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The aim of the study was to determine whether tibiofemoral contact stress predicts risk for worsening knee pain over 84 ms in adults aged 50-79 yrs with or at elevated risk for knee osteoarthritis.Baseline tibiofemoral contact stress was estimated using discrete element analysis. Other baseline measures included weight, height, hip-knee-ankle alignment, Kellgren-Lawrence grade, and Western Ontario and McMaster Universities Osteoarthritis Index pain subscale. Logistic regression models assessed the association between baseline contact stress and 84-mo worsening of Western Ontario and McMaster Universities Osteoarthritis Index pain subscale.Data from the dominant knee (72.6% Kellgren-Lawrence grade 0/1 and 27.4% Kellgren-Lawrence grade ≥ 2) of 208 participants (64.4% female, mean ± SD body mass index = 29.6 ± 5.1 kg/m 2 ) were analyzed. Baseline mean and peak contact stress were 3.3 ± 0.9 and 9.4 ± 4.3 MPa, respectively. Forty-seven knees met the criterion for worsening pain. The highest tertiles in comparison with the lowest tertiles of mean (odds ratio [95% confidence interval] = 2.47 [1.03-5.95], P = 0.04) and peak (2.49 [1.03-5.98], P = 0.04) contact stress were associated with worsening pain at 84 mos, after adjustment for age, sex, race, clinic site, and baseline pain. Post hoc sensitivity analyses including adjustment for body mass index and hip-knee-ankle alignment attenuated the effect.These findings suggest that elevated tibiofemoral contact stress can predict the development of worsening of knee pain.

We investigated whether baseline sagittal-plane ankle, knee, and hip contribution to the total support moment (TSM) are each associated with baseline-to-2-year tibiofemoral and patellofemoral tissue damage worsening in adults with knee osteoarthritis. Ambulatory lower-limb kinetics were captured and computed. TSM is the sum of ankle, knee, and hip extensor moments at each instant during gait. Ankle, knee, and hip contributions to TSM were computed as joint moments divided by TSM, expressed as percentages. Participants underwent MRI of both knees at baseline and 2 years later. Logistic regression models assessed associations of baseline ankle contribution to TSM with baseline-to-2-year cartilage damage and bone marrow lesion worsening, adjusted for age, sex, BMI, gait speed, disease severity, and pain. We used similar analytic approaches for knee and hip contributions to TSM. Sample included 391 knees from 204 persons (age[SD]: 64[10] years; 76.5% women). Greater ankle contribution may be associated with increased odds of tibiofemoral cartilage damage worsening (OR = 2.38; 95% CI: 1.02-5.57) and decreased odds of patellofemoral bone marrow lesion worsening (OR = 0.14; 95% CI: 0.03-0.73). The ORs for greater knee contribution were in the protective range for tibiofemoral compartment and in the deleterious range for patellofemoral. Greater hip contribution may be associated with increased odds of tibiofemoral worsening (OR = 2.71; 95% CI: 1.17-6.30). Greater ankle contribution to TSM may be associated with baseline-to-2-year tibiofemoral worsening, but patellofemoral tissue preservation. Conversely, greater knee contribution may be associated with patellofemoral worsening, but tibiofemoral preservation. Preliminary findings illustrate potential challenges in developing biomechanical interventions beneficial to both tibiofemoral and patellofemoral compartments.

Key Clinical Points Osteoarthritis of the Knee Potential long-term consequences of knee osteoarthritis include reduced physical activity, deconditioning, impaired sleep, fatigue, depression, functi...

Background Knee osteoarthritis (KOA) is the most prevalent type of OA and a leading cause of disability in the United States. Falls are a major public health concern in older adults. Our aim was to examine how the severity of radiographic KOA affects recurrent falls in a cohort of middle-aged and older individuals enrolled in the Osteoarthritis Initiative. Methods About 3 972 participants, mean age of 63 years, 58% female were included. Participants were divided into 5 mutually exclusive groups based on their worst Kellgren–Lawrence grade of radiographic KOA from annual x-rays from baseline to 36 months. Generalized estimating equations for repeated logistic regression were used to model the association between KOA severity and the likelihood of recurrent falls (≥2 falls/year) over 5 years of follow-up (>36 to 96 months). Results Older adults (≥age 65) with KOA were at higher odds of recurrent falls in comparison to individuals without KOA in multivariate models (possible OA odds ratio [OR] = 2.22, 95% CI = 1.09–4.52; mild OA OR = 2.48, 95% CI = 1.34–4.62; unilateral moderate–severe OA OR = 2.84, 95% CI = 1.47–5.50; bilateral moderate–severe OA OR = 2.52, 95% CI = 1.13–5.62). Middle-aged adults (aged 45–64) with KOA did not have increased odds of recurrent falls in comparison to those without KOA except for possible KOA (OR = 1.86, 95% CI = 1.01–2.78; KOA severity × Age interaction = 0.025). Conclusion Older adults with radiographic evidence of KOA have an increased likelihood of experiencing recurrent falls in comparison to those without KOA independent of established risk factors. Our results suggest that fall prevention efforts should include older adults with all stages of KOA.

Objective To test the hypothesis that superficial cartilage composition (T2) is associated with subsequent incidence or worsening of cartilage damage, and deep T2 with that of bone marrow lesions (BMLs) in knees without radiographic osteoarthritis (ROA). Design A total of 201 knees from the Osteoarthritis Initiative without ROA were included: 78 from the healthy reference cohort, 60 without ROA but with risk factors, and 63 without ROA but with contralateral ROA. Year 1 (Y1) superficial and deep cartilage T2 were derived in the medial and lateral (weightbearing) femur (MF/LF) and tibia (MT/LT), using sagittal multiecho spin echo magnetic resonance images. Cartilage and BMLs were assessed in the medial (MFTJ) and lateral femorotibial joint (LFTJ) at Y1 and 3 years later. Binary logistic regression statistics were applied. Results Incidence or worsening of cartilage damage was more frequent (MFTJ 15%, LFTJ 13%) than incidence or worsening of BMLs (6.0%, 4.5%). In knees with incident or worsening cartilage lesions in the MF and LT, deep layer T2 in the same plate was elevated (MF, 43.6 ± 4.0 vs. 41.3 ± 3.8 ms, P = 0.047; LT, 33.8 ± 2.3 vs. 32.0 ± 2.2 ms, P = 0.008) compared to those without. In knees with incident or worsening of BMLs in the LFTC and LT, superficial layer T2 was elevated (LFTJ, 49.6 ± 4.8 vs. 46.7 ± 3.1 ms; LT, 47.4 ± 4.9 vs. 44.0 ± 3.3 ms, both Ps = 0.04). Conclusions Contrary to our hypothesis, increased deep layer cartilage T2 was associated with subsequent worsening of cartilage damage, whereas superficial layer T2 was related to subsequent BML worsening. Yet, this relationship was observed in some, but not in all cartilage plates.

Introduction: The use of tobacco in all forms is increasing day by day globally causing its ill effects on oral as well as overall health of the people and affecting their sense of well-being and quality of life. Aim and Objectives: The present study was done to investigate among patients the awareness of tobacco use and its ill effects on oral health. Materials and Methods: This descriptive, cross-sectional study was conducted at Dr. RRK Dental College and Hospital, Akola. A total of 297 patients were asked using a self-structured questionnaire. Results: Out of a total of 297 patients participating in the study, 48 (16.2%) were female and 248 (83.8%) were male. About 81.7% of the patients were aware that heart problems can be one of the ill effects of tobacco chewing, while 3.7% were still not sure about it. Conclusions: We found that patients had a knowledge about the impact of tobacco on oral health.

Summary Objective To develop a model of early osteoarthritis, by examining whether radiographically normal knees with contralateral joint space narrowing (JSN), but without contralateral trauma history, display greater longitudinal cartilage composition change (transverse relaxation time; T2) than subjects with bilaterally normal knees. Methods 120 radiographically normal knees (Kellgren Lawrence grade [KLG] 0) from the Osteoarthritis Initiative were studied. 60 case knees displayed definite contralateral radiographic knee osteoarthritis (KLG ≥ 2) whereas 60 reference subjects were bilaterally KLG0, and were matched 1:1 to cases based on age, sex, and BMI. All had multi-echo spin-echo MRI acquired at year (Y) 1 and 4 follow-up, with cartilage T2 being determined in superficial and deep cartilage layers across 16 femorotibial subregions. T2 across all regions was considered the primary analytic focus. Results Of 60 KLG0 case knees (30 female, age: 65.0 ± 8.8 y, BMI: 27.6 ± 4.4 kg/m2), 21/22/13/4 displayed contralateral JSN 0/1/2/3, respectively. The longitudinal increase in the deep layer cartilage T2 between Y1 and Y4 was significantly greater (P = 0.03; Cohen's D 0.50) in the 39 KLG0 case knees with contralateral JSN (1.2 ms; 95% confidence interval [CI] [0.4, 2.0]) than in matched KLG0 reference knees (0.1 ms; 95% CI [−0.5, 0.7]). No significant differences were identified in superficial T2 change. T2 at Y1 was significantly greater in case than in reference knees, particularly in the superficial layer of the medial compartment. Conclusions Radiographically normal knees with contralateral, non-traumatic JSN represent an applicable model of early osteoarthritis, with deep layer cartilage composition (T2) changing more rapidly than in bilaterally normal knees. Clinicaltrials.gov identification NCT00080171 .

Objective To investigate the 2-year association of varus knee thrust observed during walking to the odds of worsening Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) knee pain in older adults with or at risk of osteoarthritis (OA). Methods Video recordings of self-paced walking trials of Multicenter Osteoarthritis Study participants were assessed for the presence of varus thrust at baseline. Knee pain was assessed using the WOMAC questionnaire at baseline and at 2 years. Logistic regression was used to estimate the odds of worsening knee pain (defined as either any increase in WOMAC score or as clinically important worsening), adjusting for age, sex, race, body mass index, clinic site, gait speed, and static knee alignment. Analyses were repeated, stratified by baseline radiographic OA status and among the subset of knees without baseline WOMAC pain. Results A total of 1,623 participants contributed 3,204 knees. Varus thrust was observed in 31.5% of knees. Knees with varus thrust had 1.44 times (95% confidence interval [95% CI] 1.19-1.73) the odds of any worsening and 1.37 times (95% CI 1.11-1.69) the odds of clinically important worsening WOMAC pain compared to knees without thrust. Knees with thrust without baseline WOMAC pain had 2.01 times (95% CI 1.47-2.74) the odds of incident total pain. Conclusion Results indicate that varus thrust is a risk factor for worsening and incident knee pain. Targeting varus thrust through noninvasive therapies could prevent development or worsening of knee pain in older adults with or at risk for knee OA.

Objectives Disability prevention strategies are more achievable before osteoarthritis disease drives impairment. It is critical to identify high-risk groups, for strategy implementation and trial eligibility. An established measure, gait speed is associated with disability and mortality. We sought to develop and validate risk stratification trees for incident slow gait in persons at high risk for knee osteoarthritis, feasible in community and clinical settings. Methods Osteoarthritis Initiative (derivation cohort) and Multicenter Osteoarthritis Study (validation cohort) participants at high risk for knee osteoarthritis were included. Outcome was incident slow gait over up to 10-year follow-up. Derivation cohort classification and regression tree analysis identified predictors from easily assessed variables and developed risk stratification models, then applied to the validation cohort. Logistic regression compared risk group predictive values; area under the receiver operating characteristic curves (AUCs) summarised discrimination ability. Results 1870 (derivation) and 1279 (validation) persons were included. The most parsimonious tree identified three risk groups, from stratification based on age and WOMAC Function. A 7-risk-group tree also included education, strenuous sport/recreational activity, obesity and depressive symptoms; outcome occurred in 11%, varying 0%–29 % (derivation) and 2%–23 % (validation) depending on risk group. AUCs were comparable in the two cohorts (7-risk-group tree, 0.75, 95% CI 0.72 to 0.78 (derivation); 0.72, 95% CI 0.68 to 0.76 (validation)). Conclusions In persons at high risk for knee osteoarthritis, easily acquired data can be used to identify those at high risk of incident functional impairment. Outcome risk varied greatly depending on tree-based risk group membership. These trees can inform individual awareness of risk for impaired function and define eligibility for prevention trials.

Summary Objective Examine associations of hip abductor strength with (1) cartilage damage worsening in the tibiofemoral and patellofemoral compartments 2 years later, and (2) poor function and disability outcomes 5 years later. Methods Participants had knee osteoarthritis (K/L ≥ 2) in at least one knee. Hip abductor strength was measured using Biodex Dynamometry. Participants underwent 3.0T MRI of both knees at baseline and 2 years later. Baseline-to-2-year cartilage damage progression, defined as any worsening of WORMS cartilage damage score, was assessed at each tibiofemoral and patellofemoral surface. LLFDI (Late-Life Function and Disability Instrument) and Chair-Stand-Rate were recorded at baseline and 5-year follow-up; outcomes analyzed using quintiles. Poor outcomes were defined as remaining in the same low-function quintiles or being in a worse quintile at 5-year follow-up. We analyzed associations of baseline hip abductor strength with cartilage damage worsening and function and disability outcomes using multivariable log-binomial models. Results 275 knees from 164 persons [age = 63.7 (SD = 9.8) years, 79.3% women] comprised the structural outcome sample, and 187 persons [age = 64.2 (9.7), 78.6% women] the function and disability outcomes sample. Greater baseline hip abductor strength was associated with reduced risks of baseline-to-2-year medial patellofemoral and lateral tibiofemoral cartilage damage worsening [adjusted relative risks (RRs) range: 0.80–0.83) and with reduced risks of baseline-to-5-year poor outcomes for Chair-Stand-Rate and LLFDI Basic Lower-Extremity Function and Disability Limitation (adjusted RRs range: 0.91–0.94). Conclusion Findings support a beneficial role of hip abductor strength for disease modification and for function and disability outcomes, and as a potential therapeutic target in managing knee osteoarthritis.

Summary Objective To investigate individual preferences for physical activity (PA) attributes in adults with chronic knee pain, to identify clusters of individuals with similar preferences, and to identify whether individuals in these clusters differ by their demographic and health characteristics. Design An adaptive conjoint analysis (ACA) was conducted using the Potentially All Pairwise RanKings of all possible Alternatives (PAPRIKA) method to determine preference weights representing the relative importance of six PA attributes. Cluster analysis was performed to identify clusters of participants with similar weights. Chi-square and ANOVA were used to assess differences in individual characteristics by cluster. Multinomial logistic regression was used to assess associations between individual characteristics and cluster assignment. Results The study sample included 146 participants; mean age 65, 72% female, 47% white, non-Hispanic. The six attributes (mean weights in parentheses) are: health benefit (0.26), enjoyment (0.24), convenience (0.16), financial cost (0.13), effort (0.11) and time cost (0.10). Three clusters were identified: Cluster 1 (n = 33): for whom enjoyment (0.35) is twice as important as health benefit; Cluster 2 (n = 63): for whom health benefit (0.38) is most important; and Cluster 3 (n = 50): for whom cost (0.18), effort (0.18), health benefit (0.17) and enjoyment (0.18) are equally important. Cluster 1 was healthiest, Cluster 2 most self-efficacious, and Cluster 3 was in poorest health. Conclusions Patients with chronic knee pain have preferences for PA that can be distinguished effectively using ACA methods. Adults with chronic knee pain, clustered by PA preferences, share distinguishing characteristics. Understanding preferences may help clinicians and researchers to better tailor PA interventions.

Objective The benefits of physical activity among persons with or at higher risk for knee osteoarthritis are well established. However, activity levels in this population are low, in part due to concern that activity will damage the knee joint. We hypothesized that sedentary and moderate-vigorous physical activity are each associated with greater risk of radiographic worsening of knee OA. Methods In Osteoarthritis Initiative participants with or at higher risk for knee OA enrolled in an accelerometer substudy at 48 months (study baseline), physical activity was measured by a uniaxial accelerometer (ActiGraph GT1M). Radiographic progression was defined as any 48 month to 96 month worsening of Kellgren/Lawrence (K/L) grade scores. All analyses were knee-level; we used multivariable logistic regression with generalized estimating equations, adjusting for key covariates. Results Of the 1,206 participants, 631 (52%) were female, the mean ± SD age was 64 ± 9 years, and mean ± SD body mass index (BMI) was 28 ± 5. The mean ± SD average daily sedentary activity was 602 ± 86 minutes, average daily light activity was 284 ± 75 minutes, and average daily moderate-vigorous activity was 20 ± 20 minutes. In 1,978 knees, 267 (14%) had worsening of K/L grade scores. In the multivariable model, age, sex, BMI, and pain, were associated with K/L grade worsening, but neither sedentary activity (adjusted odds ratio [OR] 0.99 [95% confidence interval (95% CI) 0.97-1.01]) nor moderate-vigorous activity (adjusted OR 1.00 [95% CI 0.91-1.09]) were associated with K/L grade worsening. Conclusion In persons with or at higher risk for knee OA, age, sex, BMI, and pain, but not objectively measured average daily minutes of sedentary or moderate-vigorous activity, were associated with subsequent worsening of K/L grade. Whether findings differ in persons with more severe knee OA and/or engaged more frequently in moderate-vigorous activity should be examined in future studies.

Objective Identify distinct trajectories of lack of knee confidence over an 8-year follow-up period and examine baseline factors associated with poor trajectories in persons with or at risk for knee osteoarthritis (OA). Methods The Osteoarthritis Initiative is a prospective cohort study of persons with or at high risk for knee OA. Confidence in the knees was assessed within the Knee Injury and Osteoarthritis Outcome Score instrument querying how much the individual is troubled by lack of confidence in his/her knee(s), rated as not-at-all (0), mildly (1), moderately (2), severely (3), and extremely (4) troubled, reported annually from baseline to 96 months. Lack of knee confidence was defined as a score ≥ 2. We used latent class models to identify subgroups that share similar underlying knee confidence trajectories over an 8-year period, and multivariable multinomial logistic regression models to examine baseline factors associated with poor trajectories. Results Among 4515 participants [mean age 61.2 years (SD 9.2), BMI 28.6 kg/m2 (4.8); 2640 (58.5%) women], four distinct knee confidence trajectories were identified: persistently good (65.6%); declining (9.1%); poor, improving (13.9%); and persistently poor (11.4%). Baseline predictors associated with persistently poor confidence (reference: persistently good) were younger age, male sex, higher BMI, depressive symptoms, more advanced radiographic disease, worse knee pain, weaker knee extensors, history of knee injury and surgery, and reported hip and/or ankle pain. Conclusion Findings suggest the dynamic nature of self-reported knee confidence and addressing modifiable factors (e.g., BMI, knee strength, depressive symptoms, lower limb pain) may improve its long-term course.

Development and sustainability both are crucial parts of any economy. Developing countries are working for sustainability development whereas developed countries are focused on growth and developments. The Indian economy stands in stable economies worldwide. There are various sectors that provide their contribution to the GDP growth. The IT sector in India plays a significant role in development as well as sustainability development during the slowdown in economy. At present the Indian IT industries and support services are leading industries. With the slogan of “Digital India” rapid development in this sector take place now. At present Indian IT industries’ participation in GDP is 7.7% approx and till 2025 it is expected to reach 10%. The present paper is an effort to depict a view of Indian IT industries and its role and presence in national development and sustainability. The study focuses on the current slight economy slowdown and position of IT industries.

Purpose To test whether radiographically normal knees with contralateral radiographic knee osteoarthritis (ROA) (i.e. ‘early OA model’) exhibit MRI-defined structural tissue pathology to a greater extent and show higher rates of progression compared to knees with bilateral radiographically normal knees without risk factors (‘healthy reference’). Methods We included 154 knees from the Osteoarthritis Initiative without ROA (Kellgren-Lawrence = 0), but with definite ROA (Kellgren-Lawrence ≥2) in the contralateral knee, and 78 participants from the OAI healthy reference cohort (without any signs of radiographic OA, knee pain or risk factors in either knee). Effusion-synovitis, Hoffa-synovitis, bone marrow lesions (BMLs), cartilage lesions, meniscus morphology and - extrusion and osteophytes were assessed at year 1 (Y1) and year 4 (Y4). Frequencies of features for both groups at Y1 and rates of worsening from Y1 to Y4 were compared using Fisher's exact test. Results 69% (early OA model) vs. 46% (healthy reference) had baseline Hoffa-synovitis, 26% vs. 19% effusion-synovitis, 27% vs. 13% femorotibial (FT) BMLs, 77% vs. 50% FT cartilage lesions, 36% vs. 9% meniscal damage, 51% vs. 24% meniscus extrusion, and 92% vs. 74% FT osteophytes. Apart from effusion-synovitis, all differences were statistically significant. For structural worsening, statistically significant differences were observed for FT cartilage (p = 0.03) and FT osteophytes (p = 0.01). Conclusion MRI structural abnormalities are substantially more frequent and more progressive in radiographically normal knees with contralateral osteoarthritis than in 'healthy reference' controls. Compared with published data, they also are more frequent compared to radiographically normal knees “at risk”, without contralateral knee OA.

Our effort is to analyze the effect of the rampant over the economies of 10 affected nations by studying their stock market values during the COVID-19 episode. We have endowed the nations with their respective stock markets stated in brackets - Brazil(Ibovespa), Canada (S&P/TSX Composite), France (AEX), Germany (DAX 30), India (NIFTY 50), Italy (FTSE MIB), Russia (IMOEX), Spain (IBEX 35), U.K. (FTSE 100), U.S.A. (DOW JONES INDUSTRIAL AVERAGE). We have gathered the indices of stock per country from 2 March to 23rd June, collected from official website of respective stocks. In order to collect data, we had to inculcate the fundamental lessons of Statistics. R-software aided us to plot the curves of stock values providing an ease to master our project. We also formulated a Python 3.7 language program code to solidify analysis on various aspects of economy of the countries and comparison between these aspects.

Physical inactivity is a leading risk factor for developing disability. Although randomized clinical trials have demonstrated improving physical activity can reduce this risk in older adults with arthritis, these studies did not specifically evaluate inactive adults.The aim of this study was to evaluate the relationship of changes in physical activity with disability changes among initially inactive adults with or at high risk of knee osteoarthritis from Osteoarthritis Initiative.Inactive persons were identified at baseline based on the US Department of Health and Human Services classification (no [zero] 10-minute session of moderate-to-vigorous [MV] activity over 1 week) from objective accelerometer monitoring. Two years later, physical activity change status was classified as follows: (1) met Federal physical activity guidelines (≥150 MV minutes/week acquired in bouts ≥10 minutes), (2) insufficiently increased activity (some but150 MV bout minutes/week), or (3) remained inactive. Disability at baseline and 2 years was assessed by Late Life Disability Instrument limitation and frequency scores. Multiple regression evaluated the relationship of physical activity change status with baseline-to-2-year changes in disability scores adjusting for socioeconomics, health factors, and baseline disability score.Increased physical activity showed a graded relationship with improved disability scores in Late Life Disability Instrument limitation (P0.001) and frequency scores (P = 0.027). While increasing MV activity to guideline levels showed the greatest reduction, even insufficiently increased physical activity was related to reduced disability.Findings support advice to increase MV physical activity to reduce disability among inactive adults with or at high risk of knee osteoarthritis, even when guidelines are not met.

Background Structural joint pathology on MRI has been found in knees without radiographic evidence of osteoarthritis (OA). We have previously shown that structural abnormalities on MRI may be precursors of disease and associated with the detection of incident radiographic knee OA (ROA) up to 2 years later, and in some circumstances up to seven years later. The prognostic value of structural abnormalities on MRI for knee OA, however, is unknown. Objectives Estimate the probability of incident ROA over 10 years of follow-up, according to structural abnormalities detected on baseline MRIs. Methods A subcohort of participants (862 knees, one knee/person) from the Osteoarthritis Initiative (OAI) with at least one knee at risk of developing ROA (i.e., Kellgren-Lawrence (KL) 0,1 at baseline) was randomly selected. MRI-detected structural features of the knee were assessed by expert readers using the MRI Osteoarthritis Knee Score (MOAKS). Participants underwent bilateral posteroanterior fixed-flexion weight-bearing knee radiography at baseline and annually through year 4, and then every two years until year 10. Radiographs were centrally read for KL grade, with ROA defined as KL≥2. Survival was estimated with the Turnbull non-parametric maximum likelihood estimator, a generalization of Kaplan Meier curves for interval censored data. Survival curves were compared using a log rank permutation test available in the R package interval. Hazard ratios were estimated using Cox models fit using the R package icenReg, designed for interval censored data. Features were considered one at a time, with no adjustments. Results Knees with any of the following structural abnormalities had higher estimated probabilities for the development of radiographic OA within two, four and 10 years of follow-up: effusion-synovitis, Hoffa-synovitis, bone marrow lesions in the medial compartment and whole knee, surface area and full thickness cartilage damage in the medial compartment and whole knee, and medial meniscal extrusion (Table 1). Differences in the probability for the development of ROA within two, four, and 10 years of follow-up were significant (pointwise 95% confidence intervals did not include 0), between knees without the abnormality and knees in the most severe category for all features, with one exception at the two-year follow-up. All of these abnormalities were significantly associated with time to ROA over 10 years of follow-up. Conclusion Our results demonstrate the prognostic value of effusion-synovitis, Hoffa-synovitis, bone marrow lesions, cartilage damage, and meniscal extrusion for the development of ROA up to 10 years later. Future directions include developing a predictive model that incorporates multiple features. Disclosure of Interests C. Kent Kwoh Grant/research support from: EMD Serono and Abbvie, Consultant for: EMD Serono, Fidia, Regulus, GSK, Taiwan Lipopsome Company, Inc, Kolon Tissue Gene, Express Scripts, Frank Roemer Shareholder of: Boston Imaging Core Lab (BICL), LLC., Leena Sharma: None declared, Erin Ashbeck Consultant for: EMD Serono, Chengcheng Hu: None declared, Ali Guermazi Shareholder of: Boston Imaging Core Lab (BICL), LLC., Consultant for: Pfizer, AstraZeneca, MerckSerono, TissueGene, Galapagos and Roche

Hoarding is the persistent difficulty discarding or parting with possessions, regardless of their actual value. Objectives: 1) To investigate three features of hoarding behaviour i.e. clutter, difficulty discarding and excessive acquisition in older adults. 2) To identified gender differences in older adults regarding hoarding behaviour Methodology: The study was conducted on 60 older adults in selected urban area. Data collected through socio demographic variables and Saving Inventory?Revised Scale (23 items). Results hoarding behaviours were identified in older adults and excessive acquisition was the major issue in older adults. The current study shows that there was no significant difference in male and female older adults mean score regarding hoarding behaviour. Conclusion: Hoarding behaviour is mainly found in older adults and need better community and mental health services.

Introduction Physical activity guidelines recommend minimum thresholds. This study sought to identify evidence-based thresholds to maintain disability-free status over 4years among adults with lower extremity joint symptoms. Methods Prospective multisite Osteoarthritis Initiative accelerometer monitoring cohort data from September 2008 through December 2014 were analyzed. Adults (n=1,564) aged ≥49years at elevated disability risk because of lower extremity joint symptoms were analyzed for biennial assessments of disability-free status from gait speed ≥1meter/second (mobility disability–free) and self-report of no limitations in activities of daily living (activities of daily living disability–free). Classification tree analyses conducted in 2017–2018 identified optimal thresholds across candidate activity intensities (sedentary, light, moderate–vigorous, total light and moderate–vigorous activity, and moderate–vigorous accrued in bouts lasting ≥10 minutes). Results Minimal thresholds of 56 and 55 moderate–vigorous minutes/week best predicted disability-free status over 4years from mobility and activities of daily living disabilities, respectively, across the candidate measures. Thresholds were consistent across sex, BMI, age, and knee osteoarthritis presence. Mobility disability onset was one eighth as frequent (3% vs 24%, RR=0.14, 95% CI=0.09, 0.20) and activities of daily living disability onset was almost half (12% vs 23%, RR=0.55, 95% CI=0.44, 0.70) among people above versus below the minimum threshold. Conclusions Attaining an evidence-based threshold of approximately 1-hour moderate–vigorous activity/week significantly increased the likelihood of maintaining disability-free status over 4years. This minimum threshold tied to maintaining independent living abilities has value as an intermediate goal to motivate adults to take action towards the many health benefits of a physically active lifestyle.

SummaryThe purpose of this review is to highlight clinical research in osteoarthritis (OA). A literature search was conducted using PubMed (http://www.ncbi.nlm.nih.gov/pubmed/) with the search terms “osteoarthritis [All Fields] AND treatment [All Fields]” and the following limits activated: humans, English language, all adult 19+ years, published between April 1, 2014 and April 1, 2015. A second literature search was then conducted with the search terms “osteoarthritis [All Fields] AND epidemiology [All Fields]”, with the same limits. Reports of surgical outcome, case series, surgical technique, tissue sample or culture studies, trial protocols, and pilot studies were excluded. Of 1523, 150 were considered relevant. Among epidemiologic and observational clinical studies, themes included physical activity, early knee OA, and confidence/instability/falls. Symptom outcomes of pharmacologic treatments were reported for methotrexate, adalimumab, anti-nerve growth factor monoclonal antibodies, strontium ranelate, bisphosphonates, glucosamine, and chondroitin sulfate, and structural outcomes of pharmacologic treatments for strontium ranelate, recombinant human fibroblast growth factor 18, and glucosamine and chondroitin sulfate. Symptom outcomes of non-pharmacologic interventions were reported for: neuromuscular exercise, quadriceps strengthening, weight reduction and maintenance, TENS, therapeutic ultrasound, stepped care strategies, cognitive behavior therapy for sleep disturbance, acupuncture, gait modification, booster physical therapy, a web-based therapeutic exercise resource center for knee OA; hip physical therapy for hip OA; and joint protection and hand exercises for hand OA. Structure outcomes of non-pharmacologic interventions were reported for patellofemoral bracing.

This cohort study evaluates long-term levels of physical activity and inactivity among adults with or likely to develop knee osteoarthritis., Key Points Question Are long-term strenuous physical activity and extensive sitting each associated with risk for developing radiographic knee osteoarthritis in individuals at high risk for the disease? Findings In this cohort study of 1194 persons at high risk for but without radiographic evidence of knee osteoarthritis who were followed up for up to 10 years, long-term participation in strenuous physical activities was not associated with risk of incident radiographic knee osteoarthritis. Persistent extensive sitting was not associated with either elevated or reduced risk. Meaning These findings suggest that older adults at high risk for knee osteoarthritis may safely engage in strenuous physical activities at a moderate level to improve their general health., Importance Persons with knee symptoms recognize the health benefits of engaging in physical activity, but uncertainty persists about whether regular strenuous physical activity or exercise can accelerate tissue damage. A sedentary lifestyle of inactivity or underloading may also be associated with deleterious joint health. Objective To establish whether long-term strenuous physical activity participation and extensive sitting behavior are each associated with increased risk of developing radiographic knee osteoarthritis (KOA) in individuals at high risk for the disease. Design, Setting, and Participants This cohort study analyzed data from the Osteoarthritis Initiative, a prospective longitudinal cohort study of men and women with or at an increased risk of developing symptomatic, radiographic KOA. Community-dwelling adults were recruited from 4 US sites (Baltimore, Maryland; Columbus, Ohio; Pittsburgh, Pennsylvania; and Pawtucket, Rhode Island) and were followed up for up to 10 years. Individuals were included if they had a baseline Kellgren and Lawrence grade of 0 in both knees and completed a PASE (Physical Activity Scale for the Elderly) questionnaire at baseline and at least 2 follow-up visits over an 8-year interval. Data analyses were conducted from May 2018 to November 2018. Exposures Baseline to 8-year trajectories of strenuous physical activity participation and extensive sitting behavior were identified using group-based trajectory models. Main Outcomes and Measures Incident radiographic KOA, defined as Kellgren and Lawrence grade 2 or higher in either knee by the 10-year follow-up visit. Results A total of 1194 participants were included in the sample (697 women [58.4%]), with a baseline mean (SD) age of 58.4 (8.9) years and mean body mass index (BMI) of 26.8 (4.5). Four distinct trajectories of weekly hours spent in strenuous physical activities and 3 distinct trajectories of extensive sitting were identified. Long-term engagement in low-to-moderate physical activities (adjusted odds ratio [OR], 0.69; 95% CI, 0.48-1.01) or any strenuous physical activities (adjusted OR, 0.75; 95% CI, 0.53-1.07) was not associated with 10-year incident radiographic KOA. Persistent extensive sitting was not associated with incident KOA. Despite relatively mild symptoms and high function in this early-stage sample, 594 participants (49.7%) did not engage in any strenuous physical activities (ie, 0 h/wk) across 8 years, and 507 (42.5%) engaged in persistent moderate-to-high frequency of extensive sitting. Older age, higher BMI, more severe knee pain, non–college graduate educational level, weaker quadriceps, and depression were each associated with a persistent lack of engagement in strenuous physical activities. Conclusions and Relevance Results from this study appeared to show no association between long-term strenuous physical activity participation and incident radiographic KOA. The findings raise the possibility of a protective association between incident KOA and a low-to-moderate level of strenuous physical activities.

Summary Objective To test whether radiographically normal knees with contralateral radiographic knee osteoarthritis (OA), but without contralateral trauma history, display greater cartilage thickness loss than knees from subjects with bilaterally radiographically normal knees. Methods 828 radiographically normal knees (Kellgren Lawrence grade [KLG] 0) from the Osteoarthritis Initiative [OAI] were studied; 150 case knees displayed definite radiographic knee OA (KLG ≥ 2) contralaterally, and had MRI double echo steady state (DESS) images available at 12 and 48 month follow-up. 678 reference knees displayed KLG0 at the contralateral side. Cartilage thickness change was determined in femorotibial subregions and location-independent cartilage thinning scores were computed. Case and reference knees were compared using ANCOVA. Results Of the 150 KLG0 case knees, 108 had a contralateral KLG2 knee (50 without, and 58 with joint space narrowing [JSN]), 31 a KLG3 and 11 a KLG4 knee. The cartilage thinning score tended to be greater in case than reference knees; the cartilage thinning score in KLG0 case knees with contralateral radiographic JSN (−858 μm; [95% confidence interval −1016, −701 μm]) was significantly greater (P = 0.0012) than that in bilaterally KLG0 reference knees (−634 μm; [−673, −596 μm]), whereas KLG0 knees with contralateral KLG2 without JSN only showed relatively small thinning scores (−530 μm, [−631, −428 μm]). Region-specific analysis suggested greater rates of cartilage loss in case than in reference knees in the lateral, rather than medial, femorotibial compartment. Conclusions Radiographically normal knees with contralateral JSN may serve as a human model of early OA, for testing disease modifying drugs in clinical trials designed to prevent cartilage loss before the onset of radiographic change. Clinicaltrials.gov identification NCT00080171 .

“Secure and Sustainable” digitization plays a vital role for Indian economy to achieve global leadership. India's experience, towards the transformative changes in governance and socio-economic development, has resulted in the formation of digital revolution. With the optimum usage of computing technologies, huge Internet connectivity and reliable networking in the sectors like digital literacy, financial inclusion, rural development and e-governance has triggered the sustainabilty growth of Digital India. However, the Digital tools taken under the sustainable measures have created significant risks and attacks. The level of increase in cybercrimes in recent developments has drastically effected the sustainable growth of digital economy. This study will explore the two most common and prominent sides of the digital economy: Security and Sustainability. The major drawback seen in the economy is the study of these perspectives individually. Digital revolution needs to have a correlation between the sustainable measures and their secuirty measures as unified objective. This study will be the base to inter-relate these two perspectives, so as to reach the sustainable development goals of Digital India. The objective of the research study is to revisit the requirements of secure sustainable Digital India. The imperative focus is to present a broad overview about the digital security and digital sustainabilty as the major features to transform the Indian economy. The paper aims to review and emphasis on conclusive findings for future research in the related domain based on the published work and industry/organization reports.

Objective Manifestations of instability in knee osteoarthritis (OA) include low overall knee confidence, low confidence that the knees will not buckle, buckling, and excessive motion during gait. Confidence and buckling may particularly influence activity choices, contributing to events leading to disability. Buckling is more likely to affect advanced than basic functional tasks. In this prospective longitudinal study, we tested the hypothesis that overall knee confidence, buckling confidence, buckling, and frontal plane motion during gait are associated with advanced 2-year function outcomes in persons with knee OA. Methods Persons with knee OA were queried about overall knee confidence (higher score = worse confidence), buckling confidence, and knee buckling, and underwent quantitative gait analysis to quantify varus–valgus excursion and angular velocity. Physical function was assessed using the Late-Life Function and Disability Instrument Basic and Advanced Lower Extremity Domain scores. Logistic regression was used to evaluate the relationship between baseline instability measures and baseline-to-2-year function outcome, adjusting for potential confounders. Results The sample was comprised of 212 persons (mean age 64.6 years, 76.9% women). Buckling was significantly associated with poor advanced function outcome (adjusted odds ratio [OR] 2.08, 95% confidence interval [95% CI] 1.03–4.20) but not basic function outcome. Overall knee confidence was significantly associated with advanced outcome (adjusted OR 1.65, 95% CI 1.01–2.70), while associations between buckling confidence and both outcomes approached significance. Neither varus–valgus excursion nor angular velocity during gait was associated with either outcome. Conclusion Knee buckling and low knee confidence were each associated with poor 2-year advanced function outcomes. Current treatment does not address these modifiable factors; interventions to address them may improve outcome in knee OA.

Summary Objective Test the hypothesis that greater baseline peak external knee adduction moment (KAM), KAM impulse, and peak external knee flexion moment (KFM) during the stance phase of gait are associated with baseline-to-2-year medial tibiofemoral cartilage damage and bone marrow lesion progression, and cartilage thickness loss. Methods Participants all had knee OA in at least one knee. Baseline peak KAM, KAM impulse, and peak KFM (normalized to body weight and height) were captured and computed using a motion analysis system and six force plates. Participants underwent MRI of both knees at baseline and 2 years later. To assess the association between baseline moments and baseline-to-2-year semiquantitative cartilage damage and bone marrow lesion progression and quantitative cartilage thickness loss, we used logistic and linear regressions with generalized estimating equations (GEE), adjusting for gait speed, age, gender, disease severity, knee pain severity, and medication use. Results The sample consisted of 391 knees (204 persons): mean age 64.2 years (SD 10.0); BMI 28.4 kg/m 2 (5.7); 156 (76.5%) women. Greater baseline peak KAM and KAM impulse were each associated with worsening of medial bone marrow lesions, but not cartilage damage. Higher baseline KAM impulse was associated with 2-year medial cartilage thickness loss assessed both as % loss and as a threshold of loss, whereas peak KAM was related only to % loss. There was no relationship between baseline peak KFM and any medial disease progression outcome measures. Conclusion Findings support targeting KAM parameters in an effort to delay medial OA disease progression.

Objective Investigate the relationship between sedentary behavior and physical function in adults with knee osteoarthritis (OA), controlling for moderate-vigorous physical activity () levels.

Summary Objective Among high risk individuals, whether knee lesions in tissues involved in osteoarthritis (OA) can improve prediction of knee OA is unclear. We hypothesized that models predicting (1) incident osteophytes and (2) incident osteophytes and joint space narrowing can be improved by including symptoms or function, and further improved by lesion status. Design In Osteoarthritis Initiative (OAI) participants with normal knee X-rays, we assessed cartilage damage, bone marrow lesions (BMLs), and menisci. Cox proportional hazards models were used to develop risk prediction models for risk of each outcome. Nested models (increasingly larger baseline covariable sets) were compared using likelihood ratio tests and Schwarz Bayesian Information Criterion (SBC). Model discrimination used receiver operating characteristic (ROC) curves and area under the curve (AUC). Results In 841 participants [age 59.6, body mass index (BMI) 26.7, 55.9% women] over up to 7 years follow-up, each larger set improved prediction (+hand OA, injury, surgery, activities; +symptoms/function). Prediction was further improved by including cartilage damage both compartments, BMLs both compartments, meniscal tear, meniscal extrusion, sum of lesion types, number of subregions with cartilage damage, number of subregions with BMLs, and (concurrently) subregion number with cartilage damage, subregion number with BMLs, and meniscal tear. AUCs were ≥0.80 for both outcomes for number of subregions with cartilage damage and the combined model. Conclusions Among persons at higher risk for knee OA with normal X-rays, MRI tissue lesions improved prediction of mild as well as moderate disease. These findings support that disease onset is likely occurring during the "high-risk" period and encourage a reorientation of approach.

Objective. Few strategies to improve pain outcome in knee osteoarthritis (OA) exist in part because how best to evaluate pain over the long term is unclear. Our objectives were to determine the frequency of a good pain experience outcome based on previously formulated OA pain stages and test the hypothesis that less depression and pain catastrophizing and greater self-efficacy and social support are each associated with greater likelihood of a good outcome. Methods. Study participants, all with knee OA, reported pain stage at baseline and 2 years. Baseline assessments utilized the Geriatric Depression Scale, Pain Catastrophizing Scale, Arthritis Self-Efficacy Scale, and Medical Outcomes Study social support survey. Using pain experience stages, good outcome was defined as persistence in or movement to no pain or stage 1 (predictable pain, known trigger) at 2 years. A multivariable logistic regression model was developed to identify independent predictors of a good outcome. Results. Of 212 participants, 136 (64%) had a good pain outcome and 76 (36%) a poor pain outcome. In multivariable analysis, higher self-efficacy was associated with a significantly higher likelihood of good outcome (adjusted odds ratio [OR] 1.14 [95% confidence interval (95% CI) 1.04 –1.24]); higher pain catastrophizing was associated with a significantly lower likelihood of good outcome (adjusted OR 0.88 [95% CI 0.83– 0.94]). Conclusion. This stage-based measure provides a meaningful and interpretable means to assess pain outcome in knee OA. The odds of a good 2-year outcome in knee OA were lower in persons with greater pain catastrophizing and higher in persons with greater self-efficacy. Targeting these factors may help to improve pain outcome in knee OA.

Objective Little is known about early knee osteoarthritis (OA). The significance of lesions on magnetic resonance imaging (MRI) in older persons without radiographic OA is unclear. Our objectives were to determine the extent of tissue pathology by MRI and evaluate its significance by testing the following hypotheses: cartilage damage, bone marrow lesions, and meniscal damage are associated with prevalent frequent knee symptoms and incident persistent symptoms; bone marrow lesions and meniscal damage are associated with incident tibiofemoral (TF) cartilage damage; and bone marrow lesions are associated with incident patellofemoral (PF) cartilage damage. Methods In a cohort study of 849 Osteoarthritis Initiative (OAI) participants who had a bilateral Kellgren/Lawrence (K/L) score of 0, we assessed cartilage damage, bone marrow lesions, and meniscal damage using the MRI OA Knee Score, as well as prevalent frequent knee symptoms, incident persistent symptoms, and incident cartilage damage. Multiple logistic regression (one knee per person) was used to evaluate associations between MRI lesions and each of these outcomes. Results Of the participants evaluated, 76% had cartilage damage, 61% had bone marrow lesions, 21% had meniscal tears, and 14% had meniscal extrusion. Cartilage damage (any; TF and PF), bone marrow lesions (any; TF and PF), meniscal extrusion, and body mass index (BMI) were associated with prevalent frequent symptoms. Cartilage damage (isolated PF; TF and PF), bone marrow lesions (any; isolated PF; TF and PF), meniscal tears, and BMI were associated with incident persistent symptoms. Hand OA, but no individual lesion type, was associated with incident TF cartilage damage, and bone marrow lesions (any; any PF) with incident PF damage. Having more lesion types was associated with a greater risk of outcomes. Conclusion MRI-detected lesions are not incidental and may represent early disease in persons at increased risk of knee OA.

Objective Health-related utility measures overall health status and quality of life and is commonly incorporated into cost-effectiveness analyses. This study investigates whether attainment of federal physical activity guidelines translates into better health-related utility in adults with or at risk for knee osteoarthritis (OA). Methods Cross-sectional data from 1,908 adults with or at risk for knee OA participating in the accelerometer ancillary study of the Osteoarthritis Initiative were assessed. Physical activity was measured using 7 days of accelerometer monitoring and was classified as 1) meeting guidelines (≥150 bouted moderate-to-vigorous [MV] minutes per week); 2) insufficiently active (≥1 MV bout[s] per week but below guidelines); or 3) inactive (zero MV bouts per week). A Short Form 6D health-related utility score was derived from patient-reported health status. Relationship of physical activity levels to median health-related utility adjusted for socioeconomic and health factors was tested using quantile regression. Results Only 13% of participants met physical activity guidelines, and 45% were inactive. Relative to the inactive group, median health-related utility scores were significantly greater for the meeting guidelines group (0.063; 95% confidence interval [95% CI] 0.055, 0.071) and the insufficiently active group (0.059; 95% CI 0.054, 0.064). These differences showed a statistically significant linear trend and strong cross-sectional relationship with physical activity level even after adjusting for socioeconomic and health factors. Conclusion We found a significant positive relationship between physical activity level and health-related utility. Interventions that encourage adults, including persons with knee OA, to increase physical activity even if recommended levels are not attained may improve their quality of life.

Objectives: Indoor Air Quality (IAQ) is very important for the health of human beings. Proper ventilation of apartment can improve IAQ. The objective of the study is to analyse the pollutant dispersion behaviour inside the fluid domain at fixed boundary conditions. Methods/Statistical Analysis: A 2BHK apartment has been taken for study. The fluid domain of apartment has been simulated in the Computational Fluid Dynamics (CFD) software “ANSYS Fluent 16.2”. Four inlet doors, four inlet windows, one outlet door, one outlet window and two ventilations from toilets were taken in the apartment. Seven inlet pollutant sources at the middle of the bottom of each enclosed area i.e. drawing/dining room, master bedroom, bedroom 1, kitchen, toilet 1 and toilet 2 have been considered. The methane gas is selected as the pollutant in the study. The k-epsilon (2 equations) model has been used and methane-air mixture has been taken for species transport. Findings: The methane mass fraction has been studied at different planes and at different locations of the domain. It was observed that the pollutant dispersion phenomena were varying at different locations and with this the highest methane mass fraction zone have been discussed. Application/Improvements: Simulated model can be useful in urban management and planning to find the best geometrical configurations of infrastructure, especially residential, to achieve proper and effective ventilations. Present model can also be more effective with environmental wind tunnel validations.