Practice and reflection of participatory design in tableware design for the elderly.

BACKGROUND: In the past, the designers used to dominate and conduct user-centered design and research. The findings of such surveys might not reflect the user needs and produce the best design solutions. OBJECTIVE: This project aimed to use PD to introduce the design curriculum to break through the previous user-centered design thinking, as the designer and the user design together, with the user given the right to lead the entire design process. METHODS: The theme of this research design is tableware; 55 students and 11 elderly (over the age of 65) were invited to participate in this study. Questionnaires divided into the beginning, middle and final stages tested the teaching effectiveness of PD. RESULTS: The results showed that PD effectively improves five points: (1) design concepts and attitudes, (2) design methods, (3) problem solving and communication skills, (4) implementing design concepts, and (5) responding to the variety of user needs. CONCLUSION: This PD teaching model employs a well-established practical process to form an effective teaching routine, which is expected to be universally applied to other related design courses.

Effects of food nutrition labels on the health awareness of school-age children.

BACKGROUND: Overweight and obesity have been described as a global epidemic that seriously affects the health of adults and children. Front of Package (FOP) Nutrition Labeling can increase consumers' awareness of unhealthy foods. The purpose of this study is to find effective deterrence and improve children's health awareness via the FOP. METHODS: This study examined children's health awareness of snack packaging using the four labels: guideline daily amounts (GDA), traffic light system (TLS), Apple label (designed in this study), and Warning label. This study recruited 343 children in the sixth grade, including 223 children living in cities and 120 children living in rural areas. First, 30 children in grades 3 to 6 selected 8 snacks that they often buy. Then, each snack was synthesized into these four labels according to their nutritional content for a total of 32 samples. Finally, a questionnaire was used to evaluate the health of snack packaging and the visibility of nutrition labels. RESULTS: Four results can be drawn: (1) GDA, Apple label and TLS can help children determine healthier snack choices, (2) black Warning label cannot induce children to make healthier choices, (3) children who often buy snacks have low health awareness, and (4) rural children have weak health awareness of snack packaging. CONCLUSIONS: These results can provide a packaging label design, which can effectively improve children's health awareness.

Factors Associated with Attitudes toward Aging among Taiwanese Middle-Aged and Older Adults: Based on Population-Representative National Data.

In middle-aged and older adults, attitude toward aging (ATA) exerts significant influences on their current and future health. For health promotion to be successful, participants' ATA requires health care providers' attention. Knowing the factors associated with ATA can facilitate future studies to investigate effective interventions. The aim of this study was to identify the factors associated with ATA in middle-aged and older adults. This cross-sectional study analyzed data of a nationally representative sample of adults aged 58 years and older collected in a population-based longitudinal study: the Taiwan Longitudinal Study on Aging (TLSA). To identify the factors associated with ATA, we investigated demographic factors (age, gender, education, marital and cohabitation status, and financial satisfaction status) and health-related factors (number of co-morbidities, depression, physical function dependency) with bivariate analysis and multiple regression analysis. To identify the activities beneficial to ATA over and above demographic and health-related factors, various activities (exercise, volunteer service, and leisure activities) were each examined individually by multiple regression analysis. The factors detrimental to ATA were advanced age, a higher number of co-morbidities, living alone, depression, and dependence on physical function. Those beneficial to ATA were higher education, financial satisfaction, physical exercise, volunteer service, and six leisure activities.

Postural Maintenance Is Associated With Walking Ability in People Receiving Acute Rehabilitation After a Stroke.

OBJECTIVES: The Postural Assessment Scale for Stroke Patients (PASS) assesses the ability of people post stroke to maintain or change a given posture from lying to standing, and the items on which people with different walking status perform differently may suggest potential interventions. The purpose of this study was to (1) examine the association of PASS scores at admission for acute rehabilitation with walking status at admission and 3 months post stroke (3 M), and (2) identify PASS items that discriminate walking status. METHODS: In this prospective observational study, 93 people post stroke were assessed with the PASS and a 2.44-m gait speed test at admission, with walking status assessed by telephone interview at 3 M. Those who could walk over a 2.44-m distance without the assistance of a walking aid or another person were considered to be independent in walking; others were considered to be dependent. Those who were dependent at admission were divided into the "regained independence" and "remained dependent" groups based on their status at 3 M. The association of the PASS at admission with 3 levels of walking status (independent at admission, regained independence, and remained dependent) was examined using the Kruskal-Wallis test. For those dependent at admission, the association of PASS score at admission with walking status at 3 M was examined using logistic regression and receiver operating curve analysis. RESULTS: PASS scores at admission differed significantly across the 3 walking status groups and were significantly associated with walking status at 3 M (odds ratio = 0.864; 95% CI = 0.798-0.935) over and above length of stay. People post stroke who were dependent at admission and had PASS scores ≥22 were more likely to regain independence at 3 M. Nine PASS items differed among the 3 groups. CONCLUSIONS: PASS score is significantly associated with walking status at admission and at 3 M. The identified 9 items suggest possible interventions for acute rehabilitation. IMPACT: This study identified 9 PASS items that could guide clinicians in selecting interventions for acute rehabilitation.

Use of photo diary and focus group to explore needs for digital disease management program among community older adults with chronic disease.

As technology advanced, new e-health solutions are evolved to empower people to manage their care at home. This study explored the needs for disease management in activity tracking using photo diary through older adults' subjective perspective. It further aimed to suggest which lifestyle measures, symptoms and behaviours would be meaningful to include in such a digital diseases care management program for technology design. Both photo diary and focus group discussion were used, 11 older adults with multiple metabolism-related chronic diseases (Mean age, 72.5 ± 6.14 years) were recruited and asked to carry out the photo diary to trace their living situation and needs using a tablet camera. A focus group discussion was applied to identify the needs of chronic disease management, based on the results of living context tracing. Five themes, regular physical activity, smart management of healthy behaviors, healthy diet, regular daily routine and social connection, were identified by content analysis from photo diary and the focus group discussion. The results indicated that the photo diary program can raise awareness and promotes positive behavior changes. It is believed that the E-approach can be applied to the effectively enhance older adults' self-management by monitoring their health status and their daily routine activities.

The influence of semantic relevance on the discernment of product appearance and function.

BACKGROUND: This study investigated the impact of semantic relevance on the ability to comprehend the appearance and function of a product, as presented in images. METHODS: The images used the constructs of Simile, Metaphor and Analogy to correspond to congruent, related and incongruent semantic structures, and measured the amplitude of Event-Related Potentials (ERPs) to compare these images with Landscape images. Sixteen participants with design-related educational backgrounds were invited to join in the ERP experiment. RESULTS: The results found that the image depicting the Metaphor showed a stronger N600 amplitude in the right anterior region of the brain than the Landscape image and the Analogy image induced a stronger N600 effect in the left anterior and right anterior part of the brain than the Landscape image. However, the Simile image did not trigger the N600. The N600 was triggered when the meaning of the Metaphor and Analogy being presented could not be understood. This indicates that a greater processing effort to comprehend them than was required for Simile. Analogy has a wider N600 distribution than Metaphor in the anterior area, suggesting that Analogy would require higher-level thinking processes and more complex semantic processing mechanisms than Metaphor. CONCLUSIONS: The N600 implicated that an assessment method to detect the semantic relationship between appearance and function of a product would assist in determining whether a symbol was suitable to be associated with a product.

Molecular evidence of SARS-CoV-2 in New York before the first pandemic wave.

Numerous reports document the spread of SARS-CoV-2, but there is limited information on its introduction before the identification of a local case. This may lead to incorrect assumptions when modeling viral origins and transmission. Here, we utilize a sample pooling strategy to screen for previously undetected SARS-CoV-2 in de-identified, respiratory pathogen-negative nasopharyngeal specimens from 3,040 patients across the Mount Sinai Health System in New York. The patients had been previously evaluated for respiratory symptoms or influenza-like illness during the first 10 weeks of 2020. We identify SARS-CoV-2 RNA from specimens collected as early as 25 January 2020, and complete SARS-CoV-2 genome sequences from multiple pools of samples collected between late February and early March, documenting an increase prior to the later surge. Our results provide evidence of sporadic SARS-CoV-2 infections a full month before both the first officially documented case and emergence of New York as a COVID-19 epicenter in March 2020.

First report of human infection caused by Colletotrichum chlorophyti occurring in a post-corneal transplant patient with endophthalmitis.

Keratomycosis or mycotic keratitis is recognized as one of the major causes of ophthalmic morbidity worldwide. The most common organisms linked to keratomycosis include Candida spp., Fusarium spp., and Aspergillus spp. However, varieties of saprobic fungi have been reported as causative agents of keratomycosis. Amongst these are members of the genus Colletotrichum. Herein we present the first reported case of C. chlorophyti infection in a post-corneal transplant patient, suggesting an increasing role for Colletotrichum species as emerging human pathogens, particularly in the transplant population.

Early Rehabilitation in Acute Care Inpatient Wards May Be Crucial to Functional Recovery 3 Months After Ischemic Stroke.

OBJECTIVE: Early rehabilitation in acute care inpatient wards may maximize functional outcome at 3 months after stroke in survivors of stroke. It is unknown whether functional change during acute care hospitalization is significantly associated with functional recovery at 3 months in survivors of acute stroke. The purposes of this study were to examine the association of the Barthel Index (BI) at 3 months with functional change as measured with the Barthel Index (ΔBI) in an acute care inpatient ward and to identify the factors associated with ΔBI and who could benefit from an early rehabilitation program. METHODS: In this prospective longitudinal study, 76 patients with ischemic stroke in an acute care inpatient ward received early rehabilitation of up to 2 sessions per day for 5 d/wk during their stay. Therapy density was calculated as the proportion of total therapy sessions completed. At admission and discharge, they were assessed with the BI and the Postural Assessment Scale for Stroke Patients (PASS). Demographic and health-related information was also collected. The Barthel Index (BI) was reassessed at 3 months. RESULTS: ΔBI in the acute care inpatient ward significantly predicted the BI at 3 months, over and above the other significant variables; in addition, therapy density and change in PASS were significantly associated with ΔBI. Patients with moderate initial functional dependence had the largest ΔBI, followed by the group with a more severe condition. CONCLUSIONS: ΔBI in acute care inpatient wards may be an important predictor of the BI at 3 months. Therapy density and change in PASS were significantly associated with ΔBI. IMPACT: Survivors of acute stroke who receive up to 2 rehabilitation sessions per day for 5 d/wk early in their hospitalization have better functional recovery at 3 months after stroke.

Criterion-Referenced Values of Grip Strength and Usual Gait Speed Using Instrumental Activities of Daily Living Disability as the Criterion.

BACKGROUND AND PURPOSE: Current evidence suggests that grip strength and usual gait speed (UGS) are important predictors of instrumental activities of daily living (IADL) disability. Knowing the optimum cut points of these tests for discriminating people with and without IADL disability could help clinicians or researchers to better interpret the test results and make medical decisions. The purpose of this study was to determine the cutoff values of grip strength and UGS for best discriminating community-dwelling older adults with and without IADL disability, separately for men and women, and to investigate their association with IADL disability. METHODS: We conducted secondary data analysis on a national dataset collected in the Sarcopenia and Translational Aging Research in Taiwan (START). The data used in this study consisted of health data of 2420 community-dwelling older adults 65 years and older with no history of stroke and with complete data. IADL disability was defined as at least 1 IADL item scored as "need help" or "unable to perform." Receiver operating characteristics analysis was used to estimate the optimum grip strength and UGS cut points for best discriminating older adults with/without IADL disability. The association between each physical performance (grip strength and UGS) and IADL disability was assessed with odds ratios (ORs). RESULTS AND DISCUSSION: With IADL disability as the criterion, the optimal cutoff values of grip strength were 28.7 kg for men and 16.0 kg for women, and those for UGS were 0.76 m/s for men and 0.66 m/s for women. The grip strength test showed satisfactory discriminant validity (area under the curve > 0.7) in men and a strong association with IADL disability (OR > 4). Our cut points using IADL disability as the criterion were close to those indicating frailty or sarcopenia. CONCLUSIONS: Our reported cutoffs can serve as criterion-referenced values, along with those previously determined using different indicators, and provide important landmarks on the performance continua of older adults' grip strength and UGS. These landmarks could be useful in interpreting test results, monitoring changes in performance, and identifying individuals requiring timely intervention. For identifying older adults at risk of IADL disability, grip strength is superior to UGS.

Self-reported Sitting Time is Associated With Decreased Mobility in Older Adults.

BACKGROUND AND PURPOSE: Prolonged sitting is associated with increased risk of sarcopenia in community-dwelling older adults and can lead to poor muscle function, limited balance and transfer abilities, and mobility limitations. Sitting time can be a modifiable factor in preserving independent mobility in older adults. Assessing sitting time is an important measure for preventive medicine in older populations. The purposes of this study were to examine the test-retest reliability of older adults' reported (using a recall strategy) sitting time and to determine its association with mobility limitation. METHODS: In this cross-sectional study, 140 older adults aged 65 years or more from community centers were assessed for their sitting time and mobility limitation. A week later, 86 participants returned for the retest of sitting time. The test-retest reliability of the reported (recall strategy) measure of sitting time was examined by intraclass correlation coefficient (ICC), and its association with mobility limitation was examined by logistic regression analysis adjusted for age. RESULTS: The reported measure (recall strategy) of sitting time showed good test-retest reliability (ICC = 0.85). The results of logistic regression analysis indicated that sitting time was associated with mobility limitation, adjusted for age. DISCUSSION: Older adults' reported (recall strategy) sitting time had good test-retest reliability (ICC(2,1) = 0.85). The reported measure (recall strategy) seems to have yielded consistent reporting. The association of prolonged sitting time with mobility limitation needs to be substantiated in a future longitudinal study to determine whether a causality relationship exists. CONCLUSIONS: Sitting time in older adults can be reliably measured with a reported measure (a recall strategy) over a 1-week interval. Older adults who spend more time sitting are more likely to experience mobility limitation.

Basolateral amygdalar D2 receptor activation is required for the companions-exerted suppressive effect on the cocaine conditioning.

The presence of companions renders decreases in cocaine-stimulated dopamine release in the nucleus accumbens and cocaine-induced conditioned place preference (CPP) magnitude. Limbic systems are widely believed to underlie the modulation of accumbal dopamine release and cocaine conditioning. Thus, this study aimed to assess whether intact basolateral nucleus of amygdala (BLA), dorsal hippocampus (DH), and dorsolateral striatum (DLS) is required for the companions-exerted suppressive effect on the cocaine-induced CPP. Three cage mates, serving as companions, were arranged to house with the experimental mice in the cocaine conditioning compartment throughout the cocaine conditioning sessions. Approximately 1week before the conditioning procedure, intracranial ibotenic acid infusions were done in an attempt to cause excitotoxic lesions targeting bilateral BLA, DH and DLS. Albeit their BLA, DH, and DLS lesions, the lesioned mice exhibited comparable cocaine-induced CPP magnitudes compared to the intact and sham lesion controls. Bilateral BLA, but not DH or DLS, lesions abolished the companions-exerted suppressive effect on the cocaine-induced CPP. Intact mice receiving intra-BLA infusion of raclopride, a selective D2 antagonist, 30min prior to the cocaine conditioning did not exhibit the companions-exerted suppressive effect on the cocaine-induced CPP. Intra-BLA infusion of Sch23390, a selective D1 antagonist, did not affect the companions-exerted suppressive effect on the CPP. These results, taken together, prompt us to conclude that the intactness of BLA is required for the companions-exerted suppressive effect on the cocaine-induced CPP. Importantly, activation of D2 receptor in the BLA is required for such suppressive effect on the CPP.

Rottlerin impairs the formation and maintenance of psychostimulant-supported memory.

RATIONALE AND OBJECTIVE: Since brain proteins such as protein kinase C (PKC), brain-derived neurotrophic factor (BDNF), and mammalian target of rapamycin (mTOR) are involved in the establishment and maintenance of psychostimulant memory, we sought to determine if systemic treatment with rottlerin, a natural compound affecting all these proteins, may modulate stimulant-supported memory. MATERIALS AND METHODS: Stimulant-induced conditioned place preference (CPP) was used in modeling stimulant-supported memory. RESULTS: Three cocaine (10 mg/kg; COC) or three methamphetamine (1 mg/kg; MA) conditioning trials reliably established the drug-induced CPP in male C57BL/6 mice. An intra-peritoneal rottlerin injection (5 mg/kg) at least 24 h prior to the first COC or first MA conditioning trial prevented the establishment of CPP. Following the establishment of the COC- or MA-induced CPP, saline conditioning trial was used to extinguish the CPP. Rottlerin (5 mg/kg, intra-peritoneal (i.p.)) administered 20 h prior to the first saline conditioning trial diminished subsequent drug- and stressor-primed reinstatement of the extinguished CPP. Rottlerin (5 mg/kg, i.p.) produced a fast-onset and long-lasting increase in hippocampal BDNF levels. However, treatment with a BDNF tropomyosin receptor kinase B (TrkB) receptor antagonist, K252a (5 µg/kg), did not affect rottlerin's suppressing effect on COC-induced CPP and treatment with 7,8-dihydroxyflavone (10 mg/kg x 6, 7,8-DHF), a selective TrkB agonist, prior to each conditioning trial did not affect COC-induced CPP. CONCLUSION: These results suggest that systemic rottlerin treatment may impair the formation of COC- and MA-supported memory. Importantly, such a treatment may advance our understanding of the underlying mechanism through which extinction training resulted in the "forgetting" of the COC- and MA-supported memory.

The progression of disability among older adults in Mexico.

PURPOSE: This paper seeks to document the progression of disability in a developing country and to examine gender differences in this process. METHODS: The data come from the Mexican Health and Aging Study (MHAS), a nationally representative sample of older adults. An ordinal logistic regression (n = 3283) is used to measure the progression of disability that considers: (1) no disability, (2) mobility problems, (3) mobility problems with IADLs limitations, (4) mobility problems with ADLs limitations, (5) combinations of the latter three and (6) death. RESULTS: Approximately 43% of the sample remained in the same level of disability after 2 years. The patterns of progression with two disabilities differ for men and women. CONCLUSIONS: Our model reflects the importance of separating ADLs and IADLs in the study of disability progression in Mexico. Varying risk profiles and cultural differences might influence the divergent disability paths followed by each gender. Implications for Rehabilitation The disablement process involving transitions from mobility impairments to IADL and ADL limitations seen in developed countries differs for older adults in Mexico. Cultural differences may influence the progression from non-disabled to becoming disabled in different ways for females in developing countries like Mexico. One-fifth of individuals showed greater function and independence over time, suggesting that the disablement process is reversible. This finding highlights the need to focus on improving mobility, ADL, and IADL skills to facilitate successful aging. Although disability is often conceptualised as a combination of ADL and IADL limitations, gender differences seen in Mexico indicate the need to separate ADL and IADL when developing approaches to prevent or ameliorate disability.

Sex Differences in Stress and Group Housing Effects on the Number of Newly Proliferated Cells and Neuroblasts in Middle-Aged Dentate Gyrus.

Sex differences in stress and coping responses have been frequently documented in aged people, while whether such differences in aged people may appear at the middle age are unknown. This study was undertaken to study the impact of acute stress and social interaction on early neurogenesis in the dentate gyrus (DG) and hippocampus-related memory in two sexes of middle-aged mice. The number of newly proliferated cells, neuroblasts in DG, the object recognition and location memory in 9-month-old male and female C57BL/6N mice were assessed under baseline conditions as well as following an acute stressor regimen and group housing. Three conspecific companions, serving as "the housing group," were used to model the social interaction throughout the stressor regimen. Males had lower numbers of newly proliferated cells and neuroblasts under baseline conditions as compared to females. The stressor regimen caused rapid decreases in the number of newly proliferated cells and neuroblasts in female DG but no obvious changes were observed in male DG. Group housing, regardless of companions' age, prevented the stress-induced decreases in the number of newly proliferated cells and neuroblasts in female DG. In contrast, the presence of young or age-matched companions potentiated the stress effect in males by decreasing the number of newly proliferated cells and neuroblasts. Finally, neither the stressor regimen nor group housing affected mouse performances in the object recognition and location memory in either sex. These findings, taken together, provide evidence to support a notion that middle-aged females appear to demonstrate more stress susceptibility on early neurogenesis in DG as compared to middle-aged males, although the hippocampus-related memory performances are comparable and not affected by stress in these males and females. Experiencing stress, middle-aged females are more prone to benefit from social interaction as compared to middle-aged males in this regard. We suggest, accordingly, that involving social interaction may afford a therapeutic advance in preventing stress-produced decreases in early neurogenesis in middle-aged females' DG.

Combined association of chronic disease and low skeletal muscle mass with physical performance in older adults in the Sarcopenia and Translational Aging Research in Taiwan (START) study.

BACKGROUND: Multiple chronic conditions and low skeletal muscle mass are common features of aging that are detrimental to physical performance. This study evaluates the simultaneous impact of these conditions on physical performance in older adults. METHODS: Five studies from 2003 to 2012 were pooled to include 2,398 adults aged ≥65 years with diagnosed chronic diseases measured by self-administered questionnaire. Low muscle mass was defined as an appendicular skeletal muscle mass index less than that of the sex-specific lowest quintile in the population of older adults. Poor physical performances were defined as the lowest quintile of grip strength and gait speed in the population of older adults and the slowest sex-specific 20% of Timed Up and Go (TUG) test at each study site. Chi-squared and logistic regression tests were applied for data analysis. RESULTS: Mean age of the study participants, of whom approximately 50% were men, was 74.3 years. Slow gait speed was nearly three times more likely to occur in the presence of low muscle mass coupled with chronic disease than in the absence of both factors after adjustment for study site, age, sex, education, marital status, body mass index, tobacco and alcohol use, and comorbidities. The independent effect of low muscle mass was generally stronger than that of each disease. Participants with more than two chronic diseases and low muscle mass were significantly more likely to perform poorly than those with no risk factors (odds ratio [OR] = 2.51 in patients with low grip strength, OR = 3.89 in patients with low gait speed, and OR = 3.67 in patients with poor TUG test scores, all P < 0 .05) after adjustment. CONCLUSIONS: The combined association of chronic disease and low skeletal mass with physical performance was stronger than the effect of either factor alone.

Concurrent and convergent validity of the mobility- and multidimensional-hierarchical disability categorization models with physical performance in community older adults.

A valid, time-efficient and easy-to-use instrument is important for busy clinical settings, large scale surveys, or community screening use. The purpose of this study was to validate the mobility hierarchical disability categorization model (an abbreviated model) by investigating its concurrent validity with the multidimensional hierarchical disability categorization model (a comprehensive model) and triangulating both models with physical performance measures in older adults. 604 community-dwelling older adults of at least 60 years in age volunteered to participate. Self-reported function on mobility, instrumental activities of daily living (IADL) and activities of daily living (ADL) domains were recorded and then the disability status determined based on both the multidimensional hierarchical categorization model and the mobility hierarchical categorization model. The physical performance measures, consisting of grip strength and usual and fastest gait speeds (UGS, FGS), were collected on the same day. Both categorization models showed high correlation (γs = 0.92, p < 0.001) and agreement (kappa = 0.61, p < 0.0001). Physical performance measures demonstrated significant different group means among the disability subgroups based on both categorization models. The results of multiple regression analysis indicated that both models individually explain similar amount of variance on all physical performances, with adjustments for age, sex, and number of comorbidities. Our results found that the mobility hierarchical disability categorization model is a valid and time efficient tool for large survey or screening use.

FIM motor scores for classifying community discharge after inpatient rehabilitation for hip fracture.

OBJECTIVE: To assess the utility of functional status in classifying patients by discharge setting after inpatient rehabilitation for hip fracture. DESIGN: Retrospective cohort study. SETTING: A total of 1257 inpatient rehabilitation facilities in the United States. PATIENTS: Medicare beneficiaries (N = 117,168) receiving inpatient rehabilitation for hip fracture from 2007 to 2009. METHODS: Receiver operating characteristic curve analyses to assess the overall discriminatory ability of functional status scores (Functional Independence Measure [FIM] total, FIM cognition, and FIM motor) and to identify the functioning threshold that best differentiates patients by discharge setting. MAIN OUTCOME MEASUREMENTS: Discharge setting (community versus institutional). RESULTS: Approximately 68% of patients were discharged to the community after inpatient rehabilitation for hip fracture. Receiver operating characteristic curve analyses indicate that discharge FIM motor ratings (area under the curve: 0.84) alone are as effective as a multivariable model (area under the curve: 0.85), including sociodemographic and clinical factors, in discriminating patients discharged to the community from those discharged to an institution. A discharge FIM motor rating of 58 yielded the best balance in sensitivity and specificity for classifying patients by discharge setting. CONCLUSIONS: Discharge FIM motor ratings demonstrated good discriminatory ability for classifying discharge setting. An FIM motor rating of 58 may serve as a clinical tool to guide treatment plans and/or as additional information in complex discharge planning decisions for patients with hip fracture.