Volumetric femoral BMD, bone geometry, and serum sclerostin levels differ between type 2 diabetic postmenopausal women with and without fragility fractures.

UNLABELLED: While type 2 diabetes (T2D) is associated with higher skeletal fragility, specific risk stratification remains incompletely understood. We found volumetric bone mineral density, geometry, and serum sclerostin differences between low-fracture risk and high-fracture risk T2D women. These features might help identify T2D individuals at high fracture risk in the future. INTRODUCTION: Diabetic bone disease, an increasingly recognized complication of type 2 diabetes mellitus (T2D), is associated with high skeletal fragility. Exactly which T2D individuals are at higher risk for fracture, however, remains incompletely understood. Here, we analyzed volumetric bone mineral density (vBMD), geometry, and serum sclerostin levels in two specific T2D subsets with different fracture risk profiles. We examined a T2D group with prior history of fragility fractures (DMFx, assigned high-risk group) and a fracture-free T2D group (DM, assigned low-risk group) and compared their results to nondiabetic controls with (Fx) and without fragility fractures (Co). METHODS: Eighty postmenopausal women (n = 20 per group) underwent quantitative computed tomography (QCT) to compute vBMD and bone geometry of the proximal femur. Additionally, serum sclerostin, vitamin D, parathyroid hormone (PTH), HbA1c, and glomerular filtration rate (GFR) levels were measured. Statistical analyses employed linear regression models. RESULTS: DMFx subjects exhibited up to 33 % lower femoral neck vBMD than DM subjects across all femoral sites (-19 % ≤ ΔvBMD ≤ -33 %, 0.008 ≤ p ≤0.021). Additionally, DMFx subjects showed significantly thinner cortices (-6 %, p = 0.046) and a trend toward larger bone volume (+10 %, p = 0.055) relative to DM women and higher serum sclerostin levels when compared to DM (+31.4 %, p = 0.013), Fx (+25.2 %, p = 0.033), and control (+22.4 %, p = 0.028) subjects. CONCLUSION: Our data suggest that volumetric bone parameters by QCT and serum sclerostin levels can identify T2D individuals at high risk of fracture and might therefore show promise as clinical tools for fracture risk assessment in T2D. However, future research is needed to establish diabetes-specific QCT- and sclerostin-reference databases.

Student perceptions of nurse doctorates: similarities and differences.

This study explored, from a student perspective, similarities and differences between three types of doctoral programs in nursing: doctor of education (EdD), doctor of nursing science (DNSc), and the doctor of philosophy (PhD). Specifically, the study focused on student perceptions of personal and professional growth, research preparation, available support systems, and role preparation within the three types of doctoral programs. Data were collected using a mailed questionnaire that was developed from an earlier qualitative investigation. The findings of the study indicated that there were no significant differences between PhD, EdD, and DNSc students on the first factor, personal and professional growth. Attaining a doctorate was perceived to be enriching from both a personal as well as a professional perspective. A significant difference on the factor related to research was noted by the participants. Although students recognized the programs they were enrolled in as preparing them for research, when asked about other programs, students perceived PhD programs as preparing nurses to conduct research. Support in doctoral programs from faculty and peers was strong, and there was no significant difference on this factor. The fourth and final factor, related to role preparation, did note a significant difference. PhD students did not perceive the doctorate as preparing them for roles as educators, practitioners, or administrators. The results indicate that students do perceive differences in the doctoral education process, particularly in the area of research preparation. It is important that faculty in doctoral programs continue to assess what doctoral graduates view as the primary emphasis of their programs to understand future curricular, academic, and support needs of students.

Polymyalgia rheumatica: a comprehensive review of this debilitating disease.

Polymyalgia rheumatica (PMR) is a cause of moderate to severe musculoskeletal pain in older people. This debilitating disease is characterized by bilateral proximal aching and morning stiffness in the neck, shoulders, upper arms, lower back, hips, and thighs. This article includes specific assessments related to PMR and an associated disease, giant cell arteritis (GCA). A comprehensive review of the incidence, etiology, duration of illness, pertinent laboratory studies, and medical treatment is provided for health care practitioners. A patient teaching handout summarizes key concepts. Specific clues that help the practitioner recognize the disease in patients and associated treatments are emphasized.

Time-frequency analysis of the surface EMG during maximum height jumps under altered-G conditions.

Surface electromyographic (SEMG) signals are often used to study motor control during human movement. Typically, the SEMG signal is used to determine when the muscle was on or off during the movement. However, determining the time-based frequency content of the SEMG signal in conjunction with the time-history of the movement may provide us with more insight into how the motion is organized. We collected SEMG from 4 muscles, (soleus, vasti, gluteus maximus, hamstrings) while subjects performed jumping and sit-to-stand tasks under altered g-environments. The experiment was performed on the Dynamic Environmental Simulator at Wright Patterson AFB, OH. The subjects performed the tasks at 1.0, 1.2, 1.4, 1.6, and 1.8 g. The SEMG signals were then analyzed using a continuous discrete wavelet transform based on a 4-coefficient Daubechie wavelet. Our initial results show that although the time-history of muscle activation patterns during movements do not always vary significantly at different g levels, the frequency content does change, with more high frequency activation at low g levels, and more low frequency activation at higher g levels. One possible explanation for the difference in frequency activation is fatigue of fast twitch fibers during the experiment. These differences were not apparent from the time-history activation patterns, and are difficult to interpret from standard FFT manipulations.

Noninvasive, quantitative respirator fit testing through dynamic pressure measurement.

A new method has been invented for the noninvasive and quantitative determination of fit for a respirator. The test takes a few seconds and requires less expensive instrumentation than presently used for invasive testing. In this test, the breath is held at a negative pressure for a few seconds, and the leak-induced pressure decay inside the respirator cavity is monitored. A dynamic pressure sensor is attached to a modified cartridge of an air-purifying respirator or built into the respirator body or into the air supply line of an air-supplied respirator. The method is noninvasive in that the modified cartridge can be mounted onto any air-purifying respirator. The pressure decay during testing quantifies the airflow entered through the leak site. An equation has been determined which gives the air leakage as a function of pressure decay slope, respirator volume and the pressure differential during actual wear--all of which are determined by the dynamic pressure sensor. Thus, the ratio of air inhaled through the filters or via the air supply line to the leak rate is a measure of respirator fit, independent of aerosol deposition in the lung and aerosol distribution in the respirator cavity as found for quantitative fit testing with aerosols. The new method is shown to be independent of leak and sensor locations. The concentration and distribution of aerosols entered through the leak site is dependent only on the physical dimensions of the leak site and the air velocity in it, which can be determined independently.(ABSTRACT TRUNCATED AT 250 WORDS)

Quantitative respirator fit testing: dynamic pressure versus aerosol measurement.

A noninvasive, fast, inexpensive new fit testing method has been invented which relates the slope of the pressure decay inside a respirator during breath-holding to the fit of the respirator on the wearer's face. The dynamic pressure test has been compared with the conventional aerosol test at different leakage levels. The results of this comparison show that the sensitivity of the dynamic pressure test is similar to that of the aerosol test. The pressure test, however, is independent of leak site and probe location and can be performed on respirators before and after their use.