ABSTRACT
PURPOSE: Intertrochanteric hip fracture is a common injury in the Medicare population. Very little is known about the in-hospital mortality risk of intertrochanteric hip fractures and associated demographics for the US Medicare population. The purpose of this study is to determine the in-hospital mortality rate of closed intertrochanteric hip fractures and to evaluate demographic factors influencing an increased mortality risk. METHODS: The PearlDiver Medicare database from 2005 to 2010 was queried for closed intertrochanteric hip fractures. Stratified sampling was conducted by creating subset for individuals with a death discharge from inpatient facilities. Statistical analysis was performed where appropriate. RESULTS: Throughout 2005-2010 there were a total of 1,138,142 intertrochanteric hip fractures. There were 19,385 deaths during the initial hospital stay, yielding a mortality rate of 1.70%. There was a 1.83% mortality rate for patients 75 and older and patients over the age of 84 comprised the majority of deaths at 58%. The mortality rate was lower for females (1.39%) than for males (2.56%) (p < 0.0002). CONCLUSION: We found in the Medicare database that there is a relatively low rate of in-hospitality mortality associated with intertrochanteric hip fractures; this rate is lower than previously reported. We report a 1.70% in-hospital mortality using a complete Medicare dataset. Based on previous reporting for short term and one-year mortality risk, the present study suggests that mortality risk is greatest after patients have been released from the hospital. More attention should be paid to understanding and attenuating the mortality associated with intertrochanteric hip fractures after the acute hospital phase.
Subject(s)
Hip Fractures/mortality , Hospital Mortality , Age Factors , Aged , Aged, 80 and over , Female , Fractures, Closed/mortality , Humans , Male , Medicare/statistics & numerical data , Risk , Sex Factors , United States/epidemiologyABSTRACT
A model of the structure of erythropoietin (Epo) is presented based on structural homology to other hemopoietic cytokines. A model of the erythropoietin receptor complex was made based on evidence that this includes a homodimer of the receptor chain with known sequence. Key interactions are noted which explain data from mutation experiments, although at not all residues believed to be important to binding of Epo are at the interface. This is consistent with the hypothesis that the Epo receptor complex includes proteins in addition to the cloned receptor chain that have been cross-linked to Epo (Todokoro et al., Proc. Natl. Acad. Sci. USA 84:4126-4130, 1987; Mayeux et al., J. Biol. Chem. 266:23380-23385, 1991) but not isolated.
Subject(s)
Erythropoietin/chemistry , Models, Molecular , Receptors, Erythropoietin/chemistry , Amino Acid Sequence , Animals , Binding Sites/genetics , Cytokines/chemistry , Cytokines/genetics , Erythropoietin/genetics , Humans , Hydrogen Bonding , Macromolecular Substances , Molecular Sequence Data , Molecular Structure , Mutation , Receptors, Cytokine/chemistry , Receptors, Cytokine/genetics , Receptors, Erythropoietin/genetics , Sequence Homology, Amino AcidABSTRACT
This study determined the acoustical properties of speech known as Lombard Speech produced in background noise. Tape recordings were made for ten normally hearing adults (5 women, 5 men) reading connected speech (131 word passage "My Grandfather") at their most comfortable level in quiet and in wideband, traffic, and multitalker noise delivered through earphones at 70 and 90 dB SPL. Spectral analysis of the recordings revealed that, compared with speech in quiet, Lombard speech was characterized by: (1) an increase in overall SPL; (2) smaller vocal pitch shifts for female than male subjects; (3) shifts in spectral distributions of speech energy; and (4) the same spectral slope above 630 Hz regardless of subject gender, noise level, or noise type. Overall, the results of this study do not provide support for the theory that acoustical properties of Lombard speech are identical with loud speech produced in quiet.
