bluuebunny/crossref_metadata_2025 huggingface dataset:
Functional and Cognitive Consequences of Silent Stroke Discovered Using Brain Magnetic Resonance Imaging in an Elderly Population
Authors: Schmidt Wolf‐Peter , Roesler Andreas , Kretzschmar Konrad , Ladwig Karl‐Heinz , Junker Ralf , Berger Klaus
Published: June 2004

Objectives: To evaluate the prevalence of silent stroke and its associated consequences on physical, cognitive, and emotional functioning in an elderly population.

Design: Population‐based cross‐sectional survey.

Setting: The Memory and Morbidity in Augsburg Elderly project in the Augsburg region of southern Germany.

Participants: Two hundred sixty‐seven community‐dwelling persons aged 65 to 83.

Measurements: The presence of silent stroke was determined using magnetic resonance imaging brain scan and a single question asking for physician‐diagnosed stroke in each participant. The health effect of silent stroke was assessed using rating scales for self‐perceived health status (36‐item short‐form health survey), activities of daily living (ADLs) and instrumental ADLs, cognitive function, and depression (Center for Epidemiologic Studies Depression scale).

Results: Just fewer than 13% (12.7%) of participants were affected by silent stroke. Silent stroke was associated with a history of hypertension, heart surgery, and elevated C‐reactive protein. Individuals with silent stroke showed impairments on the Mini‐Mental State Examination test and in the cognitive domains of memory, procedural speed, and motor performance.

Conclusion: The presence of silent stroke has a considerable effect on cognitive performance in those affected. Determining the presence of silent stroke using brain imaging may contribute to identifying individuals at risk for developing gradual neurological deficits.
Physician Recognition of Cognitive Impairment: Evaluating the Need for Improvement
Authors: Chodosh Joshua , Petitti Diana B. , Elliott Marc , Hays Ron D. , Crooks Valerie C. , Reuben David B. , Galen Buckwalter J. , Wenger Neil
Published: June 2004

Objectives: To assess physician recognition of dementia and cognitive impairment, compare recognition with documentation, and identify physician and patient factors associated with recognition.

Design: Survey of physicians and review of medical records.

Setting: Health maintenance organization in southern California.

Participants: Seven hundred twenty‐nine physicians who provided care for women participating in a cohort study of memory (Women's Memory Study).

Measurements: Percentage of patients with dementia or cognitive impairment (using the Telephone Interview of Cognitive Status supplemented by the Telephone Dementia Questionnaire) recognized by physicians. Relationship between physician recognition and patient characteristics and physician demographics, practice characteristics, training, knowledge, and attitudes about dementia.

Results: Physicians (n=365) correctly identified 81% of patients with dementia and 44% of patients with cognitive impairment without definite dementia. Medical records documented cognitive impairment in 83% of patients with dementia and 26% of patients with cognitive impairment without definite dementia. In a multivariable model, physicians with geriatric credentials (defined as geriatric fellowship experience and/or the certificate of added qualifications) recognized cognitive impairment more often than did those without (risk ratio (RR)=1.56, 95% confidence interval (CI)=1.04–1.66). Physicians were more likely to recognize cognitive impairment in patients with a history of depression treatment (RR=1.3, 95% CI=1.03–1.45) or stroke (RR=1.37, 95% CI=1.04–1.45) and less likely to recognize impairment in patients with cognitive impairment without definite dementia than in those with dementia (RR=0.46, 95% CI=0.23–0.72) and in patients with a prior hospitalization for myocardial infarction (RR=0.37, 95% CI=0.09–0.88) or cancer (RR=0.49, 95% CI=0.18–0.90).

Conclusion: Medical record documentation reflects physician recognition of dementia, yet physicians are aware of, but have not documented, many patients with milder cognitive impairment. Physicians are unaware of cognitive impairment in more than 40% of their cognitively impaired patients. Additional geriatrics training may promote recognition, but systems solutions are needed to improve recognition critical to provision of emerging therapies for early dementia.
Cognitive Deficits and the Course of Major Depression in a Cohort of Middle‐Aged and Older Community‐Dwelling Adults
Authors: Mojtabai Ramin , Olfson Mark
Published: June 2004

Objectives:To examine associations between cognitive deficits and persistent significant depressive symptoms at baseline and 2‐ and 4‐year follow‐ups in a sample of community‐dwelling middle‐aged and older adults.

Design:Prospective cohort study.

Setting:A U.S. national prospective cohort study of middle‐aged and older adults, the Health and Retirement Study.

Participants:A sample of 661 participants of the 1996 wave of the Health and Retirement Study who met criteria for 12‐monthDiagnostic and Statistical Manual of Mental Disorders, Third Edition, Revisedmajor depression (MD).

Measurements:MD was assessed using the World Health Organization Composite International Diagnostic Interview—Short Form. Persistent significant depressive symptoms were assessed using an eight‐item version of the Center for Epidemiological Studies Depression scale.

Results:Cognitive deficits were associated with persistent significant depressive symptoms at follow‐up. In a latent state‐trait analysis, two stable and strongly correlated traits best explained variations in cognitive functioning and depressive symptoms across assessment points.

Conclusion:Trait‐like cognitive deficits commonly complicate the course of MD in community‐dwelling middle‐aged and older adults and may help to explain the persistent course of depressive symptoms in a large subgroup of adults with MD in this age range.
Galantamine Maintains Ability to Perform Activities of Daily Living in Patients with Alzheimer's Disease
Authors: Galasko Douglas , Kershaw Paul R. , Schneider Lon , Zhu Young , Tariot Pierre N.
Published: June 2004

Objectives: To examine the effect of galantamine on activities of daily living (ADLs) with respect to baseline dementia severity, correlation with cognitive and global function, specific ADLs affected, and maintenance of ADL independence.

Design: Secondary analysis of a 5‐month randomized, placebo‐controlled trial.

Setting: Multiple U.S. clinical centers.

Participants: Six hundred fifty‐nine patients with mild to moderate Alzheimer's disease (AD) who completed 5 months of treatment.

Intervention: Galantamine at a maintenance dose of 16 or 24 mg/d.

Measurements: The AD Cooperative Study ADL Inventory (ADCS/ADL).

Results: Galantamine resulted in more improvement in ADCS/ADL scores than placebo regardless of baseline dementia severity, with the greatest differences occurring in patients with more severe disease. Changes in ADCS/ADL scores correlated significantly with change scores on the cognitive subscale of the AD Assessment Scale (r=−0.24). Galantamine treatment resulted in maintenance or improvement of basic and instrumental ADLs, and change from baseline to Month 5 in scores for each individual ADL item favored galantamine over placebo in three of six basic ADLs and six of 17 instrumental ADLs.

Conclusion: Galantamine has a favorable effect on ADL performance in patients with AD, detectable after 5 months of treatment, regardless of dementia severity. The ADCS/ADL appears to better measure distinct abilities that may be relevant not only in clinical trials but also in individual patients than do cognitive assessments. J Am Geriatr Soc 52:000–000, 2004.
A Clinical Trial of the Effectiveness of Regularly Scheduled Versus As‐Needed Administration of Acetaminophen in the Management of Discomfort in Older Adults with Dementia
Authors: Buffum Martha D. , Sands Laura , Miaskowski Christine , Brod Meryl , Washburn Allyson
Published: June 2004

Objectives: To determine in a sample of nursing home patients with dementia and a painful condition whether the regularly scheduled administration of acetaminophen (650 mg four times a day (qid)) was more or less effective than as‐needed (prn) administration of acetaminophen in reducing discomfort.

Design: Double‐blind, double‐dummy, placebo‐controlled, crossover study. One arm consisted of 650 mg of acetaminophen administered qid with placebo prn; the other arm consisted of placebo administered qid with acetaminophen prn.

Setting: Two community and one Veterans Affairs nursing homes in the San Francisco Bay area.

Participants: Thirty‐nine nursing home patients with a mean±standard deviation Mini‐Mental State Examination score of 4.3±5, a mean Global Deterioration Scale score of 5.7±0.4, and a mean Discomfort Scale score of 10.7±6.8. Approximately 84% had degenerative joint disease.

Results: Mean Discomfort Scale scores of 7.4±3.7 during the prn arm and 7.2±2.1 during the qid arm (t=0.249, nonsignificant) were within the range previously shown to indicate substantial discomfort. No significant differences in discomfort scores were found between the trial arms after controlling for baseline discomfort and prn use of acetaminophen.

Conclusion: Although this trial was negative in terms of the analgesic effects of acetaminophen, the findings have important implications for clinical practice. Prn administration of acetaminophen is sometimes the standard of care for pain management in nursing homes or is offered as an intervention to assess effectiveness. Findings from this study suggest that a 2,600‐mg/d dose of acetaminophen is inadequate for elderly nursing home patients with degenerative joint disease, fractures, or back pain who have significant discomfort.
Physical Activity, Exercise, and Inflammatory Markers in Older Adults: Findings from The Health, Aging and Body Composition Study
Authors: Colbert Lisa H. , Visser Marjolein , Simonsick Eleanor M. , Tracy Russell P. , Newman Anne B. , Kritchevsky Stephen B. , Pahor Marco , Taaffe Dennis R. , Brach Jennifer , Rubin Susan , Harris Tamara B.
Published: June 2004

Objectives: To examine the association between physical activity and inflammatory markers, with consideration for body fatness and antioxidant use.

Design: Cross‐sectional study, using baseline data from the Health, Aging and Body Composition Study.

Setting: Metropolitan areas surrounding Pittsburgh, Pennsylvania, and Memphis, Tennessee.

Participants: Black and white, well‐functioning men and women (N=3,075), aged 70 to 79.

Measurements: Interviewer‐administered questionnaires of previous‐week household, walking, exercise, and occupational/volunteer physical activities. Analysis of covariance was used to examine the association between activity level and serum C‐reactive protein (CRP), interleukin‐6 (IL‐6), and plasma tumor necrosis factor alpha (TNFα) with covariate adjustment. Antioxidant supplement use (multivitamin, vitamins E or C, beta carotene) was evaluated as an effect modifier of the association.

Results: Higher levels of exercise were associated with lower levels of CRP (P<.01), IL‐6 (P<.001), and TNFα (P=.02) (e.g., CRP=1.95 mg/L for no exercise and 1.72 for >180 min/wk). Adjustment for body fatness attenuated the associations somewhat. Use of antioxidant supplements modified the CRP (Pinteraction=.01) and IL‐6 (Pinteraction=.08) associations such that concentrations were low in those taking supplements (e.g., CRP=1.79–1.84 across exercise levels) and higher in nonsupplement users who did no exercise (2.03) than in those who did the most (1.72). Among nonexercisers, higher levels of other physical activity were related to lower levels of CRP (P<.01) and IL‐6 (P=.02) but not TNFα (P=.36), even after accounting for body fat.

Conclusion: Inflammatory markers are lower in older adults with higher levels of exercise and nonexercise activity and in antioxidant supplement users regardless of exercise level.
Inflammatory Markers and Incident Mobility Limitation in the Elderly
Authors: Penninx Brenda W. J. H. , Kritchevsky Stephen B. , Newman Anne B. , Nicklas Barbara J. , Simonsick Eleanor M. , Rubin Susan , Nevitt Michael , Visser Marjolein , Harris Tamara , Pahor Marco
Published: June 2004

Objectives: To examine the relationship between indicators of inflammation and the incidence of mobility limitation in older persons.

Design: Prospective cohort study: the Health, Aging and Body Composition Study.

Setting: Pittsburgh, Pennsylvania, and Memphis, Tennessee.

Participants: A total of 2,979 men and women, aged 70 to 79, without mobility limitation at baseline.

Measurements: Serum levels of interleukin (IL)‐6, tumor necrosis factor alpha (TNFα), and C‐reactive protein (CRP) and soluble cytokine receptors (IL‐2sR, IL‐6sR, TNFsR1, TNFsR2) were measured. Mobility limitation was assessed and defined as reporting difficulty or inability to walk one‐quarter of a mile or to climb 10 steps during two consecutive semiannual assessments over 30 months.

Results: Of the 2,979 participants, 30.1% developed incident mobility limitation. After adjustment for confounders (demographics, prevalent conditions at baseline, body composition), the relative risk (RR) of incident mobility limitation per standard deviation (SD) increase was 1.19 (95% confidence interval (CI)=1.10–1.28) for IL‐6, 1.20 (95% CI=1.12–1.29) for TNFα, and 1.40 (95% CI=1.18–1.68) for CRP. The association between inflammation and incident mobility limitation was especially strong for the onset of more severe mobility limitation and when the levels of multiple inflammatory markers were high. When persons with baseline or incident cardiovascular disease events or persons who were hospitalized during study follow‐up were excluded, findings remained similar. In a subset (n=499), high levels of the soluble receptors IL2sR and TNFsR1 (per SD increase: RR=1.23 (95% CI=1.04–1.46) and RR=1.28 (95% CI=1.04–1.57), respectively) were also associated with incident mobility limitation.

Conclusion: Findings suggest that inflammation is prognostic for incident mobility limitation over 30 months, independent of cardiovascular disease events and incident severe illness.
Physical Therapy and Mobility 2 and 6 Months After Hip Fracture
Authors: Penrod Joan D. , Boockvar Kenneth S. , Litke Ann , Magaziner Jay , Hannan Edward L. , Halm Ethan A. , Silberzweig Stacey B. , Sean Morrison R. , Orosz Gretchen M. , Koval Kenneth J. , Siu Albert L.
Published: June 2004

Objectives: To examine the relationship between early physical therapy (PT), later therapy, and mobility 2 and 6 months after hip fracture.

Design: Prospective, multisite observational study.

Setting: Four hospitals in the New York City area.

Participants: Four hundred forty‐three hospitalized older patients discharged after surgery for hip fracture in 1997–98.

Measurements: Patient demographics, fracture type, comorbidities, dementia, number of new impairments at discharge, amount of PT between day of surgery and postoperative day (POD) 3, amount of therapy between POD4 and 8 weeks later, and prefracture, 2‐, and 6‐month mobility measured using the Functional Independence Measure.

Results: More PT immediately after hip fracture surgery was associated with significantly better locomotion 2 months later. Each additional session from the day of surgery through POD3 was associated with an increase of 0.4 points (P=.032) on the 14‐point locomotion scale, but the positive relationship between early PT and mobility was attenuated by 6 months postfracture. There was no association between later therapy and 2‐ or 6‐month mobility.

Conclusion: PT immediately after hip fracture surgery is beneficial. The effects of later therapy on mobility were difficult to assess because of limitations of the data. Well‐designed randomized, controlled trials of the effect of varying schedules and amounts of therapy on functional status after hip fracture would be informative.
Muscle Weakness and Falls in Older Adults: A Systematic Review and Meta‐Analysis
Authors: Moreland Julie D. , Richardson Julie A. , Goldsmith Charlie H. , Clase Catherine M.
Published: June 2004

Objectives: To evaluate and summarize the evidence of muscle weakness as a risk factor for falls in older adults.

Design: Random‐effects meta‐analysis.

Setting: English‐language studies indexed in MEDLINE and CINAHL (1985–2002) under the key words aged and accidental falls and risk factors; bibliographies of retrieved papers.

Participants: Fifty percent or more subjects in a study were aged 65 and older. Studies of institutionalized and community‐dwelling subjects were included.

Measurements: Prospective cohort studies that included measurement of muscle strength at inception (in isolation or with other factors) with follow‐up for occurrence of falls.

Methods: Sample size, population, setting, measure of muscle strength, and length of follow‐up, raw data if no risk estimate, odds ratios (ORs), rate ratios, or incidence density ratios. Each study was assessed using the validity criteria: adjustment for confounders, objective definition of fall outcome, reliable method of measuring muscle strength, and blinded outcome measurement.

Results: Thirty studies met the selection criteria; data were available from 13. For lower extremity weakness, the combined OR was 1.76 (95% confidence interval (CI)=1.31–2.37) for any fall and 3.06 (95% CI=1.86–5.04) for recurrent falls. For upper extremity weakness the combined OR was 1.53 (95% CI=1.01–2.32) for any fall and 1.41 (95% CI=1.25–1.59) for recurrent falls.

Conclusion: Muscle strength (especially lower extremity) should be one of the factors that is assessed and treated in older adults at risk for falls. More clinical trials are needed to isolate whether muscle‐strengthening exercises are effective in preventing falls.
A Population‐Based Osteoporosis Screening Program: Who Does Not Participate, and What Are the Consequences?
Authors: Buist Diana S. M. , LaCroix Andrea Z. , Brenneman Susan K. , Abbott Thomas
Published: June 2004

Objectives: To describe differences in osteoporosis risk factors and rates of fracture and antiresorptive therapy use in women who did and did not participate in an osteoporosis screening program.

Setting: Group Health Cooperative, a health maintenance organization in western Washington state.

Participants: A total of 9,268 women (aged 60–80) who were not using any antiresorptive therapy were invited to participate in an osteoporosis screening program. This study compares the 35% who participated with the 65% who did not.

Design: This observational cohort study of women invited to participate in a randomized, controlled trial of an osteoporosis screening program provided all participants with personalized feedback on their risk of osteoporosis. Some participants also received bone density testing. Automated administrative data were used to examine differences between participants and nonparticipants in fracture outcomes and medication initiation before and after invitation.

Results: Baseline fracture rates did not differ between participants and nonparticipants. After age adjustment, nonparticipants had a higher hip fracture rate (14.1 vs 8.3 per 1,000) and a lower rate of initiating any antiresorptive therapy (10.3 vs 17.9 per 100) than participants after an average of 28 to 29 months of follow‐up.

Conclusion: Participants had reduced hip fracture rates and increased initiation of antiresorptive therapy compared with nonparticipants. It was not possible to determine whether participating in the screening program, unmeasured confounding, or selection bias accounted for differences in hip fracture or therapy initiation rates. These results suggest that women who do not participate in osteoporosis screening should be pursued to idenepsy individuals who could benefit from primary and secondary osteoporosis prevention.
Clock Drawing, Clock Reading, Clock Setting, and Judgment of Clock Faces in Elderly People with Dementia and Depression
Authors: Bodner Thomas , Delazer Margarete , Kemmler Georg , Gurka Peter , Marksteiner Josef , Fleischhacker W. Wolfgang
Published: June 2004

Objectives: To assess patient performance on different clock tasks.

Design: Group comparisons.

Setting: A hospital‐based memory clinic; inpatient and outpatient memory clinic.

Participants: Patients with dementia (n=30), patients with depression (n=30), and healthy controls (n=30).

Measurements: General neuropsychological tests, clock drawing tests, and three additional clock tasks: clock reading, clock setting, and judgment of clock faces (each comprising 12 items).

Results: Demented patients differed significantly from the control and depression groups on all clock tasks; controls and depressed patients differed only in the clock‐setting task. A comparison between tasks showed that clock setting was the most difficult, which differentiated best between diagnostic groups. Groups differed not only in overall performance scores, but also in error characteristics.

Conclusion: Overall, study results indicate that clock setting is a sensitive task that may prove to be a valuable tool when screening for dementia.
Anticoagulant Use for Atrial Fibrillation in the Elderly
Authors: Brophy Mary T. , Snyder Kerri E. , Gaehde Stephan , Ives Charlene , Gagnon David , Fiore Louis D.
Published: June 2004

Objectives: To determine the influence of advanced age on anticoagulant use in subjects with atrial fibrillation and to explore the extent to which risk factors for stroke and contraindications to anticoagulant therapy predict subsequent use.

Design: Retrospective cohort study.

Setting: The Veterans Affairs Boston Healthcare System.

Participants: A total of 2,217 subjects with nonvalvular atrial fibrillation.

Measurements: Administrative databases were use to identify subject's age, anticoagulant use, and the presence of a diagnosis of atrial fibrillation, cerebrovascular accident, hypertension, diabetes mellitus, congestive heart failure, or gastrointestinal or cerebral hemorrhage.

Results: Unadjusted analysis showed no difference in warfarin use between those aged 75 and older and younger subjects regardless of the presence (33.9% vs 35.7%, P=.37) or absence (33.4% vs 34.7%, P=.58) of contraindications to anticoagulant therapy. Multivariate modeling demonstrated a 14% reduction (95% confidence interval (CI)=4–22%) in anticoagulant use with each advancing decade of life. Intracranial hemorrhage was a significant deterrent (odds ratio (OR)=0.27 95% CI=0.06–0.85). History of hypertension (OR=2.90, 95% CI=2.15–3.89), congestive heart failure (OR=1.70, 95% CI=1.41–2.04), and cerebrovascular accident (OR=1.54, 95% CI=1.25–1.89) were significant independent predictors for anticoagulant use.

Conclusion: Despite consensus guidelines to treat all atrial fibrillation patients aged 75 and older with anticoagulants, advancing age was found to be a deterrent to warfarin use. Better estimates of the risk:benefit ratio for oral anticoagulant therapy in older patients with atrial fibrillation are needed to optimize decision‐making.
Concordance of Proxy‐Perceived Change and Measured Change in Multiple Domains of Function in Older Persons
Authors: Yasuda Nobufumi , Zimmerman Sheryl , Hawkes William G. , Gruber‐Baldini Ann L. , Hebel J. Richard , Magaziner Jay
Published: June 2004

Objectives: To compare proxy perceptions about change over 6 months in physical, instrumental, affective, and cognitive functioning of older persons with computed change in patient self‐report and performance and patient's own perceptions about change.

Design: Prospective study.

Setting: Recovery from hip fracture that occurred in community‐dwelling persons in Baltimore, Maryland, in 1990–91. The recovery from the sixth to the 12th month postfracture was observed.

Participants: One hundred forty‐one hip fracture patients aged 65 and older and a self‐designated proxy for each.

Measurements: For specific tasks of physical and instrumental functioning, proxy perception of change over the previous 6 months asked in the 12th month postfracture was compared with change in criterion measures (subject self‐report and observed performance) from the sixth to the 12th month postfracture. For global change over the previous 6 months in each area of functioning, proxy perception was compared with the subject's own perception in the 12th month postfracture.

Results: Agreement between proxy perceptions of change and change in criterion measures was poor. There was a general pattern for proxies to overstate improvement and understate deterioration in comparison with change observed in criterion measures for specific tasks of physical and instrumental functioning. Proxies' global perceptions reported subjects improving less and deteriorating more than patients' own perceptions.

Conclusion: Proxy perceptions about task‐specific and global changes in subjects' functional health over a short period of time are systematically different from patient report and observed performance.
The Personal and Social Context of Planning for End‐of‐Life Care
Authors: Kahana Boaz , Dan Amy , Kahana Eva , Kercher Kyle
Published: June 2004

Objectives: To examine the potential facilitators of or deterrents to end‐of‐life planning for community‐dwelling older adults, including personal (health‐related and sociodemographic) and social (physician and family) influences.

Design: In‐person interviews with older adults, telephone interviews with physicians and family members.

Setting: Cleveland, Ohio.

Participants: Two hundred thirty‐one adults aged 65 to 99 who were aging in place, 99 of their primary care physicians, and 127 of their family members.

Measurements: Questions assessing older adults' discussions with others about end‐of‐life plans, implementation of advance directives, and physical (Older American Resources and Services) illness index and mental (Short Portable Mental Status Questionnaire) health status.

Results: Just fewer than half of older adults had executed an advance directive and discussed their wishes with others. Only personal characteristics of elderly individuals were related to end‐of‐life plans, with whites, unmarried individuals, and younger adults more likely to have made preparations. Older adults' health status, as evaluated by the patient, physician, and caregiver, did not relate to the tendency to have made advance care plans. Older adults' family members were much more likely to report knowledge of advance care plans than were physicians.

Conclusion: These findings suggest that many physicians are not talking with their patients about their end‐of‐life wishes. Furthermore, the propensity to have such discussions may relate more to the personal preferences and level of comfort of patients, physicians, and family members than on the health status of the older adult.
Tests of Stepping as Indicators of Mobility, Balance, and Fall Risk in Balance‐Impaired Older Adults
Authors: Cho Be‐long , Scarpace Diane , Alexander Neil B.
Published: June 2004

Objectives: To determine the relationships between two tests of stepping ability (the maximal step length (MSL) and rapid step test (RST)) and standard tests of standing balance, gait, mobility, and functional impairment in a group of at‐risk older adults.

Design: Cross‐sectional study.

Setting: University‐based laboratory.

Participants: One hundred sixty‐seven mildly balance‐impaired older adults recruited for a balance‐training and fall‐reduction program (mean age 78, range 65–90).

Measurements: Measures of stepping maximally (MSL, the ability to maximally step out and return to the initial position) and rapidly (RST, the time taken to step out and return in multiple directions as fast as possible); standard measures of balance, gait, and mobility including timed tandem stance (TS), tandem walk (TW, both timing and errors), timed unipedal stance (US), timed up and go (TUG), performance oriented mobility assessment (POMA), and 6‐minute walk (SMW); measures of leg strength (peak knee and ankle torque and power at slow and fast speeds); self‐report measures of frequent falls (>2 per 12 months), disability (Established Population for Epidemiologic Studies of the Elderly (EPESE) physical function), and confidence to avoid falls (Activity‐specific Balance Confidence (ABC) Scale). Spearman and Pearson correlation, intraclass correlation coefficient, logistic regression, and linear regression were used for data analysis.

Results: MSL consistently predicted a number of self‐report and performance measures at least as well as other standard balance measures. MSL correlations with EPESE physical function, ABC, TUG, and POMA scores; SMW; and peak maximum knee and ankle torque and power were at least as high as those correlations seen with TS, TW, or US. MSL score was associated with the risk of being a frequent faller. In addition, the six MSL directions were highly correlated (up to 0.96), and any one of the leg directions yielded similar relationships with functional measures and a history of falls. Relationships between RST and these measures were relatively modest.

Conclusion: MSL is as good a predictor of mobility performance, frequent falls, self‐reported function, and balance confidence as standard stance tests such as US. MSL simplified to one direction may be a useful clinical indicator of mobility, balance, and fall risk in older adults.
Of Worms and Women: Sarcopenia and its Role in Disability and Mortality
Authors: Fisher Alfred L.
Published: June 2004

The loss of muscle mass during aging has been termed sarcopenia. Sarcopenia results in a decrease in physical strength during aging that results in important consequences for more severely affected individuals in terms of function and as a marker for disability and increased mortality. Despite the clinical importance of this condition, the pathophysiology leading to the development of sarcopenia is not well understood, and few treatments exist to prevent or reverse the condition. Recently, sarcopenia has been found to occur during aging in the nematode Caenorhabditis elegans, which is an organism increasingly used to study genetic and biochemical events involved in aging. Like in humans, sarcopenia in C. elegans leads to declines in mobility and serves as a marker for increased mortality. Interestingly, mutations affecting the age‐1 gene, which slows aging of the animal, result in significant delays in the development of sarcopenia, suggesting a direct causal relationship between organismal aging and sarcopenia. These findings suggest that, in humans and worms, sarcopenia may represent a biomarker for the biological age, as opposed to chronological age, of the individual. These findings also suggest that C. elegans will develop into an important model system in which to study the biochemical and genetics events responsible for sarcopenia and to test therapeutics designed to prevent or reverse sarcopenia.
An Unfolding Case with a Linked Objective Structured Clinical Examination (OSCE): A Curriculum in Inpatient Geriatric Medicine
Authors: Karani Reena , Leipzig Rosanne M. , Callahan Eileen H. , Thomas David C.
Published: June 2004

As the percentage of time devoted to the care of older adults by internists continues to rise, the need for these physicians to be skilled at their care becomes even more critical. In fact, the Education Committee of the American Geriatrics Society has recommended the development of structured educational curricula to teach the principles of geriatric care. This article describes a comprehensive, evidence‐based curriculum for internal medicine house staff in inpatient geriatric medicine. The intervention encompasses a novel instructional method, defined skill and behavioral goals, and a competency‐based effectiveness evaluation. Moreover, the principles in this curricular model are those that may affect any hospitalized older adult and so will be important for all house staff taking care of inpatient geriatric patients, regardless of their future subspecialty choice.
So I Thought I Wanted to Be a Chief
Authors: Sachs Greg A.
Published: June 2004

In July 2000, Dr. William Hazzard published an article in the Journal of the American Geriatrics Society entitled “So you think you want to lead an academic geriatric program?” My answer to that question the same month was “Yes,” as I agreed to become the chief of the newly established Section of Geriatrics at the University of Chicago. With about 3.5 years on the job now, I offer a more complete reply to Dr. Hazzard's query. Although his paper covered many important and practical issues to consider in looking at becoming a chief, this article provides a perspective on the academic geriatric leadership position based on a new chief's observations. Topics covered include pressures for and against becoming a chief, changing perspectives on goals and rewards, good help, mentoring, money problems/issues, support for the chief, and communication and relationships. It is hoped that these observations will be of use to geriatricians considering leading an academic geriatrics program and to other newly appointed chiefs.
The evolving new understanding of endodontic infections
Authors: Tronstad Leif , Sunde Pia Titterud
Published: June 2004

The science of oral microbiology is in a period of change from the era of bacterial cultivation to an era of molecular genetic methods and techniques. Already a significant body of new knowledge exists with regard to the oral flora in health and disease. Inevitably, this new knowledge has led to a better understanding of many oral diseases. In endodontics, the prevailing concepts are still to a great extent based on the results of the classical cultivation studies. However, a few groups have started to use molecular methods, and a new understanding of endodontic infections is presently evolving. Thus, the root canal infection clearly is more complex than revealed by cultivation methods alone, and both previously unidentified and uncultivable microorganisms have been detected by molecular methods. A reasonable estimate at present is that the infected root canal contains, not less than 10, but rather between 10 and 50 bacterial species which coincide well with the number of bacterial species normally found in a dental plaque sample and at different sites in the oral cavity. A further interesting finding in the studies using molecular techniques is that the microbiota of the infected root canal appears to be very similar to the flora of the periodontal pocket in patients with active periodontal disease. With regard to infection of periapical lesions in patients with asymptomatic apical periodontitis, electron microscopic and molecular methods have confirmed our cultivation findings that this is a common occurrence. Mature biofilms have been demonstrated on the external surfaces of root tips and in the form of sulfur granules within periapical granulomas. As in dental plaque, Actinomyces species appear to have a special role as scaffold builders in the development of sulfur granules. Other bacteria are then attracted to the site and a multibacterial granule (biofilm) develops. In addition, in situ hybridization studies show a variety of different bacteria and bacterial morphotypes in periapical lesions. With DNA–DNA hybridization between 11and 39 bacterial species have been recognized in the lesions, again confirming that in patients with active disease, the microbiotas of endodontic and periodontal infections are very similar. Thus, the recent findings demonstrate and confirm that the periapical endodontic lesion is not as hostile to microorganisms as many have thought. As clinicians we have to understand and accept that an infection might not be limited to the root of the tooth, but include the periapical lesion as well.
Enterococcus faecalis– the root canal survivor and ‘star’ in post‐treatment disease
Authors: Portenier Isabelle , Waltimo Tuomos M.T. , Haapasalo Markus
Published: June 2004

In the past few years, Enterococcus faecalis has been the focus of increased interest both in medicine and dentistry. A recognized pathogen in post‐treatment endodontic infections, E. faecalis is frequently isolated both in mixed flora and in monocultures. E. faecalis is probably the species that can best adapt to and tolerate the ecologically demanding conditions in the filled root canal. Eradication of E. faecalis from the root canal with chemomechanical preparation and using disinfecting irrigants and antibacterial dressings is difficult. In this article, the different factors that make E. faecalis a potential problem in medicine and dentistry are summarized, with special focus on the role of E. faecalis in post‐treatment endodontic disease.
Non‐microbial etiology: foreign body reaction maintaining post‐treatment apical periodontitis
Authors: Ramachandran Nair P.N.
Published: June 2004

The polymerase chain reaction (PCR) is an elegant technology for faithfully replicating and amplifying the master molecule of life, but a valid scientific procedure remains essential without which the resulting data have only very limited value. The presence of microbial infection in the complex apical root canal system is the major cause of post‐treatment apical periodontitis in well‐treated teeth. However, in rare cases, non‐microbial etiological factors, located beyond the root canal system (within the inflamed periapical tissues), can maintain the disease in root‐filled teeth. These factors include foreign body reaction to exogenous materials or endogenous cholesterol crystals, a cystic condition of the lesion and extraradicular actinomycotic infections. This article addresses foreign body reaction at the periapex, as a pathobiological factor that maintains post‐treatment apical periodontitis.
Life as an endodontic pathogen
Authors: Sundqvist Göran , Figdor David
Published: June 2004

This review describes the type of microbial flora in the untreated root canal and the root‐filled canal with persistent infection. Recent contributions of molecular methods of microbial identification are outlined along with a discussion of advantages and limitations of these methods. Ecological and environmental factors are the prime reasons for differences in the microbial flora in these distinct habitats. Shared phenotypic traits and an ability to respond to the modified environment select for the species that establish a persistent root canal infection.
Roles of Trust in Consulting to Financial Families
Authors: Kaye Kenneth , Hamilton Sara
Published: June 2004

Trust is not only crucial to success among the owners of substantial wealth, it is also the sine qua non for successful teamwork among professionals who work with them. There can be dangers, however, in too much trust and too little healthy confrontation, just as there are in mistrust and chronic conflict.
Interplay between SERCA and sarcolemmal Ca2+ efflux pathways controls spontaneous release of Ca2+ from the sarcoplasmic reticulum in rat ventricular myocytes
Authors: O'Neill S. C. , Miller L. , Hinch R. , Eisner D. A.
Published: June 2004

Waves of calcium‐induced calcium release occur in a variety of cell types and have been implicated in the origin of cardiac arrhythmias. We have investigated the effects of inhibiting the SR Ca2+‐ATPase (SERCA) with the reversible inhibitor 2′,5′‐di(tert‐butyl)‐1,4‐benzohydroquinone (TBQ) on the properties of these waves. Cardiac myocytes were voltage clamped at a constant potential between −65 and −40 mV and spontaneous waves evoked by increasing external Ca2+ concentration to 4 mm. Application of 100 μm TBQ decreased the frequency of waves. This was associated with increases of resting [Ca2+]i, the time constant of decay of [Ca2+]i and the integral of the accompanying Na+–Ca2+ exchange current. There was also a decrease in propagation velocity of the waves. There was an increase of the calculated Ca2+ efflux per wave. The SR Ca2+ content when a wave was about to propagate decreased to 91.7 ± 3.2%. The period between waves increased in direct proportion to the Ca2+ efflux per wave meaning that TBQ had no effect on the Ca2+ efflux per unit time. We conclude that (i) decreased wave frequency is not a direct consequence of decreased Ca2+ pumping by SERCA between waves but, rather, to more Ca2+ loss on each wave; (ii) inhibiting SERCA increases the chance of spontaneous Ca2+ release propagating at a given SR content.
On the fate of skeletal myoblasts in a cardiac environment: down‐regulation of voltage‐gated ion channels
Authors: Ott H. C. , Berjukow S. , Marksteiner R. , Margreiter E. , Böck G. , Laufer G. , Hering S.
Published: June 2004

We have analysed the voltage‐gated ion channels and fusion competence of skeletal muscle myoblasts labelled with green fluorescent protein (GFP) and the membrane dye PKH transplanted into the infarcted myocardium of syngenic rats. After cell transplantation the animals were killed and GFP+–PKH+ myoblasts enzymatically isolated for subsequent studies of ionic currents through voltage‐gated sodium, calcium and potassium channels. A down‐regulation of all three types of ion channels after engraftment was observed. The fraction of cells with calcium (68%) and sodium channels (65%) declined to zero within 24 h and 1 week, respectively. Down‐regulation of potassium currents (90% in control) occurred within 2 weeks to about 30%. Before injection myoblasts expressed predominantly transient outward potassium channels whereas after isolation from the myocardium exclusively rapid delayed rectifier channels. The currents recovered completely between 1 and 6 weeks under cell culture conditions. The down‐regulation of ion channels and changes in potassium current kinetics suggest that the environment provided by infarcted myocardium affects  expression of voltage‐gated ion channels of skeletal myoblasts.
PAR2 activation alters colonic paracellular permeability in mice via IFN‐γ‐dependent and ‐independent pathways
Authors: Cenac Nicolas , Chin Alex C. , Garcia‐Villar Rafael , Salvador‐Cartier Christel , Ferrier Laurent , Vergnolle Nathalie , Buret André G. , Fioramonti Jean , Bueno Lionel
Published: June 2004

Activation of colonic proteinase‐activated receptor‐2 (PAR2) caused inflammation and increased mucosal permeability in mouse colon. The present study was aimed at characterizing the possible links between these two phenomena. We evaluated the effects of intracolonic infusion of PAR2‐activating peptide, SLIGRL, on colonic paracellular permeability and inflammation at two different doses, 5 and 100 μg per mouse, in an attempt to discriminate between both PAR2‐mediated effects. We further investigated the possible involvement of interferon γ (IFN‐γ) and calmodulin‐dependent activation of myosin light chain kinase (MLCK), and alterations of zonula occludens‐1 (ZO‐1) localization in PAR2‐induced responses. Thus, at the lower dose, SLIGRL increased colonic permeability without causing inflammation. Western blotting showed phosphorylation of mucosal myosin light chain (MLC) expression after both doses of SLIGRL. Moreover, while the MLCK inhibitor, ML‐7, abolished the permeability effects of the low dose of SLIGRL, it only partially inhibited that of the high dose. In IFN‐γ‐deficient mice (B6 ifng−/−), the increases in permeability were similar for both doses of SLIGRL and prevented by ML‐7. In addition, MLCK immunoprecipitation revealed an increase of calmodulin binding to MLCK in the mucosa of mice treated with either dose of SLIGRL. Finally, we have shown that direct activation of PAR2 on enterocytes is responsible for increased permeability and ZO‐1 disruption. Moreover, SLIGRL at a dose that does not produce inflammation increases permeability via calmodulin activation, which binds and activates MLCK. The resulting tight junction opening does not depend upon IFN‐γ secretion, while the increased permeability in response to the high dose of PAR2 agonist involves IFN‐γ secretion.
Roles of phosphorylation of myosin binding protein‐C and troponin I in mouse cardiac muscle twitch dynamics
Authors: Tong Carl W. , Gaffin Robert D. , Zawieja David C. , Muthuchamy Mariappan
Published: June 2004

A normal heart increases its contractile force with increasing heart rate. Although calcium handling and myofibrillar proteins have been implicated in maintaining this positive force–frequency relationship (FFR), the exact mechanisms by which it occurs have not been addressed. In this study, we have developed an analytical method to define the calcium–force loop data, which characterizes the function of the contractile proteins in response to calcium that is independent of the calcium handling proteins. Results demonstrate that increasing the stimulation frequency causes increased force production per unit calcium concentration and decreased frequency‐dependent calcium sensitivity during the relaxation phase. We hypothesize that phosphorylation of myosin binding protein‐C (MyBP‐C) and troponin I (TnI) acts coordinately to change the rates of force generation and relaxation, respectively. To test this hypothesis, we performed simultaneous calcium and force measurements on stimulated intact mouse papillary bundles before and after inhibition of MyBP‐C and TnI phosphorylation using the calcium/calmodulin kinase II (CaMK2) inhibitor autocamtide‐2 related inhibitory peptide, or the protein kinase A (PKA) inhibitor 14–22 amide. CaMK2 inhibition reduced both MyBP‐C and TnI phosphorylation and decreased active force without changing the magnitude of the [Ca2+]i transient. This reduced the normalized change in force per change in calcium by 19–39%. Data analyses demonstrated that CaMK2 inhibition changed the myofilament characteristics via a crossbridge feedback mechanism. These results strongly suggest that the phosphorylation of  MyBP‐C and TnI contributes significantly to the rates of force development and relaxation.
Heterogeneous expression of repolarizing, voltage‐gated K+ currents in adult mouse ventricles
Authors: Brunet Sylvain , Aimond Franck , Li Huilin , Guo Weinong , Eldstrom Jodene , Fedida David , Yamada Kathryn A. , Nerbonne Jeanne M.
Published: June 2004

Previous studies have documented the expression of four kinetically distinct voltage‐gated K+ (Kv) currents, Ito,f, Ito,s, IK,slow and Iss, in mouse ventricular myocytes and demonstrated that Ito,f and Ito,s are differentially expressed in the left ventricular apex and the interventricular septum. The experiments here were undertaken to test the hypothesis that there are further regional differences in the expression of Kv currents or the Kv subunits (Kv4.2, Kv4.3, KChIP2, Kv1.5, Kv2.1) encoding these currents in adult male and female (C57BL6) mouse ventricles. Whole‐cell voltage‐clamp recordings revealed that mean (±s.e.m.) peak outward K+ current and Ito,f densities are significantly (P < 0.001) higher in cells isolated from the right (RV) than the left (LV) ventricles. Within the LV, peak outward K+ current and Ito,f densities are significantly (P < 0.05) higher in cells from the apex than the base. In addition, Ito,f and IK,slow densities are lower in cells isolated from the endocardial (Endo) than the epicardial (Epi) surface of the LV wall. Importantly, similar to LV apex cells, Ito,s is not detected in RV, LV base, LV Epi or LV Endo myocytes. No measurable differences in K+ current densities or properties are evident in RV or LV cells from adult male and female mice, although Ito,f, Ito,s, IK,slow and Iss densities are significantly (P < 0.01) higher, and action potential durations at 50% (APD50) are significantly (P < 0.05) shorter in male septum cells. Western blot analysis revealed that the expression levels of Kv4.2, Kv4.3, KChIP2, Kv1.5 and Kv2.1 are similar in male and female ventricles. In addition, consistent with the similarities in repolarizing Kv current densities, no measurable differences in ECG parameters, including corrected QT (QTc) intervals, are detected in telemetric recordings from adult male and female (C57BL6) mice.