No Bones About It: Sex Is Binary.

Anthropologists have led the way in formulating techniques that reveal skeletal differences between males and females. Understanding of physical differences in the pelvis related to childbirth, hormonal impacts on bones, and extensive comparative studies have provided anthropologists with an array of traits and measurements that help them estimate sex using just bones. Forensic anthropologists and bioarcheologists are improving their ability to differentiate males and females by increasing research on a variety of postcranial bones and through the use of molecular data, especially new methods called proteomics, to identify sex in prepubescent juveniles. As remains from more cultures and time periods are studied, sex identification will continue to improve, because skeletal sex differences are in large part biologically determined. Yet, anthropologists have also been at the forefront of arguing that sex lies on a spectrum. Anthropologists who view sex as on a spectrum may deter sex identification progress; from their perspective, an individual of an undetermined sex may just be a nonbinary individual. Anthropologists who consider sex is on a spectrum are coming to this conclusion in part because they are looking for anatomical ideals, mistaking pathology for variation, and confusing independent variables with dependent variables. Nonetheless, anthropologists need to continue to improve sex identification techniques to reconstruct the past accurately, which may reveal less strict sex roles than previously presumed and help with the identification of crime victims. Forensic anthropologists should also increase their efforts to identify whether individuals have undergone medical procedures intended to change one's gender due to the current rise in transitioning individuals.

Clinical Applications of Four-Dimensional Flow MRI.

Four-dimensional flow MRI is a powerful phase contrast technique used for assessing three-dimensional (3D) blood flow dynamics. By acquiring a time-resolved velocity field, it enables flexible retrospective analysis of blood flow that can include qualitative 3D visualization of complex flow patterns, comprehensive assessment of multiple vessels, reliable placement of analysis planes, and calculation of advanced hemodynamic parameters. This technique provides several advantages over routine two-dimensional flow imaging techniques, allowing it to become part of clinical practice at major academic medical centers. In this review, we present the current state-of-the-art cardiovascular, neurovascular, and abdominal applications.

Focused navigation for respiratory-motion-corrected free-running radial 4D flow MRI.

PURPOSE: To validate a respiratory motion correction method called focused navigation (fNAV) for free-running radial whole-heart 4D flow MRI. METHODS: Using fNAV, respiratory signals derived from radial readouts are converted into three orthogonal displacements, which are then used to correct respiratory motion in 4D flow datasets. Hundred 4D flow acquisitions were simulated with non-rigid respiratory motion and used for validation. The difference between generated and fNAV displacement coefficients was calculated. Vessel area and flow measurements from 4D flow reconstructions with (fNAV) and without (uncorrected) motion correction were compared to the motion-free ground-truth. In 25 patients, the same measurements were compared between fNAV 4D flow, 2D flow, navigator-gated Cartesian 4D flow, and uncorrected 4D flow datasets. RESULTS: For simulated data, the average difference between generated and fNAV displacement coefficients was 0.04 ± $$ \pm $$ 0.32 mm and 0.31 ± $$ \pm $$ 0.35 mm in the x and y directions, respectively. In the z direction, this difference was region-dependent (0.02 ± $$ \pm $$ 0.51 mm up to 5.85 ± $$ \pm $$ 3.41 mm). For all measurements (vessel area, net volume, and peak flow), the average difference from ground truth was higher for uncorrected 4D flow datasets (0.32 ± $$ \pm $$ 0.11 cm2 , 11.1 ± $$ \pm $$ 3.5 mL, and 22.3 ± $$ \pm $$ 6.0 mL/s) than for fNAV 4D flow datasets (0.10 ± $$ \pm $$ 0.03 cm2 , 2.6 ± $$ \pm $$ 0.7 mL, and 5.1 ± 0 $$ \pm 0 $$ .9 mL/s, p < 0.05). In vivo, average vessel area measurements were 4.92 ± $$ \pm $$ 2.95 cm2 , 5.06 ± $$ \pm $$ 2.64 cm2 , 4.87 ± $$ \pm $$ 2.57 cm2 , 4.87 ± $$ \pm $$ 2.69 cm2 , for 2D flow and fNAV, navigator-gated and uncorrected 4D flow datasets, respectively. In the ascending aorta, all 4D flow datasets except for the fNAV reconstruction had significantly different vessel area measurements from 2D flow. Overall, 2D flow datasets demonstrated the strongest correlation to fNAV 4D flow for both net volume (r2  = 0.92) and peak flow (r2  = 0.94), followed by navigator-gated 4D flow (r2  = 0.83 and r2  = 0.86, respectively), and uncorrected 4D flow (r2  = 0.69 and r2  = 0.86, respectively). CONCLUSION: fNAV corrected respiratory motion in vitro and in vivo, resulting in fNAV 4D flow measurements that are comparable to those derived from 2D flow and navigator-gated Cartesian 4D flow datasets, with improvements over those from uncorrected 4D flow.

Impact of pulmonary artery flow distribution on Fontan hemodynamics and flow energetics.

BACKGROUND: With improved life expectancy following Fontan palliation, there is an increasing population of patients with a total cavopulmonary connection. However, there is a poor understanding of which patients will experience Fontan failure and when. 4D flow MRI has identified several metrics of clinical interest, but longitudinal studies investigating hemodynamics in Fontan patients are lacking. OBJECTIVE: We aimed to investigate the relationship between flow distribution to the pulmonary arteries and regional hemodynamic metrics in a unique cohort with follow-up 4D flow MRI. MATERIALS AND METHODS: Patients with > 6 months of 4D flow MRI follow-up were included. Flow distribution from the caval veins to pulmonary arteries was measured in addition to regional measures of peak velocity, viscous energy loss (ELmean and ELtot), and kinetic energy. RESULTS: Ten patients with total cavopulmonary connection (17.7 ± 8.8 years at baseline, follow-up: 4.4 ± 2.6 years) were included. Five subjects had unequal flow distribution from the IVC to the pulmonary arteries at baseline. Over time, these subjects tended to have larger increases in peak velocity (39.2% vs 6.6%), ELmean (11.6% vs -38.3%), ELtot (9.5% vs -36.2%), and kinetic energy (96.1% vs 36.3%) in the IVC. However, these differences were statistically insignificant. We found that changes in ELmean and ELtot were significantly associated with changes in peak velocity in the caval veins (R2 > 0.5, P < 0.001). CONCLUSION: Unequal flow distribution from the IVC may drive increasing peak velocities and viscous energy losses, which have been associated with worse clinical outcomes. Changes in peak velocity may serve as a surrogate measure for changes in viscous energy loss.

Systolic reverse flow derived from 4D flow cardiovascular magnetic resonance in bicuspid aortic valve is associated with aortic dilation and aortic valve stenosis: a cross sectional study in 655 subjects.

BACKGROUND: Bicuspid aortic valve (BAV) disease is associated with increased risk of aortopathy. In addition to current intervention guidelines, BAV mediated changes in aortic 3D hemodynamics have been considered as risk stratification measures. We aimed to evaluate the association of 4D flow cardiovascular magnetic resonance (CMR) derived voxel-wise aortic reverse flow with aortic dilation and to investigate the role of aortic valve regurgitation (AR) and stenosis (AS) on reverse flow in systole and diastole. METHODS: 510 patients with BAV (52 ± 14 years) and 120 patients with trileaflet aortic valve (TAV) (61 ± 11 years) and mid-ascending aorta diameter (MAAD) > 35 mm who underwent CMR including 4D flow CMR were retrospectively included. An age and sex-matched healthy control cohort (n = 25, 49 ± 12 years) was selected. Voxel-wise reverse flow was calculated in the aorta and quantified by the mean reverse flow in the ascending aorta (AAo) during systole and diastole. RESULTS: BAV patients without AS and AR demonstrated significantly increased systolic and diastolic reverse flow (222% and 13% increases respectively, p < 0.01) compared to healthy controls and also had significantly increased systolic reverse flow compared to TAV patients with aortic dilation (79% increase, p < 0.01). In patients with isolated AR, systolic and diastolic AAo reverse flow increased significantly with AR severity (c = - 83.2 and c = - 205.6, p < 0.001). In patients with isolated AS, AS severity was associated with an increase in both systolic (c = - 253.1, p < 0.001) and diastolic (c = - 87.0, p = 0.02) AAo reverse flow. Right and left/right and non-coronary fusion phenotype showed elevated systolic reverse flow (> 17% increase, p < 0.01). Right and non-coronary fusion phenotype showed decreased diastolic reverse flow (> 27% decrease, p < 0.01). MAAD was an independent predictor of systolic (p < 0.001), but not diastolic, reverse flow (p > 0.1). CONCLUSION: 4D flow CMR derived reverse flow associated with BAV was successfully captured even in the absence of AR or AS and in comparison to TAV patients with aortic dilation. Diastolic AAo reverse flow increased with AR severity while AS severity strongly correlated with increased systolic reverse flow in the AAo. Additionally, increasing MAAD was independently associated with increasing systolic AAo reverse flow. Thus, systolic AAo reverse flow may be a valuable metric for evaluating disease severity in future longitudinal outcome studies.

Hemodynamic Evaluation of Type B Aortic Dissection Using Compressed Sensing Accelerated 4D Flow MRI.

BACKGROUND: 4D Flow MRI is a quantitative imaging technique to evaluate blood flow patterns; however, it is unclear how compressed sensing (CS) acceleration would impact aortic hemodynamic quantification in type B aortic dissection (TBAD). PURPOSE: To investigate CS-accelerated 4D Flow MRI performance compared to GRAPP-accelerated 4D Flow MRI (GRAPPA) to evaluate aortic hemodynamics in TBAD. STUDY TYPE: Prospective. POPULATION: Twelve TBAD patients, two volunteers. FIELD STRENGTH/SEQUENCE: 1.5T, 3D time-resolved cine phase-contrast gradient echo sequence. ASSESSMENT: GRAPPA (acceleration factor [R] = 2) and two CS-accelerated (R = 7.7 [CS7.7] and 10.2 [CS10.2]) 4D Flow MRI scans were acquired twice for interscan reproducibility assessment. Voxelwise kinetic energy (KE), peak velocity (PV), forward flow (FF), reverse flow (RF), and stasis were calculated. Plane-based mid-lumen flows were quantified. Imaging times were recorded. TESTS: Repeated measures analysis of variance, Pearson correlation coefficients (r), intraclass correlation coefficients (ICC). P < 0.05 indicated statistical significance. RESULTS: The KE and FF in true lumen (TL) and PV in false lumen (FL) did not show difference among three acquisition types (P = 0.818, 0.065, 0.284 respectively). The PV and stasis in TL were higher, KE, FF, and RF in FL were lower, and stasis was higher in GRAPPA compared to CS7.7 and CS10.2. The RF was lower in GRAPPA compared to CS10.2. The correlation coefficients were strong in TL (r = [0.781-0.986]), and low to strong in FL (r = [0.347-0.948]). The ICC levels demonstrated moderate to excellent interscan reproducibility (0.732-0.989). The FF and net flow in mid-descending aorta TL were significantly different between CS7.7 and CS10.2. CONCLUSION: CS-accelerated 4D Flow MRI has potential for clinical utilization with shorter scan times in TBAD. Our results suggest similar hemodynamic trends between acceleration types, but CS-acceleration impacts KE, FF, RF, and stasis more in FL. EVIDENCE LEVEL: 1 Technical Efficacy: Stage 2.

Baseline 4D Flow-Derived in vivo Hemodynamic Parameters Stratify Descending Aortic Dissection Patients With Enlarging Aortas.

Purpose: The purpose of our study was to assess the value of true lumen and false lumen hemodynamics compared to aortic morphological measurements for predicting adverse-aorta related outcomes (AARO) and aortic growth in patients with type B aortic dissection (TBAD). Materials and Methods: Using an IRB approved protocol, we retrospectively identified patients with descending aorta (DAo) dissection at a large tertiary center. Inclusion criteria includes known TBAD with ≥ 6 months of clinical follow-up after initial presentation for TBAD or after ascending aorta intervention for patients with repaired type A dissection with residual type B aortic dissection (rTAAD). Patients with prior descending aorta intervention were excluded. The FL and TL of each patient were manually segmented from 4D flow MRI data, and 3D parametric maps of aortic hemodynamics were generated. Groups were divided based on (1) presence vs. absence of AARO and (2) growth rate ≥ vs. < 3 mm/year. True and false lumen kinetic energy (KE), stasis, peak velocity (PV), reverse/forward flow (RF/FF), FL to TL KE ratio, as well as index aortic diameter were compared between groups using the Mann-Whitney U or independent t-test. Results: A total of n = 51 patients (age: 58.4 ± 15.0 years, M/F: 31/20) were included for analysis of AARO. This group contained n = 26 patients with TBAD and n = 25 patients with rTAAD. In the overall cohort, AARO patients had larger baseline diameters, lower FL-RF, FL stasis, TL-KE, TL-FF and TL-PV. Among patients with de novo TBAD, those with AAROs had larger baseline diameter, lower FL stasis and TL-PV. In both the overall cohort and in the subgroup of de novo TBAD, subjects with aortic growth ≥ 3mm/year, patients had a higher KE ratio. Conclusion: Our study suggests that 4D flow MRI is a promising tool for TBAD evaluation that can provide information beyond traditional MRA or CTA. 4D flow has the potential to become an integral aspect of TBAD work-up, as hemodynamic assessment may allow earlier identification of at-risk patients who could benefit from earlier intervention.

Case study of a rare occipital osteoma related to cranial trauma.

Burial 280 is a 31- to 40-year-old male Native American individual who lived in a 10th to 16th century coastal foraging society in California. His remains display a large ectocranial elevation on the occipital, measuring 23.3 mm anteroposteriorly, 25.3 mm mediolaterally, and is elevated to 20.1 mm. It is located along the superior nuchal line on the left side of the occipital and represents an extremely rare occipital localization of a particular type of trauma-related osteoma. In our prior study of Burial 280, trauma etiology was not considered; herein, we present evidence for such a cause. Such trauma-related neoplasms are sometimes called ballooned (or giant, depending on size) osteomas. The presence of this tumor appears to have resulted in asymmetrical cranial muscle use and consequent skeletal changes. This case study illustrates that cranial trauma may sometimes induce benign tumor elevations, rather than a depression or pronounced fracture.

Symmetric-Key Encryption Based on Bioaffinity Interactions.

The research presented here shows a bridge between biochemistry and cryptography. Enzyme-based assays were used in a new methodology linked to ciphers and cipher systems. Three separate enzyme assays, alkaline phosphatase (ALP) (E.C. 3.1.3.1), lysozyme (E.C. 3.2.1.17), and horseradish peroxidase (HRP) (E.C. 1.11.1.7), were used to create a cipher key in order to encrypt a message. By choosing certain parameters for one's experiment that are performed in the same way as a person receiving the message, correct encryption and decryption keys would be produced, resulting in a correct encryption and decryption of a message. It is imperative that both parties perform the same experiment under the same conditions in order to correctly interpret the message. Bioaffinity-based assays, in particular enzymatic assays, provide a specific, yet flexible mechanism to use for the encryption of messages. Because of the nature of this process there are a multitude of sets of parameters that may be chosen, each of which would result in a different key being produced, heightening the security and the robustness of the method. This paper shows that by using this concept of forming encryption keys using a bioaffinity-based approach, one is able to properly encrypt and decrypt a message, which could be viable for other biochemically based techniques.

Using fMRI connectivity to define a treatment-resistant form of post-traumatic stress disorder.

A mechanistic understanding of the pathology of psychiatric disorders has been hampered by extensive heterogeneity in biology, symptoms, and behavior within diagnostic categories that are defined subjectively. We investigated whether leveraging individual differences in information-processing impairments in patients with post-traumatic stress disorder (PTSD) could reveal phenotypes within the disorder. We found that a subgroup of patients with PTSD from two independent cohorts displayed both aberrant functional connectivity within the ventral attention network (VAN) as revealed by functional magnetic resonance imaging (fMRI) neuroimaging and impaired verbal memory on a word list learning task. This combined phenotype was not associated with differences in symptoms or comorbidities, but nonetheless could be used to predict a poor response to psychotherapy, the best-validated treatment for PTSD. Using concurrent focal noninvasive transcranial magnetic stimulation and electroencephalography, we then identified alterations in neural signal flow in the VAN that were evoked by direct stimulation of that network. These alterations were associated with individual differences in functional fMRI connectivity within the VAN. Our findings define specific neurobiological mechanisms in a subgroup of patients with PTSD that could contribute to the poor response to psychotherapy.

Biological distance at the Ryan Mound site.

OBJECTIVES: The Ryan Mound site in California spans 2000 years and has been utilized in over 200 studies. The Ryan Mound has been assumed to be a culturally and, therefore, a biologically continuous population over time. This study attempts to determine whether adults at the Ryan Mound consisted of a continuous population over the span of three temporal periods by using nonmetric skeletal traits. MATERIALS AND METHODS: Thirty-eight nonmetric cranial traits and four nonmetric post-cranial traits were scored on adults. Trait correlations were assessed for sex and age using chi-square and Fisher's exact tests. For bilateral traits, data were recorded for both sides, but only results from the left side are reported. Most data were recorded as present or absent. Twelve traits had scores that had more than two nominal categories, which were converted to binary values to enable mean measure of divergence (MMD) statistical analyses. RESULTS: After data reduction, 36 traits remained. Using these traits, standardized MMD analyses revealed that the oldest temporal period and the most recent temporal period individuals were significantly different. CONCLUSION: This study illustrates the importance of testing for biological continuity. Nonmetric studies provide a way to examine relationships within a sample to determine biological continuity. For the Ryan Mound, new populations may have moved into the region early on as part of the Meganos intrusion, or new populations may have moved into the region later, between AD 1500 and AD 1800. Comparative data from nearby sites further support the Meganos intrusion theory.

Can we create ethnically diverse skeletal collection from donated bodies?

Understanding bone health is least invasively and most effectively done through studying skeletal remains that reflect the living populations who will benefit from the knowledge produced through research. Donated body collections that accurately represent modern populations are needed for osteological insights to be applied to clinical practices. However, even though the US is growing increasingly diverse, donated body collections still suffer from a lack of ethnic diversity. Most individuals who donate their whole-bodies after death are European-American. Reasons for a lack of ethnic diversity stem from past injustices and present religious norms. Increasing body donation among minorities in the US and abroad may be difficult.

A Voxel-by-Voxel Comparison of Deformable Vector Fields Obtained by Three Deformable Image Registration Algorithms Applied to 4DCT Lung Studies.

BACKGROUND: Commonly used methods of assessing the accuracy of deformable image registration (DIR) rely on image segmentation or landmark selection. These methods are very labor intensive and thus limited to relatively small number of image pairs. The direct voxel-by-voxel comparison can be automated to examine fluctuations in DIR quality on a long series of image pairs. METHODS: A voxel-by-voxel comparison of three DIR algorithms applied to lung patients is presented. Registrations are compared by comparing volume histograms formed both with individual DIR maps and with a voxel-by-voxel subtraction of the two maps. When two DIR maps agree one concludes that both maps are interchangeable in treatment planning applications, though one cannot conclude that either one agrees with the ground truth. If two DIR maps significantly disagree one concludes that at least one of the maps deviates from the ground truth. We use the method to compare 3 DIR algorithms applied to peak inhale-peak exhale registrations of 4DFBCT data obtained from 13 patients. RESULTS: All three algorithms appear to be nearly equivalent when compared using DICE similarity coefficients. A comparison based on Jacobian volume histograms shows that all three algorithms measure changes in total volume of the lungs with reasonable accuracy, but show large differences in the variance of Jacobian distribution on contoured structures. Analysis of voxel-by-voxel subtraction of DIR maps shows differences between algorithms that exceed a centimeter for some registrations. CONCLUSION: Deformation maps produced by DIR algorithms must be treated as mathematical approximations of physical tissue deformation that are not self-consistent and may thus be useful only in applications for which they have been specifically validated. The three algorithms tested in this work perform fairly robustly for the task of contour propagation, but produce potentially unreliable results for the task of DVH accumulation or measurement of local volume change. Performance of DIR algorithms varies significantly from one image pair to the next hence validation efforts, which are exhaustive but performed on a small number of image pairs may not reflect the performance of the same algorithm in practical clinical situations. Such efforts should be supplemented by validation based on a longer series of images of clinical quality.

Knee osteoarthritis, body mass index and pain: data from the Osteoarthritis Initiative.

OBJECTIVE: This study aimed to determine whether BMI increases knee pain as measured from self-reported surveys even when controlling for OA severity as measured by osteophytes and joint space narrowing visible on X-rays. METHODS: Data available through the Osteoarthritis Initiative (OAI) were analysed, which included a sample of 4769 individuals, to answer the above question regarding OA, excess weight and pain. OA severity was assessed through baseline X-rays on right knees that were scored on a composite quasi-Kellgren and Lawrence grade. Weight was assessed through BMI. Pain was assessed through self-reports of the WOMAC pain subset as well as a 30-day pain severity question based on a 0-10 scale. Data were analysed using SPSS and analyses of covariance (ANCOVAs) were run to examine models adjusted for age, smoking, prior injury, pain medication and Heberden's nodes. Critical alpha levels were set at 0.05. RESULTS: The results reported here confirm that knee pain does increase with OA severity. However, ANCOVA multiple regressions with controls reveal that even when taking into account OA severity, individuals with higher BMIs experience greater pain than individuals with lower BMIs. CONCLUSION: Weight loss may reduce knee OA pain even if the osteological symptoms are not treated.

Is vertebral body osteophytosis a reliable indicator of occupational stress?

Whether activity patterns cause vertebral body osteophytosis (VO) remains unanswered. Although, many previous researchers indicate physical activity as an etiological factor of VO, a number of recent studies have questioned this conclusion. Thus, using a sample of 101 adult males from medieval Poland, this current study examines whether individuals with VO have greater entheseal change (EC) scores since EC are commonly used as an indicator of activity. The sample was divided into younger adults (20 to 40 years old) and older adults (41 to 56 years old). Three aggregate variables (aggregate VO, upper limb ECs, and lower limb ECs) were created to determine whether VO may be useful in activity pattern reconstructions. No significant age differences were found and, thus, all correlations were run without age controls. A significant positive correlation was found between aggregate VO and lower limb EC (rho = 0.347, p < 0.01). The existence of the correlation between aggregate VO and lower limb EC in this study implies that vertebral osteophytosis may relate to occupational stresses and there may be similar etiologies present in VO and EC formation, but there remains much unexplained variance that suggests that VO and EC etiologies are complex.

Hand osteoarthritis and bone loss: is there an inverse relationship?

An inverse relationship between osteoarthritis (OA) and bone loss has been supported in clinical research, but there has been little research on bioarchaeological skeletal remains. The current study examines 115 adults from a prehistoric hunter-gatherer population to aid in determining whether hand OA and bone loss are negatively correlated. OA lipping is scored on a four-point scale on left and right trapezia, MC1s, and MC2s and then analyzed with regard to their relationships with sex, age, right MC2 cortical index, and left and right MC1 robusticity, midshaft circumference, and midshaft diameter values. With sexes and ages combined, higher OA scores are found in individuals with greater midshaft diameters. However, lower cortical indices were found in individuals with higher right MC2 OA scores. The data presented tenuously support that bone loss is lower in individuals with more severe osteoarthritis, but age-related changes in bone deposition may make cortical index and other external shaft dimensions an unsuitable variable to examine this relationship.

A paracondylar process and early onset cervical osteoarthritis in a California Amerind adult.

Burial 65 is a 25-39-year-old male from a hunter-gatherer California Amerind collection with a large bone spur called a paracondylar process. The process measures 11.92mm in width and 13.32mm in length. It is located on the left anteromedial region near the foramen magnum and articulates with a pseudarthrosis to the atlas. The atlas, too, has a pseudarthrosis1 on the left transverse process. The paracondylar process may be the result of caudal occipitalization, which is a congenital variant that results from a lack of fusion of the occipital bone to the foramen magnum. Trauma is another possible explanation for the occipital-atlas variation. High-impact accidents can cause both atlas and condylar fractures. Regardless of the cause, the paracondylar process and pseudarthrosis likely caused early onset cervical osteoarthritis.

Attachment style and coping in relation to posttraumatic stress disorder symptoms among adults living with HIV/AIDS.

Research indicates that a significant proportion of people living with HIV/AIDS report symptoms of posttraumatic stress disorder (PTSD). Moreover, attachment style has been associated with psychological and behavioral outcomes among persons living with HIV/AIDS. Attachment style may influence the ability to cope with traumatic stress and affect PTSD symptoms. To examine the association between attachment style and coping with PTSD symptoms, we assessed 94 HIV-positive adults on self-report measures of posttraumatic stress, coping, and attachment style. In multiple regression analysis, avoidant attachment and emotion-focused coping were positively and significantly associated with greater PTSD symptomatology. Support was also found for the moderating effects of avoidant and insecure attachment styles on emotion-focused coping in relation to greater PTSD symptoms. Taken altogether, these results suggest that interventions that develop adaptive coping skills and focus on the underlying construct of attachment may be particularly effective in reducing trauma-related symptoms in adults living with HIV/AIDS.

Calcaneal spurs: examining etiology using prehistoric skeletal remains to understand present day heel pain.

BACKGROUND: Calcanei are the most common sites for bony spurs. Although calcaneal enthesophytes have been extensively researched, many unknowns remain. Whether biological factors, such as age, weight and genetics, play a greater role in calcaneal spur etiology than activity is still unknown. OBJECTIVES: The current study examines 121 adults from a prehistoric hunter-gatherer population to aid in understanding bony spur etiology. METHODS: Calcaneal spurs are scored as present or absent on the dorsal or plantar side; they are analyzed in regards to their relationships with age, sex, osteoarthritis, cortical index, femoral head breadth and muscle markers. RESULTS: Dorsal and plantar spurs frequencies increase with age (chi-squares=16.90, 7.268, Ps<0.05, respectively). Dorsal spurs were more frequent than plantar spurs (chi-square=38.000; P<0.0001). There is a positive relationship with calcaneal spurs and upper limb and lower limb osteoarthritis (chi-squares=5.587, 7.640, Ps<0.05, respectively). CONCLUSIONS: The data presented support that dorsal spurs are in part the result of activities, but plantar spurs may be a more modern phenomena resulting from long periods of standing and excess weight.