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Antihypertensive drugs can cause hypotension in the elderly and such an effect may lead to fall injuries. This thesis examined the association between antihypertensive drugs and hip fracture risk among elderly patients during the initiation of monotherapy. This population-based self-controlled case series study used healthcare administrative databases to identify Ontario residents aged ≥ 66 years with a first prescription for a thiazide diuretic, angiotension II converting-enzyme inhibitor, angiotensin II receptor antagonist, calcium channel blocker or beta-adrenergic blocker. A cohort of newly treated hypertensive elderly was then linked to the occurrence of hip fractures from April 1, 2000 to March 31, 2009. We found that hypertensive elderly initiated on an antihypertensive drug had a 43% increased risk of having a hip fracture during the first 45 days of treatment, IRR 1.43 (95% CI 1.19-1.72). Initiating antihypertensive drugs in community-dwelling elderly should be approached with caution due to increased fracture risk.

Antihypertensive drugs can cause hypotension in the elderly and such an effect may lead to fall injuries. This thesis examined the association between antihypertensive drugs and hip fracture risk among elderly patients during the initiation of monotherapy. This population-based self-controlled case series study used healthcare administrative databases to identify Ontario residents aged ≥ 66 years with a first prescription for a thiazide diuretic, angiotension II converting-enzyme inhibitor, angiotensin II receptor antagonist, calcium channel blocker or beta-adrenergic blocker. A cohort of newly treated hypertensive elderly was then linked to the occurrence of hip fractures from April 1, 2000 to March 31, 2009. We found that hypertensive elderly initiated on an antihypertensive drug had a 43% increased risk of having a hip fracture during the first 45 days of treatment, IRR 1.43 (95% CI 1.19-1.72). Initiating antihypertensive drugs in community-dwelling elderly should be approached with caution due to increased fracture risk.

Hip fracture trials have used a wide range of patient-reported outcomes (PRO) suggesting a lack of consensus among clinicians on what are considered the most relevant functional outcomes. We conducted a systematic review to identify the outcomes used in hip fracture randomized controlled trials (RCTs). We hypothesized that there had been an increase in numbers of PROs over time and the health status measure, SF-36, would be used the most. A database search and screening yielded 86 original trials. The mean Detsky score (and standard error) for quality was: 75.8% ± 1.76%. There was a trend in the increase of functional outcome; however, the SF-36 was used only in (10 out of 86) 11.6% trials. Both the ADL-Katz Index and HHS have lower respondent burden than the SF36 which may contribute to their frequent use in hip RCTs. There is a lack of applicable measures suitable for patients with dementia.

Navigating in the arctic has become more common, but it is dicult and dangerousdue to the presence of ice. Any training under safer circumstances is therefore veryvaluable, enter the need for ship simulators. Ship simulators today incorporate manyfeatures, such as cranes, anchors, wires, and state of the art physics. However, theinclusion of ice is very rare due to the complexity of simulating the feedback from theice breaking progress.The purpose of this project is to build a model and numerical methods to simulate icefracture in real-time, which is to be used in ship simulators. The model presented inthis project is implemented with the use of the physics engine AgX Multiphysics madeby Algoryx Simulation ABThe method represents the ice sheet as a non-homogeneous mesh. A collision with thehull of the ship injects deformation energy into the ice. The energy from the inelasticimpact is distributed on the ice sheet according to a quasi-static crack propagationmodel that is dened on a static mesh. The cracks are guided using stress elds thatapproximate the strain in each vertex. The distribution of the strain is done by a simplemodel which allows for breaking ice in non-uniform fragments. This is more realisticthan fracture in predened shapes which is the main contribution of this project. Thefragments become unbreakable rigid body ice oes that interact with the ship's hull bycollision and friction.The implementation of the ice model is tested by using a trimesh model of the TorViking II icebreaker using approximated buoyancy calculations, damping equations,and engine forces.Real-time performance is not achieved yet in the general case, but this is due to thechoice of collision geometry and the oe creation. Unstable force spikes from thecontacts between the ship and the ice is detected, but the overall global ice resistanceshows few abnormalities. Replacing the collision geometry and the rigid body oes isnecessary for the implementation to be able to run in real-time. Further experimentsto compare with real model data is needed to be able to validate the model.