People with human immunodeficiency virus (HIV) often have neurocognitive impairment. People with HIV make riskier decisions when the outcome probabilities are known, and have abnormal neural architecture underlying risky decision making. However, ambiguous decision making, when the outcome probabilities are unknown, is more common in daily life, but the neural architecture underlying ambiguous decision making in people with HIV is unknown. Eighteen people with HIV and 20 controls completed a decision making task while undergoing functional magnetic resonance imaging scanning. Participants chose between a certain reward and uncertain reward with a known (risky) or unknown (ambiguous) probability of winning. There were three levels of risk: high, medium, and low. Ambiguous > risky brain activity was compared between groups. Ambiguous > risky brain activity was correlated with emotional/psychiatric functioning in people with HIV. Both groups were similarly ambiguity-averse. People with HIV were more risk-averse than controls and chose the high-risk uncertain option less often. People with HIV had hypoactivity in the precuneus, posterior cingulate cortex (PCC), and fusiform gyrus during ambiguous > medium risk decision making. Ambiguous > medium risk brain activity was negatively correlated with emotional/psychiatric functioning in individuals with HIV. To make ambiguous decisions, people with HIV underrecruit key regions of the default mode network, which are thought to integrate internally and externally derived information to come to a decision. These regions and related cognitive processes may be candidates for interventions to improve decision-making outcomes in people with HIV.

BACKGROUND: In the Lake Atitlán region of Guatemala, traditional bonesetters (hueseros) commonly treat bone fractures. The indigenous Kaqchikel population has access to biomedical care, but traditional medicine remains the preferred treatment modality for bone fracture. METHODS: Households in four villages were surveyed to assess experiences with bone fracture treatment. Of 108 households sampled, 83 met inclusion criteria and completed the survey. Responses were analyzed to assess for group demographics, bone fracture prevalence, and treatment history. Independence testing assessed for subgroup differences. RESULTS: Mean age: 40 years old. For fracture treatment, 37% (31/83) consulted with a physician/nurse whereas 75% (62/83) consulted with a bonesetter. 19% (16/83) consulted with both. Cast immobilization was utilized by only 16% (13/83) of participants. The services provided by bonesetters included massage, temazcal (sweat lodge), herbal poultice, prayer, and recommended rest. When comparing participants that used a cast (n=13) and those that used a bonesetter exclusively (n=46), the bonesetter group had lower rates of continued pain and movement limitation, higher satisfaction with treatment, and higher interest in seeking the same treatment in the future, though these findings were not statistically significant. Regarding future care, 66% (55/83) would consider consulting a doctor whereas 83% (69/83) would seek services from a bonesetter. 53% (44/83) would utilize both.  If recommended, 46% (38/83) would consider using a cast. Only 22% (18/83) of participants reported previous musculoskeletal imaging. CONCLUSION: These results suggest a high preference of bonesetters for bone injury treatment, reduced acceptance of biomedical care, and limited acceptance of cast immobilization.

Background: Unicameral bone cysts (UBCs) are frequently associated with pathologic fracture due to aggressive osteolysis. Methods/Results: We present a case series (n=5) with complex or refractory bone cysts treated with doxycycline injections that exhibited increased ossification and symptom resolution at short term follow up with minimal side effects. Conclusions: In addition to its antibiotic properties, doxycycline is also known to inhibit matrix metalloproteinases, angiogenesis, and osteoclast activity suggesting that UBCs are dependent on MMP, VEGF or RANKL-mediated osteolysis. Further investigation is warranted regarding the use of doxycycline injections in UBCs.