Rate of tarsal and metatarsal bone mineral density change in adults with diabetes mellitus and peripheral neuropathy: A longitudinal study

BACKGROUND: In people with diabetes (DM) and peripheral neuropathy (PN), loss of bone mineral density (BMD) in the tarsals and metatarsals contribute to foot complications; however, changes in BMD of the calcaneal bone is most commonly reported. This study reports rate of change in BMD of all the individual bones in the foot, in participants with DM and PN. Our aim was to investigate whether the rate of BMD change is similar across all the bones of the foot. METHODS: Participants with DM and PN (n = 60) were included in this longitudinal cohort study. Rate of BMD change of individual bones was monitored using computed tomography at baseline and 6 months, 18 months, and 3-4 years from baseline. Personal factors (age, sex, medication use, step count, sedentary time, and PN severity) were assessed. A random coefficient model estimated rate of change of BMD in all bones and Pearson correlation tested relationships between personal factor variables and rate of BMD change. RESULTS: Mean and calcaneal BMD decreased over the study period (p \u3c 0.05). Individual tarsal and metatarsal bones present a range of rate of BMD change (-0.3 to -0.9%/year) but were not significantly different than calcaneal BMD change. Only age showed significant correlation with BMD and rate of BMD change. CONCLUSION: The rate of BMD change did not significantly differ across different foot bones at the group level in people with DM and PN without foot deformity. Asymmetric BMD loss between individual bones of the foot and aging may be indicators of pathologic changes and require further investigation. TRIAL REGISTRATION: Metatarsal Phalangeal Joint Deformity Progression-R01. Registered 25 November 2015, https://clinicaltrials.gov/ct2/show/NCT02616263

Collateral Consequences: Living in the Shadow of a Conviction

Over the course of fifteen weeks, fourteen students and two professors explored the Criminal Justice System and the immense challenges faced by citizens as they attempt to reintegrate into their communities after being incarcerated. Through the lens of Systems Thinking, a system pioneered and described by Peter Senge, we dissected seemingly unrelated experiences to identify behaviors and patterns that have been intrinsic in the Criminal Justice System since “tough on crime” policies emerged into the early 1970’s. During this time, criminal justice and public opinion moved from a more rehabilitative stance to one of punishment and punitive vengeance on those that have wronged society, particularly those who committed drug offenses.. Along with extended sentences came a slew of collateral consequences that kept people impoverished and oppressed even after leaving prison. This specific aspect was the focus of our class’ research and discussion. By breaking this down into subsystems, the class characterized the challenges faced by citizens trying to return to their communities and normal life, and provided areas and suggestions for improving the system and in turn, the lives of these people. This book is the culmination of that research