the dissociation constant. [EU] Age of Onset: The age or period of life at which a disease or the initial symptoms or manifestations of a disease appear in an individual. [NIH] Agonist: In anatomy, a prime mover. In pharmacology, a drug that has affinity for and stimulates physiologic activity at cell receptors normally stimulated by naturally occurring substances. [EU] Aldosterone: (11 beta)-11,21-Dihydroxy-3,20-dioxopregn-4-en-18-al. A hormone secreted by the adrenal cortex that functions in the regulation of electrolyte and water balance by increasing the renal retention of sodium and the excretion of potassium. [NIH] Algorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task. [NIH] Alimentary: Pertaining to food or nutritive material, or to the organs of digestion. [EU] Alkaline: Having the reactions of an alkali. [EU] Alkaline Phosphatase: An enzyme that catalyzes the conversion of an orthophosphoric monoester and water to an alcohol and orthophosphate. EC 3.1.3.1. [NIH] Allogeneic: Taken from different individuals of the same species. [NIH] Alpha Particles: Positively charged particles composed of two protons and two neutrons, i.e., helium nuclei, emitted during disintegration of very heavy isotopes; a beam of alpha particles or an alpha ray has very strong ionizing power, but weak penetrability. [NIH] Alternative medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used instead of standard treatments. Alternative medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Alveolar Process: The thickest and spongiest part of the maxilla and mandible hollowed out into deep cavities for the teeth. [NIH] Amenorrhea: Absence of menstruation. [NIH] Amino acid: Any organic compound containing an amino (-NH2 and a carboxyl (- COOH) group. The 20 a-amino acids listed in the accompanying table are the amino acids from which proteins are synthesized by formation of peptide bonds during ribosomal translation of messenger RNA; all except glycine, which is not optically active, have the L configuration. Other amino acids occurring in proteins, such as hydroxyproline in collagen, are formed by posttranslational enzymatic modification of amino acids residues in polypeptide chains. There are also several important amino acids, such as the neurotransmitter y-aminobutyric acid, that have no relation to proteins. Abbreviated AA. [EU] Amino Acid Sequence: The order of amino acids as they occur in a polypeptide chain. This is referred to as the primary structure of proteins. It is of fundamental importance in determining protein conformation. [NIH] Ammonia: A colorless alkaline gas. It is formed in the body during decomposition of organic materials during a large number of metabolically important reactions. [NIH] Anabolic: Relating to, characterized by, or promoting anabolism. [EU] Anaesthesia: Loss of feeling or sensation. Although the term is used for loss of tactile sensibility, or of any of the other senses, it is applied especially to loss of the sensation of

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pain, as it is induced to permit performance of surgery or other painful procedures. [EU] Anal: Having to do with the anus, which is the posterior opening of the large bowel. [NIH] Analgesic: An agent that alleviates pain without causing loss of consciousness. [EU] Analog: In chemistry, a substance that is similar, but not identical, to another. [NIH] Anatomical: Pertaining to anatomy, or to the structure of the organism. [EU] Androgens: A class of sex hormones associated with the development and maintenance of the secondary male sex characteristics, sperm induction, and sexual differentiation. In addition to increasing virility and libido, they also increase nitrogen and water retention and stimulate skeletal growth. [NIH] Anemia: A reduction in the number of circulating erythrocytes or in the quantity of hemoglobin. [NIH] Aneurysm: A sac formed by the dilatation of the wall of an artery, a vein, or the heart. [NIH] Angulation: Deviation from the normal long axis, as in a fractured bone healed out of line. [NIH]

Animal model: An animal with a disease either the same as or like a disease in humans. Animal models are used to study the development and progression of diseases and to test new treatments before they are given to humans. Animals with transplanted human cancers or other tissues are called xenograft models. [NIH] Anorexia: Lack or loss of appetite for food. Appetite is psychologic, dependent on memory and associations. Anorexia can be brought about by unattractive food, surroundings, or company. [NIH] Anorexia Nervosa: The chief symptoms are inability to eat, weight loss, and amenorrhea. [NIH]

Antiallergic: Counteracting allergy or allergic conditions. [EU] Antibacterial: A substance that destroys bacteria or suppresses their growth or reproduction. [EU] Antibiotic: A drug used to treat infections caused by bacteria and other microorganisms. [NIH]

Antibiotic Prophylaxis: Use of antibiotics before, during, or after a diagnostic, therapeutic, or surgical procedure to prevent infectious complications. [NIH] Antibodies: Immunoglobulin molecules having a specific amino acid sequence by virtue of which they interact only with the antigen that induced their synthesis in cells of the lymphoid series (especially plasma cells), or with an antigen closely related to it. [NIH] Antibody: A type of protein made by certain white blood cells in response to a foreign substance (antigen). Each antibody can bind to only a specific antigen. The purpose of this binding is to help destroy the antigen. Antibodies can work in several ways, depending on the nature of the antigen. Some antibodies destroy antigens directly. Others make it easier for white blood cells to destroy the antigen. [NIH] Anticoagulant: A drug that helps prevent blood clots from forming. Also called a blood thinner. [NIH] Antiepileptic: An agent that combats epilepsy. [EU] Antigen: Any substance which is capable, under appropriate conditions, of inducing a specific immune response and of reacting with the products of that response, that is, with specific antibody or specifically sensitized T-lymphocytes, or both. Antigens may be soluble substances, such as toxins and foreign proteins, or particulate, such as bacteria and tissue cells; however, only the portion of the protein or polysaccharide molecule known as the

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antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte. Abbreviated Ag. [EU] Anti-inflammatory: Having to do with reducing inflammation. [NIH] Anti-Inflammatory Agents: Substances that reduce or suppress inflammation. [NIH] Antineoplastic: Inhibiting or preventing the development of neoplasms, checking the maturation and proliferation of malignant cells. [EU] Antioxidant: A substance that prevents damage caused by free radicals. Free radicals are highly reactive chemicals that often contain oxygen. They are produced when molecules are split to give products that have unpaired electrons. This process is called oxidation. [NIH] Antithrombotic: Preventing or interfering with the formation of thrombi; an agent that so acts. [EU] Antitussive: An agent that relieves or prevents cough. [EU] Anus: The opening of the rectum to the outside of the body. [NIH] Anxiety: Persistent feeling of dread, apprehension, and impending disaster. [NIH] Aorta: The main trunk of the systemic arteries. [NIH] Applicability: A list of the commodities to which the candidate method can be applied as presented or with minor modifications. [NIH] Arterial: Pertaining to an artery or to the arteries. [EU] Arteries: The vessels carrying blood away from the heart. [NIH] Artery: Vessel-carrying blood from the heart to various parts of the body. [NIH] Arthroplasty: Surgical reconstruction of a joint to relieve pain or restore motion. [NIH] Articular: Of or pertaining to a joint. [EU] Artifacts: Any visible result of a procedure which is caused by the procedure itself and not by the entity being analyzed. Common examples include histological structures introduced by tissue processing, radiographic images of structures that are not naturally present in living tissue, and products of chemical reactions that occur during analysis. [NIH] Ascorbic Acid: A six carbon compound related to glucose. It is found naturally in citrus fruits and many vegetables. Ascorbic acid is an essential nutrient in human diets, and necessary to maintain connective tissue and bone. Its biologically active form, vitamin C, functions as a reducing agent and coenzyme in several metabolic pathways. Vitamin C is considered an antioxidant. [NIH] Aseptic: Free from infection or septic material; sterile. [EU] Aspirin: A drug that reduces pain, fever, inflammation, and blood clotting. Aspirin belongs to the family of drugs called nonsteroidal anti-inflammatory agents. It is also being studied in cancer prevention. [NIH] Assay: Determination of the amount of a particular constituent of a mixture, or of the biological or pharmacological potency of a drug. [EU] Astigmatism: A condition in which the surface of the cornea is not spherical; causes a blurred image to be received at the retina. [NIH] Atrophy: Decrease in the size of a cell, tissue, organ, or multiple organs, associated with a variety of pathological conditions such as abnormal cellular changes, ischemia, malnutrition, or hormonal changes. [NIH] Attenuated: Strain with weakened or reduced virulence. [NIH] Attenuation: Reduction of transmitted sound energy or its electrical equivalent. [NIH]

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Auditory: Pertaining to the sense of hearing. [EU] Autoimmune disease: A condition in which the body recognizes its own tissues as foreign and directs an immune response against them. [NIH] Axons: Nerve fibers that are capable of rapidly conducting impulses away from the neuron cell body. [NIH] Bacteria: Unicellular prokaryotic microorganisms which generally possess rigid cell walls, multiply by cell division, and exhibit three principal forms: round or coccal, rodlike or bacillary, and spiral or spirochetal. [NIH] Benzene: Toxic, volatile, flammable liquid hydrocarbon biproduct of coal distillation. It is used as an industrial solvent in paints, varnishes, lacquer thinners, gasoline, etc. Benzene causes central nervous system damage acutely and bone marrow damage chronically and is carcinogenic. It was formerly used as parasiticide. [NIH] Benzodiazepines: A two-ring heterocyclic compound consisting of a benzene ring fused to a diazepine ring. Permitted is any degree of hydrogenation, any substituents and any Hisomer. [NIH] Bewilderment: Impairment or loss of will power. [NIH] Bilateral: Affecting both the right and left side of body. [NIH] Bile: An emulsifying agent produced in the liver and secreted into the duodenum. Its composition includes bile acids and salts, cholesterol, and electrolytes. It aids digestion of fats in the duodenum. [NIH] Bioavailability: The degree to which a drug or other substance becomes available to the target tissue after administration. [EU] Bioavailable: The ability of a drug or other substance to be absorbed and used by the body. Orally bioavailable means that a drug or other substance that is taken by mouth can be absorbed and used by the body. [NIH] Biochemical: Relating to biochemistry; characterized by, produced by, or involving chemical reactions in living organisms. [EU] Biological Transport: The movement of materials (including biochemical substances and drugs) across cell membranes and epithelial layers, usually by passive diffusion. [NIH] Biomechanics: The study of the application of mechanical laws and the action of forces to living structures. [NIH] Biopsy: Removal and pathologic examination of specimens in the form of small pieces of tissue from the living body. [NIH] Biopsy specimen: Tissue removed from the body and examined under a microscope to determine whether disease is present. [NIH] Biosynthesis: The building up of a chemical compound in the physiologic processes of a living organism. [EU] Biotechnology: Body of knowledge related to the use of organisms, cells or cell-derived constituents for the purpose of developing products which are technically, scientifically and clinically useful. Alteration of biologic function at the molecular level (i.e., genetic engineering) is a central focus; laboratory methods used include transfection and cloning technologies, sequence and structure analysis algorithms, computer databases, and gene and protein structure function analysis and prediction. [NIH] Bipolar Disorder: A major affective disorder marked by severe mood swings (manic or major depressive episodes) and a tendency to remission and recurrence. [NIH] Bladder: The organ that stores urine. [NIH]

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Blood Cell Count: A count of the number of leukocytes and erythrocytes per unit volume in a sample of venous blood. A complete blood count (CBC) also includes measurement of the hemoglobin, hematocrit, and erythrocyte indices. [NIH] Blood Coagulation: The process of the interaction of blood coagulation factors that results in an insoluble fibrin clot. [NIH] Blood Glucose: Glucose in blood. [NIH] Blood Platelets: Non-nucleated disk-shaped cells formed in the megakaryocyte and found in the blood of all mammals. They are mainly involved in blood coagulation. [NIH] Blood pressure: The pressure of blood against the walls of a blood vessel or heart chamber. Unless there is reference to another location, such as the pulmonary artery or one of the heart chambers, it refers to the pressure in the systemic arteries, as measured, for example, in the forearm. [NIH] Blood transfusion: The administration of blood or blood products into a blood vessel. [NIH] Blood vessel: A tube in the body through which blood circulates. Blood vessels include a network of arteries, arterioles, capillaries, venules, and veins. [NIH] Body Composition: The relative amounts of various components in the body, such as percent body fat. [NIH] Body Fluids: Liquid components of living organisms. [NIH] Body Mass Index: One of the anthropometric measures of body mass; it has the highest correlation with skinfold thickness or body density. [NIH] Bone Density: The amount of mineral per square centimeter of bone. This is the definition used in clinical practice. Actual bone density would be expressed in grams per milliliter. It is most frequently measured by photon absorptiometry or x-ray computed tomography. [NIH] Bone Marrow: The soft tissue filling the cavities of bones. Bone marrow exists in two types, yellow and red. Yellow marrow is found in the large cavities of large bones and consists mostly of fat cells and a few primitive blood cells. Red marrow is a hematopoietic tissue and is the site of production of erythrocytes and granular leukocytes. Bone marrow is made up of a framework of connective tissue containing branching fibers with the frame being filled with marrow cells. [NIH] Bone Marrow Cells: Cells contained in the bone marrow including fat cells, stromal cells, megakaryocytes, and the immediate precursors of most blood cells. [NIH] Bone Remodeling: The continuous turnover of bone matrix and mineral that involves first, an increase in resorption (osteoclastic activity) and later, reactive bone formation (osteoblastic activity). The process of bone remodeling takes place in the adult skeleton at discrete foci. The process ensures the mechanical integrity of the skeleton throughout life and plays an important role in calcium homeostasis. An imbalance in the regulation of bone remodeling's two contrasting events, bone resorption and bone formation, results in many of the metabolic bone diseases, such as osteoporosis. [NIH] Bone Resorption: Bone loss due to osteoclastic activity. [NIH] Bone scan: A technique to create images of bones on a computer screen or on film. A small amount of radioactive material is injected into a blood vessel and travels through the bloodstream; it collects in the bones and is detected by a scanner. [NIH] Bony Callus: The bony deposit formed between and around the broken ends of a fractured bone during normal healing. [NIH] Bowel: The long tube-shaped organ in the abdomen that completes the process of digestion. There is both a small and a large bowel. Also called the intestine. [NIH]

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Bronchitis: Inflammation (swelling and reddening) of the bronchi. [NIH] Bursitis: Inflammation of a bursa, occasionally accompanied by a calcific deposit in the underlying supraspinatus tendon; the most common site is the subdeltoid bursa. [EU] Bypass: A surgical procedure in which the doctor creates a new pathway for the flow of body fluids. [NIH] Cadaver: A dead body, usually a human body. [NIH] Calcaneus: The largest of the tarsal bones and is situated at the lower and back part of the foot forming the heel. [NIH] Calcification: Deposits of calcium in the tissues of the breast. Calcification in the breast can be seen on a mammogram, but cannot be detected by touch. There are two types of breast calcification, macrocalcification and microcalcification. Macrocalcifications are large deposits and are usually not related to cancer. Microcalcifications are specks of calcium that may be found in an area of rapidly dividing cells. Many microcalcifications clustered together may be a sign of cancer. [NIH] Calcitonin: A peptide hormone that lowers calcium concentration in the blood. In humans, it is released by thyroid cells and acts to decrease the formation and absorptive activity of osteoclasts. Its role in regulating plasma calcium is much greater in children and in certain diseases than in normal adults. [NIH] Calcium: A basic element found in nearly all organized tissues. It is a member of the alkaline earth family of metals with the atomic symbol Ca, atomic number 20, and atomic weight 40. Calcium is the most abundant mineral in the body and combines with phosphorus to form calcium phosphate in the bones and teeth. It is essential for the normal functioning of nerves and muscles and plays a role in blood coagulation (as factor IV) and in many enzymatic processes. [NIH] Capsules: Hard or soft soluble containers used for the oral administration of medicine. [NIH] Carbohydrate: An aldehyde or ketone derivative of a polyhydric alcohol, particularly of the pentahydric and hexahydric alcohols. They are so named because the hydrogen and oxygen are usually in the proportion to form water, (CH2O)n. The most important carbohydrates are the starches, sugars, celluloses, and gums. They are classified into mono-, di-, tri-, polyand heterosaccharides. [EU] Carbon Dioxide: A colorless, odorless gas that can be formed by the body and is necessary for the respiration cycle of plants and animals. [NIH] Carcinogenic: Producing carcinoma. [EU] Cardiac: Having to do with the heart. [NIH] Cardiac Output: The volume of blood passing through the heart per unit of time. It is usually expressed as liters (volume) per minute so as not to be confused with stroke volume (volume per beat). [NIH] Cardiorespiratory: Relating to the heart and lungs and their function. [EU] Cardiovascular: Having to do with the heart and blood vessels. [NIH] Cardiovascular disease: Any abnormal condition characterized by dysfunction of the heart and blood vessels. CVD includes atherosclerosis (especially coronary heart disease, which can lead to heart attacks), cerebrovascular disease (e.g., stroke), and hypertension (high blood pressure). [NIH] Carrier Proteins: Transport proteins that carry specific substances in the blood or across cell membranes. [NIH] Case report: A detailed report of the diagnosis, treatment, and follow-up of an individual

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patient. Case reports also contain some demographic information about the patient (for example, age, gender, ethnic origin). [NIH] Castration: Surgical removal or artificial destruction of gonads. [NIH] Cataract: An opacity, partial or complete, of one or both eyes, on or in the lens or capsule, especially an opacity impairing vision or causing blindness. The many kinds of cataract are classified by their morphology (size, shape, location) or etiology (cause and time of occurrence). [EU] Causal: Pertaining to a cause; directed against a cause. [EU] Cell: The individual unit that makes up all of the tissues of the body. All living things are made up of one or more cells. [NIH] Cell membrane: Cell membrane = plasma membrane. The structure enveloping a cell, enclosing the cytoplasm, and forming a selective permeability barrier; it consists of lipids, proteins, and some carbohydrates, the lipids thought to form a bilayer in which integral proteins are embedded to varying degrees. [EU] Central Nervous System: The main information-processing organs of the nervous system, consisting of the brain, spinal cord, and meninges. [NIH] Centrifugation: A method of separating organelles or large molecules that relies upon differential sedimentation through a preformed density gradient under the influence of a gravitational field generated in a centrifuge. [NIH] Cerebral: Of or pertaining of the cerebrum or the brain. [EU] Cerebrovascular: Pertaining to the blood vessels of the cerebrum, or brain. [EU] Cervical: Relating to the neck, or to the neck of any organ or structure. Cervical lymph nodes are located in the neck; cervical cancer refers to cancer of the uterine cervix, which is the lower, narrow end (the "neck") of the uterus. [NIH] Chaos: Complex behavior that seems random but actually has some hidden order. [NIH] Character: In current usage, approximately equivalent to personality. The sum of the relatively fixed personality traits and habitual modes of response of an individual. [NIH] Chin: The anatomical frontal portion of the mandible, also known as the mentum, that contains the line of fusion of the two separate halves of the mandible (symphysis menti). This line of fusion divides inferiorly to enclose a triangular area called the mental protuberance. On each side, inferior to the second premolar tooth, is the mental foramen for the passage of blood vessels and a nerve. [NIH] Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH] Chromaffin System: The cells of the body which stain with chromium salts. They occur along the sympathetic nerves, in the adrenal gland, and in various other organs. [NIH] Chromatin: The material of chromosomes. It is a complex of DNA, histones, and nonhistone proteins (chromosomal proteins, non-histone) found within the nucleus of a cell. [NIH] Chromosomal: Pertaining to chromosomes. [EU] Chromosome: Part of a cell that contains genetic information. Except for sperm and eggs, all human cells contain 46 chromosomes. [NIH] Chronic: A disease or condition that persists or progresses over a long period of time. [NIH] Chronic Disease: Disease or ailment of long duration. [NIH] Chronic Obstructive Pulmonary Disease: Collective term for chronic bronchitis and emphysema. [NIH]

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Chronic renal: Slow and progressive loss of kidney function over several years, often resulting in end-stage renal disease. People with end-stage renal disease need dialysis or transplantation to replace the work of the kidneys. [NIH] Circulatory system: The system that contains the heart and the blood vessels and moves blood throughout the body. This system helps tissues get enough oxygen and nutrients, and it helps them get rid of waste products. The lymph system, which connects with the blood system, is often considered part of the circulatory system. [NIH] Clinical Medicine: The study and practice of medicine by direct examination of the patient. [NIH]

Clinical trial: A research study that tests how well new medical treatments or other interventions work in people. Each study is designed to test new methods of screening, prevention, diagnosis, or treatment of a disease. [NIH] Cloning: The production of a number of genetically identical individuals; in genetic engineering, a process for the efficient replication of a great number of identical DNA molecules. [NIH] Cluster Analysis: A set of statistical methods used to group variables or observations into strongly inter-related subgroups. In epidemiology, it may be used to analyze a closely grouped series of events or cases of disease or other health-related phenomenon with welldefined distribution patterns in relation to time or place or both. [NIH] Coenzyme: An organic nonprotein molecule, frequently a phosphorylated derivative of a water-soluble vitamin, that binds with the protein molecule (apoenzyme) to form the active enzyme (holoenzyme). [EU] Cofactor: A substance, microorganism or environmental factor that activates or enhances the action of another entity such as a disease-causing agent. [NIH] Cognition: Intellectual or mental process whereby an organism becomes aware of or obtains knowledge. [NIH] Cohort Studies: Studies in which subsets of a defined population are identified. These groups may or may not be exposed to factors hypothesized to influence the probability of the occurrence of a particular disease or other outcome. Cohorts are defined populations which, as a whole, are followed in an attempt to determine distinguishing subgroup characteristics. [NIH] Colitis: Inflammation of the colon. [NIH] Collagen: A polypeptide substance comprising about one third of the total protein in mammalian organisms. It is the main constituent of skin, connective tissue, and the organic substance of bones and teeth. Different forms of collagen are produced in the body but all consist of three alpha-polypeptide chains arranged in a triple helix. Collagen is differentiated from other fibrous proteins, such as elastin, by the content of proline, hydroxyproline, and hydroxylysine; by the absence of tryptophan; and particularly by the high content of polar groups which are responsible for its swelling properties. [NIH] Colon: The long, coiled, tubelike organ that removes water from digested food. The remaining material, solid waste called stool, moves through the colon to the rectum and leaves the body through the anus. [NIH] Comorbidity: The presence of co-existing or additional diseases with reference to an initial diagnosis or with reference to the index condition that is the subject of study. Comorbidity may affect the ability of affected individuals to function and also their survival; it may be used as a prognostic indicator for length of hospital stay, cost factors, and outcome or survival. [NIH]

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Complement: A term originally used to refer to the heat-labile factor in serum that causes immune cytolysis, the lysis of antibody-coated cells, and now referring to the entire functionally related system comprising at least 20 distinct serum proteins that is the effector not only of immune cytolysis but also of other biologic functions. Complement activation occurs by two different sequences, the classic and alternative pathways. The proteins of the classic pathway are termed 'components of complement' and are designated by the symbols C1 through C9. C1 is a calcium-dependent complex of three distinct proteins C1q, C1r and C1s. The proteins of the alternative pathway (collectively referred to as the properdin system) and complement regulatory proteins are known by semisystematic or trivial names. Fragments resulting from proteolytic cleavage of complement proteins are designated with lower-case letter suffixes, e.g., C3a. Inactivated fragments may be designated with the suffix 'i', e.g. C3bi. Activated components or complexes with biological activity are designated by a bar over the symbol e.g. C1 or C4b,2a. The classic pathway is activated by the binding of C1 to classic pathway activators, primarily antigen-antibody complexes containing IgM, IgG1, IgG3; C1q binds to a single IgM molecule or two adjacent IgG molecules. The alternative pathway can be activated by IgA immune complexes and also by nonimmunologic materials including bacterial endotoxins, microbial polysaccharides, and cell walls. Activation of the classic pathway triggers an enzymatic cascade involving C1, C4, C2 and C3; activation of the alternative pathway triggers a cascade involving C3 and factors B, D and P. Both result in the cleavage of C5 and the formation of the membrane attack complex. Complement activation also results in the formation of many biologically active complement fragments that act as anaphylatoxins, opsonins, or chemotactic factors. [EU] Complementary and alternative medicine: CAM. Forms of treatment that are used in addition to (complementary) or instead of (alternative) standard treatments. These practices are not considered standard medical approaches. CAM includes dietary supplements, megadose vitamins, herbal preparations, special teas, massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Complementary medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used to enhance or complement the standard treatments. Complementary medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Compliance: Distensibility measure of a chamber such as the lungs (lung compliance) or bladder. Compliance is expressed as a change in volume per unit change in pressure. [NIH] Computational Biology: A field of biology concerned with the development of techniques for the collection and manipulation of biological data, and the use of such data to make biological discoveries or predictions. This field encompasses all computational methods and theories applicable to molecular biology and areas of computer-based techniques for solving biological problems including manipulation of models and datasets. [NIH] Computed tomography: CT scan. A series of detailed pictures of areas inside the body, taken from different angles; the pictures are created by a computer linked to an x-ray machine. Also called computerized tomography and computerized axial tomography (CAT) scan. [NIH] Computer Simulation: Computer-based representation of physical systems and phenomena such as chemical processes. [NIH] Computerized axial tomography: A series of detailed pictures of areas inside the body, taken from different angles; the pictures are created by a computer linked to an x-ray machine. Also called CAT scan, computed tomography (CT scan), or computerized tomography. [NIH]

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Computerized tomography: A series of detailed pictures of areas inside the body, taken from different angles; the pictures are created by a computer linked to an x-ray machine. Also called computerized axial tomography (CAT) scan and computed tomography (CT scan). [NIH] Confidence Intervals: A range of values for a variable of interest, e.g., a rate, constructed so that this range has a specified probability of including the true value of the variable. [NIH] Confusion: A mental state characterized by bewilderment, emotional disturbance, lack of clear thinking, and perceptual disorientation. [NIH] Congestive heart failure: Weakness of the heart muscle that leads to a buildup of fluid in body tissues. [NIH] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Consciousness: Sense of awareness of self and of the environment. [NIH] Consultation: A deliberation between two or more physicians concerning the diagnosis and the proper method of treatment in a case. [NIH] Contamination: The soiling or pollution by inferior material, as by the introduction of organisms into a wound, or sewage into a stream. [EU] Contraindications: Any factor or sign that it is unwise to pursue a certain kind of action or treatment, e. g. giving a general anesthetic to a person with pneumonia. [NIH] Contrast Sensitivity: The ability to detect sharp boundaries (stimuli) and to detect slight changes in luminance at regions without distinct contours. Psychophysical measurements of this visual function are used to evaluate visual acuity and to detect eye disease. [NIH] Control group: In a clinical trial, the group that does not receive the new treatment being studied. This group is compared to the group that receives the new treatment, to see if the new treatment works. [NIH] Controlled study: An experiment or clinical trial that includes a comparison (control) group. [NIH]

Coronary: Encircling in the manner of a crown; a term applied to vessels; nerves, ligaments, etc. The term usually denotes the arteries that supply the heart muscle and, by extension, a pathologic involvement of them. [EU] Coronary heart disease: A type of heart disease caused by narrowing of the coronary arteries that feed the heart, which needs a constant supply of oxygen and nutrients carried by the blood in the coronary arteries. When the coronary arteries become narrowed or clogged by fat and cholesterol deposits and cannot supply enough blood to the heart, CHD results. [NIH] Coronary Thrombosis: Presence of a thrombus in a coronary artery, often causing a myocardial infarction. [NIH] Cortex: The outer layer of an organ or other body structure, as distinguished from the internal substance. [EU] Cortical: Pertaining to or of the nature of a cortex or bark. [EU] Corticosteroid: Any of the steroids elaborated by the adrenal cortex (excluding the sex hormones of adrenal origin) in response to the release of corticotrophin (adrenocorticotropic hormone) by the pituitary gland, to any of the synthetic equivalents of these steroids, or to angiotensin II. They are divided, according to their predominant biological activity, into

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three major groups: glucocorticoids, chiefly influencing carbohydrate, fat, and protein metabolism; mineralocorticoids, affecting the regulation of electrolyte and water balance; and C19 androgens. Some corticosteroids exhibit both types of activity in varying degrees, and others exert only one type of effect. The corticosteroids are used clinically for hormonal replacement therapy, for suppression of ACTH secretion by the anterior pituitary, as antineoplastic, antiallergic, and anti-inflammatory agents, and to suppress the immune response. Called also adrenocortical hormone and corticoid. [EU] Cortisone: A natural steroid hormone produced in the adrenal gland. It can also be made in the laboratory. Cortisone reduces swelling and can suppress immune responses. [NIH] Cost Savings: Reductions in all or any portion of the costs of providing goods or services. Savings may be incurred by the provider or the consumer. [NIH] Criterion: A standard by which something may be judged. [EU] Cross-Cultural Comparison: Comparison of various psychological, sociological, or cultural factors in order to assess the similarities or diversities occurring in two or more different cultures or societies. [NIH] Cross-Sectional Studies: Studies in which the presence or absence of disease or other health-related variables are determined in each member of the study population or in a representative sample at one particular time. This contrasts with longitudinal studies which are followed over a period of time. [NIH] Curative: Tending to overcome disease and promote recovery. [EU] Cysteine: A thiol-containing non-essential amino acid that is oxidized to form cystine. [NIH] Cystine: A covalently linked dimeric nonessential amino acid formed by the oxidation of cysteine. Two molecules of cysteine are joined together by a disulfide bridge to form cystine. [NIH]

Cytokine: Small but highly potent protein that modulates the activity of many cell types, including T and B cells. [NIH] Cytoplasm: The protoplasm of a cell exclusive of that of the nucleus; it consists of a continuous aqueous solution (cytosol) and the organelles and inclusions suspended in it (phaneroplasm), and is the site of most of the chemical activities of the cell. [EU] Dairy Products: Raw and processed or manufactured milk and milk-derived products. These are usually from cows (bovine) but are also from goats, sheep, reindeer, and water buffalo. [NIH] Dalteparin: A drug that helps prevent the formation of blood clots; it belongs to the family of drugs called anticoagulants. [NIH] Data Collection: Systematic gathering of data for a particular purpose from various sources, including questionnaires, interviews, observation, existing records, and electronic devices. The process is usually preliminary to statistical analysis of the data. [NIH] Deamination: The removal of an amino group (NH2) from a chemical compound. [NIH] Decision Making: The process of making a selective intellectual judgment when presented with several complex alternatives consisting of several variables, and usually defining a course of action or an idea. [NIH] Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU] Dehydroepiandrosterone: DHEA. A substance that is being studied as a cancer prevention drug. It belongs to the family of drugs called steroids. [NIH] Delirium: (DSM III-R) an acute, reversible organic mental disorder characterized by reduced

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ability to maintain attention to external stimuli and disorganized thinking as manifested by rambling, irrelevant, or incoherent speech; there are also a reduced level of consciousness, sensory misperceptions, disturbance of the sleep-wakefulness cycle and level of psychomotor activity, disorientation to time, place, or person, and memory impairment. Delirium may be caused by a large number of conditions resulting in derangement of cerebral metabolism, including systemic infection, poisoning, drug intoxication or withdrawal, seizures or head trauma, and metabolic disturbances such as hypoxia, hypoglycaemia, fluid, electrolyte, or acid-base imbalances, or hepatic or renal failure. Called also acute confusional state and acute brain syndrome. [EU] Delivery of Health Care: The concept concerned with all aspects of providing and distributing health services to a patient population. [NIH] Dementia: An acquired organic mental disorder with loss of intellectual abilities of sufficient severity to interfere with social or occupational functioning. The dysfunction is multifaceted and involves memory, behavior, personality, judgment, attention, spatial relations, language, abstract thought, and other executive functions. The intellectual decline is usually progressive, and initially spares the level of consciousness. [NIH] Dendrites: Extensions of the nerve cell body. They are short and branched and receive stimuli from other neurons. [NIH] Density: The logarithm to the base 10 of the opacity of an exposed and processed film. [NIH] Dental Caries: Localized destruction of the tooth surface initiated by decalcification of the enamel followed by enzymatic lysis of organic structures and leading to cavity formation. If left unchecked, the cavity may penetrate the enamel and dentin and reach the pulp. The three most prominent theories used to explain the etiology of the disase are that acids produced by bacteria lead to decalcification; that micro-organisms destroy the enamel protein; or that keratolytic micro-organisms produce chelates that lead to decalcification. [NIH]

Dentate Gyrus: Gray matter situated above the gyrus hippocampi. It is composed of three layers. The molecular layer is continuous with the hippocampus in the hippocampal fissure. The granular layer consists of closely arranged spherical or oval neurons, called granule cells, whose axons pass through the polymorphic layer ending on the dendrites of pyramidal cells in the hippocampus. [NIH] Depressive Disorder: An affective disorder manifested by either a dysphoric mood or loss of interest or pleasure in usual activities. The mood disturbance is prominent and relatively persistent. [NIH] Diabetes Mellitus: A heterogeneous group of disorders that share glucose intolerance in common. [NIH] Diagnostic Errors: Incorrect diagnoses after clinical examination or technical diagnostic procedures. [NIH] Diagnostic procedure: A method used to identify a disease. [NIH] Diathesis: A constitution or condition of the body which makes the tissues react in special ways to certain extrinsic stimuli and thus tends to make the person more than usually susceptible to certain diseases. [EU] Diffusion: The tendency of a gas or solute to pass from a point of higher pressure or concentration to a point of lower pressure or concentration and to distribute itself throughout the available space; a major mechanism of biological transport. [NIH] Digestive tract: The organs through which food passes when food is eaten. These organs are the mouth, esophagus, stomach, small and large intestines, and rectum. [NIH]

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Digital rectal examination: DRE. An examination in which a doctor inserts a lubricated, gloved finger into the rectum to feel for abnormalities. [NIH] Dilution: A diluted or attenuated medicine; in homeopathy, the diffusion of a given quantity of a medicinal agent in ten or one hundred times the same quantity of water. [NIH] Direct: 1. Straight; in a straight line. 2. Performed immediately and without the intervention of subsidiary means. [EU] Discrete: Made up of separate parts or characterized by lesions which do not become blended; not running together; separate. [NIH] Discrimination: The act of qualitative and/or quantitative differentiation between two or more stimuli. [NIH] Disorientation: The loss of proper bearings, or a state of mental confusion as to time, place, or identity. [EU] Dissociation: 1. The act of separating or state of being separated. 2. The separation of a molecule into two or more fragments (atoms, molecules, ions, or free radicals) produced by the absorption of light or thermal energy or by solvation. 3. In psychology, a defense mechanism in which a group of mental processes are segregated from the rest of a person's mental activity in order to avoid emotional distress, as in the dissociative disorders (q.v.), or in which an idea or object is segregated from its emotional significance; in the first sense it is roughly equivalent to splitting, in the second, to isolation. 4. A defect of mental integration in which one or more groups of mental processes become separated off from normal consciousness and, thus separated, function as a unitary whole. [EU] Distal: Remote; farther from any point of reference; opposed to proximal. In dentistry, used to designate a position on the dental arch farther from the median line of the jaw. [EU] Double-blind: Pertaining to a clinical trial or other experiment in which neither the subject nor the person administering treatment knows which treatment any particular subject is receiving. [EU] Double-blinded: A clinical trial in which neither the medical staff nor the person knows which of several possible therapies the person is receiving. [NIH] Drive: A state of internal activity of an organism that is a necessary condition before a given stimulus will elicit a class of responses; e.g., a certain level of hunger (drive) must be present before food will elicit an eating response. [NIH] Drug Interactions: The action of a drug that may affect the activity, metabolism, or toxicity of another drug. [NIH] Drusen: Tiny yellow or white deposits in the retina or optic nerve head. [NIH] Duct: A tube through which body fluids pass. [NIH] Dynamometer: An instrument for measuring the force of muscular contraction. [NIH] Dyspareunia: Painful sexual intercourse. [NIH] Dystrophy: Any disorder arising from defective or faulty nutrition, especially the muscular dystrophies. [EU] Efficacy: The extent to which a specific intervention, procedure, regimen, or service produces a beneficial result under ideal conditions. Ideally, the determination of efficacy is based on the results of a randomized control trial. [NIH] Elasticity: Resistance and recovery from distortion of shape. [NIH] Elastin: The protein that gives flexibility to tissues. [NIH] Elective: Subject to the choice or decision of the patient or physician; applied to procedures

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that are advantageous to the patient but not urgent. [EU] Electrolyte: A substance that dissociates into ions when fused or in solution, and thus becomes capable of conducting electricity; an ionic solute. [EU] Electrons: Stable elementary particles having the smallest known negative charge, present in all elements; also called negatrons. Positively charged electrons are called positrons. The numbers, energies and arrangement of electrons around atomic nuclei determine the chemical identities of elements. Beams of electrons are called cathode rays or beta rays, the latter being a high-energy biproduct of nuclear decay. [NIH] Emphysema: A pathological accumulation of air in tissues or organs. [NIH] Emulsion: A preparation of one liquid distributed in small globules throughout the body of a second liquid. The dispersed liquid is the discontinuous phase, and the dispersion medium is the continuous phase. When oil is the dispersed liquid and an aqueous solution is the continuous phase, it is known as an oil-in-water emulsion, whereas when water or aqueous solution is the dispersed phase and oil or oleaginous substance is the continuous phase, it is known as a water-in-oil emulsion. Pharmaceutical emulsions for which official standards have been promulgated include cod liver oil emulsion, cod liver oil emulsion with malt, liquid petrolatum emulsion, and phenolphthalein in liquid petrolatum emulsion. [EU] Endocrine Glands: Ductless glands that secrete substances which are released directly into the circulation and which influence metabolism and other body functions. [NIH] Endocrine System: The system of glands that release their secretions (hormones) directly into the circulatory system. In addition to the endocrine glands, included are the chromaffin system and the neurosecretory systems. [NIH] Endocytosis: Cellular uptake of extracellular materials within membrane-limited vacuoles or microvesicles. Endosomes play a central role in endocytosis. [NIH] Endometrial: Having to do with the endometrium (the layer of tissue that lines the uterus). [NIH]

Endometrium: The layer of tissue that lines the uterus. [NIH] End-stage renal: Total chronic kidney failure. When the kidneys fail, the body retains fluid and harmful wastes build up. A person with ESRD needs treatment to replace the work of the failed kidneys. [NIH] Enhancer: Transcriptional element in the virus genome. [NIH] Enoxaparin: A drug used to prevent blood clots. It belongs to the family of drugs called anticoagulants. [NIH] Entorhinal Cortex: Cortex where the signals are combined with those from other sensory systems. [NIH] Environmental Health: The science of controlling or modifying those conditions, influences, or forces surrounding man which relate to promoting, establishing, and maintaining health. [NIH]

Enzymatic: Phase where enzyme cuts the precursor protein. [NIH] Enzyme: A protein that speeds up chemical reactions in the body. [NIH] Epidemic: Occurring suddenly in numbers clearly in excess of normal expectancy; said especially of infectious diseases but applied also to any disease, injury, or other healthrelated event occurring in such outbreaks. [EU] Epidemiologic Studies: Studies designed to examine associations, commonly, hypothesized causal relations. They are usually concerned with identifying or measuring the effects of risk factors or exposures. The common types of analytic study are case-control studies, cohort

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studies, and cross-sectional studies. [NIH] Epidemiological: Relating to, or involving epidemiology. [EU] Erythrocytes: Red blood cells. Mature erythrocytes are non-nucleated, biconcave disks containing hemoglobin whose function is to transport oxygen. [NIH] Estradiol: The most potent mammalian estrogenic hormone. It is produced in the ovary, placenta, testis, and possibly the adrenal cortex. [NIH] Estrogen: One of the two female sex hormones. [NIH] Estrogen receptor: ER. Protein found on some cancer cells to which estrogen will attach. [NIH]

Estrogen Replacement Therapy: The use of hormonal agents with estrogen-like activity in postmenopausal or other estrogen-deficient women to alleviate effects of hormone deficiency, such as vasomotor symptoms, dyspareunia, and progressive development of osteoporosis. This may also include the use of progestational agents in combination therapy. [NIH]

Ethnic Groups: A group of people with a common cultural heritage that sets them apart from others in a variety of social relationships. [NIH] Etidronate: A drug that belongs to the family of drugs called bisphosphonates. Bisphosphonates are used as treatment for hypercalcemia (abnormally high levels of calcium in the blood) and for cancer that has spread to the bone (bone metastases). [NIH] Excitability: Property of a cardiac cell whereby, when the cell is depolarized to a critical level (called threshold), the membrane becomes permeable and a regenerative inward current causes an action potential. [NIH] Exercise Test: Controlled physical activity, more strenuous than at rest, which is performed in order to allow assessment of physiological functions, particularly cardiovascular and pulmonary, but also aerobic capacity. Maximal (most intense) exercise is usually required but submaximal exercise is also used. The intensity of exercise is often graded, using criteria such as rate of work done, oxygen consumption, and heart rate. Physiological data obtained from an exercise test may be used for diagnosis, prognosis, and evaluation of disease severity, and to evaluate therapy. Data may also be used in prescribing exercise by determining a person's exercise capacity. [NIH] Exhaustion: The feeling of weariness of mind and body. [NIH] Exogenous: Developed or originating outside the organism, as exogenous disease. [EU] Exon: The part of the DNA that encodes the information for the actual amino acid sequence of the protein. In many eucaryotic genes, the coding sequences consist of a series of exons alternating with intron sequences. [NIH] Extensor: A muscle whose contraction tends to straighten a limb; the antagonist of a flexor. [NIH]

Extracellular: Outside a cell or cells. [EU] Extracellular Matrix: A meshwork-like substance found within the extracellular space and in association with the basement membrane of the cell surface. It promotes cellular proliferation and provides a supporting structure to which cells or cell lysates in culture dishes adhere. [NIH] Extraction: The process or act of pulling or drawing out. [EU] Extremity: A limb; an arm or leg (membrum); sometimes applied specifically to a hand or foot. [EU] Family Planning: Programs or services designed to assist the family in controlling

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reproduction by either improving or diminishing fertility. [NIH] Fat: Total lipids including phospholipids. [NIH] Fatigue: The state of weariness following a period of exertion, mental or physical, characterized by a decreased capacity for work and reduced efficiency to respond to stimuli. [NIH]

Femoral: Pertaining to the femur, or to the thigh. [EU] Femoral Fractures: Fractures of the femur. [NIH] Femoral Neck Fractures: Fractures of the short, constricted portion of the thigh bone between the femur head and the trochanters. It excludes intertrochanteric fractures which are hip fractures. [NIH] Femur: The longest and largest bone of the skeleton, it is situated between the hip and the knee. [NIH] Fibrinolysis: The natural enzymatic dissolution of fibrin. [NIH] Fibula: The bone of the lower leg lateral to and smaller than the tibia. In proportion to its length, it is the most slender of the long bones. [NIH] Fissure: Any cleft or groove, normal or otherwise; especially a deep fold in the cerebral cortex which involves the entire thickness of the brain wall. [EU] Fixation: 1. The act or operation of holding, suturing, or fastening in a fixed position. 2. The condition of being held in a fixed position. 3. In psychiatry, a term with two related but distinct meanings : (1) arrest of development at a particular stage, which like regression (return to an earlier stage), if temporary is a normal reaction to setbacks and difficulties but if protracted or frequent is a cause of developmental failures and emotional problems, and (2) a close and suffocating attachment to another person, especially a childhood figure, such as one's mother or father. Both meanings are derived from psychoanalytic theory and refer to 'fixation' of libidinal energy either in a specific erogenous zone, hence fixation at the oral, anal, or phallic stage, or in a specific object, hence mother or father fixation. 4. The use of a fixative (q.v.) to preserve histological or cytological specimens. 5. In chemistry, the process whereby a substance is removed from the gaseous or solution phase and localized, as in carbon dioxide fixation or nitrogen fixation. 6. In ophthalmology, direction of the gaze so that the visual image of the object falls on the fovea centralis. 7. In film processing, the chemical removal of all undeveloped salts of the film emulsion, leaving only the developed silver to form a permanent image. [EU] Flexor: Muscles which flex a joint. [NIH] Fold: A plication or doubling of various parts of the body. [NIH] Foot Care: Taking special steps to avoid foot problems such as sores, cuts, bunions, and calluses. Good care includes daily examination of the feet, toes, and toenails and choosing shoes and socks or stockings that fit well. People with diabetes have to take special care of their feet because nerve damage and reduced blood flow sometimes mean they will have less feeling in their feet than normal. They may not notice cuts and other problems as soon as they should. [NIH] Forearm: The part between the elbow and the wrist. [NIH] Fovea: The central part of the macula that provides the sharpest vision. [NIH] Fracture Fixation: The use of metallic devices inserted into or through bone to hold a fracture in a set position and alignment while it heals. [NIH] Fracture Healing: The physiological restoration of bone tissue and function after a fracture. It includes bony callus formation and normal replacement of bone tissue. [NIH]

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Functional magnetic resonance imaging: A noninvasive tool used to observe functioning in the brain or other organs by detecting changes in chemical composition, blood flow, or both. [NIH]

Fundus: The larger part of a hollow organ that is farthest away from the organ's opening. The bladder, gallbladder, stomach, uterus, eye, and cavity of the middle ear all have a fundus. [NIH] Gait: Manner or style of walking. [NIH] Gallbladder: The pear-shaped organ that sits below the liver. Bile is concentrated and stored in the gallbladder. [NIH] Gas: Air that comes from normal breakdown of food. The gases are passed out of the body through the rectum (flatus) or the mouth (burp). [NIH] Gastrectomy: An operation to remove all or part of the stomach. [NIH] Gastrin: A hormone released after eating. Gastrin causes the stomach to produce more acid. [NIH]

Gastrointestinal: Refers to the stomach and intestines. [NIH] Gastrointestinal tract: The stomach and intestines. [NIH] Gelatin: A product formed from skin, white connective tissue, or bone collagen. It is used as a protein food adjuvant, plasma substitute, hemostatic, suspending agent in pharmaceutical preparations, and in the manufacturing of capsules and suppositories. [NIH] Gene: The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein. [NIH]

Gene Expression: The phenotypic manifestation of a gene or genes by the processes of gene action. [NIH] Genetic Code: The specifications for how information, stored in nucleic acid sequence (base sequence), is translated into protein sequence (amino acid sequence). The start, stop, and order of amino acids of a protein is specified by consecutive triplets of nucleotides called codons (codon). [NIH] Genetic Engineering: Directed modification of the gene complement of a living organism by such techniques as altering the DNA, substituting genetic material by means of a virus, transplanting whole nuclei, transplanting cell hybrids, etc. [NIH] Genetic Markers: A phenotypically recognizable genetic trait which can be used to identify a genetic locus, a linkage group, or a recombination event. [NIH] Genotype: The genetic constitution of the individual; the characterization of the genes. [NIH] Geriatric: Pertaining to the treatment of the aged. [EU] Geriatric Psychiatry: A subspecialty of psychiatry concerned with the mental health of the aged. [NIH] Gland: An organ that produces and releases one or more substances for use in the body. Some glands produce fluids that affect tissues or organs. Others produce hormones or participate in blood production. [NIH] Glomerular: Pertaining to or of the nature of a glomerulus, especially a renal glomerulus. [EU]

Glucocorticoid: A compound that belongs to the family of compounds called corticosteroids (steroids). Glucocorticoids affect metabolism and have anti-inflammatory and immunosuppressive effects. They may be naturally produced (hormones) or synthetic (drugs). [NIH]

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Glucose: D-Glucose. A primary source of energy for living organisms. It is naturally occurring and is found in fruits and other parts of plants in its free state. It is used therapeutically in fluid and nutrient replacement. [NIH] Glucose Intolerance: A pathological state in which the fasting plasma glucose level is less than 140 mg per deciliter and the 30-, 60-, or 90-minute plasma glucose concentration following a glucose tolerance test exceeds 200 mg per deciliter. This condition is seen frequently in diabetes mellitus but also occurs with other diseases. [NIH] Glycine: A non-essential amino acid. It is found primarily in gelatin and silk fibroin and used therapeutically as a nutrient. It is also a fast inhibitory neurotransmitter. [NIH] Goats: Any of numerous agile, hollow-horned ruminants of the genus Capra, closely related to the sheep. [NIH] Gonad: A sex organ, such as an ovary or a testicle, which produces the gametes in most multicellular animals. [NIH] Gonadal: Pertaining to a gonad. [EU] Governing Board: The group in which legal authority is vested for the control of healthrelated institutions and organizations. [NIH] Grade: The grade of a tumor depends on how abnormal the cancer cells look under a microscope and how quickly the tumor is likely to grow and spread. Grading systems are different for each type of cancer. [NIH] Graft: Healthy skin, bone, or other tissue taken from one part of the body and used to replace diseased or injured tissue removed from another part of the body. [NIH] Graft Rejection: An immune response with both cellular and humoral components, directed against an allogeneic transplant, whose tissue antigens are not compatible with those of the recipient. [NIH] Granule: A small pill made from sucrose. [EU] Habitual: Of the nature of a habit; according to habit; established by or repeated by force of habit, customary. [EU] Haematuria: Blood in the urine. [EU] Haemophilia: A haemorrhagic diathesis occurring in two main forms: 1. Haemophilia A (classic haemophilia, factor VIII deficiency), an X-linked disorder due to deficiency of coagulation factor VIII; 2. Haemophilia B (factor IX deficiency, Christmas disease), also Xlinked, due to deficiency of coagulation factor IX. Both forms are determined by a mutant gene near the telomere of the long arm of the X chromosome (Xq), but a different loci, and are characterized by subcutaneous and intramuscular haemorrhages; bleeding from the mouth, gums, lips, and tongue; haematuria; and haemarthroses. [EU] Handicap: A handicap occurs as a result of disability, but disability does not always constitute a handicap. A handicap may be said to exist when a disability causes a substantial and continuing reduction in a person's capacity to function socially and vocationally. [NIH] Haptens: Small antigenic determinants capable of eliciting an immune response only when coupled to a carrier. Haptens bind to antibodies but by themselves cannot elicit an antibody response. [NIH] Headache: Pain in the cranial region that may occur as an isolated and benign symptom or as a manifestation of a wide variety of conditions including subarachnoid hemorrhage; craniocerebral trauma; central nervous system infections; intracranial hypertension; and other disorders. In general, recurrent headaches that are not associated with a primary disease process are referred to as headache disorders (e.g., migraine). [NIH]

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Health Care Costs: The actual costs of providing services related to the delivery of health care, including the costs of procedures, therapies, and medications. It is differentiated from health expenditures, which refers to the amount of money paid for the services, and from fees, which refers to the amount charged, regardless of cost. [NIH] Health Expenditures: The amounts spent by individuals, groups, nations, or private or public organizations for total health care and/or its various components. These amounts may or may not be equivalent to the actual costs (health care costs) and may or may not be shared among the patient, insurers, and/or employers. [NIH] Health Promotion: Encouraging consumer behaviors most likely to optimize health potentials (physical and psychosocial) through health information, preventive programs, and access to medical care. [NIH] Health Services: Services for the diagnosis and treatment of disease and the maintenance of health. [NIH] Health Status: The level of health of the individual, group, or population as subjectively assessed by the individual or by more objective measures. [NIH] Heart attack: A seizure of weak or abnormal functioning of the heart. [NIH] Heart failure: Loss of pumping ability by the heart, often accompanied by fatigue, breathlessness, and excess fluid accumulation in body tissues. [NIH] Heartbeat: One complete contraction of the heart. [NIH] Hematocrit: Measurement of the volume of packed red cells in a blood specimen by centrifugation. The procedure is performed using a tube with graduated markings or with automated blood cell counters. It is used as an indicator of erythrocyte status in disease. For example, anemia shows a low hematocrit, polycythemia, high values. [NIH] Hemiparesis: The weakness or paralysis affecting one side of the body. [NIH] Hemiplegia: Severe or complete loss of motor function on one side of the body. This condition is usually caused by BRAIN DISEASES that are localized to the cerebral hemisphere opposite to the side of weakness. Less frequently, BRAIN STEM lesions; cervical spinal cord diseases; peripheral nervous system diseases; and other conditions may manifest as hemiplegia. The term hemiparesis (see paresis) refers to mild to moderate weakness involving one side of the body. [NIH] Hemoglobin: One of the fractions of glycosylated hemoglobin A1c. Glycosylated hemoglobin is formed when linkages of glucose and related monosaccharides bind to hemoglobin A and its concentration represents the average blood glucose level over the previous several weeks. HbA1c levels are used as a measure of long-term control of plasma glucose (normal, 4 to 6 percent). In controlled diabetes mellitus, the concentration of glycosylated hemoglobin A is within the normal range, but in uncontrolled cases the level may be 3 to 4 times the normal conentration. Generally, complications are substantially lower among patients with Hb levels of 7 percent or less than in patients with HbA1c levels of 9 percent or more. [NIH] Hemorrhage: Bleeding or escape of blood from a vessel. [NIH] Hemostasis: The process which spontaneously arrests the flow of blood from vessels carrying blood under pressure. It is accomplished by contraction of the vessels, adhesion and aggregation of formed blood elements, and the process of blood or plasma coagulation. [NIH]

Hepatic: Refers to the liver. [NIH] Hepatitis: Inflammation of the liver and liver disease involving degenerative or necrotic alterations of hepatocytes. [NIH]

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Hepatocytes: The main structural component of the liver. They are specialized epithelial cells that are organized into interconnected plates called lobules. [NIH] Heredity: 1. The genetic transmission of a particular quality or trait from parent to offspring. 2. The genetic constitution of an individual. [EU] Heritability: The proportion of observed variation in a particular trait that can be attributed to inherited genetic factors in contrast to environmental ones. [NIH] Heterogeneity: The property of one or more samples or populations which implies that they are not identical in respect of some or all of their parameters, e. g. heterogeneity of variance. [NIH]

Hippocampus: A curved elevation of gray matter extending the entire length of the floor of the temporal horn of the lateral ventricle (Dorland, 28th ed). The hippocampus, subiculum, and dentate gyrus constitute the hippocampal formation. Sometimes authors include the entorhinal cortex in the hippocampal formation. [NIH] Histones: Small chromosomal proteins (approx 12-20 kD) possessing an open, unfolded structure and attached to the DNA in cell nuclei by ionic linkages. Classification into the various types (designated histone I, histone II, etc.) is based on the relative amounts of arginine and lysine in each. [NIH] Homeostasis: The processes whereby the internal environment of an organism tends to remain balanced and stable. [NIH] Hormonal: Pertaining to or of the nature of a hormone. [EU] Hormone: A substance in the body that regulates certain organs. Hormones such as gastrin help in breaking down food. Some hormones come from cells in the stomach and small intestine. [NIH] Hormone Replacement Therapy: Therapeutic use of hormones to alleviate the effects of hormone deficiency. [NIH] Hormone therapy: Treatment of cancer by removing, blocking, or adding hormones. Also called endocrine therapy. [NIH] Human growth hormone: A protein hormone, secreted by the anterior lobe of the pituitary, which promotes growth of the whole body by stimulating protein synthesis. The human gene has already been cloned and successfully expressed in bacteria. [NIH] Humoral: Of, relating to, proceeding from, or involving a bodily humour - now often used of endocrine factors as opposed to neural or somatic. [EU] Hybrid: Cross fertilization between two varieties or, more usually, two species of vines, see also crossing. [NIH] Hydrogel: A network of cross-linked hydrophilic macromolecules used in biomedical applications. [NIH] Hydrogenation: Specific method of reduction in which hydrogen is added to a substance by the direct use of gaseous hydrogen. [NIH] Hydroxylysine: A hydroxylated derivative of the amino acid lysine that is present in certain collagens. [NIH] Hydroxyproline: A hydroxylated form of the imino acid proline. A deficiency in ascorbic acid can result in impaired hydroxyproline formation. [NIH] Hypercalcemia: Abnormally high level of calcium in the blood. [NIH] Hyperopia: Farsightedness; ability to see distant objects more clearly than close objects; may be corrected with glasses or contact lenses. [NIH]

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Hypersensitivity: Altered reactivity to an antigen, which can result in pathologic reactions upon subsequent exposure to that particular antigen. [NIH] Hypertension: Persistently high arterial blood pressure. Currently accepted threshold levels are 140 mm Hg systolic and 90 mm Hg diastolic pressure. [NIH] Hypoglycaemia: An abnormally diminished concentration of glucose in the blood, which may lead to tremulousness, cold sweat, piloerection, hypothermia, and headache, accompanied by irritability, confusion, hallucinations, bizarre behaviour, and ultimately, convulsions and coma. [EU] Hypogonadism: Condition resulting from or characterized by abnormally decreased functional activity of the gonads, with retardation of growth and sexual development. [NIH] Hypokinesia: Slow or diminished movement of body musculature. It may be associated with basal ganglia diseases; mental disorders; prolonged inactivity due to illness; experimental protocols used to evaluate the physiologic effects of immobility; and other conditions. [NIH] Hypotension: Abnormally low blood pressure. [NIH] Hypothalamic: Of or involving the hypothalamus. [EU] Hypothalamic Hormones: Hormones isolated from the hypothalamus which exercise control over other organs, primarily the pituitary gland. Well-known members include certain pituitary hormone-releasing hormones and pituitary hormone release inhibiting hormones. Vasopressin and oxytocin which are found in the posterior pituitary may also be secreted by the hypothalamus but are not grouped here (pituitary hormones, posterior). [NIH]

Hypothalamus: Ventral part of the diencephalon extending from the region of the optic chiasm to the caudal border of the mammillary bodies and forming the inferior and lateral walls of the third ventricle. [NIH] Hypovitaminosis: A condition due to a deficiency of one or more essential vitamins. [EU] Hypoxia: Reduction of oxygen supply to tissue below physiological levels despite adequate perfusion of the tissue by blood. [EU] Iliac Artery: Either of two large arteries originating from the abdominal aorta; they supply blood to the pelvis, abdominal wall and legs. [NIH] Immune response: The activity of the immune system against foreign substances (antigens). [NIH]

Immunogenic: Producing immunity; evoking an immune response. [EU] Immunology: The study of the body's immune system. [NIH] Immunosuppressive: Describes the ability to lower immune system responses. [NIH] Impairment: In the context of health experience, an impairment is any loss or abnormality of psychological, physiological, or anatomical structure or function. [NIH] In vitro: In the laboratory (outside the body). The opposite of in vivo (in the body). [NIH] In vivo: In the body. The opposite of in vitro (outside the body or in the laboratory). [NIH] Incision: A cut made in the body during surgery. [NIH] Incontinence: Inability to control the flow of urine from the bladder (urinary incontinence) or the escape of stool from the rectum (fecal incontinence). [NIH] Infantile: Pertaining to an infant or to infancy. [EU] Infarction: A pathological process consisting of a sudden insufficient blood supply to an area, which results in necrosis of that area. It is usually caused by a thrombus, an embolus,

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or a vascular torsion. [NIH] Infection: 1. Invasion and multiplication of microorganisms in body tissues, which may be clinically unapparent or result in local cellular injury due to competitive metabolism, toxins, intracellular replication, or antigen-antibody response. The infection may remain localized, subclinical, and temporary if the body's defensive mechanisms are effective. A local infection may persist and spread by extension to become an acute, subacute, or chronic clinical infection or disease state. A local infection may also become systemic when the microorganisms gain access to the lymphatic or vascular system. 2. An infectious disease. [EU]

Infertility: The diminished or absent ability to conceive or produce an offspring while sterility is the complete inability to conceive or produce an offspring. [NIH] Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Inflammatory bowel disease: A general term that refers to the inflammation of the colon and rectum. Inflammatory bowel disease includes ulcerative colitis and Crohn's disease. [NIH]

Infusion: A method of putting fluids, including drugs, into the bloodstream. Also called intravenous infusion. [NIH] Innervation: 1. The distribution or supply of nerves to a part. 2. The supply of nervous energy or of nerve stimulus sent to a part. [EU] Inorganic: Pertaining to substances not of organic origin. [EU] Inpatients: Persons admitted to health facilities which provide board and room, for the purpose of observation, care, diagnosis or treatment. [NIH] Insight: The capacity to understand one's own motives, to be aware of one's own psychodynamics, to appreciate the meaning of symbolic behavior. [NIH] Insomnia: Difficulty in going to sleep or getting enough sleep. [NIH] Insulin: A protein hormone secreted by beta cells of the pancreas. Insulin plays a major role in the regulation of glucose metabolism, generally promoting the cellular utilization of glucose. It is also an important regulator of protein and lipid metabolism. Insulin is used as a drug to control insulin-dependent diabetes mellitus. [NIH] Insulin-dependent diabetes mellitus: A disease characterized by high levels of blood glucose resulting from defects in insulin secretion, insulin action, or both. Autoimmune, genetic, and environmental factors are involved in the development of type I diabetes. [NIH] Insulin-like: Muscular growth factor. [NIH] Intermittent: Occurring at separated intervals; having periods of cessation of activity. [EU] Interstitial: Pertaining to or situated between parts or in the interspaces of a tissue. [EU] Intervention Studies: Epidemiologic investigations designed to test a hypothesized causeeffect relation by modifying the supposed causal factor(s) in the study population. [NIH] Intestinal: Having to do with the intestines. [NIH] Intestine: A long, tube-shaped organ in the abdomen that completes the process of digestion. There is both a large intestine and a small intestine. Also called the bowel. [NIH] Intoxication: Poisoning, the state of being poisoned. [EU] Intracellular: Inside a cell. [NIH] Intramuscular: IM. Within or into muscle. [NIH]

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Intraocular: Within the eye. [EU] Intraocular pressure: Pressure of the fluid inside the eye; normal IOP varies among individuals. [NIH] Intravenous: IV. Into a vein. [NIH] Intrinsic: Situated entirely within or pertaining exclusively to a part. [EU] Invasive: 1. Having the quality of invasiveness. 2. Involving puncture or incision of the skin or insertion of an instrument or foreign material into the body; said of diagnostic techniques. [EU]

Ion Transport: The movement of ions across energy-transducing cell membranes. Transport can be active or passive. Passive ion transport (facilitated diffusion) derives its energy from the concentration gradient of the ion itself and allows the transport of a single solute in one direction (uniport). Active ion transport is usually coupled to an energy-yielding chemical or photochemical reaction such as ATP hydrolysis. This form of primary active transport is called an ion pump. Secondary active transport utilizes the voltage and ion gradients produced by the primary transport to drive the cotransport of other ions or molecules. These may be transported in the same (symport) or opposite (antiport) direction. [NIH] Ionization: 1. Any process by which a neutral atom gains or loses electrons, thus acquiring a net charge, as the dissociation of a substance in solution into ions or ion production by the passage of radioactive particles. 2. Iontophoresis. [EU] Ionizing: Radiation comprising charged particles, e. g. electrons, protons, alpha-particles, etc., having sufficient kinetic energy to produce ionization by collision. [NIH] Ipsilateral: Having to do with the same side of the body. [NIH] Kb: A measure of the length of DNA fragments, 1 Kb = 1000 base pairs. The largest DNA fragments are up to 50 kilobases long. [NIH] Kinetic: Pertaining to or producing motion. [EU] Labyrinth: The internal ear; the essential part of the organ of hearing. It consists of an osseous and a membranous portion. [NIH] Large Intestine: The part of the intestine that goes from the cecum to the rectum. The large intestine absorbs water from stool and changes it from a liquid to a solid form. The large intestine is 5 feet long and includes the appendix, cecum, colon, and rectum. Also called colon. [NIH] Least-Squares Analysis: A principle of estimation in which the estimates of a set of parameters in a statistical model are those quantities minimizing the sum of squared differences between the observed values of a dependent variable and the values predicted by the model. [NIH] Length of Stay: The period of confinement of a patient to a hospital or other health facility. [NIH]

Lens: The transparent, double convex (outward curve on both sides) structure suspended between the aqueous and vitreous; helps to focus light on the retina. [NIH] Lesion: An area of abnormal tissue change. [NIH] Leucine: An essential branched-chain amino acid important for hemoglobin formation. [NIH] Leukocytes: White blood cells. These include granular leukocytes (basophils, eosinophils, and neutrophils) as well as non-granular leukocytes (lymphocytes and monocytes). [NIH] Levo: It is an experimental treatment for heroin addiction that was developed by German scientists around 1948 as an analgesic. Like methadone, it binds with opioid receptors, but it is longer acting. [NIH]

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Libido: The psychic drive or energy associated with sexual instinct in the broad sense (pleasure and love-object seeking). It may also connote the psychic energy associated with instincts in general that motivate behavior. [NIH] Life Expectancy: A figure representing the number of years, based on known statistics, to which any person of a given age may reasonably expect to live. [NIH] Ligament: A band of fibrous tissue that connects bones or cartilages, serving to support and strengthen joints. [EU] Likelihood Functions: Functions constructed from a statistical model and a set of observed data which give the probability of that data for various values of the unknown model parameters. Those parameter values that maximize the probability are the maximum likelihood estimates of the parameters. [NIH] Linear Models: Statistical models in which the value of a parameter for a given value of a factor is assumed to be equal to a + bx, where a and b are constants. The models predict a linear regression. [NIH] Linkage: The tendency of two or more genes in the same chromosome to remain together from one generation to the next more frequently than expected according to the law of independent assortment. [NIH] Lipid: Fat. [NIH] Lithium: An element in the alkali metals family. It has the atomic symbol Li, atomic number 3, and atomic weight 6.94. Salts of lithium are used in treating manic-depressive disorders. [NIH]

Liver: A large, glandular organ located in the upper abdomen. The liver cleanses the blood and aids in digestion by secreting bile. [NIH] Liver scan: An image of the liver created on a computer screen or on film. A radioactive substance is injected into a blood vessel and travels through the bloodstream. It collects in the liver, especially in abnormal areas, and can be detected by the scanner. [NIH] Lobe: A portion of an organ such as the liver, lung, breast, or brain. [NIH] Localization: The process of determining or marking the location or site of a lesion or disease. May also refer to the process of keeping a lesion or disease in a specific location or site. [NIH] Localized: Cancer which has not metastasized yet. [NIH] Logistic Models: Statistical models which describe the relationship between a qualitative dependent variable (that is, one which can take only certain discrete values, such as the presence or absence of a disease) and an independent variable. A common application is in epidemiology for estimating an individual's risk (probability of a disease) as a function of a given risk factor. [NIH] Longitudinal Studies: Studies in which variables relating to an individual or group of individuals are assessed over a period of time. [NIH] Longitudinal study: Also referred to as a "cohort study" or "prospective study"; the analytic method of epidemiologic study in which subsets of a defined population can be identified who are, have been, or in the future may be exposed or not exposed, or exposed in different degrees, to a factor or factors hypothesized to influence the probability of occurrence of a given disease or other outcome. The main feature of this type of study is to observe large numbers of subjects over an extended time, with comparisons of incidence rates in groups that differ in exposure levels. [NIH] Long-Term Care: Care over an extended period, usually for a chronic condition or disability, requiring periodic, intermittent, or continuous care. [NIH]

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Lumbar: Pertaining to the loins, the part of the back between the thorax and the pelvis. [EU] Lymphatic: The tissues and organs, including the bone marrow, spleen, thymus, and lymph nodes, that produce and store cells that fight infection and disease. [NIH] Lymphatic system: The tissues and organs that produce, store, and carry white blood cells that fight infection and other diseases. This system includes the bone marrow, spleen, thymus, lymph nodes and a network of thin tubes that carry lymph and white blood cells. These tubes branch, like blood vessels, into all the tissues of the body. [NIH] Lymphocyte: A white blood cell. Lymphocytes have a number of roles in the immune system, including the production of antibodies and other substances that fight infection and diseases. [NIH] Lymphoid: Referring to lymphocytes, a type of white blood cell. Also refers to tissue in which lymphocytes develop. [NIH] Macula: A stain, spot, or thickening. Often used alone to refer to the macula retinae. [EU] Macula Lutea: An oval area in the retina, 3 to 5 mm in diameter, usually located temporal to the superior pole of the eye and slightly below the level of the optic disk. [NIH] Macular Degeneration: Degenerative changes in the macula lutea of the retina. [NIH] Magnetic Resonance Imaging: Non-invasive method of demonstrating internal anatomy based on the principle that atomic nuclei in a strong magnetic field absorb pulses of radiofrequency energy and emit them as radiowaves which can be reconstructed into computerized images. The concept includes proton spin tomographic techniques. [NIH] Major Histocompatibility Complex: The genetic region which contains the loci of genes which determine the structure of the serologically defined (SD) and lymphocyte-defined (LD) transplantation antigens, genes which control the structure of the immune responseassociated (Ia) antigens, the immune response (Ir) genes which control the ability of an animal to respond immunologically to antigenic stimuli, and genes which determine the structure and/or level of the first four components of complement. [NIH] Malabsorption: Impaired intestinal absorption of nutrients. [EU] Malignant: Cancerous; a growth with a tendency to invade and destroy nearby tissue and spread to other parts of the body. [NIH] Malignant tumor: A tumor capable of metastasizing. [NIH] Malnutrition: A condition caused by not eating enough food or not eating a balanced diet. [NIH]

Mammary: Pertaining to the mamma, or breast. [EU] Mammogram: An x-ray of the breast. [NIH] Mammography: Radiographic examination of the breast. [NIH] Mandible: The largest and strongest bone of the face constituting the lower jaw. It supports the lower teeth. [NIH] Manic: Affected with mania. [EU] Manifest: Being the part or aspect of a phenomenon that is directly observable : concretely expressed in behaviour. [EU] Medial: Lying near the midsaggital plane of the body; opposed to lateral. [NIH] Mediate: Indirect; accomplished by the aid of an intervening medium. [EU] Mediator: An object or substance by which something is mediated, such as (1) a structure of the nervous system that transmits impulses eliciting a specific response; (2) a chemical substance (transmitter substance) that induces activity in an excitable tissue, such as nerve

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or muscle; or (3) a substance released from cells as the result of the interaction of antigen with antibody or by the action of antigen with a sensitized lymphocyte. [EU] Medical castration: Refers to the use of drugs to suppress the function of the ovaries or testicles. [NIH] Medical Errors: Errors or mistakes committed by health professionals which result in harm to the patient. They include errors in diagnosis (diagnostic errors), errors in the administration of drugs and other medications (medication errors), errors in the performance of surgical procedures, in the use of other types of therapy, in the use of equipment, and in the interpretation of laboratory findings. Medical errors are differentiated from malpractice in that the former are regarded as honest mistakes or accidents while the latter is the result of negligence, reprehensible ignorance, or criminal intent. [NIH] Medical Records: Recording of pertinent information concerning patient's illness or illnesses. [NIH] Medical Staff: Professional medical personnel who provide care to patients in an organized facility, institution or agency. [NIH] Medication Errors: Errors in prescribing, dispensing, or administering medication with the result that the patient fails to receive the correct drug or the indicated proper drug dosage. [NIH]

MEDLINE: An online database of MEDLARS, the computerized bibliographic Medical Literature Analysis and Retrieval System of the National Library of Medicine. [NIH] Megakaryocytes: Very large bone marrow cells which release mature blood platelets. [NIH] Membrane: A very thin layer of tissue that covers a surface. [NIH] Memory: Complex mental function having four distinct phases: (1) memorizing or learning, (2) retention, (3) recall, and (4) recognition. Clinically, it is usually subdivided into immediate, recent, and remote memory. [NIH] Meninges: The three membranes that cover and protect the brain and spinal cord. [NIH] Menopause: Permanent cessation of menstruation. [NIH] Menstruation: The normal physiologic discharge through the vagina of blood and mucosal tissues from the nonpregnant uterus. [NIH] Mental: Pertaining to the mind; psychic. 2. (L. mentum chin) pertaining to the chin. [EU] Mental Health: The state wherein the person is well adjusted. [NIH] Mentors: Senior professionals who provide guidance, direction and support to those persons desirous of improvement in academic positions, administrative positions or other career development situations. [NIH] Meta-Analysis: A quantitative method of combining the results of independent studies (usually drawn from the published literature) and synthesizing summaries and conclusions which may be used to evaluate therapeutic effectiveness, plan new studies, etc., with application chiefly in the areas of research and medicine. [NIH] Metabolite: Any substance produced by metabolism or by a metabolic process. [EU] MI: Myocardial infarction. Gross necrosis of the myocardium as a result of interruption of the blood supply to the area; it is almost always caused by atherosclerosis of the coronary arteries, upon which coronary thrombosis is usually superimposed. [NIH] Microcalcifications: Tiny deposits of calcium in the breast that cannot be felt but can be detected on a mammogram. A cluster of these very small specks of calcium may indicate that cancer is present. [NIH]

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Microorganism: An organism that can be seen only through a microscope. Microorganisms include bacteria, protozoa, algae, and fungi. Although viruses are not considered living organisms, they are sometimes classified as microorganisms. [NIH] Milliliter: A measure of volume for a liquid. A milliliter is approximately 950-times smaller than a quart and 30-times smaller than a fluid ounce. A milliliter of liquid and a cubic centimeter (cc) of liquid are the same. [NIH] Mineralization: The action of mineralizing; the state of being mineralized. [EU] Mineralocorticoids: A group of corticosteroids primarily associated with the regulation of water and electrolyte balance. This is accomplished through the effect on ion transport in renal tubules, resulting in retention of sodium and loss of potassium. Mineralocorticoid secretion is itself regulated by plasma volume, serum potassium, and angiotensin II. [NIH] Minority Groups: A subgroup having special characteristics within a larger group, often bound together by special ties which distinguish it from the larger group. [NIH] Mitochondrial Swelling: Increase in volume of mitochondria due to an influx of fluid; it occurs in hypotonic solutions due to osmotic pressure and in isotonic solutions as a result of altered permeability of the membranes of respiring mitochondria. [NIH] Mobility: Capability of movement, of being moved, or of flowing freely. [EU] Modeling: A treatment procedure whereby the therapist presents the target behavior which the learner is to imitate and make part of his repertoire. [NIH] Modification: A change in an organism, or in a process in an organism, that is acquired from its own activity or environment. [NIH] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Molecular Structure: The location of the atoms, groups or ions relative to one another in a molecule, as well as the number, type and location of covalent bonds. [NIH] Molecule: A chemical made up of two or more atoms. The atoms in a molecule can be the same (an oxygen molecule has two oxygen atoms) or different (a water molecule has two hydrogen atoms and one oxygen atom). Biological molecules, such as proteins and DNA, can be made up of many thousands of atoms. [NIH] Monitor: An apparatus which automatically records such physiological signs as respiration, pulse, and blood pressure in an anesthetized patient or one undergoing surgical or other procedures. [NIH] Mood Disorders: Those disorders that have a disturbance in mood as their predominant feature. [NIH] Morphology: The science of the form and structure of organisms (plants, animals, and other forms of life). [NIH] Motility: The ability to move spontaneously. [EU] Multiple Myeloma: A malignant tumor of plasma cells usually arising in the bone marrow; characterized by diffuse involvement of the skeletal system, hyperglobulinemia, Bence-Jones proteinuria, and anemia. [NIH] Muscle Fibers: Large single cells, either cylindrical or prismatic in shape, that form the basic unit of muscle tissue. They consist of a soft contractile substance enclosed in a tubular sheath. [NIH] Muscular Atrophy: Derangement in size and number of muscle fibers occurring with aging, reduction in blood supply, or following immobilization, prolonged weightlessness, malnutrition, and particularly in denervation. [NIH] Muscular Dystrophies: A general term for a group of inherited disorders which are

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characterized by progressive degeneration of skeletal muscles. [NIH] Myocardial infarction: Gross necrosis of the myocardium as a result of interruption of the blood supply to the area; it is almost always caused by atherosclerosis of the coronary arteries, upon which coronary thrombosis is usually superimposed. [NIH] Myocardium: The muscle tissue of the heart composed of striated, involuntary muscle known as cardiac muscle. [NIH] Myopia: That error of refraction in which rays of light entering the eye parallel to the optic axis are brought to a focus in front of the retina, as a result of the eyeball being too long from front to back (axial m.) or of an increased strength in refractive power of the media of the eye (index m.). Called also nearsightedness, because the near point is less distant than it is in emmetropia with an equal amplitude of accommodation. [EU] Myotonic Dystrophy: A condition presenting muscle weakness and wasting which may be progressive. [NIH] Narcotic: 1. Pertaining to or producing narcosis. 2. An agent that produces insensibility or stupor, applied especially to the opioids, i.e. to any natural or synthetic drug that has morphine-like actions. [EU] Necrosis: A pathological process caused by the progressive degradative action of enzymes that is generally associated with severe cellular trauma. It is characterized by mitochondrial swelling, nuclear flocculation, uncontrolled cell lysis, and ultimately cell death. [NIH] Nerve: A cordlike structure of nervous tissue that connects parts of the nervous system with other tissues of the body and conveys nervous impulses to, or away from, these tissues. [NIH] Nervous System: The entire nerve apparatus composed of the brain, spinal cord, nerves and ganglia. [NIH] Neural: 1. Pertaining to a nerve or to the nerves. 2. Situated in the region of the spinal axis, as the neutral arch. [EU] Neurologic: Having to do with nerves or the nervous system. [NIH] Neurology: A medical specialty concerned with the study of the structures, functions, and diseases of the nervous system. [NIH] Neuromuscular: Pertaining to muscles and nerves. [EU] Neurons: The basic cellular units of nervous tissue. Each neuron consists of a body, an axon, and dendrites. Their purpose is to receive, conduct, and transmit impulses in the nervous system. [NIH] Neurosecretory Systems: A system of neurons that has the specialized function to produce and secrete hormones, and that constitutes, in whole or in part, an endocrine organ or system. [NIH] Neurosyphilis: A late form of syphilis that affects the brain and may lead to dementia and death. [NIH] Neurotransmitter: Any of a group of substances that are released on excitation from the axon terminal of a presynaptic neuron of the central or peripheral nervous system and travel across the synaptic cleft to either excite or inhibit the target cell. Among the many substances that have the properties of a neurotransmitter are acetylcholine, norepinephrine, epinephrine, dopamine, glycine, y-aminobutyrate, glutamic acid, substance P, enkephalins, endorphins, and serotonin. [EU] Neutrons: Electrically neutral elementary particles found in all atomic nuclei except light hydrogen; the mass is equal to that of the proton and electron combined and they are unstable when isolated from the nucleus, undergoing beta decay. Slow, thermal, epithermal,

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and fast neutrons refer to the energy levels with which the neutrons are ejected from heavier nuclei during their decay. [NIH] Nitrogen: An element with the atomic symbol N, atomic number 7, and atomic weight 14. Nitrogen exists as a diatomic gas and makes up about 78% of the earth's atmosphere by volume. It is a constituent of proteins and nucleic acids and found in all living cells. [NIH] Nuclear: A test of the structure, blood flow, and function of the kidneys. The doctor injects a mildly radioactive solution into an arm vein and uses x-rays to monitor its progress through the kidneys. [NIH] Nuclei: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Nucleic acid: Either of two types of macromolecule (DNA or RNA) formed by polymerization of nucleotides. Nucleic acids are found in all living cells and contain the information (genetic code) for the transfer of genetic information from one generation to the next. [NIH] Nucleus: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Nursing Care: Care given to patients by nursing service personnel. [NIH] Observational study: An epidemiologic study that does not involve any intervention, experimental or otherwise. Such a study may be one in which nature is allowed to take its course, with changes in one characteristic being studied in relation to changes in other characteristics. Analytical epidemiologic methods, such as case-control and cohort study designs, are properly called observational epidemiology because the investigator is observing without intervention other than to record, classify, count, and statistically analyze results. [NIH] Occult: Obscure; concealed from observation, difficult to understand. [EU] Occupational Therapy: The field concerned with utilizing craft or work activities in the rehabilitation of patients. Occupational therapy can also refer to the activities themselves. [NIH]

Ocular: 1. Of, pertaining to, or affecting the eye. 2. Eyepiece. [EU] Odds Ratio: The ratio of two odds. The exposure-odds ratio for case control data is the ratio of the odds in favor of exposure among cases to the odds in favor of exposure among noncases. The disease-odds ratio for a cohort or cross section is the ratio of the odds in favor of disease among the exposed to the odds in favor of disease among the unexposed. The prevalence-odds ratio refers to an odds ratio derived cross-sectionally from studies of prevalent cases. [NIH] Oophorectomy: Surgery to remove one or both ovaries. [NIH] Opacity: Degree of density (area most dense taken for reading). [NIH] Ophthalmology: A surgical specialty concerned with the structure and function of the eye and the medical and surgical treatment of its defects and diseases. [NIH] Opiate: A remedy containing or derived from opium; also any drug that induces sleep. [EU] Opium: The air-dried exudate from the unripe seed capsule of the opium poppy, Papaver somniferum, or its variant, P. album. It contains a number of alkaloids, but only a few morphine, codeine, and papaverine - have clinical significance. Opium has been used as an analgesic, antitussive, antidiarrheal, and antispasmodic. [NIH] Optic Nerve: The 2nd cranial nerve. The optic nerve conveys visual information from the retina to the brain. The nerve carries the axons of the retinal ganglion cells which sort at the

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optic chiasm and continue via the optic tracts to the brain. The largest projection is to the lateral geniculate nuclei; other important targets include the superior colliculi and the suprachiasmatic nuclei. Though known as the second cranial nerve, it is considered part of the central nervous system. [NIH] Optic nerve head: The circular area (disc) where the optic nerve connects to the retina. [NIH] Orchiectomy: The surgical removal of one or both testicles. [NIH] Orthopaedic: Pertaining to the correction of deformities of the musculoskeletal system; pertaining to orthopaedics. [EU] Osteoblasts: Bone-forming cells which secrete an extracellular matrix. Hydroxyapatite crystals are then deposited into the matrix to form bone. [NIH] Osteocalcin: Vitamin K-dependent calcium-binding protein synthesized by osteoblasts and found primarily in bone. Serum osteocalcin measurements provide a noninvasive specific marker of bone metabolism. The protein contains three residues of the amino acid gammacarboxyglutamic acid (GLA), which, in the presence of calcium, promotes binding to hydroxyapatite and subsequent accumulation in bone matrix. [NIH] Osteoclasts: A large multinuclear cell associated with the absorption and removal of bone. An odontoclast, also called cementoclast, is cytomorphologically the same as an osteoclast and is involved in cementum resorption. [NIH] Osteomalacia: A condition marked by softening of the bones (due to impaired mineralization, with excess accumulation of osteoid), with pain, tenderness, muscular weakness, anorexia, and loss of weight, resulting from deficiency of vitamin D and calcium. [EU]

Osteopetrosis: Excessive formation of dense trabecular bone leading to pathological fractures, osteitis, splenomegaly with infarct, anemia, and extramedullary hemopoiesis. [NIH]

Osteoporosis: Reduction of bone mass without alteration in the composition of bone, leading to fractures. Primary osteoporosis can be of two major types: postmenopausal osteoporosis and age-related (or senile) osteoporosis. [NIH] Outpatient: A patient who is not an inmate of a hospital but receives diagnosis or treatment in a clinic or dispensary connected with the hospital. [NIH] Ovariectomy: The surgical removal of one or both ovaries. [NIH] Ovaries: The pair of female reproductive glands in which the ova, or eggs, are formed. The ovaries are located in the pelvis, one on each side of the uterus. [NIH] Ovary: Either of the paired glands in the female that produce the female germ cells and secrete some of the female sex hormones. [NIH] Oxygen Consumption: The oxygen consumption is determined by calculating the difference between the amount of oxygen inhaled and exhaled. [NIH] Oxytocin: A nonapeptide posterior pituitary hormone that causes uterine contractions and stimulates lactation. [NIH] Palliative: 1. Affording relief, but not cure. 2. An alleviating medicine. [EU] Pancreas: A mixed exocrine and endocrine gland situated transversely across the posterior abdominal wall in the epigastric and hypochondriac regions. The endocrine portion is comprised of the Islets of Langerhans, while the exocrine portion is a compound acinar gland that secretes digestive enzymes. [NIH] Panic: A state of extreme acute, intense anxiety and unreasoning fear accompanied by disorganization of personality function. [NIH]

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Paralysis: Loss of ability to move all or part of the body. [NIH] Paraparesis: Mild to moderate loss of bilateral lower extremity motor function, which may be a manifestation of spinal cord diseases; peripheral nervous system diseases; muscular diseases; intracranial hypertension; parasagittal brain lesions; and other conditions. [NIH] Parathyroid: 1. Situated beside the thyroid gland. 2. One of the parathyroid glands. 3. A sterile preparation of the water-soluble principle(s) of the parathyroid glands, ad-ministered parenterally as an antihypocalcaemic, especially in the treatment of acute hypoparathyroidism with tetany. [EU] Parathyroid Glands: Two small paired endocrine glands in the region of the thyroid gland. They secrete parathyroid hormone and are concerned with the metabolism of calcium and phosphorus. [NIH] Parathyroid hormone: A substance made by the parathyroid gland that helps the body store and use calcium. Also called parathormone, parathyrin, or PTH. [NIH] Parenteral: Not through the alimentary canal but rather by injection through some other route, as subcutaneous, intramuscular, intraorbital, intracapsular, intraspinal, intrasternal, intravenous, etc. [EU] Paresis: A general term referring to a mild to moderate degree of muscular weakness, occasionally used as a synonym for paralysis (severe or complete loss of motor function). In the older literature, paresis often referred specifically to paretic neurosyphilis. "General paresis" and "general paralysis" may still carry that connotation. Bilateral lower extremity paresis is referred to as paraparesis. [NIH] Parkinsonism: A group of neurological disorders characterized by hypokinesia, tremor, and muscular rigidity. [EU] Pathogenesis: The cellular events and reactions that occur in the development of disease. [NIH]

Pathologic: 1. Indicative of or caused by a morbid condition. 2. Pertaining to pathology (= branch of medicine that treats the essential nature of the disease, especially the structural and functional changes in tissues and organs of the body caused by the disease). [EU] Pathologies: The study of abnormality, especially the study of diseases. [NIH] Pathophysiology: Altered functions in an individual or an organ due to disease. [NIH] Patient Compliance: Voluntary cooperation of the patient in following a prescribed regimen. [NIH] Patient Education: The teaching or training of patients concerning their own health needs. [NIH]

Patient Satisfaction: The degree to which the individual regards the health care service or product or the manner in which it is delivered by the provider as useful, effective, or beneficial. [NIH] Pediatrics: A medical specialty concerned with maintaining health and providing medical care to children from birth to adolescence. [NIH] Pelvic: Pertaining to the pelvis. [EU] Pelvis: The lower part of the abdomen, located between the hip bones. [NIH] Peptide: Any compound consisting of two or more amino acids, the building blocks of proteins. Peptides are combined to make proteins. [NIH] Perception: The ability quickly and accurately to recognize similarities and differences among presented objects, whether these be pairs of words, pairs of number series, or multiple sets of these or other symbols such as geometric figures. [NIH]

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Percutaneous: Performed through the skin, as injection of radiopacque material in radiological examination, or the removal of tissue for biopsy accomplished by a needle. [EU] Perimetry: Determination of the extent of the visual field for various types and intensities of stimuli. [NIH] Peripheral Nervous System: The nervous system outside of the brain and spinal cord. The peripheral nervous system has autonomic and somatic divisions. The autonomic nervous system includes the enteric, parasympathetic, and sympathetic subdivisions. The somatic nervous system includes the cranial and spinal nerves and their ganglia and the peripheral sensory receptors. [NIH] Peripheral Nervous System Diseases: Diseases of the peripheral nerves external to the brain and spinal cord, which includes diseases of the nerve roots, ganglia, plexi, autonomic nerves, sensory nerves, and motor nerves. [NIH] Peripheral Vascular Disease: Disease in the large blood vessels of the arms, legs, and feet. People who have had diabetes for a long time may get this because major blood vessels in their arms, legs, and feet are blocked and these limbs do not receive enough blood. The signs of PVD are aching pains in the arms, legs, and feet (especially when walking) and foot sores that heal slowly. Although people with diabetes cannot always avoid PVD, doctors say they have a better chance of avoiding it if they take good care of their feet, do not smoke, and keep both their blood pressure and diabetes under good control. [NIH] Peripheral vision: Side vision; ability to see objects and movement outside of the direct line of vision. [NIH] Pernicious anemia: A type of anemia (low red blood cell count) caused by the body's inability to absorb vitamin B12. [NIH] Peroneal Nerve: The lateral of the two terminal branches of the sciatic nerve. The peroneal (or fibular) nerve provides motor and sensory innervation to parts of the leg and foot. [NIH] PH: The symbol relating the hydrogen ion (H+) concentration or activity of a solution to that of a given standard solution. Numerically the pH is approximately equal to the negative logarithm of H+ concentration expressed in molarity. pH 7 is neutral; above it alkalinity increases and below it acidity increases. [EU] Phallic: Pertaining to the phallus, or penis. [EU] Pharmaceutical Preparations: Drugs intended for human or veterinary use, presented in their finished dosage form. Included here are materials used in the preparation and/or formulation of the finished dosage form. [NIH] Pharmacologic: Pertaining to pharmacology or to the properties and reactions of drugs. [EU] Phenotype: The outward appearance of the individual. It is the product of interactions between genes and between the genotype and the environment. This includes the killer phenotype, characteristic of yeasts. [NIH] Phospholipids: Lipids containing one or more phosphate groups, particularly those derived from either glycerol (phosphoglycerides; glycerophospholipids) or sphingosine (sphingolipids). They are polar lipids that are of great importance for the structure and function of cell membranes and are the most abundant of membrane lipids, although not stored in large amounts in the system. [NIH] Phosphorus: A non-metallic element that is found in the blood, muscles, nevers, bones, and teeth, and is a component of adenosine triphosphate (ATP; the primary energy source for the body's cells.) [NIH] Phosphorylation: The introduction of a phosphoryl group into a compound through the formation of an ester bond between the compound and a phosphorus moiety. [NIH]

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Physical Endurance: The time span between the beginning of physical activity by an individual and the termination because of exhaustion. [NIH] Physical Therapy: The restoration of function and the prevention of disability following disease or injury with the use of light, heat, cold, water, electricity, ultrasound, and exercise. [NIH]

Physiologic: Having to do with the functions of the body. When used in the phrase "physiologic age," it refers to an age assigned by general health, as opposed to calendar age. [NIH]

Physiology: The science that deals with the life processes and functions of organismus, their cells, tissues, and organs. [NIH] Pilot study: The initial study examining a new method or treatment. [NIH] Pituitary Gland: A small, unpaired gland situated in the sella turcica tissue. It is connected to the hypothalamus by a short stalk. [NIH] Pituitary Hormone Release Inhibiting Hormones: Polypeptide hormones produced in the hypothalamus which inhibit the release of pituitary hormones. Used for PHRIH in general or for which there is no specific heading. [NIH] Pituitary Hormone-Releasing Hormones: Hormones released by one structure (e.g., the hypothalamus or the thyroid gland) that effect the secretion of hormones from the pituitary gland. [NIH] Pituitary Hormones: Hormones secreted by the anterior and posterior lobes of the pituitary gland and the pars intermedia, an ill-defined region between the two. Their secretion is regulated by the hypothalamus. [NIH] Placenta: A highly vascular fetal organ through which the fetus absorbs oxygen and other nutrients and excretes carbon dioxide and other wastes. It begins to form about the eighth day of gestation when the blastocyst adheres to the decidua. [NIH] Plants: Multicellular, eukaryotic life forms of the kingdom Plantae. They are characterized by a mainly photosynthetic mode of nutrition; essentially unlimited growth at localized regions of cell divisions (meristems); cellulose within cells providing rigidity; the absence of organs of locomotion; absense of nervous and sensory systems; and an alteration of haploid and diploid generations. [NIH] Plasma: The clear, yellowish, fluid part of the blood that carries the blood cells. The proteins that form blood clots are in plasma. [NIH] Plasma cells: A type of white blood cell that produces antibodies. [NIH] Plasma Volume: Volume of plasma in the circulation. It is usually measured by indicator dilution techniques. [NIH] Plasticity: In an individual or a population, the capacity for adaptation: a) through gene changes (genetic plasticity) or b) through internal physiological modifications in response to changes of environment (physiological plasticity). [NIH] Plexus: A network or tangle; a general term for a network of lymphatic vessels, nerves, or veins. [EU] Pneumonia: Inflammation of the lungs. [NIH] Poisoning: A condition or physical state produced by the ingestion, injection or inhalation of, or exposure to a deleterious agent. [NIH] Poliomyelitis: An acute viral disease, occurring sporadically and in epidemics, and characterized clinically by fever, sore throat, headache, and vomiting, often with stiffness of the neck and back. In the minor illness these may be the only symptoms. The major illness,

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which may or may not be preceded by the minor illness, is characterized by involvement of the central nervous system, stiff neck, pleocytosis in the spinal fluid, and perhaps paralysis. There may be subsequent atrophy of groups of muscles, ending in contraction and permanent deformity. The major illness is called acute anterior p., infantile paralysis and Heine-Medin disease. The disease is now largely controlled by vaccines. [EU] Polymorphic: Occurring in several or many forms; appearing in different forms at different stages of development. [EU] Polymorphism: The occurrence together of two or more distinct forms in the same population. [NIH] Polypeptide: A peptide which on hydrolysis yields more than two amino acids; called tripeptides, tetrapeptides, etc. according to the number of amino acids contained. [EU] Polysaccharide: A type of carbohydrate. It contains sugar molecules that are linked together chemically. [NIH] Posterior: Situated in back of, or in the back part of, or affecting the back or dorsal surface of the body. In lower animals, it refers to the caudal end of the body. [EU] Postmenopausal: Refers to the time after menopause. Menopause is the time in a woman's life when menstrual periods stop permanently; also called "change of life." [NIH] Postnatal: Occurring after birth, with reference to the newborn. [EU] Postoperative: After surgery. [NIH] Postoperative Complications: Pathologic processes that affect patients after a surgical procedure. They may or may not be related to the disease for which the surgery was done, and they may or may not be direct results of the surgery. [NIH] Postural: Pertaining to posture or position. [EU] Potassium: An element that is in the alkali group of metals. It has an atomic symbol K, atomic number 19, and atomic weight 39.10. It is the chief cation in the intracellular fluid of muscle and other cells. Potassium ion is a strong electrolyte and it plays a significant role in the regulation of fluid volume and maintenance of the water-electrolyte balance. [NIH] Practice Guidelines: Directions or principles presenting current or future rules of policy for the health care practitioner to assist him in patient care decisions regarding diagnosis, therapy, or related clinical circumstances. The guidelines may be developed by government agencies at any level, institutions, professional societies, governing boards, or by the convening of expert panels. The guidelines form a basis for the evaluation of all aspects of health care and delivery. [NIH] Precursor: Something that precedes. In biological processes, a substance from which another, usually more active or mature substance is formed. In clinical medicine, a sign or symptom that heralds another. [EU] Predictive factor: A situation or condition that may increase a person's risk of developing a certain disease or disorder. [NIH] Prednisolone: A glucocorticoid with the general properties of the corticosteroids. It is the drug of choice for all conditions in which routine systemic corticosteroid therapy is indicated, except adrenal deficiency states. [NIH] Prednisone: A synthetic anti-inflammatory glucocorticoid derived from cortisone. It is biologically inert and converted to prednisolone in the liver. [NIH] Preoperative: Preceding an operation. [EU] Prevalence: The total number of cases of a given disease in a specified population at a designated time. It is differentiated from incidence, which refers to the number of new cases

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in the population at a given time. [NIH] Probe: An instrument used in exploring cavities, or in the detection and dilatation of strictures, or in demonstrating the potency of channels; an elongated instrument for exploring or sounding body cavities. [NIH] Progesterone: Pregn-4-ene-3,20-dione. The principal progestational hormone of the body, secreted by the corpus luteum, adrenal cortex, and placenta. Its chief function is to prepare the uterus for the reception and development of the fertilized ovum. It acts as an antiovulatory agent when administered on days 5-25 of the menstrual cycle. [NIH] Progression: Increase in the size of a tumor or spread of cancer in the body. [NIH] Progressive: Advancing; going forward; going from bad to worse; increasing in scope or severity. [EU] Projection: A defense mechanism, operating unconsciously, whereby that which is emotionally unacceptable in the self is rejected and attributed (projected) to others. [NIH] Proline: A non-essential amino acid that is synthesized from glutamic acid. It is an essential component of collagen and is important for proper functioning of joints and tendons. [NIH] Promoter: A chemical substance that increases the activity of a carcinogenic process. [NIH] Prophylaxis: An attempt to prevent disease. [NIH] Proportional Hazards Models: Statistical models used in survival analysis that assert that the effect of the study factors on the hazard rate in the study population is multiplicative and does not change over time. [NIH] Propoxyphene: A narcotic analgesic structurally related to methadone. Only the dextroisomer has an analgesic effect; the levo-isomer appears to exert an antitussive effect. [NIH] Proprioception: The mechanism involved in the self-regulation of posture and movement through stimuli originating in the receptors imbedded in the joints, tendons, muscles, and labyrinth. [NIH] Prospective Payment System: A system wherein reimbursement rates are set, for a given period of time, prior to the circumstances giving rise to actual reimbursement claims. [NIH] Prospective study: An epidemiologic study in which a group of individuals (a cohort), all free of a particular disease and varying in their exposure to a possible risk factor, is followed over a specific amount of time to determine the incidence rates of the disease in the exposed and unexposed groups. [NIH] Prostate: A gland in males that surrounds the neck of the bladder and the urethra. It secretes a substance that liquifies coagulated semen. It is situated in the pelvic cavity behind the lower part of the pubic symphysis, above the deep layer of the triangular ligament, and rests upon the rectum. [NIH] Prosthesis: An artificial replacement of a part of the body. [NIH] Protease: Proteinase (= any enzyme that catalyses the splitting of interior peptide bonds in a protein). [EU] Protein C: A vitamin-K dependent zymogen present in the blood, which, upon activation by thrombin and thrombomodulin exerts anticoagulant properties by inactivating factors Va and VIIIa at the rate-limiting steps of thrombin formation. [NIH] Protein Kinases: A family of enzymes that catalyze the conversion of ATP and a protein to ADP and a phosphoprotein. EC 2.7.1.37. [NIH] Protein S: The vitamin K-dependent cofactor of activated protein C. Together with protein C, it inhibits the action of factors VIIIa and Va. A deficiency in protein S can lead to recurrent venous and arterial thrombosis. [NIH]

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Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH] Proteinuria: The presence of protein in the urine, indicating that the kidneys are not working properly. [NIH] Protocol: The detailed plan for a clinical trial that states the trial's rationale, purpose, drug or vaccine dosages, length of study, routes of administration, who may participate, and other aspects of trial design. [NIH] Protons: Stable elementary particles having the smallest known positive charge, found in the nuclei of all elements. The proton mass is less than that of a neutron. A proton is the nucleus of the light hydrogen atom, i.e., the hydrogen ion. [NIH] Psychiatric: Pertaining to or within the purview of psychiatry. [EU] Psychiatry: The medical science that deals with the origin, diagnosis, prevention, and treatment of mental disorders. [NIH] Psychic: Pertaining to the psyche or to the mind; mental. [EU] Psychoactive: Those drugs which alter sensation, mood, consciousness or other psychological or behavioral functions. [NIH] Psychomotor: Pertaining to motor effects of cerebral or psychic activity. [EU] Public Health: Branch of medicine concerned with the prevention and control of disease and disability, and the promotion of physical and mental health of the population on the international, national, state, or municipal level. [NIH] Public Policy: A course or method of action selected, usually by a government, from among alternatives to guide and determine present and future decisions. [NIH] Publishing: "The business or profession of the commercial production and issuance of literature" (Webster's 3d). It includes the publisher, publication processes, editing and editors. Production may be by conventional printing methods or by electronic publishing. [NIH]

Pulmonary: Relating to the lungs. [NIH] Pulse: The rhythmical expansion and contraction of an artery produced by waves of pressure caused by the ejection of blood from the left ventricle of the heart as it contracts. [NIH]

Pyramidal Cells: Projection neurons in the cerebral cortex and the hippocampus. Pyramidal cells have a pyramid-shaped soma with the apex and an apical dendrite pointed toward the pial surface and other dendrites and an axon emerging from the base. The axons may have local collaterals but also project outside their cortical region. [NIH] Quality of Life: A generic concept reflecting concern with the modification and enhancement of life attributes, e.g., physical, political, moral and social environment. [NIH] Race: A population within a species which exhibits general similarities within itself, but is both discontinuous and distinct from other populations of that species, though not sufficiently so as to achieve the status of a taxon. [NIH] Radiation: Emission or propagation of electromagnetic energy (waves/rays), or the waves/rays themselves; a stream of electromagnetic particles (electrons, neutrons, protons, alpha particles) or a mixture of these. The most common source is the sun. [NIH] Radioactive: Giving off radiation. [NIH] Radioimmunoassay: Classic quantitative assay for detection of antigen-antibody reactions using a radioactively labeled substance (radioligand) either directly or indirectly to measure the binding of the unlabeled substance to a specific antibody or other receptor system. Non-

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immunogenic substances (e.g., haptens) can be measured if coupled to larger carrier proteins (e.g., bovine gamma-globulin or human serum albumin) capable of inducing antibody formation. [NIH] Radiological: Pertaining to radiodiagnostic and radiotherapeutic procedures, and interventional radiology or other planning and guiding medical radiology. [NIH] Radiology: A specialty concerned with the use of x-ray and other forms of radiant energy in the diagnosis and treatment of disease. [NIH] Random Allocation: A process involving chance used in therapeutic trials or other research endeavor for allocating experimental subjects, human or animal, between treatment and control groups, or among treatment groups. It may also apply to experiments on inanimate objects. [NIH] Randomization: Also called random allocation. Is allocation of individuals to groups, e.g., for experimental and control regimens, by chance. Within the limits of chance variation, random allocation should make the control and experimental groups similar at the start of an investigation and ensure that personal judgment and prejudices of the investigator do not influence allocation. [NIH] Randomized: Describes an experiment or clinical trial in which animal or human subjects are assigned by chance to separate groups that compare different treatments. [NIH] Randomized clinical trial: A study in which the participants are assigned by chance to separate groups that compare different treatments; neither the researchers nor the participants can choose which group. Using chance to assign people to groups means that the groups will be similar and that the treatments they receive can be compared objectively. At the time of the trial, it is not known which treatment is best. It is the patient's choice to be in a randomized trial. [NIH] Randomized Controlled Trials: Clinical trials that involve at least one test treatment and one control treatment, concurrent enrollment and follow-up of the test- and control-treated groups, and in which the treatments to be administered are selected by a random process, such as the use of a random-numbers table. Treatment allocations using coin flips, odd-even numbers, patient social security numbers, days of the week, medical record numbers, or other such pseudo- or quasi-random processes, are not truly randomized and trials employing any of these techniques for patient assignment are designated simply controlled clinical trials. [NIH] Reaction Time: The time from the onset of a stimulus until the organism responds. [NIH] Receptor: A molecule inside or on the surface of a cell that binds to a specific substance and causes a specific physiologic effect in the cell. [NIH] Receptors, Serotonin: Cell-surface proteins that bind serotonin and trigger intracellular changes which influence the behavior of cells. Several types of serotonin receptors have been recognized which differ in their pharmacology, molecular biology, and mode of action. [NIH] Recombinant: A cell or an individual with a new combination of genes not found together in either parent; usually applied to linked genes. [EU] Recombination: The formation of new combinations of genes as a result of segregation in crosses between genetically different parents; also the rearrangement of linked genes due to crossing-over. [NIH] Rectal: By or having to do with the rectum. The rectum is the last 8 to 10 inches of the large intestine and ends at the anus. [NIH] Rectum: The last 8 to 10 inches of the large intestine. [NIH] Recurrence: The return of a sign, symptom, or disease after a remission. [NIH]

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Refer: To send or direct for treatment, aid, information, de decision. [NIH] Refraction: A test to determine the best eyeglasses or contact lenses to correct a refractive error (myopia, hyperopia, or astigmatism). [NIH] Regimen: A treatment plan that specifies the dosage, the schedule, and the duration of treatment. [NIH] Regression Analysis: Procedures for finding the mathematical function which best describes the relationship between a dependent variable and one or more independent variables. In linear regression (see linear models) the relationship is constrained to be a straight line and least-squares analysis is used to determine the best fit. In logistic regression (see logistic models) the dependent variable is qualitative rather than continuously variable and likelihood functions are used to find the best relationship. In multiple regression the dependent variable is considered to depend on more than a single independent variable. [NIH]

Rehabilitative: Instruction of incapacitated individuals or of those affected with some mental disorder, so that some or all of their lost ability may be regained. [NIH] Relative risk: The ratio of the incidence rate of a disease among individuals exposed to a specific risk factor to the incidence rate among unexposed individuals; synonymous with risk ratio. Alternatively, the ratio of the cumulative incidence rate in the exposed to the cumulative incidence rate in the unexposed (cumulative incidence ratio). The term relative risk has also been used synonymously with odds ratio. This is because the odds ratio and relative risk approach each other if the disease is rare ( 5 percent of population) and the number of subjects is large. [NIH] Reliability: Used technically, in a statistical sense, of consistency of a test with itself, i. e. the extent to which we can assume that it will yield the same result if repeated a second time. [NIH]

Remission: A decrease in or disappearance of signs and symptoms of cancer. In partial remission, some, but not all, signs and symptoms of cancer have disappeared. In complete remission, all signs and symptoms of cancer have disappeared, although there still may be cancer in the body. [NIH] Renal failure: Progressive renal insufficiency and uremia, due to irreversible and progressive renal glomerular tubular or interstitial disease. [NIH] Research Support: Financial support of research activities. [NIH] Resorption: The loss of substance through physiologic or pathologic means, such as loss of dentin and cementum of a tooth, or of the alveolar process of the mandible or maxilla. [EU] Respiration: The act of breathing with the lungs, consisting of inspiration, or the taking into the lungs of the ambient air, and of expiration, or the expelling of the modified air which contains more carbon dioxide than the air taken in (Blakiston's Gould Medical Dictionary, 4th ed.). This does not include tissue respiration (= oxygen consumption) or cell respiration (= cell respiration). [NIH] Retina: The ten-layered nervous tissue membrane of the eye. It is continuous with the optic nerve and receives images of external objects and transmits visual impulses to the brain. Its outer surface is in contact with the choroid and the inner surface with the vitreous body. The outer-most layer is pigmented, whereas the inner nine layers are transparent. [NIH] Retinal: 1. Pertaining to the retina. 2. The aldehyde of retinol, derived by the oxidative enzymatic splitting of absorbed dietary carotene, and having vitamin A activity. In the retina, retinal combines with opsins to form visual pigments. One isomer, 11-cis retinal combines with opsin in the rods (scotopsin) to form rhodopsin, or visual purple. Another, all-trans retinal (trans-r.); visual yellow; xanthopsin) results from the bleaching of rhodopsin

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by light, in which the 11-cis form is converted to the all-trans form. Retinal also combines with opsins in the cones (photopsins) to form the three pigments responsible for colour vision. Called also retinal, and retinene1. [EU] Retrospective: Looking back at events that have already taken place. [NIH] Rheumatism: A group of disorders marked by inflammation or pain in the connective tissue structures of the body. These structures include bone, cartilage, and fat. [NIH] Rheumatoid: Resembling rheumatism. [EU] Rheumatoid arthritis: A form of arthritis, the cause of which is unknown, although infection, hypersensitivity, hormone imbalance and psychologic stress have been suggested as possible causes. [NIH] Rheumatology: A subspecialty of internal medicine concerned with the study of inflammatory or degenerative processes and metabolic derangement of connective tissue structures which pertain to a variety of musculoskeletal disorders, such as arthritis. [NIH] Rickets: A condition caused by deficiency of vitamin D, especially in infancy and childhood, with disturbance of normal ossification. The disease is marked by bending and distortion of the bones under muscular action, by the formation of nodular enlargements on the ends and sides of the bones, by delayed closure of the fontanelles, pain in the muscles, and sweating of the head. Vitamin D and sunlight together with an adequate diet are curative, provided that the parathyroid glands are functioning properly. [EU] Risk factor: A habit, trait, condition, or genetic alteration that increases a person's chance of developing a disease. [NIH] Risk patient: Patient who is at risk, because of his/her behaviour or because of the type of person he/she is. [EU] Rod: A reception for vision, located in the retina. [NIH] Saline: A solution of salt and water. [NIH] Saponins: Sapogenin glycosides. A type of glycoside widely distributed in plants. Each consists of a sapogenin as the aglycon moiety, and a sugar. The sapogenin may be a steroid or a triterpene and the sugar may be glucose, galactose, a pentose, or a methylpentose. Sapogenins are poisonous towards the lower forms of life and are powerful hemolytics when injected into the blood stream able to dissolve red blood cells at even extreme dilutions. [NIH] Scans: Pictures of structures inside the body. Scans often used in diagnosing, staging, and monitoring disease include liver scans, bone scans, and computed tomography (CT) or computerized axial tomography (CAT) scans and magnetic resonance imaging (MRI) scans. In liver scanning and bone scanning, radioactive substances that are injected into the bloodstream collect in these organs. A scanner that detects the radiation is used to create pictures. In CT scanning, an x-ray machine linked to a computer is used to produce detailed pictures of organs inside the body. MRI scans use a large magnet connected to a computer to create pictures of areas inside the body. [NIH] Schizoid: Having qualities resembling those found in greater degree in schizophrenics; a person of schizoid personality. [NIH] Schizophrenia: A mental disorder characterized by a special type of disintegration of the personality. [NIH] Schizotypal Personality Disorder: A personality disorder in which there are oddities of thought (magical thinking, paranoid ideation, suspiciousness), perception (illusions, depersonalization), speech (digressive, vague, overelaborate), and behavior (inappropriate affect in social interactions, frequently social isolation) that are not severe enough to

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characterize schizophrenia. [NIH] Sciatic Nerve: A nerve which originates in the lumbar and sacral spinal cord (L4 to S3) and supplies motor and sensory innervation to the lower extremity. The sciatic nerve, which is the main continuation of the sacral plexus, is the largest nerve in the body. It has two major branches, the tibial nerve and the peroneal nerve. [NIH] Screening: Checking for disease when there are no symptoms. [NIH] Secretion: 1. The process of elaborating a specific product as a result of the activity of a gland; this activity may range from separating a specific substance of the blood to the elaboration of a new chemical substance. 2. Any substance produced by secretion. [EU] Segmentation: The process by which muscles in the intestines move food and wastes through the body. [NIH] Seizures: Clinical or subclinical disturbances of cortical function due to a sudden, abnormal, excessive, and disorganized discharge of brain cells. Clinical manifestations include abnormal motor, sensory and psychic phenomena. Recurrent seizures are usually referred to as epilepsy or "seizure disorder." [NIH] Selective estrogen receptor modulator: SERM. A drug that acts like estrogen on some tissues, but blocks the effect of estrogen on other tissues. Tamoxifen and raloxifene are SERMs. [NIH] Self Care: Performance of activities or tasks traditionally performed by professional health care providers. The concept includes care of oneself or one's family and friends. [NIH] Semen: The thick, yellowish-white, viscid fluid secretion of male reproductive organs discharged upon ejaculation. In addition to reproductive organ secretions, it contains spermatozoa and their nutrient plasma. [NIH] Senile: Relating or belonging to old age; characteristic of old age; resulting from infirmity of old age. [NIH] Sensibility: The ability to receive, feel and appreciate sensations and impressions; the quality of being sensitive; the extend to which a method gives results that are free from false negatives. [NIH] Sensor: A device designed to respond to physical stimuli such as temperature, light, magnetism or movement and transmit resulting impulses for interpretation, recording, movement, or operating control. [NIH] Septic: Produced by or due to decomposition by microorganisms; putrefactive. [EU] Serotonin: A biochemical messenger and regulator, synthesized from the essential amino acid L-tryptophan. In humans it is found primarily in the central nervous system, gastrointestinal tract, and blood platelets. Serotonin mediates several important physiological functions including neurotransmission, gastrointestinal motility, hemostasis, and cardiovascular integrity. Multiple receptor families (receptors, serotonin) explain the broad physiological actions and distribution of this biochemical mediator. [NIH] Serum: The clear liquid part of the blood that remains after blood cells and clotting proteins have been removed. [NIH] Serum Albumin: A major plasma protein that serves in maintaining the plasma colloidal osmotic pressure and transporting large organic anions. [NIH] Sex Characteristics: Those characteristics that distinguish one sex from the other. The primary sex characteristics are the ovaries and testes and their related hormones. Secondary sex characteristics are those which are masculine or feminine but not directly related to reproduction. [NIH]

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Sharpness: The apparent blurring of the border between two adjacent areas of a radiograph having different optical densities. [NIH] Shock: The general bodily disturbance following a severe injury; an emotional or moral upset occasioned by some disturbing or unexpected experience; disruption of the circulation, which can upset all body functions: sometimes referred to as circulatory shock. [NIH]

Side effect: A consequence other than the one(s) for which an agent or measure is used, as the adverse effects produced by a drug, especially on a tissue or organ system other than the one sought to be benefited by its administration. [EU] Skeletal: Having to do with the skeleton (boney part of the body). [NIH] Skeleton: The framework that supports the soft tissues of vertebrate animals and protects many of their internal organs. The skeletons of vertebrates are made of bone and/or cartilage. [NIH] Skilled Nursing Facilities: Extended care facilities which provide skilled nursing care or rehabilitation services for inpatients on a daily basis. [NIH] Small intestine: The part of the digestive tract that is located between the stomach and the large intestine. [NIH] Social Environment: The aggregate of social and cultural institutions, forms, patterns, and processes that influence the life of an individual or community. [NIH] Social Security: Government sponsored social insurance programs. [NIH] Social Support: Support systems that provide assistance and encouragement to individuals with physical or emotional disabilities in order that they may better cope. Informal social support is usually provided by friends, relatives, or peers, while formal assistance is provided by churches, groups, etc. [NIH] Sodium: An element that is a member of the alkali group of metals. It has the atomic symbol Na, atomic number 11, and atomic weight 23. With a valence of 1, it has a strong affinity for oxygen and other nonmetallic elements. Sodium provides the chief cation of the extracellular body fluids. Its salts are the most widely used in medicine. (From Dorland, 27th ed) Physiologically the sodium ion plays a major role in blood pressure regulation, maintenance of fluid volume, and electrolyte balance. [NIH] Sodium Fluoride: A source of inorganic fluoride which is used topically to prevent dental caries. [NIH] Soft tissue: Refers to muscle, fat, fibrous tissue, blood vessels, or other supporting tissue of the body. [NIH] Somatostatin: A polypeptide hormone produced in the hypothalamus, and other tissues and organs. It inhibits the release of human growth hormone, and also modulates important physiological functions of the kidney, pancreas, and gastrointestinal tract. Somatostatin receptors are widely expressed throughout the body. Somatostatin also acts as a neurotransmitter in the central and peripheral nervous systems. [NIH] Specialist: In medicine, one who concentrates on 1 special branch of medical science. [NIH] Species: A taxonomic category subordinate to a genus (or subgenus) and superior to a subspecies or variety, composed of individuals possessing common characters distinguishing them from other categories of individuals of the same taxonomic level. In taxonomic nomenclature, species are designated by the genus name followed by a Latin or Latinized adjective or noun. [EU] Specificity: Degree of selectivity shown by an antibody with respect to the number and types of antigens with which the antibody combines, as well as with respect to the rates and

Dictionary 205

the extents of these reactions. [NIH] Spectrum: A charted band of wavelengths of electromagnetic vibrations obtained by refraction and diffraction. By extension, a measurable range of activity, such as the range of bacteria affected by an antibiotic (antibacterial s.) or the complete range of manifestations of a disease. [EU] Sperm: The fecundating fluid of the male. [NIH] Spinal cord: The main trunk or bundle of nerves running down the spine through holes in the spinal bone (the vertebrae) from the brain to the level of the lower back. [NIH] Spinal Cord Diseases: Pathologic conditions which feature spinal cord damage or dysfunction, including disorders involving the meninges and perimeningeal spaces surrounding the spinal cord. Traumatic injuries, vascular diseases, infections, and inflammatory/autoimmune processes may affect the spinal cord. [NIH] Splenomegaly: Enlargement of the spleen. [NIH] Spondylitis: Inflammation of the vertebrae. [EU] Stabilization: The creation of a stable state. [EU] Staging: Performing exams and tests to learn the extent of the cancer within the body, especially whether the disease has spread from the original site to other parts of the body. [NIH]

Stem Cells: Relatively undifferentiated cells of the same lineage (family type) that retain the ability to divide and cycle throughout postnatal life to provide cells that can become specialized and take the place of those that die or are lost. [NIH] Stenosis: Narrowing or stricture of a duct or canal. [EU] Sterile: Unable to produce children. [NIH] Sterility: 1. The inability to produce offspring, i.e., the inability to conceive (female s.) or to induce conception (male s.). 2. The state of being aseptic, or free from microorganisms. [EU] Steroid: A group name for lipids that contain a hydrogenated cyclopentanoperhydrophenanthrene ring system. Some of the substances included in this group are progesterone, adrenocortical hormones, the gonadal hormones, cardiac aglycones, bile acids, sterols (such as cholesterol), toad poisons, saponins, and some of the carcinogenic hydrocarbons. [EU] Stimulus: That which can elicit or evoke action (response) in a muscle, nerve, gland or other excitable issue, or cause an augmenting action upon any function or metabolic process. [NIH] Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between the termination of the esophagus and the beginning of the duodenum. [NIH] Stool: The waste matter discharged in a bowel movement; feces. [NIH] Stress: Forcibly exerted influence; pressure. Any condition or situation that causes strain or tension. Stress may be either physical or psychologic, or both. [NIH] Stricture: The abnormal narrowing of a body opening. Also called stenosis. [NIH] Stroke: Sudden loss of function of part of the brain because of loss of blood flow. Stroke may be caused by a clot (thrombosis) or rupture (hemorrhage) of a blood vessel to the brain. [NIH] Stromal: Large, veil-like cell in the bone marrow. [NIH] Stromal Cells: Connective tissue cells of an organ found in the loose connective tissue. These are most often associated with the uterine mucosa and the ovary as well as the hematopoietic system and elsewhere. [NIH] Subacute: Somewhat acute; between acute and chronic. [EU]

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Subcapsular: Situated below a capsule. [EU] Subclinical: Without clinical manifestations; said of the early stage(s) of an infection or other disease or abnormality before symptoms and signs become apparent or detectable by clinical examination or laboratory tests, or of a very mild form of an infection or other disease or abnormality. [EU] Subcutaneous: Beneath the skin. [NIH] Subiculum: A region of the hippocampus that projects to other areas of the brain. [NIH] Subspecies: A category intermediate in rank between species and variety, based on a smaller number of correlated characters than are used to differentiate species and generally conditioned by geographical and/or ecological occurrence. [NIH] Substance P: An eleven-amino acid neurotransmitter that appears in both the central and peripheral nervous systems. It is involved in transmission of pain, causes rapid contractions of the gastrointestinal smooth muscle, and modulates inflammatory and immune responses. [NIH]

Subtrochanteric: Below a trochanter. [NIH] Supplementation: Adding nutrients to the diet. [NIH] Suppositories: A small cone-shaped medicament having cocoa butter or gelatin at its basis and usually intended for the treatment of local conditions in the rectum. [NIH] Suppression: A conscious exclusion of disapproved desire contrary with repression, in which the process of exclusion is not conscious. [NIH] Symphysis: A secondary cartilaginous joint. [NIH] Synergistic: Acting together; enhancing the effect of another force or agent. [EU] Systemic: Affecting the entire body. [NIH] Talus: The second largest of the tarsal bones and occupies the middle and upper part of the tarsus. [NIH] Tamoxifen: A first generation selective estrogen receptor modulator (SERM). It acts as an agonist for bone tissue and cholesterol metabolism but is an estrogen antagonist in mammary and uterine. [NIH] Tarsal Bones: The seven bones which form the tarsus - namely, calcaneus, talus, cuboid, navicular, and first, second and third cuneiforms. The tarsus is a skeletal part of the foot. [NIH]

Telomere: A terminal section of a chromosome which has a specialized structure and which is involved in chromosomal replication and stability. Its length is believed to be a few hundred base pairs. [NIH] Temporal: One of the two irregular bones forming part of the lateral surfaces and base of the skull, and containing the organs of hearing. [NIH] Tendon: A discrete band of connective tissue mainly composed of parallel bundles of collagenous fibers by which muscles are attached, or two muscles bellies joined. [NIH] Testicles: The two egg-shaped glands found inside the scrotum. They produce sperm and male hormones. Also called testes. [NIH] Testis: Either of the paired male reproductive glands that produce the male germ cells and the male hormones. [NIH] Testosterone: A hormone that promotes the development and maintenance of male sex characteristics. [NIH] Tetany: 1. Hyperexcitability of nerves and muscles due to decrease in concentration of

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extracellular ionized calcium, which may be associated with such conditions as parathyroid hypofunction, vitamin D deficiency, and alkalosis or result from ingestion of alkaline salts; it is characterized by carpopedal spasm, muscular twitching and cramps, laryngospasm with inspiratory stridor, hyperreflexia and choreiform movements. 2. Tetanus. [EU] Therapeutics: The branch of medicine which is concerned with the treatment of diseases, palliative or curative. [NIH] Thigh: A leg; in anatomy, any elongated process or part of a structure more or less comparable to a leg. [NIH] Thorax: A part of the trunk between the neck and the abdomen; the chest. [NIH] Threshold: For a specified sensory modality (e. g. light, sound, vibration), the lowest level (absolute threshold) or smallest difference (difference threshold, difference limen) or intensity of the stimulus discernible in prescribed conditions of stimulation. [NIH] Thrombosis: The formation or presence of a blood clot inside a blood vessel. [NIH] Thymus: An organ that is part of the lymphatic system, in which T lymphocytes grow and multiply. The thymus is in the chest behind the breastbone. [NIH] Thyroid: A gland located near the windpipe (trachea) that produces thyroid hormone, which helps regulate growth and metabolism. [NIH] Thyroid Gland: A highly vascular endocrine gland consisting of two lobes, one on either side of the trachea, joined by a narrow isthmus; it produces the thyroid hormones which are concerned in regulating the metabolic rate of the body. [NIH] Tibia: The second longest bone of the skeleton. It is located on the medial side of the lower leg, articulating with the fibula laterally, the talus distally, and the femur proximally. [NIH] Tibial Nerve: The medial terminal branch of the sciatic nerve. The tibial nerve fibers originate in lumbar and sacral spinal segments (L4 to S2). They supply motor and sensory innervation to parts of the calf and foot. [NIH] Tissue: A group or layer of cells that are alike in type and work together to perform a specific function. [NIH] Tomography: Imaging methods that result in sharp images of objects located on a chosen plane and blurred images located above or below the plane. [NIH] Topical: On the surface of the body. [NIH] Toxic: Having to do with poison or something harmful to the body. Toxic substances usually cause unwanted side effects. [NIH] Toxicity: The quality of being poisonous, especially the degree of virulence of a toxic microbe or of a poison. [EU] Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Toxins: Specific, characterizable, poisonous chemicals, often proteins, with specific biological properties, including immunogenicity, produced by microbes, higher plants, or animals. [NIH] Transfection: The uptake of naked or purified DNA into cells, usually eukaryotic. It is analogous to bacterial transformation. [NIH] Transfusion: The infusion of components of blood or whole blood into the bloodstream. The blood may be donated from another person, or it may have been taken from the person earlier and stored until needed. [NIH]

208

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Translation: The process whereby the genetic information present in the linear sequence of ribonucleotides in mRNA is converted into a corresponding sequence of amino acids in a protein. It occurs on the ribosome and is unidirectional. [NIH] Transplantation: Transference of a tissue or organ, alive or dead, within an individual, between individuals of the same species, or between individuals of different species. [NIH] Trauma: Any injury, wound, or shock, must frequently physical or structural shock, producing a disturbance. [NIH] Tremor: Cyclical movement of a body part that can represent either a physiologic process or a manifestation of disease. Intention or action tremor, a common manifestation of cerebellar diseases, is aggravated by movement. In contrast, resting tremor is maximal when there is no attempt at voluntary movement, and occurs as a relatively frequent manifestation of Parkinson disease. [NIH] Tricyclic: Containing three fused rings or closed chains in the molecular structure. [EU] Tryptophan: An essential amino acid that is necessary for normal growth in infants and for nitrogen balance in adults. It is a precursor serotonin and niacin. [NIH] Type 2 diabetes: Usually characterized by a gradual onset with minimal or no symptoms of metabolic disturbance and no requirement for exogenous insulin. The peak age of onset is 50 to 60 years. Obesity and possibly a genetic factor are usually present. [NIH] Ulcer: A localized necrotic lesion of the skin or a mucous surface. [NIH] Urea: A compound (CO(NH2)2), formed in the liver from ammonia produced by the deamination of amino acids. It is the principal end product of protein catabolism and constitutes about one half of the total urinary solids. [NIH] Uremia: The illness associated with the buildup of urea in the blood because the kidneys are not working effectively. Symptoms include nausea, vomiting, loss of appetite, weakness, and mental confusion. [NIH] Urethra: The tube through which urine leaves the body. It empties urine from the bladder. [NIH]

Urinary: Having to do with urine or the organs of the body that produce and get rid of urine. [NIH] Urine: Fluid containing water and waste products. Urine is made by the kidneys, stored in the bladder, and leaves the body through the urethra. [NIH] Urolithiasis: Stones in the urinary system. [NIH] Uterus: The small, hollow, pear-shaped organ in a woman's pelvis. This is the organ in which a fetus develops. Also called the womb. [NIH] Vaccines: Suspensions of killed or attenuated microorganisms (bacteria, viruses, fungi, protozoa, or rickettsiae), antigenic proteins derived from them, or synthetic constructs, administered for the prevention, amelioration, or treatment of infectious and other diseases. [NIH]

Vacuoles: Any spaces or cavities within a cell. They may function in digestion, storage, secretion, or excretion. [NIH] Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] Vasomotor: 1. Affecting the calibre of a vessel, especially of a blood vessel. 2. Any element or agent that effects the calibre of a blood vessel. [EU] Vein: Vessel-carrying blood from various parts of the body to the heart. [NIH] Venous: Of or pertaining to the veins. [EU]

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Ventricle: One of the two pumping chambers of the heart. The right ventricle receives oxygen-poor blood from the right atrium and pumps it to the lungs through the pulmonary artery. The left ventricle receives oxygen-rich blood from the left atrium and pumps it to the body through the aorta. [NIH] Vertebrae: A bony unit of the segmented spinal column. [NIH] Vertebral: Of or pertaining to a vertebra. [EU] Veterinary Medicine: The medical science concerned with the prevention, diagnosis, and treatment of diseases in animals. [NIH] Viral: Pertaining to, caused by, or of the nature of virus. [EU] Virus: Submicroscopic organism that causes infectious disease. In cancer therapy, some viruses may be made into vaccines that help the body build an immune response to, and kill, tumor cells. [NIH] Visual Acuity: Acuteness or clearness of vision, especially of form vision, which is dependent mainly on the sharpness of the retinal focus. [NIH] Visual field: The entire area that can be seen when the eye is forward, including peripheral vision. [NIH] Vitamin D: The vitamin that mediates intestinal calcium absorption, bone calcium metabolism, and probably muscle activity. It usually acts as a hormone precursor, requiring 2 stages of metabolism before reaching actual hormonal form. It is isolated from fish liver oils and used in the treatment and prevention of rickets. [NIH] Vitro: Descriptive of an event or enzyme reaction under experimental investigation occurring outside a living organism. Parts of an organism or microorganism are used together with artificial substrates and/or conditions. [NIH] Vivo: Outside of or removed from the body of a living organism. [NIH] Wakefulness: A state in which there is an enhanced potential for sensitivity and an efficient responsiveness to external stimuli. [NIH] Weight-Bearing: The physical state of supporting an applied load. This often refers to the weight-bearing bones or joints that support the body's weight, especially those in the spine, hip, knee, and foot. [NIH] Withdrawal: 1. A pathological retreat from interpersonal contact and social involvement, as may occur in schizophrenia, depression, or schizoid avoidant and schizotypal personality disorders. 2. (DSM III-R) A substance-specific organic brain syndrome that follows the cessation of use or reduction in intake of a psychoactive substance that had been regularly used to induce a state of intoxication. [EU] Xenograft: The cells of one species transplanted to another species. [NIH] X-ray: High-energy radiation used in low doses to diagnose diseases and in high doses to treat cancer. [NIH] Yeasts: A general term for single-celled rounded fungi that reproduce by budding. Brewers' and bakers' yeasts are Saccharomyces cerevisiae; therapeutic dried yeast is dried yeast. [NIH]

211

INDEX A Abdominal, 163, 184, 193 Abduction, 23, 163 Acculturation, 29, 163 Activities of Daily Living, 14, 18, 52, 163 Acuity, 31, 163 Adaptation, 163, 196 Adjustment, 4, 163 Adjuvant, 163, 180 Adolescence, 163, 194 Adrenal Cortex, 163, 164, 173, 178, 198 Adverse Effect, 24, 25, 43, 163, 204 Aerobic, 12, 22, 163, 178 Aerobic Exercise, 22, 163 Affinity, 10, 163, 164, 204 Age of Onset, 164, 208 Agonist, 164, 206 Aldosterone, 41, 164 Algorithms, 17, 29, 46, 164, 167 Alimentary, 164, 194 Alkaline, 33, 164, 169, 207 Alkaline Phosphatase, 33, 164 Allogeneic, 164, 181 Alpha Particles, 164, 199 Alternative medicine, 136, 164 Alveolar Process, 164, 201 Amenorrhea, 164, 165 Amino acid, 122, 164, 165, 174, 178, 180, 181, 183, 186, 193, 194, 197, 198, 199, 203, 206, 208 Amino Acid Sequence, 164, 165, 178, 180 Ammonia, 164, 208 Anabolic, 28, 126, 164 Anaesthesia, 65, 76, 91, 100, 164 Anal, 30, 165, 177, 179, 187 Analgesic, 43, 165, 186, 192, 198 Analog, 7, 165 Anatomical, 121, 165, 170, 184 Androgens, 163, 165, 174 Anemia, 24, 25, 165, 182, 190, 193, 195 Aneurysm, 94, 165 Angulation, 29, 165 Animal model, 15, 25, 165 Anorexia, 47, 165, 193 Anorexia Nervosa, 47, 165 Antiallergic, 165, 174 Antibacterial, 165, 205 Antibiotic, 24, 25, 60, 165, 205

Antibiotic Prophylaxis, 24, 25, 165 Antibodies, 20, 165, 181, 188, 196 Antibody, 164, 165, 172, 181, 185, 189, 199, 204 Anticoagulant, 47, 165, 198 Antiepileptic, 40, 165 Antigen, 10, 52, 163, 165, 172, 184, 185, 189, 199 Anti-inflammatory, 166, 174, 180, 197 Anti-Inflammatory Agents, 166, 174 Antineoplastic, 166, 174 Antioxidant, 166 Antithrombotic, 68, 166 Antitussive, 166, 192, 198 Anus, 165, 166, 171, 200 Anxiety, 44, 166, 193 Aorta, 166, 184, 209 Applicability, 53, 166 Arterial, 11, 12, 48, 84, 166, 184, 198 Arteries, 166, 168, 173, 184, 189, 191 Artery, 165, 166, 168, 173, 199, 209 Arthroplasty, 60, 77, 101, 110, 166 Articular, 66, 166 Artifacts, 7, 166 Ascorbic Acid, 86, 166, 183 Aseptic, 46, 166, 205 Aspirin, 86, 104, 166 Assay, 83, 166, 199 Astigmatism, 166, 201 Atrophy, 166, 197 Attenuated, 166, 176, 208 Attenuation, 7, 29, 104, 166 Auditory, 11, 167 Autoimmune disease, 10, 167 Axons, 167, 175, 192, 199 B Bacteria, 165, 167, 175, 183, 190, 205, 208 Benzene, 167 Benzodiazepines, 44, 57, 61, 167 Bewilderment, 167, 173 Bilateral, 13, 167, 194 Bile, 167, 180, 187, 205 Bioavailability, 15, 167 Bioavailable, 51, 167 Biochemical, 11, 18, 22, 52, 61, 64, 66, 74, 167, 203 Biological Transport, 167, 175 Biomechanics, 8, 12, 167

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Hip Fracture

Biopsy, 19, 167, 195 Biopsy specimen, 19, 167 Biosynthesis, 26, 167 Biotechnology, 57, 58, 136, 145, 167 Bipolar Disorder, 44, 167 Bladder, 167, 172, 180, 184, 198, 208 Blood Cell Count, 168, 182, 195 Blood Coagulation, 168, 169 Blood Glucose, 168, 182, 185 Blood Platelets, 168, 189, 203 Blood pressure, 168, 169, 184, 190, 195, 204 Blood transfusion, 24, 25, 62, 69, 72, 168 Blood vessel, 168, 169, 170, 171, 187, 188, 195, 204, 205, 207, 208 Body Composition, 7, 12, 35, 36, 51, 168 Body Fluids, 168, 169, 176, 204 Body Mass Index, 4, 168 Bone Density, 7, 23, 35, 56, 61, 85, 100, 168 Bone Marrow, 21, 33, 128, 167, 168, 188, 189, 190, 205 Bone Marrow Cells, 21, 33, 168, 189 Bone Remodeling, 18, 39, 168 Bone Resorption, 15, 18, 21, 33, 168 Bone scan, 168, 202 Bony Callus, 168, 179 Bowel, 165, 168, 185, 205 Bronchitis, 169, 170 Bursitis, 150, 169 Bypass, 14, 169 C Cadaver, 29, 37, 169 Calcaneus, 91, 104, 169, 206 Calcification, 48, 169 Calcitonin, 15, 169 Capsules, 169, 180 Carbohydrate, 169, 174, 197 Carbon Dioxide, 169, 179, 196, 201 Carcinogenic, 167, 169, 198, 205 Cardiac, 12, 120, 169, 178, 191, 205 Cardiac Output, 120, 169 Cardiorespiratory, 163, 169 Cardiovascular, 11, 12, 23, 24, 25, 41, 51, 106, 169, 178, 203 Cardiovascular disease, 11, 24, 25, 41, 106, 169 Carrier Proteins, 169, 200 Case report, 66, 84, 95, 114, 169 Castration, 170 Cataract, 31, 91, 170 Causal, 170, 177, 185 Cell, 8, 10, 24, 25, 26, 33, 126, 164, 166, 167, 169, 170, 172, 174, 175, 178, 180, 183,

185, 186, 188, 191, 193, 195, 196, 200, 201, 205, 208 Cell membrane, 126, 167, 169, 170, 186, 195 Central Nervous System, 12, 167, 170, 181, 193, 197, 203 Centrifugation, 170, 182 Cerebral, 111, 170, 175, 179, 182, 199 Cerebrovascular, 169, 170 Cervical, 170, 182 Chaos, 23, 170 Character, 170, 174 Chin, 85, 170, 189 Cholesterol, 167, 170, 173, 205, 206 Chromaffin System, 170, 177 Chromatin, 33, 170 Chromosomal, 26, 27, 170, 183, 206 Chromosome, 39, 170, 181, 187, 206 Chronic, 8, 10, 12, 14, 15, 18, 27, 33, 41, 47, 48, 53, 54, 65, 120, 170, 171, 177, 185, 187, 205 Chronic Disease, 8, 14, 27, 48, 53, 54, 170 Chronic Obstructive Pulmonary Disease, 10, 170 Chronic renal, 47, 65, 171 Circulatory system, 171, 177 Clinical Medicine, 171, 197 Clinical trial, 6, 29, 34, 49, 50, 55, 145, 171, 173, 176, 199, 200 Cloning, 122, 167, 171 Cluster Analysis, 53, 171 Coenzyme, 166, 171 Cofactor, 171, 198 Cognition, 5, 48, 171 Cohort Studies, 47, 49, 54, 171, 178 Colitis, 171, 185 Collagen, 26, 56, 164, 171, 180, 198 Colon, 15, 54, 94, 96, 171, 185, 186 Comorbidity, 4, 171 Complement, 172, 180, 188 Complementary and alternative medicine, 109, 116, 172 Complementary medicine, 109, 172 Compliance, 22, 52, 55, 59, 72, 86, 113, 172 Computational Biology, 145, 172 Computed tomography, 37, 44, 82, 168, 172, 173, 202 Computer Simulation, 37, 40, 172 Computerized axial tomography, 172, 173, 202 Computerized tomography, 172, 173 Confidence Intervals, 24, 25, 173

213

Confusion, 4, 173, 176, 184, 208 Congestive heart failure, 10, 173 Connective Tissue, 166, 168, 171, 173, 180, 202, 205, 206 Consciousness, 165, 173, 175, 176, 199 Consultation, 14, 71, 173 Contamination, 50, 173 Contraindications, ii, 173 Contrast Sensitivity, 31, 173 Control group, 18, 42, 55, 173, 200 Controlled study, 75, 173 Coronary, 14, 169, 173, 189, 191 Coronary heart disease, 169, 173 Coronary Thrombosis, 173, 189, 191 Cortex, 36, 89, 173, 177, 179, 199 Cortical, 13, 35, 44, 63, 82, 89, 128, 173, 199, 203 Corticosteroid, 66, 134, 173, 197 Cortisone, 174, 197 Cost Savings, 14, 174 Criterion, 37, 174 Cross-Cultural Comparison, 112, 174 Cross-Sectional Studies, 174, 178 Curative, 174, 202, 207 Cysteine, 15, 174 Cystine, 174 Cytokine, 47, 174 Cytoplasm, 170, 174 D Dairy Products, 104, 174 Dalteparin, 106, 174 Data Collection, 35, 174 Deamination, 174, 208 Decision Making, 22, 174 Degenerative, 28, 174, 182, 188, 202 Dehydroepiandrosterone, 28, 174 Delirium, 24, 38, 63, 67, 68, 69, 71, 174 Delivery of Health Care, 175, 182 Dementia, 5, 38, 47, 68, 175, 191 Dendrites, 175, 191, 199 Dental Caries, 175, 204 Dentate Gyrus, 122, 175, 183 Depressive Disorder, 175, 187 Diabetes Mellitus, 31, 47, 175, 181, 182 Diagnostic Errors, 175, 189 Diagnostic procedure, 119, 136, 175 Diathesis, 175, 181 Diffusion, 15, 167, 175, 176, 186 Digestive tract, 175, 204 Digital rectal examination, 52, 176 Dilution, 28, 176, 196

Direct, iii, 9, 18, 120, 139, 171, 176, 183, 195, 197, 201 Discrete, 22, 34, 168, 176, 187, 206 Discrimination, 17, 68, 69, 78, 83, 176 Disorientation, 173, 175, 176 Dissociation, 163, 176, 186 Distal, 47, 51, 176 Double-blind, 51, 52, 70, 110, 113, 114, 176 Double-blinded, 52, 176 Drive, ii, vi, 25, 27, 103, 176, 186, 187 Drug Interactions, 140, 176 Drusen, 31, 176 Duct, 176, 205 Dynamometer, 36, 83, 176 Dyspareunia, 176, 178 Dystrophy, 19, 176 E Efficacy, 7, 9, 15, 19, 24, 25, 28, 42, 43, 50, 61, 72, 74, 104, 126, 176 Elasticity, 36, 176 Elastin, 171, 176 Elective, 31, 176 Electrolyte, 164, 174, 175, 177, 190, 197, 204 Electrons, 166, 177, 186, 199 Emphysema, 170, 177 Emulsion, 177, 179 Endocrine Glands, 177, 194 Endocrine System, 56, 177 Endocytosis, 15, 177 Endometrial, 49, 177 Endometrium, 177 End-stage renal, 171, 177 Enhancer, 15, 177 Enoxaparin, 66, 106, 177 Entorhinal Cortex, 177, 183 Environmental Health, 144, 146, 177 Enzymatic, 164, 169, 172, 175, 177, 179, 201 Enzyme, 164, 171, 177, 198, 209 Epidemic, 29, 135, 177 Epidemiologic Studies, 29, 51, 177 Epidemiological, 9, 44, 178 Erythrocytes, 165, 168, 178 Estradiol, 56, 178 Estrogen, 4, 21, 22, 28, 33, 41, 47, 56, 93, 134, 178, 203, 206 Estrogen receptor, 21, 56, 178 Estrogen Replacement Therapy, 22, 178 Ethnic Groups, 63, 178 Etidronate, 61, 178 Excitability, 13, 178 Exercise Test, 12, 178

214

Hip Fracture

Exhaustion, 178, 196 Exogenous, 178, 208 Exon, 26, 178 Extensor, 36, 83, 178 Extracellular, 173, 177, 178, 193, 204, 207 Extracellular Matrix, 173, 178, 193 Extraction, 121, 178 Extremity, 5, 9, 11, 18, 38, 54, 69, 77, 121, 178, 194, 203 F Family Planning, 145, 178 Fat, 7, 168, 173, 174, 179, 187, 202, 204 Fatigue, 179, 182 Femoral Fractures, 127, 179 Femoral Neck Fractures, 114, 123, 124, 179 Femur, 22, 35, 37, 44, 51, 56, 58, 63, 65, 74, 77, 80, 109, 114, 121, 124, 127, 128, 179, 207 Fibrinolysis, 12, 179 Fibula, 179, 207 Fissure, 175, 179 Fixation, 45, 96, 121, 124, 127, 128, 179 Flexor, 83, 178, 179 Fold, 4, 23, 179 Foot Care, 42, 179 Forearm, 41, 168, 179 Fovea, 179 Fracture Fixation, 83, 121, 122, 123, 179 Fracture Healing, 18, 33, 179 Functional magnetic resonance imaging, 11, 13, 180 Fundus, 31, 180 G Gait, 5, 7, 11, 12, 18, 23, 42, 180 Gallbladder, 163, 180 Gas, 164, 169, 175, 180, 192 Gastrectomy, 47, 180 Gastrin, 180, 183 Gastrointestinal, 180, 203, 204, 206 Gastrointestinal tract, 180, 203, 204 Gelatin, 91, 180, 181, 206 Gene, 26, 33, 39, 60, 122, 167, 180, 181, 183, 196 Gene Expression, 33, 180 Genetic Code, 180, 192 Genetic Engineering, 167, 171, 180 Genetic Markers, 56, 180 Genotype, 39, 180, 195 Geriatric, 5, 13, 16, 60, 82, 84, 90, 95, 104, 120, 180 Geriatric Psychiatry, 16, 60, 180

Gland, 163, 170, 174, 180, 193, 194, 196, 198, 203, 205, 207 Glomerular, 180, 201 Glucocorticoid, 41, 180, 197 Glucose, 166, 168, 175, 181, 182, 184, 185, 202 Glucose Intolerance, 175, 181 Glycine, 164, 181, 191 Goats, 174, 181 Gonad, 181 Gonadal, 21, 181, 205 Governing Board, 181, 197 Grade, 31, 181 Graft, 10, 181 Graft Rejection, 10, 181 Granule, 175, 181 H Habitual, 37, 170, 181 Haematuria, 181 Haemophilia, 99, 181 Handicap, 74, 181 Haptens, 164, 181, 200 Headache, 181, 184, 196 Health Care Costs, 28, 182 Health Expenditures, 182 Health Promotion, 42, 182 Health Services, 30, 32, 43, 45, 69, 105, 175, 182 Health Status, 22, 28, 50, 51, 92, 182 Heart attack, 169, 182 Heart failure, 39, 182 Heartbeat, 23, 182 Hematocrit, 24, 25, 168, 182 Hemiparesis, 11, 182 Hemiplegia, 111, 182 Hemoglobin, 24, 25, 165, 168, 178, 182, 186 Hemorrhage, 181, 182, 205 Hemostasis, 68, 182, 203 Hepatic, 175, 182 Hepatitis, 24, 25, 182 Hepatocytes, 182, 183 Heredity, 180, 183 Heritability, 27, 183 Heterogeneity, 13, 164, 183 Hippocampus, 122, 175, 183, 199, 206 Histones, 170, 183 Homeostasis, 168, 183 Hormonal, 19, 21, 56, 166, 174, 178, 183, 209 Hormone Replacement Therapy, 35, 183 Hormone therapy, 106, 183 Human growth hormone, 28, 74, 183, 204

215

Humoral, 181, 183 Hybrid, 26, 33, 183 Hydrogel, 15, 183 Hydrogenation, 167, 183 Hydroxylysine, 171, 183 Hydroxyproline, 164, 171, 183 Hypercalcemia, 32, 178, 183 Hyperopia, 183, 201 Hypersensitivity, 184, 202 Hypertension, 169, 181, 184, 194 Hypoglycaemia, 175, 184 Hypogonadism, 21, 47, 184 Hypokinesia, 184, 194 Hypotension, 120, 184 Hypothalamic, 126, 184 Hypothalamic Hormones, 126, 184 Hypothalamus, 184, 196, 204 Hypovitaminosis, 111, 184 Hypoxia, 175, 184 I Iliac Artery, 94, 184 Immune response, 163, 165, 167, 174, 181, 184, 188, 206, 209 Immunogenic, 184, 200 Immunology, 163, 184 Immunosuppressive, 180, 184 Impairment, 5, 8, 13, 18, 42, 45, 60, 65, 76, 93, 99, 122, 126, 167, 175, 184 In vitro, 15, 20, 29, 184 In vivo, 15, 35, 44, 184 Incision, 124, 127, 184, 186 Incontinence, 4, 98, 184 Infantile, 184, 197 Infarction, 184 Infection, 24, 69, 76, 166, 175, 185, 188, 202, 206 Infertility, 47, 185 Inflammation, 166, 169, 171, 182, 185, 196, 202, 205 Inflammatory bowel disease, 47, 185 Infusion, 185, 207 Innervation, 185, 195, 203, 207 Inorganic, 185, 204 Inpatients, 59, 65, 185, 204 Insight, 27, 37, 44, 57, 185 Insomnia, 48, 185 Insulin, 4, 19, 26, 28, 56, 114, 185, 208 Insulin-dependent diabetes mellitus, 185 Insulin-like, 19, 26, 114, 185 Intermittent, 185, 187 Interstitial, 185, 201 Intervention Studies, 16, 185

Intestinal, 32, 185, 188, 209 Intestine, 168, 185, 186 Intoxication, 175, 185, 209 Intracellular, 19, 185, 197, 200 Intramuscular, 181, 185, 194 Intraocular, 31, 186 Intraocular pressure, 31, 186 Intravenous, 185, 186, 194 Intrinsic, 10, 164, 186 Invasive, 6, 12, 18, 127, 186, 188 Ion Transport, 186, 190 Ionization, 186 Ionizing, 7, 164, 186 Ipsilateral, 121, 186 K Kb, 144, 186 Kinetic, 125, 186 L Labyrinth, 186, 198 Large Intestine, 175, 185, 186, 200, 204 Least-Squares Analysis, 186, 201 Length of Stay, 10, 34, 76, 186 Lens, 170, 186 Lesion, 186, 187, 208 Leucine, 28, 186 Leukocytes, 168, 186 Levo, 186, 198 Libido, 41, 165, 187 Life Expectancy, 36, 187 Ligament, 187, 198 Likelihood Functions, 187, 201 Linear Models, 187, 201 Linkage, 27, 39, 180, 187 Lipid, 51, 85, 185, 187 Lithium, 41, 187 Liver, 163, 167, 177, 180, 182, 183, 187, 197, 202, 208, 209 Liver scan, 187, 202 Lobe, 183, 187 Localization, 20, 187 Localized, 175, 179, 182, 185, 187, 196, 208 Logistic Models, 187, 201 Longitudinal Studies, 14, 96, 174, 187 Longitudinal study, 48, 63, 86, 187 Long-Term Care, 4, 5, 45, 187 Lumbar, 51, 65, 188, 203, 207 Lymphatic, 185, 188, 196, 207 Lymphatic system, 188, 207 Lymphocyte, 166, 188, 189 Lymphoid, 165, 188 M Macula, 179, 188

216

Hip Fracture

Macula Lutea, 188 Macular Degeneration, 31, 188 Magnetic Resonance Imaging, 52, 85, 188, 202 Major Histocompatibility Complex, 10, 188 Malabsorption, 32, 188 Malignant, 166, 188, 190 Malignant tumor, 188, 190 Malnutrition, 4, 106, 166, 188, 190 Mammary, 188, 206 Mammogram, 169, 188, 189 Mammography, 49, 188 Mandible, 164, 170, 188, 201 Manic, 167, 187, 188 Manifest, 182, 188 Medial, 188, 207 Mediate, 21, 41, 188 Mediator, 188, 203 Medical castration, 21, 189 Medical Errors, 24, 25, 189 Medical Records, 4, 38, 189 Medical Staff, 176, 189 Medication Errors, 189 MEDLINE, 145, 189 Megakaryocytes, 168, 189 Membrane, 126, 170, 172, 177, 178, 189, 195, 201 Memory, 42, 47, 165, 175, 189 Meninges, 170, 189, 205 Menopause, 56, 115, 189, 197 Menstruation, 164, 189 Mental Health, iv, 5, 28, 144, 146, 180, 189, 199 Mentors, 30, 189 Meta-Analysis, 49, 65, 76, 189 Metabolite, 83, 189 MI, 161, 189 Microcalcifications, 169, 189 Microorganism, 171, 190, 209 Milliliter, 168, 190 Mineralization, 190, 193 Mineralocorticoids, 41, 163, 174, 190 Minority Groups, 35, 190 Mitochondrial Swelling, 190, 191 Mobility, 11, 17, 28, 36, 50, 52, 66, 75, 87, 95, 125, 134, 190 Modeling, 14, 29, 30, 39, 40, 87, 190 Modification, 164, 180, 190, 199 Molecular, 20, 27, 39, 41, 86, 122, 126, 145, 147, 167, 172, 175, 190, 200, 208 Molecular Structure, 190, 208

Molecule, 165, 171, 172, 176, 190, 200 Monitor, 18, 20, 46, 52, 190, 192 Mood Disorders, 13, 16, 190 Morphology, 27, 170, 190 Motility, 190, 203 Multiple Myeloma, 47, 190 Muscle Fibers, 190 Muscular Atrophy, 120, 190 Muscular Dystrophies, 176, 190 Myocardial infarction, 24, 25, 28, 54, 173, 189, 191 Myocardium, 189, 191 Myopia, 191, 201 Myotonic Dystrophy, 19, 191 N Narcotic, 191, 198 Necrosis, 128, 184, 189, 191 Nerve, 167, 170, 175, 179, 185, 188, 191, 192, 195, 203, 205, 207 Nervous System, 170, 188, 191, 195 Neural, 11, 97, 183, 191 Neurologic, 76, 191 Neurology, 8, 13, 111, 191 Neuromuscular, 9, 11, 12, 23, 88, 191 Neurons, 175, 191, 199 Neurosecretory Systems, 177, 191 Neurosyphilis, 191, 194 Neurotransmitter, 164, 181, 191, 204, 206 Neutrons, 164, 191, 199 Nitrogen, 126, 165, 179, 192, 208 Nuclear, 20, 177, 191, 192 Nuclei, 164, 177, 180, 183, 188, 191, 192, 193, 199 Nucleic acid, 122, 126, 180, 192 Nucleus, 20, 170, 174, 191, 192, 199 Nursing Care, 38, 192, 204 O Observational study, 35, 192 Occult, 85, 89, 192 Occupational Therapy, 46, 49, 70, 192 Ocular, 31, 192 Odds Ratio, 192, 201 Oophorectomy, 47, 192 Opacity, 170, 175, 192 Ophthalmology, 179, 192 Opiate, 43, 192 Opium, 192 Optic Nerve, 176, 192, 193, 201 Optic nerve head, 176, 193 Orchiectomy, 47, 193 Orthopaedic, 9, 25, 61, 67, 68, 69, 83, 88, 90, 93, 97, 123, 124, 125, 150, 193

217

Osteoblasts, 15, 20, 26, 41, 193 Osteocalcin, 58, 95, 193 Osteoclasts, 15, 21, 169, 193 Osteomalacia, 86, 193 Osteopetrosis, 114, 193 Outpatient, 45, 49, 133, 193 Ovariectomy, 21, 193 Ovaries, 189, 192, 193, 203 Ovary, 178, 181, 193, 205 Oxygen Consumption, 178, 193, 201 Oxytocin, 184, 193 P Palliative, 6, 37, 193, 207 Pancreas, 163, 185, 193, 204 Panic, 44, 193 Paralysis, 182, 194, 197 Paraparesis, 194 Parathyroid, 56, 194, 202, 207 Parathyroid Glands, 194, 202 Parathyroid hormone, 56, 194 Parenteral, 15, 194 Paresis, 11, 182, 194 Parkinsonism, 47, 194 Pathogenesis, 20, 39, 41, 47, 194 Pathologic, 167, 173, 184, 194, 197, 201, 205 Pathologies, 23, 194 Pathophysiology, 41, 47, 194 Patient Compliance, 15, 194 Patient Education, 150, 156, 158, 161, 194 Patient Satisfaction, 32, 194 Pediatrics, 8, 194 Pelvic, 6, 124, 194, 198 Pelvis, 124, 184, 188, 193, 194, 208 Peptide, 10, 26, 122, 164, 169, 194, 197, 198, 199 Perception, 14, 59, 87, 194, 202 Percutaneous, 96, 195 Perimetry, 31, 195 Peripheral Nervous System, 182, 191, 194, 195, 204, 206 Peripheral Nervous System Diseases, 182, 194, 195 Peripheral Vascular Disease, 14, 195 Peripheral vision, 31, 195, 209 Pernicious anemia, 47, 195 Peroneal Nerve, 195, 203 PH, 168, 195 Phallic, 179, 195 Pharmaceutical Preparations, 180, 195 Pharmacologic, 7, 33, 35, 38, 195, 207 Phenotype, 26, 195 Phospholipids, 179, 195

Phosphorus, 169, 194, 195 Phosphorylation, 19, 41, 195 Physical Endurance, 18, 196 Physical Therapy, 5, 8, 18, 42, 50, 54, 73, 94, 196 Physiologic, 11, 12, 20, 52, 164, 167, 184, 189, 196, 200, 201, 208 Physiology, 8, 11, 12, 13, 40, 122, 163, 196 Pilot study, 24, 71, 87, 95, 106, 196 Pituitary Gland, 173, 184, 196 Pituitary Hormone Release Inhibiting Hormones, 184, 196 Pituitary Hormone-Releasing Hormones, 184, 196 Pituitary Hormones, 184, 196 Placenta, 178, 196, 198 Plants, 169, 181, 190, 196, 202, 207 Plasma, 165, 169, 170, 180, 181, 182, 190, 196, 203 Plasma cells, 165, 190, 196 Plasma Volume, 190, 196 Plasticity, 8, 11, 196 Plexus, 65, 196, 203 Pneumonia, 10, 24, 25, 173, 196 Poisoning, 175, 185, 196 Poliomyelitis, 47, 196 Polymorphic, 175, 197 Polymorphism, 60, 104, 197 Polypeptide, 164, 171, 196, 197, 204 Polysaccharide, 165, 197 Posterior, 91, 165, 184, 193, 196, 197 Postmenopausal, 4, 7, 15, 56, 93, 100, 102, 105, 106, 110, 111, 114, 134, 135, 178, 193, 197 Postnatal, 197, 205 Postoperative, 24, 25, 34, 63, 70, 71, 80, 197 Postoperative Complications, 24, 25, 197 Postural, 23, 36, 197 Potassium, 164, 190, 197 Practice Guidelines, 146, 151, 197 Precursor, 21, 33, 177, 197, 208, 209 Predictive factor, 79, 197 Prednisolone, 197 Prednisone, 135, 197 Preoperative, 81, 91, 197 Prevalence, 35, 38, 40, 41, 43, 67, 85, 86, 106, 192, 197 Probe, 124, 198 Progesterone, 198, 205 Progression, 31, 165, 198 Progressive, 19, 28, 29, 171, 175, 178, 191, 198, 201

218

Hip Fracture

Projection, 44, 193, 198, 199 Proline, 171, 183, 198 Promoter, 26, 41, 60, 198 Prophylaxis, 24, 25, 49, 60, 66, 68, 70, 89, 198 Proportional Hazards Models, 34, 198 Propoxyphene, 43, 198 Proprioception, 71, 83, 198 Prospective Payment System, 10, 198 Prospective study, 7, 52, 56, 67, 68, 71, 98, 101, 111, 187, 198 Prostate, 21, 51, 54, 198 Prosthesis, 98, 198 Protease, 20, 198 Protein C, 164, 193, 198, 208 Protein Kinases, 33, 198 Protein S, 19, 28, 114, 167, 180, 183, 193, 198 Proteinuria, 190, 199 Protocol, 17, 199 Protons, 164, 186, 199 Psychiatric, 16, 199 Psychiatry, 13, 16, 65, 179, 180, 199 Psychic, 187, 189, 199, 203 Psychoactive, 199, 209 Psychomotor, 68, 175, 199 Public Health, 7, 16, 22, 23, 29, 30, 40, 47, 50, 55, 67, 71, 73, 77, 92, 104, 146, 199 Public Policy, 145, 199 Publishing, 57, 199 Pulmonary, 168, 178, 199, 209 Pulse, 190, 199 Pyramidal Cells, 175, 199 Q Quality of Life, 11, 12, 14, 18, 31, 32, 36, 37, 52, 54, 55, 64, 68, 75, 77, 78, 87, 199 R Race, 4, 44, 53, 99, 199 Radiation, 7, 36, 124, 186, 199, 202, 209 Radioactive, 168, 186, 187, 192, 199, 202 Radioimmunoassay, 83, 199 Radiological, 195, 200 Radiology, 34, 35, 43, 48, 77, 200 Random Allocation, 200 Randomization, 11, 24, 25, 46, 55, 200 Randomized clinical trial, 24, 25, 35, 56, 200 Randomized Controlled Trials, 49, 200 Reaction Time, 9, 200 Receptor, 41, 56, 122, 126, 163, 166, 199, 200, 203 Receptors, Serotonin, 200, 203

Recombinant, 19, 20, 28, 74, 200 Recombination, 180, 200 Rectal, 200 Rectum, 166, 171, 175, 176, 180, 184, 185, 186, 198, 200, 206 Recurrence, 167, 200 Refer, 1, 172, 179, 187, 188, 192, 201 Refraction, 31, 191, 201, 205 Regimen, 22, 176, 194, 201 Regression Analysis, 36, 43, 201 Rehabilitative, 8, 10, 101, 201 Relative risk, 4, 24, 25, 49, 201 Reliability, 83, 94, 201 Remission, 167, 200, 201 Renal failure, 3, 175, 201 Research Support, 32, 201 Resorption, 15, 19, 21, 22, 33, 168, 193, 201 Respiration, 169, 190, 201 Retina, 166, 176, 186, 188, 191, 192, 193, 201, 202 Retinal, 192, 201, 209 Retrospective, 39, 47, 202 Rheumatism, 202 Rheumatoid, 47, 202 Rheumatoid arthritis, 47, 202 Rheumatology, 8, 59, 62, 202 Rickets, 202, 209 Risk patient, 52, 202 Rod, 121, 202 S Saline, 91, 202 Saponins, 202, 205 Scans, 35, 37, 44, 202 Schizoid, 202, 209 Schizophrenia, 202, 203, 209 Schizotypal Personality Disorder, 202, 209 Sciatic Nerve, 65, 195, 203, 207 Screening, 12, 14, 23, 48, 49, 106, 171, 203 Secretion, 27, 122, 174, 185, 190, 196, 203, 208 Segmentation, 36, 203 Seizures, 175, 203 Selective estrogen receptor modulator, 203, 206 Self Care, 163, 203 Semen, 198, 203 Senile, 20, 193, 203 Sensibility, 164, 203 Sensor, 17, 203 Septic, 166, 203 Serotonin, 73, 191, 200, 203, 208

219

Serum, 18, 20, 26, 28, 41, 48, 52, 57, 58, 86, 95, 114, 172, 190, 193, 200, 203 Serum Albumin, 200, 203 Sex Characteristics, 163, 165, 203, 206 Sharpness, 204, 209 Shock, 38, 125, 204, 208 Side effect, 19, 43, 49, 52, 139, 163, 204, 207 Skeletal, 12, 26, 28, 33, 35, 52, 165, 190, 191, 204, 206 Skeleton, 21, 121, 168, 179, 204, 207 Skilled Nursing Facilities, 94, 204 Small intestine, 15, 33, 183, 185, 204 Social Environment, 199, 204 Social Security, 200, 204 Social Support, 14, 29, 204 Sodium, 105, 164, 190, 204 Sodium Fluoride, 105, 204 Soft tissue, 18, 127, 168, 204 Somatostatin, 122, 126, 204 Specialist, 152, 204 Species, 122, 164, 183, 199, 204, 206, 208, 209 Specificity, 66, 87, 95, 164, 204 Spectrum, 41, 205 Sperm, 165, 170, 205, 206 Spinal cord, 8, 170, 182, 189, 191, 194, 195, 203, 205 Spinal Cord Diseases, 182, 194, 205 Splenomegaly, 193, 205 Spondylitis, 47, 205 Stabilization, 121, 205 Staging, 202, 205 Stem Cells, 33, 205 Stenosis, 65, 205 Sterile, 166, 194, 205 Sterility, 185, 205 Steroid, 56, 174, 202, 205 Stimulus, 176, 185, 200, 205, 207 Stomach, 163, 175, 180, 183, 204, 205 Stool, 171, 184, 186, 205 Stress, 202, 205 Stricture, 205 Stroke, 8, 10, 11, 12, 14, 24, 25, 28, 42, 48, 49, 97, 98, 110, 111, 144, 169, 205 Stromal, 168, 205 Stromal Cells, 168, 205 Subacute, 34, 45, 50, 185, 205 Subcapsular, 91, 206 Subclinical, 185, 203, 206 Subcutaneous, 19, 181, 194, 206 Subiculum, 183, 206 Subspecies, 204, 206

Substance P, 189, 203, 206 Subtrochanteric, 114, 206 Supplementation, 35, 51, 56, 84, 104, 105, 109, 110, 111, 112, 113, 206 Suppositories, 180, 206 Suppression, 21, 41, 174, 206 Symphysis, 170, 198, 206 Synergistic, 41, 206 Systemic, 33, 81, 137, 140, 166, 168, 175, 185, 197, 206 T Talus, 206, 207 Tamoxifen, 49, 203, 206 Tarsal Bones, 169, 206 Telomere, 181, 206 Temporal, 183, 188, 206 Tendon, 169, 206 Testicles, 189, 193, 206 Testis, 178, 206 Testosterone, 19, 21, 28, 41, 51, 52, 109, 206 Tetany, 194, 206 Therapeutics, 29, 32, 59, 66, 114, 140, 207 Thigh, 52, 121, 179, 207 Thorax, 188, 207 Threshold, 24, 25, 178, 184, 207 Thrombosis, 67, 68, 198, 205, 207 Thymus, 10, 188, 207 Thyroid, 169, 194, 196, 207 Thyroid Gland, 194, 196, 207 Tibia, 34, 37, 97, 179, 207 Tibial Nerve, 203, 207 Tomography, 35, 207 Topical, 52, 207 Toxic, iv, 167, 207 Toxicity, 176, 207 Toxicology, 146, 207 Toxins, 165, 185, 207 Transfection, 167, 207 Transfusion, 24, 25, 72, 77, 207 Translation, 164, 208 Transplantation, 3, 134, 171, 188, 208 Trauma, 51, 61, 67, 68, 69, 83, 84, 88, 90, 93, 97, 104, 125, 175, 181, 191, 208 Tremor, 194, 208 Tricyclic, 73, 208 Tryptophan, 171, 203, 208 Type 2 diabetes, 4, 208 U Ulcer, 34, 98, 208 Urea, 41, 208 Uremia, 201, 208 Urethra, 198, 208

220

Hip Fracture

Urinary, 4, 98, 184, 208 Urine, 18, 48, 95, 167, 181, 184, 199, 208 Urolithiasis, 47, 208 Uterus, 170, 177, 180, 189, 193, 198, 208 V Vaccines, 197, 208, 209 Vacuoles, 177, 208 Vascular, 185, 196, 205, 207, 208 Vasomotor, 178, 208 Vein, 67, 165, 186, 192, 208 Venous, 49, 66, 70, 80, 86, 99, 168, 198, 208 Ventricle, 183, 184, 199, 209 Vertebrae, 205, 209 Vertebral, 18, 37, 51, 66, 78, 209 Veterinary Medicine, 145, 209 Viral, 24, 196, 209

Virus, 177, 180, 209 Visual Acuity, 31, 173, 209 Visual field, 195, 209 Vitamin D, 100, 107, 111, 202, 209 Vitro, 15, 209 Vivo, 15, 209 W Wakefulness, 175, 209 Weight-Bearing, 50, 59, 209 Withdrawal, 21, 175, 209 X Xenograft, 165, 209 X-ray, 8, 19, 29, 35, 36, 44, 51, 52, 69, 70, 124, 168, 172, 173, 188, 192, 200, 202, 209 Y Yeasts, 195, 209