The cumulative risk of fracture for a postmenopausal woman over the age of 50 can reach up to 60%. Exercise has the potential to modify fracture risk in postmenopausal women through its effects on bone mass and geometry; however, these effects are not well characterized. To determine the effects of exercise on bone mass and geometry in postmenopausal women, we conducted a systematic review of the literature. We included all randomized controlled trials, cross-sectional studies, and prospective studies that used peripheral quantitative computed tomography to assess the effects of exercise on bone mass and geometry in this population. Exercise effects appear to be modest, site-specific, and preferentially influence cortical rather than trabecular components of bone. Exercise type also plays a role, with the most prominent mass and geometric changes being observed in response to high-impact loading exercise. Exercise appears to positively influence bone mass and geometry in postmenopausal women. However, further research is needed to determine the types and amounts of exercise that are necessary to optimize improvements in bone mass and geometry in postmenopausal women and determine whether or not these improvements are capable of preventing fractures.

Background and objectives: Cardiovascular disease (CVD) is the largest contributor to all-cause mortality in patients with end stage renal disease (ESRD). Accelerated vascular calcification is a key risk factor for CVD in these patients. The etiology of vascular calcification and the specific role calcium supplementation may play in accelerating calcification have not been fully elucidated.Design, setting, participants, & measurements: We summarize published data that report on the association between calcium supplementation, vascular calcification, and CVD in patients with and without ESRD.Results: The majority of randomized, controlled trials in patients with ESRD suggest that calcium supplementation-in the form of calcium-based phosphate binders-leads to a progression of vascular calcification. However, studies showing that calcium-based phosphate binders increase cardiovascular mortality are lacking in patients with ESRD. In contrast, one randomized trial in healthy postmenopausal women reported that, compared with those not receiving calcium supplementation, women who take supplements are at an increased risk for cardiovascular events.Conclusions: Given the potential for harm with calcium supplementation in healthy postmenopausal women and the evidence that calcium-based phosphate binders are associated with adverse intermediate outcomes in patients with ESRD, calcium-either as a phosphate binder or as a supplement-should be prescribed with caution.

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Selective estrogen-receptor modulators (SERMs), which have estrogen-like effects on bone and "antiestrogen effects" on other tissues, have been in development for osteoporosis prevention and treatment in postmenopausal women as a safer alternative to long-term estrogen. We conducted a literature review of the skeletal and extraskeletal effects of lasofoxifene, a new generation SERM approved by the European Commission for osteoporosis treatment. Published data on the effects of lasofoxifene are based on 23 clinical pharmacology studies with over 10,000 participants from 17 phase 2 and 3 randomized controlled trials (RCTs). In RCTs, lasofoxifene decreases bone turnover markers (BTMs), increases bone mineral density (BMD) at the spine and hip, and decreases the incidence of vertebral and nonvertebral nonhip fractures compared with placebo. Compared with raloxifene, lasofoxifene gave greater decreases in BTMs, and greater increases in lumbar spine BMD. Lasofoxifene also decreased the risk of breast cancer, major coronary heart disease events, and stroke, but-similar to raloxifene-there was an increased risk of venous thromboembolism. In one trial, endometrial hypertrophy and uterine polyps were more common with lasofoxifene than with placebo, but endometrial cancer and hyperplasia were not. Lasofoxifene is probably most appropriate for use among women in their early or middle menopausal years (age 55-65) who have, or are at risk of developing, osteoporosis and in particular vertebral fractures. At the time of publication, lasofoxifene is not approved for use by the US Food and Drug Administration, and as such is not used in North America.

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BackgroundIt has long been acknowledged that death is beyond a biological phenomenon but a social and cultural one, which is understood within complex cultural meanings. This presentation outlines music therapy support, delivered to a Yoruba infant and his mother, through end of life care and post death.MethodsIn the Yoruba culture, death is not perceived as the end of life, but a transition through existence. Therefore it was a priority and responsibility to respect and adapt to the mother’s emotional, spiritual and cultural beliefs. This presentation will discuss how a Music Therapist valued and responded to the cultural beliefs of a Yoruba mother through end of life care for her baby, and subsequently by singing to her deceased baby, providing the mother with reassurance through feedback. The issues encountered as a practitioner around culture will be explored during the presentation.ResultsThis grieving mother desperately wanted her child’s next life to be a healthy one. In her belief, the music therapy made this happen. The mother’s response to this intervention was ‘You don’t know what this means to me.’ Although cultural knowledge is a key component to culturally competent intervention, skills of communication rather than mastery of cultural traits, underpinned the therapeutic support. A recommendation for professionals working in palliative care will be made to take a broader view around cultural elements of death, with the emphasis being on skills such as communication.ConclusionsThe playing of music was viewed as vital to guide the baby’s soul to find his next life. This work challenges the notion of cultural competency in therapeutic intervention within palliative care. Skilful and compassionate communication with the family enabled the Music Therapist to value, promote and support cultural difference.

Four sorting algorithms—bubble, insertion, heap, and quick—are studied on an IBM 3090/600, a VAX 11/780, and the NYU Ultracomputer. It is verified that for N items the bubble and insertion sorts are of order N2 whereas the heap and quick sorts are of order N ln N. It is shown that the choice of algorithm is more important than the choice of machine. Moreover, the influence of paging on algorithm performance is examined.