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To determine whether abnormalities in heart rate (HR) were associated with long-term mortality in older, low-level care residents, 179 randomly selected persons aged 65 and older (mean, 83.2+/-7.0 [SD] years; 80% women) were prospectively assessed. At baseline, duplicate measurements of HR and blood pressure were recorded in the supine position and after standing. During the 5-year follow-up period, 97 (54%) participants died. Cox survival analysis revealed no association with total mortality when resting HR was analyzed as a continuous or categoric variable (or = 60, 61-89, and90 bpm). However, HRor = 90 bpm was associated with increased risk of dying in residents who used a walking aid (relative risk, 3.48; 95% confidence interval, 1.07-11.30; p=0.038). Postural HR change was not associated with mortality risk. The authors concluded that resting HR and postural change in HR are not significant predictors of 5-year mortality in older, low-level care residents, except in persons using a walking aid.

The Royal Chapel in the Time of the Habsburgs: Music and Court Ceremony in Early Modern Europe. Edited by Juan Jose Carreras and Bernardo Garcia. (Studies in Medieval and Renaissance Music.) Rochester, NY: Boydell Press, 2005. [viii, 402 p. ISBN 1-84383-139-2. $190.] Music examples, illustrations, bibliography, index. Spanish music, particularly that of the siglo d'oro, is finally beginning to receive serious attention by an international community of scholars and performers. For nonSpanish musicologists, the tenth Baroque Biennial Conference at the Universidad de la Rioja in summer 2002 was a critical opportunity for the exchange of ideas and symbolized the deepening integration of scholarship on Iberian music with broader musicological concerns. The present volume, originally published as La capilia real de los Atistrias (Madrid: Fundacion Carlos de Amberes, 2001) and now translated into English by Yolanda Acker and edited by Tess Knighton, is another crucial step in this direction, making a body of significant essays accessible to a broader audience. For readers more accustomed to scholarship on the Austrian branch of the Habsburgs the tide may be misleading at first glance, but the crucial distinction of "royal chapel" versus "imperial chapel" makes plain the Spanish focus. Collected and edited by Juan Jose Carreras and Bernardo Garcia, these essays now comprise the third installment of Studies in Medieval and Renaissance Music, and form a welcome companion to another collection of essays in the same series, Church Music of Fifteenth-Century Spain, edited by Kenneth Kreitner (Rochester, NY: Boydell Press, 2004). The present volume's methodological focus on the "chapel" as a comprehensive institution of worship and ceremony ensures its relevance well beyond the immediate interests of musicology or Spanish studies. As Andrew Wathey writes in his essay on the English royal chapel, a contextual view of chapels reminds us that while we may mine archival sources for evidence of composers' biographies or repertorial chronology, due attention to institutional structures, material perspectives (for example, the spatial geography of chapels), and politics may offer a richer outlook (pp. 25-27). Chapels shaped the behavior of those attending them through force of tradition and decorum; they represented the virtue of the monarch; and they could serve, at times, as platforms for political opposition (p. 246). While chapelmasters are naturally of great interest from a musical standpoint, it is worth remembering that the court preacher was often a far more pivotal figure. Francis Cerdan insists that preachers, in their role as transmitters and interpreters of the divine Word, could play powerful roles in the poli deal intrigues of the court; their sermons, furthermore, not only exalted royalty but also could mediate between the concerns of the ruling class and those of the masses (pp. 224-28). Placing chapels in a diachronic context reveals a fundamental, if uneven, transition from the itinerant chapel of the late Middle Ages to the fully institutional chapel of the early modern era. The court of Burgundy was largely responsible for the rise of a chapel featuring musicians in relatively stable roles in the fifteenth century; yet chapels were inherently volatile organizations, even into the early modern era (pp. 14-16). Herbert Seifert's essay illustrates the changing fortunes of the Austrian imperial chapel-note especially the radical reorganization and Italianization of the chapel under emperor Ferdinand II in 1619 (pp. 43-44)-while the pay records studied by Juan A. Sanchez Belen show that the Spanish royal chapel, the target of numerous reform measures in the late seventeenth century, was not on a stable financial footing until the reign of Philip V (Bourbon, 1700-1746; pp. 300-27). Nevertheless, the Burgundian example of a large and relatively well-endowed body of musicians exerted great influence throughout the period, particularly those rulers most immediately under the Burgundian spell like Charles V (1526-1566) and Philip II (1566-1598). …

Objectives: To evaluate which indices of blood pressure (BP) homeostasis are the strongest predictors of mortality in older low-level-care residents in long-term health facilities. Design: Prospective cohort study. Setting: Eight long-term healthcare facilities in Canberra, Australia. Participants: A total of 179 randomly selected semi-independent residents aged 65 and older (mean age±standard deviation 83.2±7.0; 80% women). Measurements: Baseline BP levels taken while lying, after standing for 1 and 3 minutes, and sitting before and 1 hour after meal intake were recorded, as well as demographic information, chronic medical conditions, medications, and all-cause mortality during follow-up. Postprandial hypotension (PPH) was defined as a fall in systolic BP (SBP) of 20 mmHg or more 1 hour postmeal while sitting. Orthostatic hypotension (OH) was defined as a fall in SBP of 20 mmHg or more or in diastolic BP (DBP) of 10 mmHg or more within 3 minutes of standing from a supine position. Hypertension was defined as BP greater than 160/90 mmHg at commencement of the study. Mean arterial pressure (MAP) and pulse pressure (PP) were calculated. Results: At baseline, 47% of participants had hypertension, 38% PPH, and 23% OH; PP was 70 mmHg or greater in 54%, and DBP was 65 mmHg or lower in 6%. Over 4.7 years, 97 (54%) participants died. Those who died were significantly older and more likely to have PPH (47% vs 28%) and atrial fibrillation (35% vs 17%) and a significantly greater decrease in BP after meal intake. Mortality rates in those with and without PPH were 145.0 and 98.5 per 1,000 person-years, respectively. Using multivariate Cox proportional hazards models after adjustment for age, sex, presence of atrial fibrillation, Parkinson's disease, and use of diuretics, PPH was the only BP parameter that significantly and independently predicted 4.7-year all-cause mortality (relative risk (RR)=1.79; 95% confidence interval (CI)=1.19−2.68; P=.005). Further adjustment for the presence of OH, hypertension, low resting BP, coronary artery disease, cerebrovascular disease, congestive heart failure, history of syncope, cognitive impairment, cancer, diabetes mellitus, chronic obstructive pulmonary disease, and history of smoking did not reveal any new statistically significant associations. There was a dose–response relationship between postprandial fall in SBP and mortality rates. Absolute postprandial SBP of 120 mmHg or less was also significantly associated with total mortality (RR=1.69, 95% CI=1.04−2.78; P=.04). Low DBP was also associated with increased mortality (RR=1.10, 95% CI=1.01−1.13; P=.03), although this association became nonsignificant in multivariate analysis. Conclusion: In older low-level-care residents, PPH is an independent predictor of all-cause mortality with no added predictive value explained by other BP indices: OH, hypertension, PP, MAP.

Objectives: To determine the incidence and consequences of falls in elderly people living in hostels, and the role of comorbidity, orthostatic hypotension and medications as risk factors for falls. Methods: Cross-sectional prevalence and event association was studied in eight aged-care hostels (Canberra, ACT, 1999) of 179 residents aged 65 years and older (83 ± 7 years (mean ± standard deviation), 80% women) independent in activities of daily living. History of falls and injuries on falling, comorbidity, medications and mobility data were obtained. Measurements of blood pressure and heart rate were made supine after waking from overnight sleep and after standing for 1 and 3 min. Results: Forty-three per cent of subjects had fallen in the last year (1.3 ± 2.6 falls per person per year) and 29% of these had sustained a fracture, 53% of fallers had recurrent falls. In multivariate analysis, four factors were associated independently with falling within a year: using a walking device, history of cancer, taking selective serotonin reuptake inhibitors (SSRI) and cigarette smoking. For recurrent falls, cerebrovascular disease and using nitrates were also independent risk factors. In univariate analysis, reversible inhibitors of monoamine oxidase and potassium-sparing diuretics were negatively associated with falls. There were no differences between fallers and non-fallers in blood pressure in supine and standing positions, although one-third of residents had orthostatic hypotension. Conclusions: Falls in elderly hostel residents are common and often have serious consequences. Living in an institution is associated with an increased risk of fractures. The study identified several novel potential risk factors for falls in this population: using a walking device, history of falls, presence of cancer, presence of cerebrovascular disease, taking SSRIs, taking nitrates and cigarette smoking. These can be used to identify hostel residents at high risk of falling who can then be targeted for monitoring, specific treatment and prevention strategies.

OBJECTIVE To report a case of acute myocardial infarction (AMI) following the use of albuterol (salbutamol) in a patient without preexisting coronary artery disease and to review the related literature. CASE SUMMARY An 84-year-old white woman with no history of cardiac disease was treated for an exacerbation of chronic obstructive pulmonary disease with albuterol 5 mg and ipratropium bromide 500 μg nebulized with oxygen; the albuterol was given in the same dose every 2 hours. Her respiratory condition improved, but soon after the sixth dose of albuterol, she developed increasing chest tightness. The electrocardiogram (ECG) showed ST segment elevation in the chest leads (V2,3) and, subsequently, the troponin I concentration and creatine kinase rose. Urgent coronary angiography showed smooth coronary arteries with no obstructive coronary artery disease or thrombosis. Left ventriculography showed anterior hypokinesia consistent with anterior myocardial injury. A subsequent echocardiogram also revealed normal left ventricular size but anterior, anteroseptal, and apical hypokinesia. An objective causality assessment revealed that albuterol had a probable likelihood of causing the AMI in this patient. DISCUSSION A MEDLINE search (1966–February 2004) revealed 6 other case reports of AMI associated with albuterol treatment. The possible pathogenesis of albuterol-induced myocardial necrosis includes activation of cardiac and peripheral β2-adrenoceptors, inducing positive chronotropic and inotropic effects and vasodilation with coronary blood flow redistribution. Albuterol can also cause hypokalemia and other metabolic and electrical changes, including prolonged QT interval. These effects may be especially detrimental in patients with hypoxia, hypercapnea, and preexisting heart diseases. CONCLUSIONS Although myocardial injury is a rare complication following albuterol therapy, clinicians should use high-dose β2 agonists with caution. Close monitoring of ECG and metabolic changes is recommended before early repeated high doses are administered.

Objective: To describe a case of delirium associated with use of metoprolol and to analyse 24 such cases including 22 cases reported to Australian Adverse Drug Reaction Advisory Committee and one case previously published (S. Ahmad, Am Fam Physician, 1991;44:1142, 1144). Case Summary: An 89 year old caucasian man with an acute coronary syndrome who had no psychiatric history and no infections, brain injury, stroke, metabolic nor neoplastic disease developed delirium after two small doses of metoprolol (25 mg). The delirium disappeared within 20 hours after metoprolol was ceased, despite continuing all other medications. The Combined Series: Of 24 patients (12 women, mean age 71.8 years), 83% were older than 60 years. The duration of therapy before onset of delirium in 14 (58%) subjects was within one week; 23 of 24 patients were receiving therapeutic amounts of the drug (25–200 mg/day). Clinical features included confusion/disorientation in all subjects, agitation in 13, aggression in 6, visual hallucinations in 7, auditory hallucinations in 1, paranoid delusions in 3, vivid dreams in 2 and language disturbances in 3 persons. Bradycardia was reported in 4 cases, hypotension in 2, fatigue/tiredness in 3, Raynaud's phenomenon in 1 and skin rash in 1 patient. Discussion: The mechanism of metoprolol-induced delirium is unclear. It could be due to impairment of hepatic metabolism (especially in the ageing liver) and complex neurotransmitter-related effects on brain beta-adrenoceptors and serotonin (5-HT) receptors. Conclusions: Physicians should be aware that metoprolol, a widely used beta-blocker, may rarely cause delirium, especially in the elderly population.

In Catholic regions, music and sound not only aurally decorated the eucharistic ritual itself, but they were also deployed as a means of representing the triumph of eucharistic ideology over its confessional antagonists. This chapter explores the aural dimensions of eucharistic culture in several facets, beginning with the role of music in medieval Masses and developments in eucharistic music in the age of Reformation and Counter-Reformation. The post-Tridentine church placed a marked emphasis on eucharistic culture and music, as the celebrant's physical elevation of the host and chalice increasingly became the moment for significant music. Composers in Catholic lands, especially those in the confessional borderlands north of the Alps, ever more frequently set eucharistic texts for liturgy and devotion. This chapter focuses more intently on eucharistic music in the confessional borderlands of central Europe, where the theological stakes of eucharistic culture were arguably the greatest. Keywords: eucharistic culture; eucharistic music; Reformation

In the late 16th and early 17th centuries, the city government of Augsburg, Germany, struggled to maintain religious peace as the confessional boundaries between its Catholic and Protestant communities hardened. As tensions gradually rose, city officials feared and scrutinized the disruptive potential of the psalms and chorales sung by Augsburg9s Protestant majority. Those suspected of owning, singing, or distributing inflammatory songs were subject to imprisonment, interrogation, torture, and exile. When an Imperial decree established a fully Catholic city government in March 1629, the authorities tightened this scrutiny, banning Protestant singing entirely in public and private and using a network of informants to catch violators. A remarkably well-preserved collection of criminal interrogation records in Augsburg dramatizes city officials9 concern about religious song and their attempts to restrict its cultivation through coercive measures. These records, which preserve the testimony of suspects and witnesses as well as original evidence (such as manuscript or printed songs), show the ways in which local authorities tried to control singing that they felt threatened the public peace. At the same time, these sources give us unparalleled insight into the production, performance, and circulation of religious songs. Although the interrogations reveal much about how and where songs——often contrafacta of well-known psalms or chorales——were written and performed, the authorities were especially intent on finding out how they originated, who bought, sold, and sang them, and why. These exchanges between interrogators and suspects provide a starting point for an analysis of the relationship between singing, religion, and criminality in an early modern urban environment.

The extensive use of selective histamine H2 receptor antagonists provides a unique opportunity to describe very rare adverse drug reactions. Although mild elevation of serum creatinine level following the administration of cimetidine is relatively common, acute interstitial nephritis (AIN) is a rare hypersensitivity reaction. There have been 25 published reports of AIN associated with H2 antagonist therapy and we also identified 16 cases from the Australian Adverse Drug Reaction Advisory Committee (ADRAC) database. AIN was reported most commonly following cimetidine administration. AIN was supported by renal biopsy in 28 patients and by rechallenge in 6. H2 antagonist-induced AIN was more commonly reported in men older than 50 years. In the majority of cases the onset was within 2 weeks of initiation of therapy (1 day to 11 months). The clinical manifestations were nonspecific including sterile pyuria, elevated erythrocyte sedimentation rate, fatigue, proteinuria and leucocytosis whereas rash, arthralgia and flank pain were rarely reported. There were 170 cases of hepatotoxicity following H2 antagonist administration reported to ADRAC. These were more common following ranitidine and included cholestatic, hepatocellular and mixed reactions. Hepatotoxicity was proven following liver biopsy in several cases published in the literature and in 15 cases reported to ADRAC. Hepatotoxicity recurred upon rechallenge in 6 cases. Generally, renal and hepatic adverse effects resolved quickly after cessation of H2 antagonist therapy and did not require specific treatment. Nephrotoxicity and hepatotoxicity following administration of an H2 antagonist is rare and a high index of suspicion is necessary for early detection. Now that many H2 antagonists are available over the counter, awareness of these conditions and early detection with cessation of H2 antagonist therapy would appear paramount.

Heinrich Schutz. Cantiones sacrae 1625: Lateinische Motetten fur vier Stimmen und Basso continuo. Neuausgabe von Heide Volckmar-Waschk. Kassel: Barenreiter, 2004. (Neue Ausgabe samtlicher Werke, 8/9.) [Pref., Ger., Eng., p. vii-xii; facsims., p. xiii-xvii; score, 204 p.; Krit. Bericht, p. 205-18; Ger. trans. of the motet texts, p. 219-21. Cloth. ISMN M-00649773-7; Barenreiter-Ausgabe 5961. euro130.] Heinrich Schutz. Symphoniae sacrae III (1650): Die Konzerte zu sieben Stimmen (Nr. 15-21). Herausgegeben von Werner Breig. Kassel: Barenreiter, 2002. (Neue Ausgabe samtlicher Werke, 21.) [Pref., Ger., Eng., p. vii-xvii; facsims., p. xix-xxii; score, 197 p.; Krit. Bericht, p. 199-209; overview of the facsimile reproductions in vols. 18-21, p. 210. Cloth. ISMN M-006-44886-9; Barenreiter-Ausgabe 4474. euro131.] Although the music of Heinrich Schutz (1585-1672) has been relatively well served in modern editions-at least in comparison to his more obscure seventeenth-century German contemporaries-a complete edition serving the needs of both scholars and performers has been slow in coming. In 1885, Philipp Spitta brought out the first volume of Schutz's Samtliche Werke (Leipzig: Breitkopf & Hartel), a project that would only see completion in the hands of Arnold Schering and Heinrich Spitta in 1927 (the entire set was reprinted by Breitkopf & Hartel in 1968). Spitta remained relatively faithful to the appearance of Schutz's notation, although his retention of the original clefs made these volumes rather unappealing to many performers. The editors of the earlier volumes of the Neue Ausgabe samtlicher Werke (Kassel: Barenreiter, 1955-) demonstrated somewhat more concern with the needs of performance, using modern clefs exclusively; however, scholars and many performers can be forgiven for their dismay at the frequent, clumsy transpositions of the music into remote keys, presumably for the comfort of modern SATB choirs. Gunter Graulich's Stuttgarter SchutzAusgabe, published originally by Hanssler but now in the hands of Carus-Verlag in Stuttgart, showed some promise in balancing the needs of research and performance, but since its inception in 1971, only a handful of volumes have appeared, with uncertain prospects for its continuation. Scholars and performers will even more enthusiastically welcome the final installment of Werner Breig's four-part edition of the third book of Symphoniae sacrae (1650), a collection of the greatest importance in Schutz's oeuvre and one formerly available only in the old compete edition. The exigencies of the Thirty Years War, with its attendant pestilence, famine, and economic collapse, had discouraged Schutz from publishing music on the grand scale of the Psalmen Davids (1619), but he seems to have greeted the Peace of Westphalia (1648) with an even more opulent collection: indeed it is difficult not to hear a measure of relief and hope in the repeated strains of "und verleihe immerdar Friede" (and grant us eternal peace) that form the central section (mm. 87-113) of the concluding concerto, "Nun danket alle Gott" (no. 21). The latter is one of seven works found in the present volume (nos. 15-21, SWV 412-18), scored for seven voices and obbligato instruments in various combinations and with (mostly) optional vocal and instrumental complementa. As Breig stresses in his fine general preface, Schutz's own description of these works as scored for eight voices obscures their remarkable diversity: each concerto, indeed, calls for eight obbligato parts-either six voices and two instruments or five voices and three instruments-but the complementum invariably adds considerable depth and musical interest, and is all but required for the full effect of no. …

Aims The objective of this study is (i) to evaluate trends in the incidence rates of stroke survivors aged 60 years and older over a 11-year period in the Australian Capital Territory (ACT) and (ii) to forecast future trends in Australia until 2051. Methods Analysis of age- and sex-specific standardized incidence rates of older first-ever stroke survivors in ACT from 1999-2000 to 2009-2010 and projections of number of stroke survivors (NSS) in 2021 and 2051 using 2 models based only on (i) demographic changes and (ii) assuming changing of both incidence rates and demography. Results In the ACT in the first decade of the 21st century, the absolute numbers and age-adjusted standardized incidence rates of stroke survivors (measured as a function of age and period) increased among both men and women aged 60 years or older. The trend toward increased survival rates in both sexes was driven mainly by population aging, whereas the effect of stroke year was more pronounced in men compared with women. The absolute NSS (and the financial burden to the society) in Australia is predicted to increase by 35.5%-59.3% in 2021 compared with 2011 and by 1.6- to 4.6-fold in 2051 if current only demographic (first number) or both demographic and incidence trends (second number) continue. Conclusions Our study demonstrates favorable trends in stroke survivor rates in Australia in the first decade of the new millennium and projects in the foreseeable future significant increases in the absolute numbers of older stroke survivors, especially among those aged 70 years or older and men.

First observations of intense magnetic scattering in GGG crystals and several organic liquids are compared with quantum theory of quadratic magneto-electric nonlinearities on transitions of atoms/molecules, with important implications for energy conversion and high-frequency magnetism.

Objective. To assess the prevalence, clinical and laboratory characteristics, and short-term outcomes of poststroke hip fracture (HF).Methods. A cross-sectional study of 761 consecutive patients aged ≥60 years (82.3±8.8years; 75% females) with osteoporotic HF.Results. The prevalence of poststroke HF was 13.1% occurring on average 2.4 years after the stroke. The poststroke group compared to the rest of the cohort had a higher proportion of women, subjects with dementia, history of TIA, hypertension, coronary artery disease, secondary hyperparathyroidism, higher serum vitamin B12 levels (>350 pmol/L), walking aid users, and living in residential care facilities. The majority of poststroke HF patients had vitamin D insufficiency (68%) and excess bone resorption (90%). This group had a 3-fold higher incidence of postoperative myocardial injury and need for institutionalisation. In multivariate analysis, independent indicators of poststroke HF were female sex (OR 3.6), history of TIA (OR 5.2), dementia (OR 4.1), hypertension (OR 3.2), use of walking aid (OR 2.5), and higher vitamin B12 level (OR 2.3). Only 15% of poststroke patients received antiosteoporotic therapy prior to HF.Conclusions. Approximately one in seven HFs occurs in older stroke survivors and are associated with poorer outcomes. Early implementation of fracture prevention strategies is needed.

Intense magnetic dipole scattering is induced in garnets and compared with dressed state theory of quadratic magneto-electric nonlinearities on L=0 to L=1 transitions of atoms/molecules, confirming important implications for energy conversion and high-frequency transverse magnetism.

Linearly-polarized magnetic dipole (MD) scattering as intense as Rayleigh scattering is reported in transparent garnet crystals and fused quartz through a magneto-electric interaction at the molecular level. Radiation patterns in quartz show the strongest optical magnetization relative to electric polarization ever reported. As shown in an accompanying paper, quantitative agreement is achieved with a strong-field, fully-quantized theory of magneto-electric (M-E) interactions in molecular media. The conclusion is reached that magnetic torque enables 2-photon resonance in an EH* process that excites molecular librations and accounts for the observed upper limit on magnetization. Second-order M-E dynamics can also account for unpolarized scattering from high-frequency librations previously ascribed to first-order collision-induced or third-order, all-electric processes.

Background Data on clinical characteristics and outcomes in regard to hip fracture (HF) type are controversial. This study aimed to evaluate whether clinical and laboratory predictors of poorer outcomes differ by HF type. Methods Prospective evaluation of 761 consecutively admitted patients (mean age 82.3 ± 8.8 years; 74.9% women) with low-trauma non-pathological HF. Clinical characteristics and short-term outcomes were recorded. Haematological, renal, liver and thyroid status, C-reactive protein, cardiac troponin I, serum 25(OH) vitamin D, PTH, leptin, adiponectin and resistin were determined. Results The cervical compared to the tronchanteric HF group was younger, have higher mean haemoglobin, albumin, adiponectin and resistin and lower PTH levels (all P < 0.05). In-hospital mortality, length of hospital stay (LOS), incidence of post-operative myocardial injury and need of institutionalisation were similar in both groups. Multivariate analysis revealed as independent predictors for in-hospital death in patient with cervical HF male sex, hyperparathyroidism and lower leptin levels, while in patients with trochanteric HF only hyperparathyroidism; for post-operative myocardial injury dementia, smoking and renal impairment in the former group and coronary artery disease (CAD), hyperparathyroidism and hypoleptinaemia in the latter; for LOS > 20 days CAD, and age > 75 years and hyperparathyroidism, respectively. Need of institutionalisation was predicted by age > 75 years and dementia in both groups and also by hypovitaminosis D in the cervical and by hyperparathyroidism in the trochanteric HF. Conclusions Clinical characteristics and incidence of poorer short-term outcomes in the two main HF types are rather similar but risk factors for certain outcomes are site-specific reflecting differences in underlying mechanisms.

Introduction. Experiments on genetically modified animals have discovered a complex cross-regulation between adipokines (leptin, adiponectin) and osteocalcin. The relationships between these molecules in human osteoporosis are still unclear. We evaluated the hypothesis of a bidirectional link between adipokines and osteocalcin.Materials and Methods. In a cross-sectional study of 294 older patients with osteoporotic hip fracture, we estimated serum concentrations of leptin, adiponectin, resistin, osteocalcin, parameters of mineral metabolism, and renal function.Results. After adjustment for multiple potential confounders, serum osteocalcin concentration was inversely associated with resistin and positively with leptin, leptin/resistin ratio, and adiponectin/resistin ratio. In multivariate regression models, osteocalcin was an independent predictor of serum leptin, resistin, leptin/resistin, and adiponectin/resistin ratios.Conclusions. Our data support the bidirectional regulation between osteocalcin and adipokines, but contrary to the genetically modified animal models, in older subjects with osteoporotic hip fracture, serum osteocalcin is positively associated with leptin and inversely with resistin.

Proper patterning and growth of oral structures including teeth, tongue, and palate rely on epithelial–mesenchymal interactions involving coordinated regulation of signal transduction. Understanding molecular mechanisms underpinning oral–facial development will provide novel insights into the etiology of common congenital defects such as cleft palate. In this study, we report that ablating Wnt signaling in the oral epithelium blocks the formation of palatal rugae, which are a set of specialized ectodermal appendages serving as Shh signaling centers during development and niches for sensory cells and possibly neural crest related stem cells in adults. Lack of rugae is also associated with retarded anteroposterior extension of the hard palate and precocious mid-line fusion. These data implicate an obligatory role for canonical Wnt signaling in rugae development. Based on this complex phenotype, we propose that the sequential addition of rugae and its morphogen Shh, is intrinsically coupled to the elongation of the hard palate, and is critical for modulating the growth orientation of palatal shelves. In addition, we observe a unique cleft palate phenotype at the anterior end of the secondary palate, which is likely caused by the severely underdeveloped primary palate in these mutants. Last but not least, we also discover that both Wnt and Shh signalings are essential for tongue development. We provide genetic evidence that disruption of either signaling pathway results in severe microglossia. Altogether, we demonstrate a dynamic role for Wnt-β-Catenin signaling in the development of the oral apparatus.

We assess the electoral impact of the 2009 UK parliamentary expenses scandal, focusing on whether MPs who were implicated in the scandal retired at a higher rate or received lower electoral support in the 2010 general election than those who were not. We nd that implication in the scandal led to both a higher retirement rate and a lower vote share for implicated MPs, but that retirement decisions and voting decisions seem to have depended on different factors: MPs who were more profligate expensers retired at a higher rate, while those whose abuses were viewed as more scandalous were punished by voters. Our overall results show that the expenses scandal had a modest impact on constituency-level outcomes compared to expectations and to similar cases in other countries; this is consistent with existing work on British voters as well as the broader insight that voters' ability to punish corrupt behavior depends on institutional factors like the electoral system and separation of powers.

Performing artists develop not only the skin problems of the population at large, but also problems that are a direct result of their work. We have searched the medical literature to identify the dermatologic problems of performing artists and any treatments helpful for these problems. Individual disorders are organized according to causative factors to allow for rapid reference.

Johann Leisentrit's Geistliche Lieder und Psalmen, 156 7: Hymnody of the Counter-Reformation in Germany. By Richard Wetzel and Erika Heitmeyer. (Madison, NJ: Fairleigh Dickinson University Press; co-published with Rowman and Littlefield, Lanham, MD. 2013. Pp. xi, 353. $95.00. ISBN 978-1-61147-550-0.)The history of Catholic hymnody in the wake of the Reformation has only occasionally been an object of serious research. Wilhelm Baumker's Das katholische deutsche Kirchenlied (Freiburg, 1883-1911) provided a solid basis for later work, but thorough studies of the repertory have been rare indeed, with prominent exceptions in the work of Walther Lipphardt (1963) and Dietz-Rudiger Moser (1981). Quite plausibly this is a consequence of confessionalist streaks in the tradition of German hymnology, which stressed the unique and revolutionary character of Lutheran hymnody and viewed its Catholic counterpart as a late, grudging, and spiritually impoverished reaction. There is little doubt that the Catholic production of vernacular hymnody was modest in scope compared to the Lutheran, but nevertheless it formed a significant and underestimated thread in the vibrant fabric of Catholic reform and renewal from the mid-sixteenth century onward. There is no better place to start than with the subject of Richard Wetzel and Erika Heitmeyer's new book, the Geistliche Lieder und Psalmen (Budissin, 1567) by Johannes Leisentrit, a prominent Catholic ecclesiastic and administrator based in the confessionally contested region of Lusatia. Leisentrit's songbook was not the first of its kind in the German-speaking lands, but it was by far the most comprehensive of its time, offering a wide range of pre- and post-Reformation songs for use in Catholic worship and devotion. The Geistliche Lieder und Psalmen had clear confessionalist aims, but Leisentrit's goal was less to demonize Lutherans than to edify his Catholic flock; to this end, he drew liberally on non-Catholic songs that he freely adapted to fit his theological aims.In part I of Wetzel and Heitmeyer's book, they provide an extensive introduction to Leisentrit's tome, providing information on Leisentrit's biography and his relation to Catholic reform (chapter 1); early-sixteenth-century hymnals, both Protestant and Catholic, that presented him with models for his own collection (chapter 2); the sources for Leisentrit's texts and the nature of the book's paratextual dedications, commendations, and instructional texts (chapter 3); Leisentrit's melodies, considered from the standpoint of their sources as well as their projection of mode and style (chapter 4); and the illustrations, borders, and symbols that communicated his theological messages to audiences both literate and illiterate (chapter 5). …

Alex Fisher1, Jodie Martin2, Wichat Srikusalanukul2, Michael Davis11Department of Geriatric Medicine, The Canberra Hospital, Canberra, ACT, Australia; 2Australian National University Medical School, Canberra, ACT, AustraliaAim: The objective of this article is to evaluate the relationship between the changes in prescriptions of antiosteoporotic drugs (mainly the rapid fall in the use of bisphosphonates [BPs]) and standardized hip fracture (HF) rates over the period 2005–2008 in the Australian Capital Territory (ACT).Methods: Annual sex- and age-specific HF rates (per 100,000 population) were determined and standardized using the Australian 2006 population census. Data on the annual prescriptions of BPs (mainly alendronate and risedronate), strontium ranelate, and hormone replacement therapy were obtained from the Australian Pharmaceutical Benefits Scheme (PBS) and Repatriation Australian Pharmaceutical Benefits Scheme (RPBS) databases.Results: In the ACT, the peak annual number of prescriptions for BPs was observed in 2006. Following reports linking osteonecrosis of the jaw with BP use, the number of BP prescriptions dropped by 14% in 2007–2008 compared with 2005, when the lowest HF rates were recorded. The reduction in BP prescriptions coincided with increased HF rates in females in 2007 (+22.6%) and in 2008 (+25.2%) compared with 2005; in males, HF incidence declined by 6.6% and 16.7%, respectively. The proportion of filled prescriptions for strontium ranelate, risedronate, and alendronate in 2007–2008 was 1:8.4:15.5, indicating that BPs were the dominant antiosteoporotic drugs. There was an inverse statistically significant relationship between the total annual number of BP prescriptions and standardized HF incidence rates for the 10-year period 1999–2008.Conclusion: Although currently there is no clear understanding of factors contributing to changing HF epidemiology, the available evidence suggests that much of the decline in HF rates is due to the use of BPs. The fall in the use of BPs is associated with an increase in HF rates in females, indicating that BPs should still be considered the first-line medications for the prevention and treatment of osteoporosis. Our results need to be confirmed in other populations and countries.Keywords: bisphosphonate use, hip fracture, epidemiology

Cross-disciplinary perspectives on responses to material and spiritual loss in early modern Germany trace how individuals and communities registered, coped with, and made sense of deprivation through a spectrum of activities, often turning loss into gain and acquiring agency.

Objectives To determine the relationship of serum resistin concentrations to biochemical determinants of bone metabolism, comorbidity and outcomes in patients with hip fracture (HF). Methods In 256 consecutive patients (mean age 81.9 ± 7.8 years; 71.1% women) serum levels of resistin (determined by ELISA), biochemical parameters of bone turnover and mineral metabolism as well as routine haematological and biochemical parameters were measured. Clinical data were recorded prospectively. Results In multivariate analysis cervical HF (OR = 1.81; 95% CI 1.05–3.11), diabetes (OR = 2.60; 95% CI 1.23–5.51) and history of stroke (OR = 2.67; 95% CI 1.17–6.13) were significant independent predictors of higher resistin levels (⩾16.26 ng/ml, median value). The independent correlates of serum resistin levels in patients with cervical HF were serum osteocalcin and magnesium (both negatively associated) and in patients with trochanteric HF, serum PTH, calcium and age (all positively associated). Resistin and glomerular filtration rate were the only independent (inverse) predictors of serum osteocalcin. Resistin levels on admission did not predict short-term outcomes. Conclusions In older patients with HF there is a significant association of higher resistin levels with cervical fracture, type 2 diabetes and history of stroke, which is partly influenced by the reciprocal interaction between resistin and osteocalcin. However, the design of the study does not prove causality and further prospective studies are needed to clarify these relationships.

In recent years we have learned much about musical culture behind the walls of early modern enclosed convents, spaces in which liturgical and devotional music attracted both popular interest and ecclesiastical censure in the patriarchal atmosphere of Tridentine reform. Secularization in the early nineteenth century meant the uneven preservation of records from religious institutions, especially female convents. Munich's three houses of Franciscan tertiary nuns - the Putrich house of St. Christophorus, the Ridler house of St. Johannes auf der Stiege, and the Poor Clares of St. Jakob am Anger - had been founded in the late thirteenth century and survived into the early modern era as relatively open communities with a charitable focus. In Counter-Reformation Bavaria, virginal nuns came to be seen as guarantors and symbols of God's favor toward an ideal Catholic state; their potency in this role depended on their very removal from the public sphere. Keywords: counter-reformation Munich; Franciscan convents; musical culture; post-Tridentine claustration

Increasing numbers of physicians, nurses, and dentists are becoming allergic to rubber (latex) gloves because of the increase in the use of such gloves with the advent of acquired immunodeficiency syndrome (AIDS). Seven percent of such personnel now acquire a delayed allergic, eczematous contact dermatitis, whereas 3% show an immediate allergic urticarial reaction to the aqueous protein fraction of latex obtained from the rubber tree Heveu brasiliensis. This urticarial reaction may be accompanied by anaphylaxis. Sensitized individuals give positive scratch and prick skin tests and in vitro positive RAST and IgE reactions. Iatrogenic and intraoperative contact urticaria and anaphylaxis as a result of patients reacting to rubber gloves worn by physicians and surgeons are being reported with more frequency. In March of 1991 the Food and Drug Administration (FDA) alerted health care professionals about the potential of severe allergic reactions to medical devices made of latex. These include surgical and examination gloves, catheters, intubation tubes, anesthesia masks, and dental dams. Individuals sensitive to rubber are also allergic to rubber condoms. Hospital personnel and patients sensi

To determine whether serum 25(OH)D and/or PTH levels in older patients with hip fracture (HF) could predict short-term clinical outcomes, we conducted a prospective observational study of 287 consecutive HF patients (mean age 81.9 + or - 7.5 [SD] years, 72% females). The prevalence of vitamin D inadequacy (25[OH]D80 nmol/l) was 97.1%, that of vitamin D deficiency (25[OH]D50 nmol/l) was 79.8%, and that of elevated PTH level (6.8 pmol/l) was 35.5%. After adjustment for age and sex, PTH was significantly associated with in-hospital mortality (OR = 1.12, 95% CI 10.5-1.20, P0.001), myocardial injury (OR = 1.05, 95% CI 1.03-1.15, P = 0.002), prolonged length of stay (LOSor = 20 days; OR = 1.05, 95% CI 1.01-1.06, P = 0.044), and being discharged to institutional care (OR = 1.07, 95% CI 1.01-1.18, P = 0.48). Secondary hyperparathyroidism (SHPT), but not vitamin D deficiency, was associated with older age, a higher prevalence of trochanteric fracture, coronary artery disease, hypertension, previous stroke, renal impairment, increased levels of serum osteocalcin, bone-specific alkaline phosphatase, and adiponectin as well as a significantly higher in-hospital mortality (11.8 vs. 0.54%, P = 0.001), perioperative myocardial injury (32.7 vs. 22.5%, P = 0.043), LOSor = 20 days (40.2 vs. 26.9%, P = 0.017), and being discharged to institutional care (29.5 vs. 14.6%, P = 0.019). In multivariate regression analyses, SHPT was strongly associated with in-hospital mortality and LOSor = 20 days. We conclude that elevated PTH (but not vitamin D deficiency per se) is a strong independent predictor of poor outcomes in older patients.

The purposes of this study were to analyse trends in hip fracture (HF) epidemiology over a 13-year period (1994–2007) in the Australian Capital Territory (ACT), to assess the potential impact of concurrent changes in hormone replacement therapy (HRT) and bisphosphonate use and to present a new prediction of HFs in Australia up to 2021. Annual sex- and age-specific incidence rates (per 100,000 population) were determined and standardized using the Australian 2006 population. The projected number of HFs was estimated by two models applying age- and sex-specific HF rates averaged for 2002–2006 (model 1) or continuously changing as observed in this period (model 2, Poisson regression) to the projected population. In 2006 compared to 2001, the population ≥ 60 years in the ACT increased by 19.7%. Over the last 5 years the average annual incidence HF rate compared to the previous 3-year period decreased in females ≥ 60 years of age by 28.3%. Between 2001 and 2006 the number of prescriptions for HRT dispensed in the ACT declined by 54.6, while the number of prescriptions for bisphosphonate increased by 245%, accompanied by a decline in standardized incidence of HF rates of 36.4%, mainly in women (42.1%). This represents an annual cost for bisphosphonates per one prevented HF, of $A45,250 or $A576 person/year. Compared to 2006 the total number of HFs in Australia according to model 1 will increase in 2011 by 20.1% and in 2021 by 58.8%, but according to model 2 will decrease by 15.5% in 2011 and 27.5% in 2021. Our data suggest that the previously predicted rising trend in HFs in elderly women reversed, but did not so for men. This was coincident with a significant fall in HRT use and increased prescribing of bisphosphonates, which is cost-effective. However caution should be used in attributing causation as this is an ecological study. If trends in HF observed in 2002–2006 continue, the absolute number of HFs in Australia in 2011–2021 will stabilise or decline (which is more likely), despite the rapid ageing of the population.

More than 1100 patients were tested with methylchloroisothiazolinone-methylisothiazolinone, 100 ppm, in aqueous and petrolatum-based patch test materials from 1985 to 1987 by members of the North American Contact Dermatitis Group. Thirteen reactions to the aqueous materials and 10 to the petrolatum-based materials were observed. Irritant reactions were infrequent, and about half the reactions were deemed relevant. From 1984 to 1985, patch tests with this substance at a concentration of 250 ppm in petrolatum were conducted. Thirteen persons were identified as allergic, but three others were sensitized by the patch test procedure. Sensitization as not observed in tests with aqueous or petrolatum-based substance at a concentration of 100 ppm, and this concentration appears to be the best compromise between safety and sensitive detection of allergy. Use tests are helpful but not infallible as a guide in establishing relevance with methylchloroisothiazolinone-methylisothiazolinone. Wash-off products are frequently well tolerated by patients with positive reactions to this substance.

This study examined the relationships between myocardial injury as indicated by serum cardiac troponin I (cTnI) elevation, 25 hydroxyvitamin D [25(OH)D], and PTH status and biochemical markers of bone metabolism in older patients with hip fracture (HF). In 238 consecutive patients (mean age 81.9 +/- 7.8 yr; 72% women) with low trauma HF, serum concentrations of cTnI, 25(OH)D, PTH, calcium, phosphorus, magnesium, osteocalcin, bone-specific alkaline phosphatase (BAP), and urine excretion of free deoxypyridinoline (DPD) and N-terminal cross-linked teleopeptide of type I collagen (NTx) were measured and clinical data were collected prospectively. Myocardial injury (cTnI0.06 microg/L) presented in 29%, 25(OH)D deficiency (50 nmol/L) in 81.6%, elevated PTH (6.5 pmol/L) in 53%, and excessive bone resorption (increased DPD and/or NTx excretion) in 93.7%. Multivariate logistic regression showed that elevated serum PTH level is a major predictor of peri-operative myocardial injury (OR = 2.13; 95% CI 1.01-4.51; p = 0.049) and in-hospital all-cause mortality (OR = 18.5; 95% CI 2.0-72.3; p = 0.010), independent of age, sex, 25(OH)D status, and comorbidities. The degree of hyperparathyroidism was associated with the risk of cTnI elevation and the mortality rate. In cTnI positive patients, PTH levels correlated with cTnI concentrations (r = 0.28; p = 0.026) and urine DPD exretion (r = 0.37; p = 0.004). These results suggest for the first time that in older patients with HF, elevated PTH level is associated with peri-operative myocardial injury and in-hospital all-cause mortality, and that elevated PTH level contributes to both disturbed bone metabolism and poor outcomes.