Average T-scores Research Articles

Burden of Recurrent Pericarditis on Health-Related Quality of Life

The extent to which recurrences of pericarditis episodes impact patients' health-related quality of life (HRQOL) remains poorly understood. This study aimed to evaluate HRQOL and work productivity in patients with recurrent pericarditis (RP). Adult patients from a centralized recruitment database for the rilonacept Phase 2/3 clinical trials were invited to participate in a survey. Inclusion criteria were confirmed RP diagnosis and ≥1 recurrence within the previous 12 months. The 11-Point Pain Numeric Rating Scale, Patient Global Impression of Pericarditis Severity, Patient-Reported Outcomes Measurement Information System (PROMIS) Global Health v1.2, PROMIS Short Form Sleep Disturbance 8b, Work Productivity and Activity Impairment v2.0, and customized questions about fear and economic impact were used. In total, 83 patients (55% female, average age = 49.3 years) completed the survey. The median time since pericarditis diagnosis was 3.0 years at the time of survey completion; 49% experienced ≥3 recurrences in the previous 12 months. Forty percent had an emergency room visit, and 25% were hospitalized for their most recent recurrence. Sixty-six percent of participants rated the symptoms of their last recurrence as severe. The mean value for worst pericarditis pain (0 to 10 scale) during the most recent recurrence was 6.1. The average T-scores for PROMIS physical and mental health were 37.6 and 42.8, respectively, compared with 50 in the general population. Participants reported 50% of overall work impairment and 62% of activity impairment due to RP. In conclusion, patients with RP experienced a high number of recurrences with severe symptoms that substantially reduced their HRQOL and work productivity.

A-06 Current Norms May Overestimate Rates of Neurocognitive Impairment among American Indian and Alaskan Native Adults.

Abstract Objective Currently available normative data subsume American Indian and Alaskan Native (AI/AN) populations within the non-Latinx white (NLW) ethnoracial group. The classification accuracy of such norms among AI/AN remains unknown. This cross-sectional study aims to identify whether disparities exist in the rates of neurocognitive impairment (NCI) between AI/AN and NLW adults. < br><br > Method Two hundred community-dwelling adults (50% NLW; 50% Male; M Age = 42 ± 14 years; M Education = 13 ± 3 years) completed comprehensive neurocognitive, quality of education (Wide Range Achievement Test- 4 [WRAT-4]), neuromedical, urine toxicology, and psychiatric/substance use evaluations. Average T-scores were calculated using widely used demographically corrected (age, gender, education) NLW norms to identify NCI (> 1 SD; e.g., Heaton et al., 2004; Heaton & Marcotte, 2000). A comorbid condition propensity score (CCPS) identified the probability to which comorbid conditions (e.g., Heaton et al., 2010) informed ethnoracial identity. <br><br > Results After adjusting for WRAT-4 and CCPS, the results of a logistic regression analysis demonstrated a significant ethnoracial disparity in risk for NCI (X2(3) = 13.88, p<.01, R2 = .07), such that the AI/AN group was at 2.52 times higher odds (32.3% vs. 16.0, CI: 1.15–5.46, p = .01, Cohen’s d = .51) for NCI in comparison to the NLW group. <br><br > Conclusions Published norms for NLW adults may overestimate impairment in AI/AN adults. Thus, population-specific normative data are needed to clarify the classification accuracy of neurocognitive impairment and possible disparities in neurocognitive disorders (e.g., HIV-associated neurocognitive disorders) among AI/AN adults. Future work should replicate these findings among other diverse populations (e.g., Caribbean, Middle Eastern) lacking population-specific normative data.876199.

Role of pre-operative PROMIS scores in predicting post-operative outcomes and likelihood of achieving MCID following arthroscopic meniscus surgery

Objectives:The minimum clinically important difference (MCID) for Patient Reported Outcomes Measurement and Information System computer-adaptive test (PROMIS-CAT) forms in patients undergoing meniscus surgery remains unknown. Therefore, the purpose of this study was to examine changes of PROMIS t-scores in meniscus surgery patients, as well as to determine the MCID in PROMIS scores for these patients. Secondarily, we sought to determine factors that predicted achievement of this MCID.Methods:Patients undergoing meniscal surgery (medial and/or lateral meniscectomy or meniscus repair) by one of two orthopaedic surgeons were asked to complete three PROMIS-CAT forms preoperatively, and at various postoperative visits. The three administered forms were as follows: PROMIS Physical Function (PROMIS-PF), PROMIS Pain Interference (PROMIS-PI), and PROMIS Depression (PROMIS-D). Average t-scores were analyzed across the time points within each domain. Additionally, the MCID for each PROMIS domain was calculated. Finally, predictive preoperative score cutoffs were determined for each domain with respect to MCID.Results:Average PROMIS t-score improved significantly in each domain from the preoperative to 6 weeks postoperative timepoint (38.6 ± 6.9 v 44.0 ± 3.5, 63.3 ± 6.1 v 55.3 ± 3.0, and 48.2 ± 9.6 v 44.2 ± 4.8) for PROMIS PF, PI, and D, respectively (Figure I). MCID values were calculated following a distribution-based methodology. These values were 3.48, 3.09, and 4.82, respectively. Of patients undergoing meniscus surgeries, 71.0%, 80.2% and 58.8% of patients achieved MCID respectively. After construction of prognostic preoperative score cutoffs in each PROMIS domain, 96.3%, 94.7% and 91.7% of patients meeting the prognostic cutoff scores achieved MCID, respectively (Table I).Conclusion:With respect to PROMIS CAT forms, significant improvement was detected at 6 weeks postoperatively in each of three domains, suggesting these surgeries are effective. Additionally, our results suggest that preoperative PROMIS scores can predict operative success in the form of achieving MCID.Figure 1.Table 1.PROMIS Prognostic Cutoffs That Predict Operative Patients Who Will Achieve MCID. Positive Test if Preoperative ScoreLRPretest Probability (Percent)Posttest Probability (Percent)Physical function<33.7010.571.0%96.3%Pain interference>70.054.380.2%94.7%Depression>55.4536.358.8%91.7%

A Comparison of Functional and Radiographic Outcomes following Microfracture with Extracellular Matrix Augmentation versus Osteochondral Autograft Transplantation for the Treatment of Medium-Sized Osteochondral Lesions of the Talus

Objectives:The aim of this study is to directly compare clinical outcomes following the treatment of medium-sized osteochondral lesions of the talus (OLTs) using a microfracture technique augmented with Extracellular Matrix and Bone Marrow Aspirate Concentrate (MFX) versus OAT to determine which treatment is superior for medium-sized lesions.Methods:Patients treated for an OLT between 2015 and 2018 by a single surgeon, fellowship-trained in sports medicine and foot and ankle, were screened for this study. Retrospective chart review determined treatment, lesion size, lesion location, concurrent injuries, and demographic information. Patients at a minimum of 12 months follow-up, treated with MFX or OAT, and lesions sized 80-165mm2 were eligible for inclusion. All surgical repairs were augmented with an adjuvant mixture of micronized cartilage extracellular matrix and bone marrow aspirate concentrate (ECM-BMAC). Patient-reported functional outcomes were collected through our institution’s prospective Registry database. Patients treated prior to March 2016 were administered preoperative Foot and Ankle Outcome Score questionnaires. Those treated after this date were administered preoperative Physical Function, Pain Interference, Global Physical Health, Global Mental Health, Depression, and Pain Intensity Patient-Reported Outcome Information System (PROMIS) domains. Both FAOS and PROMIS were administered postoperatively. Postoperative MRIs were assessed using a modified magnetic resonance observation of cartilage repair tissue (MOCART) score. Student’s paired and two-group t-tests were used to evaluate for statistically significant pre-to-postoperative change and differences between procedure groups (p less than 0.05).Results:Twenty-seven patients treated with MFX (age range, 14-58) and twenty-three patients treated using OAT (age range, 22-64) were identified. All OAT patients received a single-plug transplantation. The final average lesion size ± standard deviation (SD) for patients treated with MFX was 115.44mm2± 22.51 (range, 156-80mm2) and 121.78mm2± 23.98 (range, 165-80mm2) for those treated using OAT (p=0.34). On average, functional outcome scores improved pre-to-postoperatively across all scales within both groups. Statistically significant improvements were detected in PROMIS Physical Function (Δ=8.32, p=0.01), Pain Interference (Δ=-7.15, p=0.02), Global Physical Health (Δ=5.87, p=0.03), and Pain Intensity (Δ=-7.06, p=0.05) domains for the MFX cohort. For the OAT patient group, significant pre-to-postoperative change was seen in the FAOS subcategories of Pain (Δ=28.70, p=0.03), Sports Activities (Δ=43.12, p<0.01), and Quality of Life (Δ=43.75, p=0.01); overall FAOS score (Δ=29.93, p=0.01); and PROMIS Physical Function (Δ=13.66, p=0.01), Pain Interference (Δ=-14.58, p<0.01), Global Physical Health (Δ=12.2, p=0.01), Depression (Δ=-4.13, p=0.02), and Pain Intensity (Δ=-16.56, p=0.02) domains. On average, with the exception of the postoperative Sports Activities subscale, postoperative FAOS and pre-to-postoperative change in FAOS were higher and greater in the OAT patient group. Similarly, on average, the OAT group had better PROMIS t-scores indicating higher function or less pain and greater pre-to-postoperative change in each PROMIS domain. The OAT cohort’s average postoperative Pain Interference t-score (± SD) of 43.09 (± 5.81) and Depression t-score of 40.06 (± 6.84) were significantly lower than their respective counterparts in the MFX cohort: 50.08 (± 9.47) for Pain Interference and 48.09 (± 7.86) in Depression. (Table 1) Finally, the mean overall MOCART score was 55.67 (± 24.11) within the MFX cohort, average follow-up 15.29 months, and 71 (± 15.60) within the OAT cohort average follow-up 15.8 months. This difference was also statistically significant (p=0.04).Conclusion:The OAT group had a higher MOCART score indicating the use of a single osteochondral autograft plug may result in better structural repair than microfracture abrasion chondroplasty augmented with a mixture of adjuvant ECM-BMAC. In addition, higher average FAOS scores, better average PROMIS t-scores, and greater pre-to-postoperative change in the OAT patient group indicate functional results may be better in this group as well. Specifically, significantly lower Pain Interference and Depression domains and significantly higher Global Mental Health scores indicate patients treated using OAT experience less pain and better psychological benefits postoperatively compared to patients treated using MFX. These results suggest filling the lesion with transplanted autograft bone and native, hyaline cartilage may perform better than and the biomechanically inferior fibrocartilage produced following microfracture even when augmented with adjuvant therapy. OAT may result in better overall clinical outcomes, specifically in a population of patients with medium sized lesions (range, 80 mm2 -165 mm2).

The Impact of Advancement Via Individual Determination on the College Readiness of First-Generation Hispanic Students in an Urban South Texas High School

This study examined the phenomenon of college readiness in Hispanic first-generation college students. The purpose of this study was to determine if a relationship exists between first-generation Hispanic student participation in an Advancement Via Individual Determination (AVID) elective course and college readiness. The researchers used logistic regression with a dependent variable, college readiness [measured by passing and failing scores on the Texas Success Initiative (TSI) Assessment in Reading, Writing and Math] and the predictor variables: AVID participation, Average T-scores of Advanced Placement, and Average T-scores of ACT and Dual Enrollment. Findings indicated that high school AVID elective course participation was a function of TSI Reading, Writing, and Math scores; however, middle school AVID elective course participation was not a function of these scores. The results highlight the importance of continued research on AVID participation and college readiness, particularly in the form of college placement exam scores such as the Texas Success Initiative.

Failure mechanisms of pedicle screws and cortical screws fixation under large displacement: A biomechanical and microstructural study based on a clinical case scenario

Study designCadaveric biomechanical with imaging analysis. ObjectiveThis study aims to compare the fixation failure between pedicel screws (PS) and cortical screws (CS), thus to investigate their failure mechanisms under vertical migration. Summary of background dataDue to their minimal invasive nature, CS are gaining popularity. However, contradictions exist in the literature regarding whether CS may have superior fixation failure resistance compared to PS under vertical migration. MethodsHuman vertebral specimens were examined under Dual-energy X-ray. For each specimen, PS were inserted on the left and CS on the right with rods secured. Vertical force-displacement tests were applied to rods. MicroCT images were taken pre and post-MTS® for microstructural analysis. ResultsThe average T-scores of the specimens were −4±0.25. Three phases of force-displacement behaviour featuring different PS and CS failure-resistance were discovered. For phase I, the force required to migrate PS tended to be slightly higher than CS. However, during phase II, a fixation instability occurred for PS and the CS fixation strength was superior. For phase III under large displacement, CS did not require increased force to displace, whereas PS re-stabilised and revealed improved displacement resistance. Both force analysis and microstructural analysis indicated that PS migrated along the direction of the vertical loading, whereas CS had a force component in the longitudinal axis of the screw. ConclusionsDifferent failure mechanisms underlay PS and CS under large vertical displacement. PS fail with trabecular bone compaction possibly altering the initial material property surround the screw. CS fail with screw cut-out due to the force component along the screw axis.

Teriparatide treatment increases Hounsfield units in the lumbar spine out of proportion to DEXA changes.

The authors sought to assess whether Hounsfield units (HU) increase following teriparatide treatment and to compare HU increases with changes in bone mineral density (BMD) as measured by dual-energy x-ray absorptiometry (DEXA). A retrospective chart review was performed from 1997 to 2018 across all campuses at our institution. The authors identified patients who had been treated with at least 6 months of teriparatide and compared HU and BMD as measured on DEXA scans before and after treatment. Fifty-two patients were identified for analysis (46 women and 6 men, average age 67 years) who underwent an average of 20.9 ± 6.5 months of teriparatide therapy. The mean ± standard deviation HU increase throughout the lumbar spine (L1-4) was from 109.8 ± 53 to 133.9 ± 61 HU (+22%, 95% CI 1.2-46, p value = 0.039). Based on DEXA results, lumbar spine BMD increased from 0.85 to 0.93 g/cm2 (+9%, p value = 0.044). Lumbar spine T-scores improved from -2.4 ± 1.5 to -1.7 ± 1.5 (p value = 0.03). Average femoral neck T-scores improved from -2.5 ± 1.1 to -2.3 ± 1.0 (p value = 0.31). Teriparatide treatment increased both HU and BMD on DEXA in the lumbar spine, without a change in femoral BMD. The 22% improvement in HU surpassed the 9% improvement determined with DEXA. These results support some surgeons' subjective sense that intraoperative bone quality following teriparatide treatment is better than indicated by DEXA results. To the authors' knowledge, this is the first study demonstrating an increase in HU with teriparatide treatment.

Health Locus of Control and Neuropsychological Performance in Latinx and Non-Latinx White Persons Living with HIV (PLWH)

Abstract Objective Health locus of control (HLOC) refers to health attributions related to one’s actions, chance, doctors, or powerful others and impacts health service utilization. Locus of control (LOC) relates to better neurocognitive (NC) function in healthy adults, medication adherence, and quality of life in persons living with HIV (PLWH). No studies have examined HLOC and NC function in PLWH. This study examined how HLOC contributes to NC function in PLWH. Participants and Method This cross-sectional study included 130 PLWH (Latinx: n = 95; non-Latinx White [NLW]: n = 35) who completed an NC battery and Multidimensional Health Locus of Control Scale Form C (MHLS-C). MHLS-C has 4 subscales (internal, chance, doctors, and powerful others; 1 = Strongly Disagree – 6 = Strongly Agree). Demographically corrected NC T-scores were used for average global NC and domain T-scores. Results The Latinx group did worse than the NLW group in global NC, learning, memory, and verbal function (ps &amp;lt; .05). In the Latinx group, MHLS-C Chance negatively related to global NC, learning, memory, and fluency (ps &amp;lt; .05); Powerful Others was negatively related to global NC, learning, and memory (ps &amp;lt; .05). In the NLW group, MHLS-C Chance negatively related to learning and memory (ps &amp;lt; .05). In hierarchical regressions, our model (Step 1: ethnicity and Step 2: MHLC Chance and Powerful Others subscales) predicted global NC (R^2 = .10), learning (R^2 = .30), and memory (R^2=.27; all ps &amp;lt; .05), such that ethnicity was not significant (all ps &amp;gt; .05). Additionally, greater MHLS-C Chance predicted worse NC function (β’s = -.22 to -.40, ps &amp;lt; .05). Conclusions Chance HLOC is related to worse NC function in Latinx and NLW groups, but more strongly in the Latinx group. Ethnicity no longer predicted NC function once chance HLOC was considered. These findings align with prior research in the Latinx population about “fatalismo,” a belief that life events are predestined, and highlight the importance of health professionals addressing perceptions of control over one’s health to improve outcomes, including NC functioning.

The Role of Quality of Education in Neurocognitive Functioning in a Diverse Sample with Chronic Opioid Use Disorder

Abstract Objective Literacy is a proxy for quality of education (QoE) and mediates ethnicity-related differences in neurocognitive (NC) performance in some populations (Manly et al., 2002; Rivera Mindt et al., 2008). However, it is unknown whether this relationship exists in the context of chronic opioid use disorder (OUD). This study examined the role of ethnicity, QoE, opioid use severity, and depression in predicting NC performance in a diverse sample of persons with OUD. Participants and Method This cross-sectional study included 74 adults with OUD (Age M = 40.3 [SD = 10.5]; Education M = 11.3 [2.5]; 24% female; 68% Latinx and 32% Non-Latinx White [NLW]). All participants completed comprehensive NC testing and psychiatric/substance use questionnaires. Variables included ethnicity (Latinx vs. Non-Latinx White), years of education, QoE (Wide Range Achievement Test, Third Edition; WRAT-3 Reading Standard Scores), opioid use severity (high vs. low OAT dose), current depression (Beck Depression Inventory, Second Edition; BDI-II Total Score), and demographically-corrected NC T-scores were computed and used for average domain T-scores (e.g., learning, memory, verbal fluency, executive function). Bivariate and ANCOVA analyses were used to compare ethnic groups. Results There were no significant group differences on opioid use severity or current depression (p’s &amp;gt; .05). However, compared to the NLW group, the Latinx group had lower years of education (M = 10.9 [SD = 1.7] vs. M = 12.2 [SD = 3.5]; t[72)] = 2.1, p &amp;lt; .05), QoE (M = 83.1 [SD = 13.6] vs. M = 94.8 [SD = 9.4]; t[72] = 3.8, p &amp;lt; .001), executive functioning (M = 42.0 [SD = 6.5] vs. M = 45.8 [SD = 8.5]; t[72) = 2.1, p &amp;lt; .05), and learning (M = 32.2 [SD = 8.2] vs. M = 37.8 [SD = 8.7]; t[72)] = 2.7, p &amp;lt; .05), with medium to large effect sizes (Cohen’s d &amp;gt; .50). The overall effect of ethnicity became non-significant for executive functioning after accounting for QoE (F[2,70] = 10.0, p = .002) and years of education (F[2,70)] = 16.8, p &amp;lt; .001). Conclusions The current study found that accounting for years of education and QoE attenuates some differences in NC performance between Latinx and Non-Latinx participants. References Manly, J. J., Jacobs, D. M., Touradji, P., Small, S. A., &amp; Stern, Y. (2002). Reading level attenuates differences in neuropsychological test performance between African American and White elders. Journal of the International Neuropsychological Society, 8(3), 341-348. Mindt, M. R., Arentoft, A., Germano, K. K., D’Aquila, E., Scheiner, D., Pizzirusso, M., ... &amp; Gollan, T. H. (2008). Neuropsychological, cognitive, and theoretical considerations for evaluation of bilingual individuals. Neuropsychology review, 18(3), 255-268.

P39. Teriparatide treatment improves bone quality in the lumbar spine out of proportion to DEXA changes

BACKGROUND CONTEXT Teriparatide has been used to improve bone quality when considering spinal fusion surgery in patients with osteoporosis. Hounsfield units (HU), a standardized measurement for radiodensity, can be obtained on routine computed tomography (CT) scans, while dual energy X-ray absorptiometry (DEXA) is the common test for bone density. PURPOSE To compare changes in bone quality in the lumbar spine between Hounsfield unit measurements and dual energy X-ray absorptiometry (DEXA) following teriparatide treatment. STUDY DESIGN/SETTING Retrospective Chart Review. METHODS A retrospective chart review was performed from 1997 to 2018 across all campuses at our institution. We identified patients who had been treated with at least 6 months of teriparatide with a CT scan and DEXA scan before and after therapy. HU were measured from L1-L4 with three measurements per vertebral body. RESULTS Fifty-two patients (46 women, six men) were identified for analysis with an average age of 67 years who underwent an average of 20.9±6.5 months of teriparatide therapy. Mean (± standard deviation) HU improvement throughout the lumbar spine (L1-L4) was from 109.8±53 to 133.9±61 with a p-value of 0.039 and a 95% CI from 1.2 to 46.1. Each individual lumbar level also had an average improvement in HU but only L1 was statistically significant (L1 improved from 112.4 to 139.2 with a p-value of 0.013). Based on DEXA results, lumbar spine t-scores improved from -2.4±1.5 to -1.7±1.5 with a p-value of 0.03. Average femoral t-scores improved from -2.5±1.1 to -2.3±1.0 with a p-value of 0.31. CONCLUSIONS Teriparatide treatment improved BMD based on HU and DEXA in the lumbar spine, without a change in femoral BMD. The 22% improvement in HU surpassed the changes seen on DEXA. These results supports some surgeons’ subjective sense that intraoperative bone quality following teriparatide treatment is better than indicated by DEXA results. FDA DEVICE/DRUG STATUS Unavailable from authors at time of publication.

Can Women Live with More Symptoms than Men?

Category: Other Introduction/Purpose: Over the last few years an increasing focus has been directed to define cut-off points for important health improvement. Minimal clinically important difference (MCID) values have traditionally been used to determine if a statistical change translates to a clinical improvement to the patient. Although MCID is helpful, it may be even more important to identify if the current treatment is adequate or that the patient has achieved an acceptable symptom state (symptoms minimal enough to live with). The purpose of this study was to determine if gender influenced patient reported outcomes (patient acceptable symptom state (PASS) and PROMIS Physical Function, Pain Interference and Depression) in patients with foot and ankle problems. Methods: Prospectively collected PROMIS and PASS were identified for 450 surgical patients (Males=126, Females=324). The CPT codes, gender %, age and follow up were recorded (Table 1). To assure the overall recovery experienced by females and males was similar, aggregate PROMIS scores were compared using ANOVA analysis. The average PROMIS t-scores were comparable and without clinically meaningful differences between gender groups. The ability of each PROMIS scale to predict PASS status was determined using receiver operator curves (ROC). The area under the curve (AUC) and thresholds approximating 95% sensitivity/specificity for males and females were assessed for each PROMIS domain. AUC values below 0.7 are not considered clinically useful. Differences AUC or approximating 95% sensitivity/specificity thresholds by gender would support the hypothesis that PASS status is influenced by gender. Results: There were significant differences in the AUC for gender suggesting PROMIS scores are better predictors of PASS for females than males however there were only minor differences in near 95% sensitivity/specificity PROMIS threshold values by gender. The AUC values for females were higher than for males for each PROMIS scale (Figure 1). The thresholds PROMIS PF, PI and Dep for males and females are in Table 1. The thresholds for PROMIS PF to determine PASS yes was lower for females compared to males; while the thresholds for PROMIS PI to determine PASS yes were similar between males and females. This suggests that women accept lower function as an acceptable status than men. Men and women accept similar pain thresholds as PASS yes. Conclusion: PROMIS domains more accurately predict PASS status in females based on the AUC. Females are more likely to judge their physical abilities as acceptable at a lower PROMIS PF threshold value compared to males. Despite these gender differences, males and females both identify a PROMIS threshold (PF and PI) that was near the average of the US population (t-score 50). The lower AUC for males may indicate that males judge any symptoms as unacceptable and use a broader frame of reference than isolatedly perceived physical function and pain interference when judging whether their physical abilities and symptoms are acceptable.

Epidemiology and correlates of osteoporotic fractures among type 2 diabetic patients

Little is known about the association between type 2 diabetes mellitus (T2DM) and fragility fractures or the mechanism(s) involved. We examined fracture correlates among T2DM patients with osteoporosis. We used electronic health records of an osteoporosis (OP) registry cross-linked with a diabetes registry of a large payer provider healthcare organization in Israel. A cross-sectional analysis compared osteoporosis patients with and without T2DM, and a longitudinal Cox proportional hazard regression was used to identify incident fracture correlates. As of December 2015 a total of 87,224 current OP patients were identified, of whom 15,700 (18%) had T2DM. The T2DM OP patients were characterized by older age (mean 74.6 vs. 69.5), more males (20.3 vs. 14.0%), and a higher rate of chronic comorbidities compared to OP without diabetes. All major OP fractures (hip, spine, humerus, and forearm) were significantly more prevalent among T2DM OP patients (44 vs. 32%), with an overall age-standardized ratio of 1.22 (95% CI 1.19 to 1.25) and 1.15 (95% CI 1.10 to 1.21) for females and males respectively. The average T-scores were higher (femur neck - 1.8 vs. - 1.9, total hip - 1.2 vs. - 1.6, and vertebrae - 1.3 vs. - 1.7) for the T2DM OP patients compared to the non-T2DM OP patients. Among women with coexisting T2DM and osteoporosis (n = 10,812), fracture incidence was significantly associated with retinopathy (HR = 1.24, 95% CI 1.05 to 1.47) and cardiovascular disease (HR = 1.22, 95% CI 1.10 to 1.36) after controlling for age, bone mineral density T-score, rheumatoid arthritis, glucocorticoids, alcohol, and smoking). This large population-based study confirms the higher fracture risk of osteoporotic patients with T2DM, as compared to osteoporotic patients without T2DM, despite higher bone mineral density levels. The presence of micro- and macrovascular disease appears to increase this risk.

Prevalence and severity of bone loss in burned patients

Often discovered late during the clinical course of burns, bone loss is widely accepted by clinicians as a de facto consequence of burn. Literature on this bone loss is limited and contradictory in details. More insight into the prevalence and magnitude of bone loss may facilitate its prevention. To this end, over a period of two years, we gathered a test group of 34 male patients with at least six-month-old thermal burns and a control group of 50 male members of similar age and geographical background as our test group. All members with any history of metabolic or endocrine disease or ICU admission were excluded from both groups. Using dual energy X-ray absorptiometry (DXA), we measured bone mineral density (BMD), Z-score and T-score in lumbar vertebra, femoral neck, and total femur and compared the results between the two groups. T-test of density scores against total body surface area of burns was performed. We found that the average T-scores, Z-scores and BMDs in the test group were significantly smaller than the averages in the control group (P<0.001); and in the test and the control group, 25.7% and 0% of subjects respectively, had osteoporotic lumbar T-scores. Total femur and femoral neck T-scores exhibited a significant similar pattern with smaller differences across the two groups. The density scores also showed a significant reverse relationship to the total body surface area (TBSA) of burn (P<0.003). Our results indicate that thermal burn victims have lower bone density and higher prevalence of osteoporosis than their healthy counterparts and that this difference is significant enough to justify screening in these patients which requires further longitudinal studies to institute.

Two-Year Changes in Bone Density After Roux-en-Y Gastric Bypass Surgery

Bariatric surgery is increasingly popular but may lead to metabolic bone disease. The objective was to determine the rate of bone loss in the 24 months after Roux-en-Y gastric bypass. This was a prospective cohort study conducted at an academic medical center. The participants were adults with severe obesity, including 30 adults undergoing gastric bypass and 20 nonsurgical controls. We measured bone mineral density (BMD) at the lumbar spine and proximal femur by quantitative computed tomography (QCT) and dual-energy x-ray absorptiometry at 0, 12, and 24 months. BMD and bone microarchitecture were also assessed by high-resolution peripheral QCT, and estimated bone strength was calculated using microfinite element analysis. Weight loss plateaued 6 months after gastric bypass but remained greater than controls at 24 months (-37 ± 3 vs -5 ± 3 kg [ mean ± SEM]; P < .001). At 24 months, BMD was 5-7% lower at the spine and 6-10% lower at the hip in subjects who underwent gastric bypass compared with nonsurgical controls, as assessed by QCT and dual-energy x-ray absorptiometry (P < .001 for all). Despite significant bone loss, average T-scores remained in the normal range 24 months after gastric bypass. Cortical and trabecular BMD and microarchitecture at the distal radius and tibia deteriorated in the gastric bypass group throughout the 24 months, such that estimated bone strength was 9% lower than controls. The decline in BMD persisted beyond the first year, with rates of bone loss exceeding controls throughout the second year at all skeletal sites. Mean serum calcium, 25(OH)-vitamin D, and PTH were maintained within the normal range in both groups. Substantial bone loss occurs throughout the 24 months after gastric bypass despite weight stability in the second year. Although the benefits of gastric bypass surgery are well established, the potential for adverse effects on skeletal integrity remains an important concern.

Aging and HIV/AIDS: Neurocognitive Implications for Older HIV-Positive Latina/o Adults

In recent years, HIV/AIDS populations have become older and increasingly more ethnically diverse. Concurrently, the prevalence of HIV-related neurocognitive (NC) impairment remains high. This study examined the effects of age and ethnicity on NC function in HIV-positive adults. The sample (N = 126; 84 Latina/o and 42 Non-Hispanic White) completed a comprehensive NC battery. Global NC and domain average demographically-corrected t-scores were generated. There were no significant differences between Younger (<50 years) Latina/os and non-Hispanic Whites on Global NC function or NC domains (all p's >.10), with generally small effect sizes. Older Latina/os (≥50 years) were significantly more impaired than Older Non-Hispanic Whites on processing speed and learning, with trends in Global NC function and memory. Further, effect sizes fell within the medium to large range (Cohen's d's = .49–1.15). This study suggests that older Latina/os are at potentially greater risk for NC impairment, particularly in processing speed and learning, when compared to similarly-aged non-Hispanic whites.

An active lifestyle is associated with better neurocognitive functioning in adults living with HIV infection.

Studies of healthy adults show that engagement in physical, social, and mental activities is associated with better cognitive outcomes, suggesting that these activities may increase cognitive reserve. Given the prevalence and real-world impact of HIV-associated neurocognitive disorders (HAND), the present study examined the association between neurocognitive outcomes and self-reported proxies for physical exercise, social activity, and mental activity (employment was used as a proxy for mental activity) among 139 HIV-infected adults (M age = 48.7; 48 % age 50+). Participants completed a neuromedical and neuropsychological battery and were classified based on the number of self-reported active lifestyle factors (ALFs; 0 to 3), including physical exercise, social activity, and current employment. The association between ALFs and both demographically adjusted average neuropsychological T-scores and HAND diagnoses was examined. Results revealed that an increased number of ALFs were associated with better global neurocognitive performance as well as a lower prevalence of HAND. These cross-sectional findings suggest that an active engagement in life may bolster neurocognitive functioning, perhaps by enhancing cognitive and/or brain reserve. However, an alternative explanation might be that persons with better neurocognitive functioning are more inclined and able to engage in these life activities. Future studies should utilize neuroimaging methodology, longitudinal data, and interventional approaches to establish cause-effect relationships and uncover the neural mechanisms whereby physical, social, and mental stimulation may protect neurocognition via cognitive reserve among those living with HIV.

Evaluation of Bone Mineral Density in Postmenopausal Women in Kuwait

Menopause is the major risk factor for the loss of bone mineral density (BMD) and bone mineral content (BMC) in women. In this study, we determined the prevalence of osteoporosis in postmenopausal women in Kuwait and compared it with that of other Middle East and west countries. Two thousand two hundred ninety-six postmenopausal women ranging in age from 40 to 87yr were included in the study and divided into 4 age groups by decade. We measured body weight, height, body mass index (BMI), BMD, and BMC. The mean age, height, and weight were 59.1+7.9yr, 154.7+6.5cm, and 77.3+14.9kg, respectively. The mean BMI and BMC were 32.4+6.6kg/m2 and 0.9+0.14g/cm2, respectively. The average T-scores for the hip and lumbar spine were −0.280+1.2 and −1.297+1.33, respectively. BMC significantly decreased with age from 0.95 to 0.81g/cm2. Four hundred forty-four (19.3%) were found to have osteoporosis. The incidence of osteoporosis significantly increased from 4.3% to 39.9% with age, which is lower than that reported for Saudi (40%) and Moroccan women (39.6%) and higher than that for US/European (31%) and Lebanese women (11%).

The influence of participation in Better Bones and Balance™ on skeletal health: evaluation of a community-based exercise program to reduce fall and fracture risk

Older women participating in Better Bones and Balance™ (BBB) had similar bone mass at the hip compared to a sample of low active/sedentary controls. However, both groups had higher than expected hip BMD, despite higher risk for osteoporosis among BBB participants. BBB is a community-based fall and fracture risk reduction program shown to reduce bone loss at the hip in older women under controlled laboratory conditions. Whether bone benefits are derived from BBB as delivered in the community setting is unknown. The purpose of this study is to evaluate the relationship between community-based BBB participation and parameters of skeletal health in postmenopausal women. Women were recruited from BBB classes (n=69) and compared to low active/sedentary controls (n=46); total sample aged 69 + 7.7 years. Bone mineral density (BMD) of the hip and spine was measured using DXA; hip bone structure [cross-sectional area, cross-sectional moment of inertia] at the narrow neck and intertrochanter were derived using hip structural analysis software. Diet, physical activity, and health history were assessed by questionnaires. Group differences in bone outcomes were determined using ANCOVA controlling for age and body mass. While controls were heavier and exhibited greater total body BMD compared to BBB participants (p<0.05), there were no differences between groups in hip or spine BMD or bone structural outcomes (p>0.05) despite BBB participants reporting more frequent prior diagnoses of or risk factors for osteoporosis compared to controls. Both controls and BBB participants had higher than average T-scores at the hip (p<0.05) when compared to an age-matched cohort from NHANES. These data suggest that participation in BBB may not result in direct benefits to bone. However long-term participation may be associated with other positive outcomes.

Hadamard-encoded sub-slice fMRI for reduced signal dropout

T2⁎-weighted blood oxygen level-dependent functional magnetic resonance imaging is adversely affected by susceptibility-induced field gradients in brain regions adjoining air interfaces that cause image distortion and signal dropout. Reducing slice thickness diminishes signal dropout but is accompanied by reduced signal-to-noise ratio (SNR). This study proposes simultaneous excitation of subslices with total width equal to the desired slice thickness, employing alternating Hadamard-encoded radiofrequency pulses coupled with incoherent addition of the subslices to achieve reduction of through-plane dephasing with minimal SNR loss but at the expense of a reduction in temporal resolution. Using a sensory task and hypercapnic challenge with breathholding (BH), results with two subslices per slice and a twofold reduction in temporal resolution show improved activation relative to a conventional acquisition. Average (eight subjects) T-scores in the BH task increased by 16% ( P<.0003), and activation extent increased by 12% (not significant). In frontal brain regions, significant improvements in BH activation extent (11.4%, P<.05) and T-scores (18%, P<.0002) were demonstrated. Higher temporal resolution can be achieved by tradeoff of SNR.

Unbiased Group-Wise Image Registration: Applications in Brain Fiber Tract Atlas Construction and Functional Connectivity Analysis

We propose an unbiased implicit-reference group-wise (IRG) image registration method and demonstrate its applications in the construction of a brain white matter fiber tract atlas and the analysis of resting-state functional MRI (fMRI) connectivity. Most image registration techniques pair-wise align images to a selected reference image and group analyses are performed in the reference space, which may produce bias. The proposed method jointly estimates transformations, with an elastic deformation model, registering all images to an implicit reference corresponding to the group average. The unbiased registration is applied to build a fiber tract atlas by registering a group of diffusion tensor images. Compared to reference-based registration, the IRG registration improves the fiber track overlap within the group. After applying the method in the fMRI connectivity analysis, results suggest a general improvement in functional connectivity maps at a group level in terms of larger cluster size and higher average t-scores.