Browsing by Subject "CART"

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    Posttraumatic stress disorder and chronic musculoskeletal pain : how are they related?
    (2014-07-11) Peng, Xiaomei; Bair, Matthew J.; Kroenke, Kurt; Faries, Douglas E.; Mac Kinnon, Joyce
    Symptoms of post-traumatic stress disorder (PTSD) are a common comorbidity in veterans seeking treatment of chronic musculoskeletal pain (CMP). However, little is known regarding the mutual influence of PTSD and CMP in this population. Using cross-sectional and longitudinal data from a randomized clinical trial evaluating a stepped care intervention for CMP in Iraq/Afghanistan veterans (ESCAPE), this dissertation examined the relationships between PTSD and CMP along with other factors including depression, anxiety, catastrophizing and health-related quality of life. The Classification and Regression Tree (CART) analysis was conducted to identify key factors associated with baseline PTSD besides CMP severity. A series of statistical analyses including logistical regression analysis, mixed model repeated measure analysis, confirmatory factor analysis and cross-lagged panel analysis via structural equation modeling were conducted to test five competing models of PTSD symptom clusters, and to examine the mutual influences of PTSD symptom clusters and CMP outcomes. Results showed baseline pain intensity and pain disability predicted PTSD at 9 months. And baseline PTSD predicted improvement of pain disability at 9 months. Moreover, direct relationships were found between PTSD and the disability component of CMP, and indirect relationships were found between PTSD, CMP and CMP components (intensity and disability) mediated by depression, anxiety and pain catastrophizing. Finally, the coexistence of PTSD and more severe pain was associated with worse SF-36 Physical Component Summary (PCS) and Mental Component Summary (MCS) scores. Together these findings provided empirical support for the mutual maintenance theory.
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    Regional areas and widths of the midsagittal corpus callosum among HIV-infected patients on stable antiretroviral therapies
    (Springer US, 2011-08) Tate, David F.; Sampat, Mehul; Harezlak, Jaroslaw; Fiecas, Mark; Hogan, Joseph; Dewey, Jeffrey; McCaffrey, Daniel; Branson, Daniel; Russell, Troy; Conley, Jared; Taylor, Michael; Schifitto, Giavoni; Zhong, J.; Daar, Eric S.; Alger, Jeffrey; Brown, Mark; Singer, Elyse; Campbell, T.; McMahon, D.; Tso, Y.; Matesan, Janetta; Letendre, Scott; Paulose, S.; Gaugh, Michelle; Tripoli, C.; Yiannoutsos, Constantine; Bigler, Erin D.; Cohen, Ronald A.; Guttmann, Charles R. G.; Navia, Bradford; HIV Neuroimaging Consortium; Department of Biostatistics, Richard M. Fairbanks School of Public Health
    Recent reports suggest that a growing number of human immunodeficiency virus (HIV)-infected persons show signs of persistent cognitive impairment even in the context of combination antiretroviral therapies (cART). The basis for this finding remains poorly understood as there are only a limited number of studies examining the relationship between CNS injury, measures of disease severity, and cognitive function in the setting of stable disease. This study examined the effects of HIV infection on cerebral white matter using quantitative morphometry of the midsagittal corpus callosum (CC) in 216 chronically infected participants from the multisite HIV Neuroimaging Consortium study currently receiving cART and 139 controls. All participants underwent MRI assessment, and HIV-infected subjects also underwent measures of cognitive function and disease severity. The midsagittal slice of the CC was quantified using two semi-automated procedures. Group comparisons were accomplished using ANOVA, and the relationship between CC morphometry and clinical covariates (current CD4, nadir CD4, plasma and CSF HIV RNA, duration of HIV infection, age, and ADC stage) was assessed using linear regression models. HIV-infected patients showed significant reductions in both the area and linear widths for several regions of the CC. Significant relationships were found with ADC stage and nadir CD4 cell count, but no other clinical variables. Despite effective treatment, significant and possibly irreversible structural loss of the white matter persists in the setting of chronic HIV disease. A history of advanced immune suppression is a strong predictor of this complication and suggests that antiretroviral intervention at earlier stages of infection may be warranted.