Covariate-Adjusted Constrained Bayes Predictions of Random Intercepts and Slopes. Sujit Ghosh is a

Constrained Bayes methodology represents an alternative to the posterior mean (empirical Bayes) method commonly used to produce random effect predictions under mixed linear models. The general constrained Bayes methodology of Ghosh (1992) is compared to a direct implementation of constraints, and it is suggested that the former approach could feasibly be incorporated into commercial mixed model software. Simulation studies and a real-data example illustrate the main points and support the conclusions

The Influence of Intense Tai Chi Training on Physical Performance and Hemodynamic Outcomes in Transitionally Frail, Older Adults

Background. Few data exist to evaluate whether Tai Chi (TC) training improves physical performance and hemodynamic outcomes more than a wellness education (WE) program does among older fallers transitioning to frailty. Methods. This 48-week randomized clinical trial was provided at 10 matched pairs of congregate living facilities in the Atlanta metropolitan area to 291 women and 20 men, who were transitionally frail, ≥70 years old, and had fallen at least once within the past year. Pairs of facilities were randomized to either TC exercise (n = 158) or WE (control) interventions (n = 153) over 48 weeks. Physical performance (freely chosen gait speed, reach, chair-rises, 360° turn, picking up an object from the floor, and single limb support) and hemodynamic outcomes (heart rate and blood pressure) were obtained at baseline and after 4, 8, and 12 months. Results. Mean percent change (baseline to 1 year) for gait speed increased similarly in both cohorts (TC: 9.1% and WE: 8.2%; p =.78). However, time to complete three chair-rises decreased 12.3% for TC and increased 13.7% for WE (p =.006). Baseline to 1 year mean percent change decreased among TC and increased within WE cohorts for: body mass index (-2.3% vs 1.8%; p <.0001), systolic blood pressure (-3.4% vs 1.7%; p =.02), and resting heart rate (-5.9% vs 4.6%; p <.0001). Conclusions. TC significantly improved chair-rise and cardiovascular performance. Because TC training reduced fall occurrences in this cohort, factors influencing functional and cardiovascular improvements may also favorably impact fall event

The Movement Imagery Questionnaire-Revised, Second Edition (MIQ-RS) Is a Reliable and Valid Tool for Evaluating Motor Imagery in Stroke Populations

Mental imagery can improve motor performance in stroke populations when combined with physical therapy. Valid and reliable instruments to evaluate the imagery ability of stroke survivors are needed to maximize the benefits of mental imagery therapy. The purposes of this study were to: examine and compare the test-retest intra-rate reliability of the Movement Imagery Questionnaire-Revised, Second Edition (MIQ-RS) in stroke survivors and able-bodied controls, examine internal consistency of the visual and kinesthetic items of the MIQ-RS, determine if the MIQ-RS includes both the visual and kinesthetic dimensions of mental imagery, correlate impairment and motor imagery scores, and investigate the criterion validity of the MIQ-RS in stroke survivors by comparing the results to the KVIQ-10. Test-retest analysis indicated good levels of reliability (ICC range: .83–.99) and internal consistency (Cronbach α: .95–.98) of the visual and kinesthetic subscales in both groups. The two-factor structure of the MIQ-RS was supported by factor analysis, with the visual and kinesthetic components accounting for 88.6% and 83.4% of the total variance in the able-bodied and stroke groups, respectively. The MIQ-RS is a valid and reliable instrument in the stroke population examined and able-bodied populations and therefore useful as an outcome measure for motor imagery ability

Culturally-adapted and audio-technology assisted HIV/AIDS awareness and education program in rural Nigeria: a cohort study

Background: HIV-awareness programs tailored toward the needs of rural communities are needed. We sought to quantify change in HIV knowledge in three rural Nigerian villages following an integrated culturally adapted and technology assisted educational intervention. Methods: A prospective 14-week cohort study was designed to compare short-term changes in HIV knowledge between seminar-based education program and a novel program, which capitalized on the rural culture of small-group oral learning and was delivered by portable digital-audio technology. Results: Participants were mostly Moslem (99%), male (53.5%), with no formal education (55%). Baseline HIV knowledge was low (\u3c 80% correct answers for 9 of the 10 questions). Knowledge gain was higher (p \u3c 0.0001 for 8 of 10 questions) in the integrated culturally adapted and technology-facilitated (n = 511) compared with the seminar-based (n = 474) program. Conclusions: Baseline HIV-awareness was low. Culturally adapted, technology-assisted HIV education program is a feasible cost-effective method of raising HIV awareness among low-literacy rural communities

Cognitive and Neuronal Link With Inflammation: A Longitudinal Study in People With and Without HIV Infection

Background: Across many settings, lack of virologic control remains common in people with HIV (PWH) because of late presentation and lack of retention in care. This contributes to neuronal damage and neurocognitive impairment, which remains prevalent. More evidence is needed to understand these outcomes in both PWH and people without HIV (PWOH). Methods: We recruited PWH initiating antiretroviral therapy and PWOH at 2 sites in the United States. One hundred eight adults were enrolled (56 PWOH and 52 PWH), most of whom had a second assessment at least 24 weeks later (193 total assessments). Tumor necrosis factor alpha, monocyte chemotactic protein-1 (MCP-1), neopterin, soluble CD14, and neurofilament light chain protein (NFL) were measured in plasma and cerebrospinal fluid (CSF). Using multivariate models including Bayesian model averaging, we analyzed factors associated with global neuropsychological performance (NPT-9) and CSF NFL at baseline and over time. Results: At baseline, higher CSF MCP-1 and plasma sCD14 were associated with worse NPT-9 in PWH, while CSF HIV RNA decrease was the only marker associated with improved NPT-9 over time. Among PWH, higher CSF neopterin was most closely associated with higher NFL. Among PWOH, higher CSF MCP-1 was most closely associated with higher NFL. After antiretroviral therapy initiation, decrease in CSF MCP-1 was most closely associated with NFL decrease. Conclusion: Monocyte-associated CSF biomarkers are highly associated with neuronal damage in both PWH and PWOH. More research is needed to evaluate whether therapies targeting monocyte-associated inflammation may ameliorate HIV-associated neurobehavioral diseases

Quality of dietary macronutrients is associated with glycemic outcomes in adults with cystic fibrosis

ObjectivePoor diet quality contributes to metabolic dysfunction. This study aimed to gain a greater understanding of the relationship between dietary macronutrient quality and glucose homeostasis in adults with cystic fibrosis (CF).DesignThis was a cross-sectional study of N = 27 adults with CF with glucose tolerance ranging from normal (n = 9) to prediabetes (n = 6) to being classified as having cystic fibrosis-related diabetes (CFRD, n = 12). Fasted blood was collected for analysis of glucose, insulin, and C-peptide. Insulin resistance was assessed by Homeostatic Model Assessment for Insulin Resistance (HOMA2-IR). Subjects without known CFRD also underwent a 2-h oral glucose tolerance test. Three-day food records were used to assess macronutrient sources. Dietary variables were adjusted for energy intake. Statistical analyses included ANOVA, Spearman correlations, and multiple linear regression.ResultsIndividuals with CFRD consumed less total fat and monounsaturated fatty acids (MUFA) compared to those with normal glucose tolerance (p &lt; 0.05). In Spearman correlation analyses, dietary glycemic load was inversely associated with C-peptide (rho = −0.28, p = 0.05). Total dietary fat, MUFA, and polyunsaturated fatty acids (PUFA) were positively associated with C-peptide (rho = 0.39–0.41, all p &lt; 0.05). Plant protein intake was inversely related to HOMA2-IR (rho = −0.28, p = 0.048). Associations remained significant after adjustment for age and sex.DiscussionImprovements in diet quality are needed in people with CF. This study suggests that higher unsaturated dietary fat, higher plant protein, and higher carbohydrate quality were associated with better glucose tolerance indicators in adults with CF. Larger, prospective studies in individuals with CF are needed to determine the impact of diet quality on the development of CFRD

Controlled clinical comparison of two lysis-based blood culture systems, isolator and Septi-Chek Release, for detection of bloodstream infections.

A controlled clinical comparison was made of the Isolator (Wampole Laboratories, Cranbury, N.J.) and the Septi-Chek Release bottle (Roche Diagnostics, Nutley, N.J.). From 6,345 blood culture sets fulfilling minimum criteria for volume of blood cultured, 840 strains were isolated, of which only 691 (82%) were considered to be representative of bloodstream infection according to Centers for Disease Control definitions. Statistically significant differences were found between the systems for the following organisms, which were all detected more frequently in the Isolator system: Staphylococcus aureus (P = 0.0001), Alcaligenes xylosoxidans (P = 0.008), Klebsiella pneumoniae (P = 0.05), Salmonella spp. (P = 0.03), and Candida albicans (P = 0.02). The Septi-Chek Release system required a longer period of time than the Isolator system for detection of the following organisms:S. aureus (P = 0.0001), Enterococcus spp. (P = 0.0001), Enterobacter cloacae (P = 0.03), Escherichia coli (P = 0.0001), Klebsiella oxytoca (P = 0.03), K. pneumoniae (P = 0.02), Pseudomonas aeruginosa (P = 0.002), and C. albicans (P = 0.005). There were 430 episodes of bloodstream infections identified in the study; of these episodes, only those due to S. aureus were detected significantly more frequently (P = 0.0001) by the Isolator system than by the Septi-Chek Release system. However, episodes of bloodstream infections due to S. aureus, Staphylococcus epidermidis, Enterococcus spp., and E. coli were detected significantly faster by the Isolator system

The incidence and prevalence of systemic lupus erythematosus, 2002-2004:The Georgia Lupus Registry

OBJECTIVE: The Georgia Lupus Registry is a population-based registry designed to improve our ability to estimate incidence and prevalence of systemic lupus erythematosus (SLE) in a large population. METHODS: Potential cases were identified from multiple sources during the years 2002 through 2004. Cases were defined by the American College of Rheumatology (ACR) Criteria for SLE or a combined definition. Age-standardized rates were determined and stratified by race and sex. With capture-recapture analyses, we estimated the under-ascertainment of cases. RESULTS: Using the ACR case definition, the overall crude and age-adjusted incidence rate was 5.6/100,000, with capture-recapture and combined definition rates being slightly higher. The age-adjusted incidence rate for women was >5 times higher (9.2 vs. 1.8) than that for men. Black women had an incidence rate nearly 3 times higher than that for white women with a significantly higher rate in the 30 to 59 years age group. The overall crude and age-adjusted prevalence rates were 74.4 and 73/100,000, respectively. The age-adjusted prevalence rate for women was nearly 9 times higher (127.6 vs. 14.7) than that for men. Black women had very high rates (196.2). A striking difference was seen in the proportion with end-stage renal disease in prevalent cases, with a sevenfold greater involvement among blacks. CONCLUSION: With more complete case finding, our incidence and prevalence rates are among the highest reported in the United States. Results continue to underscore striking gender, age, and racial disparities between blacks and whites