Exercise in the management of knee and hip osteoarthritis

Purpose of review This review focuses on studies published during July 2001 to August 2017 of exercise as an intervention in knee and hip osteoarthritis, including its influence on an array of patient outcomes. Recent findings Studies continue to illustrate the efficacy of exercise in treating and managing osteoarthritis, with current literature more focused on the knee compared with the hip joint. Both traditional (e.g. strength, aerobic, flexibility) and more nontraditional (e.g. yoga, Tai Chi, aquatic) training modes improve patient outcomes related to joint symptoms, mobility, quality of life, psychological health, musculoskeletal properties, body composition, sleep, and fatigue. Exercise that is adequately dosed (e.g. frequency, intensity) and progressive in nature demonstrated the greatest improvements in patient outcomes. Supervised, partially supervised, and nonsupervised interventions can be successful in the treatment of osteoarthritis, but patient preference regarding level of supervision and mode of exercise may be key predictors in exercise adherence and degree of outcome improvement. A topic of increasing interest in osteoarthritis is the supplementary role of behavior training in exercise interventions. Summary Osteoarthritis is a complex, multifactorial disease that can be successfully managed and treated through exercise, with minimal risk for negative consequences. However, to have greatest impact, appropriate exercise prescription is needed. Efforts to achieve correct exercise doses and mitigate patient nonadherence are needed to lessen the lifelong burden of osteoarthritis

Knee joint unloading and daily physical activity associate with cartilage T2 relaxation times 1 month after ACL injury

Osteoarthritis (OA) is prevalent after anterior cruciate ligament (ACL) injury, but mechanismsunderlying its development are poorly understood. The purpose of this study was to determine if gait biomechanics and daily physical activity (PA) associate with cartilage T2 relaxation times, a marker of collagen organization and water content, 1 month after ACL injury. Twenty-seven participants (15–35 years old) without chondral lesions completed magnetic resonance imaging, three-dimensional gait analysis, and 1 week of PA accelerometry. Interlimb differences and ratios were calculated for gait biomechanics and T2 relaxation times, respectively. Multiple linear regression models adjusted for age, sex, and concomitant meniscus injury were used to determine the association between gait biomechanics and PA with T2 relaxation times, respectively. Altered knee adduction moment (KAM) impulse, less knee flexion excursion (kEXC) and higher daily step counts accounted for 35.8%–65.8% of T2 relaxation time variation in the weightbearing and posterior cartilage of the medial and lateral compartment (all p ≤.011). KAM impulse was the strongest factor for T2 relaxation times in all models (all p ≤.001). Lower KAM impulse associated with longer T2 relaxation times in the injured medial compartment (β = −.720 to −.901) and shorter T2 relaxation in the lateral compartment (β =.713 to.956). At 1 month after ACL injury, altered KAM impulse, less kEXC, and higher PA associated with longer T2 relaxation times, which may indicate poorer cartilage health. Statement of Clinical Significance: Gait biomechanics and daily PA are modifiable targets that may improve cartilage health acutely after ACL injury and slow progression to OA

Parameterizations of the linear energy transfer spectrum for the CRaTER instrument during the LRO mission

[1] The Cosmic Ray Telescope for the Effects of Radiation (CRaTER) instrument was launched as part of the Lunar Reconnaissance Orbiter (LRO) spacecraft in June 2009. Its purpose is to measure the linear energy transfer (LET) spectrum in lunar orbit as an aid in determining risks to human crews on future lunar missions. Part of the preparations for the mission involved estimating the LET spectrum for the anticipated environment that the instrument is likely to see during the 1 year operational phase of the LRO mission. Detailed estimates of LET spectra in the six silicon detectors and two tissue equivalent plastic segments were made using the beta version of the HETC-HEDS Monte Carlo transport code. Tables of LET in each detector component, for incident particle elemental species from hydrogen through iron, were carried out at incident particle energies from 20 MeV per nucleon to 3 GeV per nucleon. The LET values in these tables have been parameterized by elemental species and energy for ease in quickly and accurately estimating the LET response for any input solar or galactic cosmic ray spectrum likely to be encountered during the lifetime of the instrument. The parameterized LET values are in excellent agreement with the HETC-HEDS calculations. Typical differences are on the order of a few percent. These parameterizations will also be useful in validation studies of the Earth-Moon-Mars Radiation Environment Module using CRaTER measurements in lunar orbit

Measurements of galactic cosmic ray shielding with the CRaTER instrument

[1] The Cosmic Ray Telescope for the Effects of Radiation (CRaTER) instrument aboard the Lunar Reconnaissance Orbiter has been measuring energetic charged particles from the galactic cosmic rays (GCRs) and solar particle events in lunar orbit since 2009. CRaTER includes three pairs of silicon detectors, separated by pieces of tissue-equivalent plastic that shield two of the three pairs from particles incident at the zenith-facing end of the telescope. Heavy-ion beams studied in previous ground-based work have been shown to be reasonable proxies for the GCRs when their energies are sufficiently high. That work, which included GCR simulations, led to predictions for the amount of dose reduction that would be observed by CRaTER. Those predictions are compared to flight data obtained by CRaTER in 2010–2011

Interlimb differences in T1ρ MRI relaxation times linked with symptomatic knee osteoarthritis following anterior cruciate ligament reconstruction

Background: Lower proteoglycan density, as estimated by greater T1ρ magnetic resonance imaging (MRI) relaxation times, may be an indicator of early osteoarthritis development. We examined associations between femoral cartilage inter-limb T1ρ MRI relaxation time ratios and clinically relevant knee symptoms at 12 months following anterior crucial ligament reconstruction (ACLR). Methods: Twenty-nine individuals completed the Knee Osteoarthritis Outcome Score (KOOS) and underwent MRI 12 months following ACLR for this cross-sectional study. Participants were categorized as symptomatic or asymptomatic for clinically relevant knee symptoms consistent with osteoarthritis based on a standard KOOS classification. T1ρ MRI relaxation times were segmented in the weightbearing regions of lateral and medial femoral condyle (LFC and MFC). Inter-limb T1ρ MRI relaxation time ratios were calculated by normalizing the ACLR to the uninjured knee. T-tests were used to compare LFC and MFC interlimb T1ρ relaxation time ratios between individuals with and without knee symptoms. A Receiver Operating Characteristic (ROC) Curve analysis was used to determine a critical inter-limb T1ρ relaxation time ratio identifying symptomatic patients. Odds ratios (OR) and 95% confidence intervals (CI) estimated the association between the critical value and clinically relevant knee symptoms. Results: Symptomatic individuals had significantly higher LFC inter-limb T1ρ MRI relaxation time ratios compared to asymptomatic individuals (p = 0.04). Individuals with an LFC inter-limb T1ρ MRI relaxation time ratio >1.11 were more likely to have symptoms (OR 8.5; 95%CI = 1.25–57.93). Conclusion: Individuals with greater inter-limb LFC T1ρ MRI relaxation time ratios 12 months post-ACLR may be more likely to exhibit symptoms consistent with knee OA

Racial/Ethnic, Socioeconomic, and Geographic Disparities in the Epidemiology of Knee and Hip Osteoarthritis

It is estimated that 32.5 million US adults have clinical osteoarthritis (OA), with the most common sites being knee and hip. OA is associated with substantial individual and societal costs. Race/ethnicity, socioeconomic status (SES), and geographic variations in the prevalence of knee and hip OA are well established around the world. In addition, clinical outcomes associated with hip and knee OA differ according to race/ethnicity, SES, and geography. This variation is likely multifactorial and may also reflect country-specific differences in health care systems. The interplay between different factors, such as geography, SES, and race/ethnicity, is difficult to study

Earth‐Moon‐Mars Radiation Environment Module framework

[1] We are preparing to return humans to the Moon and setting the stage for exploration to Mars and beyond. However, it is unclear if long missions outside of low-Earth orbit can be accomplished with acceptable risk. The central objective of a new modeling project, the Earth-Moon-Mars Radiation Exposure Module (EMMREM), is to develop and validate a numerical module for characterizing time-dependent radiation exposure in the Earth-Moon-Mars and interplanetary space environments. EMMREM is being designed for broad use by researchers to predict radiation exposure by integrating over almost any incident particle distribution from interplanetary space. We detail here the overall structure of the EMMREM module and study the dose histories of the 2003 Halloween storm event and a June 2004 event. We show both the event histories measured at 1 AU and the evolution of these events at observer locations beyond 1 AU. The results are compared to observations at Ulysses. The model allows us to predict how the radiation environment evolves with radial distance from the Sun. The model comparison also suggests areas in which our understanding of the physics of particle propagation and energization needs to be improved to better forecast the radiation environment. Thus, we introduce the suite of EMMREM tools, which will be used to improve risk assessment models so that future human exploration missions can be adequately planned for

Capture of time-loss overuse soccer injuries in the national collegiate athletic association’s injury surveillance system, 2005–2006 through 2007–2008

Context: Overuse injuries are reported to account for nearly 50% of sports injuries and, due to their progressive nature and the uncertainty regarding date of onset, are difficult to define and categorize. Comparing the capture rates of overuse injuries between injury-surveillance systems and medical records can clarify completeness and determinants of how overuse injuries are represented in injury-surveillance data. Objective: To estimate the capture rate of time-loss medical-attention overuse injuries in men’s and women’s soccer in the National Collegiate Athletic Association Injury Surveillance System (NCAA ISS) compared with medical records maintained by certified athletic trainers and assess the differences in completeness of capture and factors contributing to those differences. Design: Capture-recapture study. Setting: Fifteen NCAA institutions provided NCAA ISS and medical record data from men’s and women’s soccer programs from 2005–2006 through 2007–2008. Patients or Other Participants: National Collegiate Athletic Association men’s and women’s soccer players. Main Outcome Measure(s): Time-loss medical-attention overuse injuries were defined as injuries with an overuse mechanism of injury in the NCAA ISS or medical records. Capture rates were calculated as the proportion of total overuse injuries classified as having overuse mechanisms in the NCAA ISS and the NCAA ISS and medical records combined. Results: The NCAA ISS captured 63.7% of the total estimated overuse mechanisms of injury in men’s and women’s soccer players. The estimated proportion of overuse injury mechanisms captured by both the NCAA ISS and medical records was 37.1%. The NCAA ISS captured more overuse injury mechanisms in men’s soccer than in women’s soccer (79.2% versus 45.0%, v2 ¼ 9.60; P ¼ .002) athletes. Conclusions: From 2005–2006 through 2007–2008, the NCAA ISS captured only two thirds of time-loss medical-attention overuse mechanisms of injury in men’s and women’s soccer players. Future researchers should consider supplementing injury-surveillance data with a clinical record review to capture the burden of these injuries

Substrate Effect on the High Temperature Oxidation Behavior of a Pt-modified Aluminide Coating. Part II: Long-term Cyclic-oxidation Tests at 1,050 C

This second part of a two-part study is devoted to the effect of the substrate on the long-term, cyclic-oxidation behavior at 1,050 C of RT22 industrial coating deposited on three Ni-base superalloys (CMSX-4, SCB, and IN792). Cyclicoxidation tests at 1,050 C were performed for up to 58 cycles of 300 h (i.e., 17,400 h of heating at 1,050 C). For such test conditions, interdiffusion between the coating and its substrate plays a larger role in the damage process of the system than during isothermal tests at 900, 1,050, and 1,150 C for 100 h and cyclicoxidation tests at 900 C which were reported in part I [N. Vialas and D. Monceau, Oxidation of Metals 66, 155 (2006)]. The results reported in the present paper show that interdiffusion has an important effect on long-term, cyclic-oxidation resistance, so that clear differences can be observed between different superalloys protected with the same aluminide coating. Net-mass-change (NMC) curves show the better cyclic-oxidation behavior of the RT22/IN792 system whereas uncoated CMSX-4 has the best cyclic-oxidation resistance among the three superalloys studied. The importance of the interactions between the superalloy substrate and its coating is then demonstrated. The effect of the substrate on cyclic-oxidation behavior is related to the extent of oxide scale spalling and to the evolution of microstructural features of the coatings tested. SEM examinations of coating surfaces and cross sections show that spalling on RT22/CMSX-4 and RT22/SCB was favored by the presence of deep voids localized at the coating/oxide interface. Some of these voids can act as nucleation sites for scale spallation. The formation of such interfacial voids was always observed when the b to c0 transformation leads to the formation of a two-phase b/c0 layer in contact with the alumina scale. On the contrary, no voids were observed in RT22/IN792, since this b to c0 transformation occurs gradually by an inward transformation of b leading to the formation of a continuous layer of c0 phase, parallel to the metal/scale interface

Sociodemographic and Clinical Predictors of Prescription Opioid Use in a Longitudinal Community-Based Cohort Study of Middle-Aged and Older Adults

Background: Despite declining opioid prescribing rates in the United States, the annual prevalence of prescription opioid use in adults ≥50 years old is estimated to be 40%, higher than that of younger adults (ages 18-29 years, 36%). As the American population ages, understanding factors that contribute to overall opioid use is a necessary first step in the determination and mitigation of inappropriate prescribing and opioid-related harms. Objective: Assess predictors of prescription opioid use in an adult population with a high prevalence of chronic pain. Methods: Data were from a community-based cohort of White and African American adults aged 50-90 years residing in predominantly rural Johnston County, North Carolina. Univariable and multivariable logistic regression models were used to evaluate sociodemographic and clinical factors in non-opioid users (n=795) at baseline (2006-2010) as predictors of opioid use at follow-up (2013-2015). Variables included age, sex, race, obesity (BMI≥30kg/m2), polypharmacy (5+ medications), educational attainment (<12, ≥12 years), employment (unemployed, employed/retired), insurance (uninsured, public, private), Census block group household poverty rate (<12%, 12–24%, ≥25%), depressive symptoms (Center for Epidemiologic Studies Depression Scale ≥16 or depression diagnosis), perceived social support (moderate/poor [<19], strong [≥19]; Strong Ties Measure of Social Support, range 0-20), pain sensitivity (sensitive [<4kg], normal [≥4kg] pressure pain threshold), and pain catastrophizing (high [≥15], moderate/low [<15]; Pain Catastrophizing Helplessness Subscale, range 0-25). Results: At follow-up, 13% (n=100) of participants were using prescription opioids. In univariable models, younger age, female sex, obesity, polypharmacy, unemployment, public (vs. private) health insurance, higher poverty rate, depressive symptoms, poorer perceived social support, pain catastrophizing, and elevated pain sensitivity were independently associated (p<0.05) with opioid use. In the multivariable model, younger age (60 vs. 70 years; adjusted odds ratio, 95% confidence interval=2.52, 1.08−5.88), polypharmacy (2.16, 1.24−3.77), high pain catastrophizing (2.17, 1.33−3.56), and depressive symptoms (2.00, 1.17−3.43) remained significant independent predictors. Conclusion: The simultaneous assessment of a breadth of clinical and sociodemographic factors identified polypharmacy, pain catastrophizing, and depressive symptoms as modifiable predictors of prescription opioid use. These findings support the incorporation of pharmacological review and behavioral approaches into chronic pain management strategies. Further research is warranted to track changes in these factors as prescription opioid use declines nationwide