Testosterone in aging male twins: relationship with physical functioning, quality of life, and depression

Research has investigated testosterone and its role in biological and psychological functioning. Testosterone levels decrease as men age, and aging has been associated with declines in muscle mass and strength. Decreased functional mobility can impact quality of life. Aging has also been associated with increased vulnerability to depressive symptomatology. The purpose of this study was to investigate interrelationships among testosterone, physical functioning, quality of life, and depression in the Vietnam Era Twin Study of Aging (VETSA). The mean age of the 1,237 men in VETSA was 55.4 (+2.5). Testosterone data collection began in the third year of VETSA, yielding an available sample of 778. It was hypothesized that there would be significant associations between testosterone and physical functioning, depression, and quality of life as well as between physical functioning and depression and quality of life. Contrary to expectations, when mixed models for linear regression were used, testosterone was shown to be related only to physical functioning. As predicted, however, physical functioning was significantly related to depression and quality of life. Cholesky decompositions were conducted to address the hypothesis that there were shared genetic determinants of each phenotype. Best fitting bivariate models included additive genetic and unique environmental but not common environmental influences. Significant genetic correlations were found between physical functioning and depression, and physical functioning and the mental health component score of the Short Form Health Survey (SF-36). Contrary to expectations, while testosterone and physical functioning were significantly correlated with each other phenotypically, there was no genetic correlation between the two. Trivariate models revealed genetic influences specific to depression as well as genetic influences shared with quality of life and depression. Finally, path analysis demonstrated that testosterone had a direct impact on physical functioning. Physical functioning, but not testosterone, directly impacted depression and quality of life. As there was no genetic correlation between testosterone and physical functioning, but there was a phenotypic correlation, it may be that other factors, such as cortisol, influenced the association. In sum, in this sample, physical functioning seemed to be more important than testosterone to both depressive symptomatology and quality of life

Guide to the building stones of downtown Columbus: a walking tour

Field trip 16 for the Annual Meeting of the Geological Society of America, Cincinnati, Ohio, October 26-29, 1992.Reprinted 1997 with additional notes (following page 33)

Quetiapine in refractory hyperactive and mixed intensive care delirium: a case series

IntroductionDelirium affects up to 80% of patients admitted to intensive care units (ICUs) and contributes to increased morbidity and mortality. Haloperidol is the gold standard for treatment, although quetiapine has been successfully used in the management of delirium.MethodsWe conducted a retrospective study of patients admitted to the ICU between February 2008 and May 2010 who were prescribed quetiapine by the attending clinician. Data collected included demographics, history of drug and/or alcohol dependence, ICU and hospital length of stay, length of mechanical ventilation and the duration of treatment with sedatives and medications for delirium. The daily dose of quetiapine was recorded. Hyperactive or mixed delirium was identified by a validated chart review and a Richmond Agitation Sedation Scale (RASS) score persistently greater than 1 for 48 hours despite therapy.ResultsSeventeen patients were included. Delirium onset occurred after a median of five days. Patients were being given at least four agents for delirium prior to the introduction of quetiapine, and they had a median RASS score of 3. Quetiapine was initiated at a 25 mg daily dose and titrated to a median daily dose of 50 mg. The median duration of delirium prior to quetiapine therapy was 15 days. Quetiapine commencement was associated with a reduction in the need for other medications (within 0 to 6 days) and resolution of delirium within a median of four days. Adverse events included somnolence and transient hypotension.ConclusionsThis case series provides an initial effort to explore a possible role for quetiapine in the management of refractory hyperactive and mixed ICU delirium

Pseudo-ataxia due to Osteoid Osteoma

Background: Ataxia is diagnosed by typical features on examination suggestive of a cerebellar etiology and can invoke extensive diagnostic testing. Osteoid osteomas (OOs) are benign bone tumors of the lower limbs that occasionally present with focal neurological signs. Case Report: A 3-year-old male presented with apparent progressive gait ataxia and non-specific leg pain. Initial imaging was unremarkable. However, 12 months later, a lesion was identified in the distal right femur, which was found to be an OO. The gait disorder and pain resolved after surgery. Discussion: This case highlights the challenges of diagnosing a gait disorder in young children

Underdiagnosis of mild cognitive impairment: A consequence of ignoring practice effects

INTRODUCTION: Longitudinal testing is necessary to accurately measure cognitive change. However, repeated testing is susceptible to practice effects, which may obscure true cognitive decline and delay detection of mild cognitive impairment (MCI). METHODS: We retested 995 late-middle-aged men in a ∼6-year follow-up of the Vietnam Era Twin Study of Aging. In addition, 170 age-matched replacements were tested for the first time at study wave 2. Group differences were used to calculate practice effects after controlling for attrition effects. MCI diagnoses were generated from practice-adjusted scores. RESULTS: There were significant practice effects on most cognitive domains. Conversion to MCI doubled after correcting for practice effects, from 4.5% to 9%. Importantly, practice effects were present although there were declines in uncorrected scores. DISCUSSION: Accounting for practice effects is critical to early detection of MCI. Declines, when lower than expected, can still indicate practice effects. Replacement participants are needed for accurately assessing disease progression.Published versio

Can the quality of social research on ethnicity be improved through the introduction of guidance? Findings from a research commissioning pilot exercise

As the volume of UK social research addressing ethnicity grows, so too do concerns regarding the ethical and scientific rigour of this research domain and its potential to do more harm than good. The establishment of standards and principles and the introduction of guidance documents at critical points within the research cycle might be one way to enhance the quality of such research. This article reports the findings from the piloting of a guidance document within the research commissioning process of a major funder of UK social research. The guidance document was positively received by researchers, the majority of whom reported it to be comprehensible, relevant and potentially useful in improving the quality of research proposals. However, a review of the submitted proposals suggested the guidance had had little impact on practice. While guidance may have a role to play, it will need to be strongly promoted by commissioners and other gatekeepers. Findings also suggest the possibility that guidance may discourage some researchers from engaging with ethnicity if it raises problems without solutions; highlighting the need for complementary investments in research capacity development in this area

Mediators of the Effect of Childhood Socioeconomic Status on Late Midlife Cognitive Abilities : A Four Decade Longitudinal Study

Peer reviewe