References

1. National Osteoporosis Foundation. Available at: http://www.nof.org/other/statistics.html. Accessed April 6, 1998.

2. Melton LJ III, Thamer M, Ray NF, et al. Fractures attributable to osteoporosis: report from the National Osteoporosis Foundation. J Bone Miner Res. 1997;12:16-23.

3. Ray NF, Chan JK, Thamer M, Melton LJ III. Medical expenditures for the treatment of osteoporotic fractures in the United States in 1995: report from the National Osteoporosis Foundation. J Bone Miner Res. 1997;12:24-35.

4. Cooper C, Melton LJ III. Epidemiology of osteoporosis. Trends Endocrinol Metab. 1992;3:224-229.

5. Cooper C, Campion G, Melton LJ III. Hip fracture in the elderly: a world-wide projection. Osteoporosis Int. 1992;2:285-289.

6. Cooper C, Atkinson EJ, O'Fallon WM, Melton LJ III. The incidence of clinically diagnosed vertebral fractures; a population-based study in Rochester, Minnesota, 1985-89. J Bone Miner Res. 1992;7:221-227.

7. Gallagher JC, Melton LJ, Riggs BL, Bergstrath E. Epidemiology of fractures of the proximal femur in Rochester, Minnesota. Clin Orthop Relat Res. 1980;150:163-171.

8. Physician's Guide to Prevention and Treatment of Osteoporosis. Washington, DC: National Osteoporosis Foundation; 1998.

9. DeFazio J, Speroff L. Estrogen replacement therapy: Current thinking and practice. Geriatrics. 1985;40(11):32-48.

10. Peck WA, Riggs BL, Bell NH. Physician's Resource Manual on Osteoporosis. Washington, DC: National Osteoporosis Foundation; 1987.

11. Mahon S. Osteoporosis: a concern for cancer survivors. Oncol Nurs Forum. 1998;25:843-853.

12. Burckhardt P, Michael C. The peak bone mass concept. Clin Rheumatol. 1989;8(suppl 2):16-21.

13. Sowers MR, Galuska DA. Epidemiology of bone mass in premenopausal women. Epidemiol Rev. 1993;15:374-398.

14. Riggs BL, Melton LJ III. Medical progress: involutional osteoporosis. Engl J Med. 1986;314:1676-1686.

15. Rousseau ME. Women's midlife health: reframing menopause. J Nurse Midwifery. 1998;43(3):208-223.

16. Looker AC, Wahner HW, Dunn WL, et al. Updated data on proximal femur bone mineral levels of US adults. Osteoporosis Int. 1998:8:468-489.

17. Huff M, Sadler C. African American women and osteoporosis. ABNF J. 1997;May/June:48-50.

18. National Institutes of Health Osteoporosis and Related Bone Diseases~National Resource Center. Available at: http://www.osteo.org/r607afrc.htm. Accessed May 26, 1999.

19. The Writing Group for the PEPI Trial. Effects of hormone therapy on bone mineral density. JAMA. 1996;276:1389-1396.

20. Cummings SR, Black DM, Nevitt MC, et al and the Study of Osteoporotic Fractures Research Group. Appendicular bone density and age predict hip fracture in women. JAMA. 1990;263:665-668.

21. Notelovitz M. Osteoporosis: screening, prevention, and management. Fertil Steril. 1993;59:707-725.

22. Lindsay R. The menopause: sex steroids and osteoporosis. Clin Obstet Gynecol. 1987;30:847-859.

23. Gallagher JC. Estrogen: Prevention and treatment of osteoporosis. In: Marcus, et al, eds. Osteoporosis. San Diego, Calif: Academic Press; 1996:chap 63.

24. Ott SM. Clinical effects of bisphosphonates in involutional osteoporosis. J Bone Miner Res. 1993;8(suppl 2):S597-S606.

25. Pacifici R, McMurtry C, Vered I, Rupich R, Avioli LV. Coherence therapy does not prevent axial bone loss in osteoporotic women: a preventive comparative study. J Clin Endocrinol Metab. 1988;66:747-753.

26. Chesnut CH, McClung MR, Ensrud KE, et al. Alendronate treatment of the postmenopausal osteoporotic woman: effect of multiple dosages on bone mass and bone remodeling. Am J Med. 1995;99:144-152.

27. Rossini M, Gatti D, Zamberlan , Braga V, Dorizzi R, Adams S. Long-term effects of a treatment course with oral alendronate on postmenopausal osteoporosis. J Bone Miner Res. 1994;9:1833-1837.

28. Hosking D, Chilvers CED, Christiansen C, et al. Prevention of bone loss with alendronate in postmenopausal women under 60 years of age. Engl J Med. 1998;338:485-492.

29. Black DM, Cummings SR, Karpf DB, for the Fracture Intervention Trial Research Group. Randomised trial of effect of alendronate on risk of fracture in women with existing vertebral fractures. Lancet. 1996;348:1535-1541.

30. Delmas PD, Bjanrson NH, Mitlak BH, et al. Effects of raloxifene on bone mineral density, serum cholesterol concentrations, and uterine endometrium in postmenopausal women. Engl J Med. 1997;337:1641-1647.

31. Raloxifene [package insert]. Indianapolis, Ind: Eli Lilly and Company; 1998.

32. Campodarve I, Drinkwater BL, Insogna KL, et al. Intranasal salmon calcitonin (INSC), 50-200 IU, does not prevent bone loss in early postmenopausal women [abstract]. J Bone Miner Res. 1994:9(suppl 1):S391.

33. Overgaard K, Riis BJ, Christiansen C, Podenphant J, Johansen JS. Nasal calcitonin for treatment of established osteoporosis. Clin Endocrinol (Oxf). 1989;30:435-442.

34. Aloia JF, Vaswani A, Yeh JK, Ross PL, Flaster E, Dilmanian FA. Calcium supplementation with and without hormone replacement therapy to prevent postmenopausal bone loss. Ann Intern Med. 1994;120:97-103.

35. Reid IR, Ames RW, Evans MC, Gamble GD, Sharpe SJ. Long-term effects of calcium supplementation on bone loss and fractures in postmenopausal women: a randomized controlled trial. Am J Med. 1995;98:331-335.

36. Dawson-Hughes B, Dallal GE, Krall EA, Sadowski L, Sahyoun, Tannenbaum S. A controlled trial of the effect of calcium supplementation on bone density in postmenopausal women. Engl J Med. 1990;323:878-883.

37. Jeffcoat MK, Chesnut CH. Systemic osteoporosis and oral bone loss. J Am Dent Assoc. 1993;124(November):49-56.

38. Kribbs PJ, Chesnut CH, Ott SM, Kilcoyne RF. Relationships between mandibular and skeletal bone in a population of normal women. J Prosthet Dent. 1990;63:86-89.

39. Daniell HW. Postmenopausal tooth loss. Contributions to edentulism by osteoporosis and cigarette smoking. Arch Intern Med. 1983;143:1678-1682.

40. Grodstein F, Colditz GA, Stampfer MJ. Post-menopausal hormone use and tooth loss: a prospective study. J Am Dent Assoc. 1996;127:370-377.

41. Paganini-Hill A. The benefits of estrogen replacement therapy on oral health. Arch Intern Med. 1995;155:2325-2329.

42. Krall EA, Dawson-Hughes B, Hannan MT, Wilson PW, Kiel D. Postmenopausal estrogen replacement and tooth retention. Am J Med. 1997;102:536-542.

43. 1999 Heart and Stroke Statistical Update. Dallas, Tex: American Heart Association; 1999.

44. 1997 Heart and Stroke Statistical Update. Dallas, Tex: American Heart Association; 1997.

45. National Center for Health Statistics. Vital Statistics of the United States. 1992, Vol II B Mortality, Part A. Hyattsville, Md: US Dept of Health and Human Services, Public Health Service; 1996. DHHS publication 96-1101.

46. Miller et al, eds. SEER Cancer Statistics Review, 1973-1993. Bethesda, Md: National Cancer Institute; 1997.

47. Wyeth-Ayerst Fourth Annual Menopause Report. 1996.

48. Millonig VL. Menopause: health promotion opportunities for the occupational health nurse. AAOHN Journal. 1996;44:585-597.

49. Stampfer MJ, Willett WC, Colditz GA, Rosner B, Speizer FE, Hennekens CH. A prospective study of postmenopausal estrogen therapy and coronary heart disease. Engl J Med. 1985;313:1044-1049.

50. Bush TL, Barrett-Connor E, Cowan LD, Criqui MH, Wallace RB, Suchindran CM, Tyroler HA, Rifkind BM. Cardiovascular mortality and noncontraceptive use of estrogen in women: results from the Lipid Research Clinics Program Follow-up Study. Circulation. 1987;75:1102-1109.

51. Petitti DB, Perlman JA, Sidney S. Noncontraceptive estrogens and mortality: Long-term follow-up of women in the Walnut Creek Study. Obstet Gynecol. 1987;70:289-293.

52. Boysen G, Nyboe J, Appleyard M, Sorensen PS, Boas J, Somnier F. Stroke incidence and risk factors for stroke in Copenhagen, Denmark. Stroke. 1988;19:1345-1353.

53. Criqui MH, Suwarez L, Barrett-Connor E, McPhillips J, Wingard DL, Garland C. Postmenopausal estrogen use and mortality. Am J Epidemiol. 1988;128:606-614.

54. Henderson BE, Paganini-Hill A, Ross RK. Estrogen replacement therapy and protection from acute myocardial infarction. Am J Obstet Gynecol. 1988;159:312-317.

55. van der Giezen AM, Schopman-Geurts van Kessel JG, Schouten EG, Slotboom BJ, Kok FJ, Collete HJ. Systolic blood pressure and cardiovascular mortality among 13,740 Dutch women. Prev Med. 1990;19:456-465.

56. Wolf PH, Madans JH, Finucane FF, Higgins M, Kleinman JC. Reduction of cardiovascular disease-related mortality among postmenopausal women who use hormones: evidence from a national cohort. Am J Obstet Gynecol. 1991;164:489-494.

57. Falkeborn M, Persson I, Adami HO, Bergstrom R, Eaker E, Lithell H. The risk of acute myocardial infarction after oestrogen and oestrogen-progestogen replacement. Br J Obstet Gynaecol. 1992;99:821-828.

58. Psaty BM, Heckbert SR, Atkins D, Lemaitre R, Koepsell TD, Wahl PW. The risk of myocardial infarction associated with the progestins in postmenopausal women. Arch Intern Med. 1994;154:1333-1339.

59. Folsom AR, Mink PJ, Sellers TA, Hong CP, Zheng W, Potter JD. Hormonal replacement therapy and morbidity and mortality in a prospective study of postmenopausal women. Am J Public Health. 1995;85:1128-1132.

60. Sullivan JM, Vander Zwaag R, Hughes JP, Maddock V, Kroetz FW, Ramanathan KB. Estrogen replacement and coronary artery disease. Effect on survival in postmenopausal women. Arch Intern Med. 1990;150:2557-2562.

61. Bush TL. Long term effect of estrogen use on cardiovascular death in women. Presented at: American Heart Association; 1991; Orlando.

62. Henderson BE, Paganini-Hill A, Ross RK. Decreased mortality in users of estrogen replacement therapy. Arch Intern Med. 1991;151:75-78.

63. Newton KM, LaCroix AZ, McKnight B, Knopp RH, Siscovick DS, Heckbert SR, Weiss NS. Estrogen replacement therapy and prognosis after first myocardial infarction. Am J Epidemiol. 1997;145:269-277.

64. Hulley S, Grady D, Bush T, et al for the Heart and Estrogen/progestin Replacement Study (HERS) Research Group. JAMA. 1998;280:605-613.

65. Gerhard M, Ganz P. How do we explain the clinical benefits of estrogen? From bed side to bench. Circulation. 1995;92:5-8.

66. Sullivan JM. Hormone replacement therapy in cardiovascular disease: The human model. Br J Obstet Gynaecol. 1996;103(suppl 13):50-67.

67. Clarkson TB, Anthony MS. Effects on the cardiovascular system: basic aspects. In: Lindsay R, Dempster DW, Jordan VC, eds. Estrogens and Antiestrogens. Philadelphia, Pa: Lippincott-Raven Publishers; 1997:89-118.

68. Keller C, Fullerton J, Fleury J. Primary and secondary prevention strategies among older postmenopausal women. J Nurse Midwifery. 1998;43:262-272.

69. The Writing Group for the PEPI Trial. Effects of estrogen or estrogen/progestin regimens on heart disease risk factors in postmenopausal women. JAMA. 1995;273:199-208.

70. Reis SE, Gloth ST, Blumenthal RS, Resar JR, Zacur HA, Gerstenblith G, Brinker JA. Ethinyl estradiol acutely attenuates abnormal coronary vasomotor responses to acetylcholine in postmenopausal women. Circulation. 1994;89:52-60.

71. Darling GM, Johns JA, McCloud PI, Davis SR. Estrogen and progestin compared with simvastatin for hypercholesterolemia in postmenopausal women. Engl J Med. 1997;337:595-601.

72. Davidson MH, Testolin LM, Maki KC, von Duvillard S, Drennan KB. A comparison of estrogen replacement, pravastatin, and combined treatment for the management of hypercholesterolemia in postmenopausal women. Arch Intern Med. 1997;157:1186-1192.

73. Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S). Lancet. 1994;344:1383-1389.

74. Gotto et al. Presented at: American Heart Association; 1997; Orlando.

75. Jha P, Flather M, Lonn E, Farkouh M, Yusuf S. The antioxidant vitamins and cardiovascular disease. Ann Intern Med. 1995;123:860-872.

76. Stampfer MJ, Hennekens CH, Manson JE, Colditz GA, Rosner B, Willett WC. Vitamin E consumption and the risk of coronary disease in women. Engl J Med. 1993;328:1444-1449.

77. Nenseter MS, Volden V, Berg T, Drevon CA, Ose L, Tonstad S. No effect of b-carotene supplementation on the susceptibility of low density lipoprotein to in vitro oxidation among hypercholesterolaemic, postmenopausal women. Scan J Clin Lab Invest. 1995;55:477-485.

78. Antiplatelet Trialists' Collaboration. Collaborative overview of randomised trials of antiplatelet therapy — I: Prevention of death, myocardial infarction, and stroke by prolonged antiplatelet therapy in various categories of patients. Br Med J. 1994;308:81-106.

79. Walsh BW, Kuller LH, Wild RA, et al. Effects of raloxifene on serum lipids and coagulation factors in healthy postmenopausal women. JAMA. 1998;279:1445-1451.

80. Premarin [package insert]. Philadelphia, Penn: Wyeth-Ayerst Laboratories; 1998.

81. Feuer EJ, Wun L-M, Boring CC, Flanders WD, Timmel MJ, Tong T. The lifetime risk of developing breast cancer. J Natl Cancer Inst. 1993;85:892-897.

82. National Cancer Institute. Cancer Facts. Available at: http://198.77.70.126_29.htm. Accessed May 25, 1999.

83. Ries LAG. Kosary CL, Hankey BF, Miller BA, Clegg L, Edwards BK, eds. SEER Cancer Statistics Review, 1973-1996. Bethesda, Md: National Cancer Institute; 1999.

84. Miller BA, Feuer EJ, Hakney BF. Eng J Med. 1992;327:1756-1757. Letter.

85. Harris JR, Lippman ME, Veronesi U, Willett W. Breast cancer. Engl J Med. 1992;327:319-328.

86. Huey FL. NIH consensus statement on breast cancer screening for women in the 40s: how will it affect patient care? Medscape Women's Health. 1997;2(4). Available at: http://www.medscape.com.

87. American College of Obstetricians and Gynecologists. Available at: http://www.acog.com/from_home/publications/press_releases/nr-mammos.htm. Accessed May 25, 1999.

88. American Cancer Society. Available at: http://www. cancer.org/media/story/1mar23.htm. Accessed May 25, 1999.

89. National Cancer Institute. Available at: http://rex.nci.gov/massmedia/pressreleases/ncabrecommend_part3.html. Accessed May 25, 1999.

90. Colditz GA, Hankinson SE, Hunter DJ, et al. The use of estrogens and progestins and the risk of breast cancer in postmenopausal women. Engl J Med. 1995;332:1589-1593.

91. Dupont WD, Page DL. Menopausal estrogen replacement therapy and breast cancer. Arch Intern Med. 1991;151:67-72.

92. Kaufman DW, Palmer JR, de Mouzon J, et al. Estrogen replacement therapy and the risk of breast cancer: results from the case-control surveillance study. Am J Epidemiol. 1991;134:1375-1385.

93. Palmer JR, Rosenberg L, Clarke EA, Miller DR, Shapiro S. Breast cancer risk after estrogen replacement therapy: results from the Toronto Breast Cancer Study. Am J Epidemiol. 1991;134:1386-1395.

94. Risch HA, Howe GR. Menopausal hormone usage and breast cancer in Saskatchewan: a record linkage cohort study. Am J Epidemiol. 1994;139:670-683.

95. Schairer C, Byrne C, Keyl PM, Brinton LA, Sturgeon SR, Hoover RN. Menopausal estrogen and estrogen-progestin replacement therapy and risk of breast cancer (United States). Cancer Causes Control. 1994;5:491-500.

96. La Vecchia C, Negri E, Franceschi S, et al. Hormone replacement therapy and breast cancer risk: a cooperative Italian study. Br J Cancer. 1995:72;244-248.

97. Schuurman AG, van den Brandt PA, Goldbohm RA. Exogenous hormone use and the risk of postmenopausal breast cancer: results from The Netherlands Cohort Study. Cancer Causes Control. 1995;6:416-424.

98. Stanford JL, Weiss NS, Voigt LF, Daling JR, Habel LA, Rossing MA. Combined estrogen and progestin hormone replacement therapy in relation to risk of breast cancer in middle-aged women. JAMA. 1995;274:137-142.

99. Newcomb PA, Longnecker MP, Storer BE, et al. Long-term hormone replacement therapy and risk of breast cancer in postmenopausal women. Am J Epidemiol. 1995;142:788-795.

100. Vassilopoulou-Sellin R. Estrogen replacement therapy in women at increased risk for breast cancer. Breast Cancer Res Treat. 1993;28:167-177.

101. Nachtigall LE, Nachtigall RH, Nachtigall RD, Beckman EM. Estrogen replacement therapy II: a prospective study in the relationship to carcinoma and cardiovascular metabolic problems. Obstet Gynecol. 1979;54:74-79.

102. Nachtigall MJ, Smilen SW, Nachtigall RD, Nachtigall RH, Nachtigall LE. Incidence of breast cancer in a 22-year study of women receiving estrogen-progestin replacement therapy. Obstet Gynecol. 1992;80:827-830.

103. Armstrong BK. Oestrogen therapy after the menopause — boon or bane? Med J Aust. 1988;148:213-214.

104. Steinberg KK, Thacker SB, Smith SJ, Stroup DF, Zack MM, Flanders D, Berkelman RL. A meta-analysis of the effect of estrogen replacement therapy on the risk of breast cancer. JAMA. 1991;265:1985-1990.

105. Sillero-Arenas M, Delgado-Rodriguez M, Rodigues-Canteras R, Bueno-Cavanillas A, Galvez-Vargas R. Menopausal hormone replacement therapy and breast cancer: a meta-analysis. Obstet Gynecol. 1992;79:286-294.

106. Colditz GA, Egan KM, Stampfer MJ. Hormone replacement therapy and risk of breast cancer: Results from epidemiologic studies. Am J Obstet Gynecol. 1993;168:1473-1480.

107. Grady D, Rubin SM, Petitti DB, et al. Hormone therapy to prevent disease and prolong life in postmenopausal women. Ann Intern Med. 1992;117:1016-1037.

108. Collaborative Group on Hormonal Factors in Breast Cancer. Breast cancer and hormone replacement therapy: collaborative reanalysis of data from 51 epidemiological studies of 52 705 women with breast cancer and 108 411 women without breast cancer. Lancet. 1997;350:1047-1059.

109. Sellers TA, Mink PJ, Cerhan JR, et al. The role of hormone replacement therapy in the risk for breast cancer and total mortality in women with a family history of breast cancer. Ann Intern Med. 1997;127:973-980.

110. Grodstein F, Stampfer MJ, Colditz GA, et al. Postmenopausal hormone therapy and mortality. Engl J Med. 1997;336:1769-1775.

111. Bergkvist L, Adami H-O, Persson I, Bergstršm R, Krusemo UB. Prognosis after breast cancer diagnosis in women exposed to estrogen and estrogen-progestogen replacement therapy. Am J Epidemiol. 1989;130:221-228.

112. Hunt K, Vessey M, McPherson K. Mortality in a cohort of long-term users of hormone replacement therapy: an updated analysis. Br J Obstet Gynaecol. 1990;97:1080-1086.

113. Henderson BE, Paganini-Hill A, Ross RK. Decreased mortality in users of estrogen replacement therapy. Arch Intern Med. 1991;151:75-78.

114. Willis DB, Calle EE, Miracle-McMahill HL, Heath CW Jr. Estrogen replacement therapy and risk of fatal breast cancer in a prospective cohort of postmenopausal women in the United States. Cancer Causes Control. 1996;7:449-457.

115. Stoll BA. Hormone replacement therapy for women with a past history of breast cancer. Clin Oncol. 1990;2:309-312.

116. DiSaia PJ, Odicino F, Grosen EA, Cowan B, Pecorelli S, Wile AG. Hormone replacement therapy in breast cancer. Lancet. 1993;342:1232.

117. Powles TJ, Hickish T, Casey S, O'Brian M. Hormone replacement therapy after breast cancer. Lancet. 1993;341:60-61.

118. Wile AG, Opfell RW, Margileth DA. Hormone replacement therapy in previously treated breast cancer patients. Am J Surg. 1993;165:372-375.

119. Eden JA, Bush T, Nand S, Wren BG. A case-controlled study of combined continuous oestrogen-progestin replacement therapy among women with a personal history of breast cancer. Menopause. 1995;2:67-72.

120. Vassilopoulou-Sellin R, Zolinski C. Estrogen replacement therapy in women with breast cancer: a survey of patient attitudes. Am J Med Sci. 1992;304(3):145-149.

121. Ziel HK, Finkle WD. Increased risk of endometrial carcinoma among users of conjugated estrogens. Engl J Med. 1975;293:1167-1170.

122. Smith DC, Prentice R, Thompson DJ, et al. Association of exogenous estrogen and endometrial carcinoma. Engl J Med. 1975;293:1164-1167.

123. Baker DP. Estrogen-replacement therapy in patients with previous endometrial carcinoma. Compr Ther. 1990;16(1):28-35.

124. Persson I, et al. Cancer incidence and mortality in women receiving estrogen and estrogen-progestin replacement therapy — long term follow-up of a Swedish cohort. Int J Cancer. 1996;67:327-332.

125. Schwartzbaum J, et al. The influence of exogenous estrogen use on survival after diagnosis of endometrial cancer. Am J Epidemiol. 1987;126:851-860.

126. Wilson PWF, Garrison RJ, Castelli WP. Postmenopausal estrogen use, cigarette smoking, and cardiovascular morbidity in women over 50: the Framingham Study. Engl J Med. 1985;313:1038-1043.

127. Grodstein F, Stampfer MJ, Manson JE, et al. Postmenopausal estrogen and progestin use and the risk of cardiovascular disease. Engl J Med. 1996;335:453-461.

128. Paganini-Hill A, Ross RK, Henderson BE. Postmenopausal oestrogen treatment and stroke: A prospective study. Br Med J. 1988;297:519-522.

129. Falkeborn M, Persson I, Terent A, Adami HO, Lithell H, Bergstrom R. Hormone replacement therapy and the risk of stroke. Follow-up of a population-based cohort in Sweden. Arch Intern Med. 1993;153:1201-1209.

130. Finucane FF, Madams JH, Bush TL, Wolf PH, Kleinman JC. Decreased risk of stroke among postmenopausal hormone users. Results from a national cohort. Arch Intern Med. 1993;153:73-79.

131. Grodstein F, Stampfer MJ, Goldhaber SZ, Manson JE, Colditz GA, Speizer FE, Willett WC, Hennekens CH. Prospective study of exogenous hormones and risk of pulmonary embolism in women. Lancet. 1996;348:983-987.

132. Daly E, Vessey MP, Hawkins MM, Carson JL, Gough P, Marsh S. Risk of venous thromboembolism in users of hormone replacement therapy. Lancet. 1996;348:977-980.

133. Jick H, Derby LE, Myers MW, Vasilakis C, Newton KM. Risk of hospital admission for idiopathic venous thromboembolism among users of postmenopausal oestrogens. Lancet. 1996;348:981-983.

134. Devor M, Barrett-Connor E, Renvall M, Feigel D Jr, Ramsdell J. Estrogen replacement therapy and the risk of venous thrombosis. Am J Med. 1992;92:275-282.