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OBJECTIVES/SPECIFIC AIMS: The aim of this study is to determine whether quantitative measures of knee structures including effusion, bone marrow lesions, cartilage, and meniscal damage can improve upon an existing model of demographic and clinical characteristics to classify accelerated knee osteoarthritis (AKOA). METHODS/STUDY POPULATION: We conducted a case-control study using data from baseline and four annual follow-up visits from the osteoarthritis initiative. Participants had no radiographic knee osteoarthritis (KOA) at baseline. AKOA is defined as progressing from no KOA to advance-stage KOA in at least 1 knee within 48 months. AKOA knees were matched 1:1 based on sex to (1) participants who did not develop KOA within 48 months and (2) participants who developed KOA but not AKOA. Analyses were person based. Classification and regression tree analysis was used to determine the important variables and percent of variance explained. RESULTS/ANTICIPATED RESULTS: A previous classification and regression tree analysis found that age, BMI, serum glucose, and femorotibial angle explained 31% of the variability between those who did and did not develop AKOA. Including structural measurements as candidate variables yielded a model that included effusion, BMI, serum glucose, cruciate ligament degeneration and coronal slope and explained 39% of the variability. DISCUSSION/SIGNIFICANCE OF IMPACT: Knee structural measurements improve classification of participants who developed AKOA Versus those who did not. Further research is needed to better classify patients at risk for AKOA.
Two ice cores (118.4 and 214.7 m in length) were collected in 2000 from the Puruogangri ice cap in the center of the Tibetan Plateau (TP) in a joint US-Chinese collaborative project. These cores yield paleoclimatic and environmental records extending through the Middle Holocene, and complement previous ice-core histories from the Dunde and Guliya ice caps in northeast and northwest Tibet, respectively, and Dasuopu glacier in the Himalaya. The high-resolution Puruogangri climate record since AD 1600 details regional temperature and moisture variability. The post-1920 period is characterized by above-average annual net balance, contemporaneous with the greatest 18O enrichment of the last 400 years, consistent with the isotopically inferred warming observed in other TP ice-core records. On longer timescales the aerosol history reveals large and abrupt events, one of which is dated ∼4.7 kyr BP and occurs close to the time of a drought that extended throughout the tropics and may have been associated with centuries-long weakening of the Asian/Indian/African monsoon system. The Puruogangri climate history, combined with the other TP ice-core records, has the potential to provide valuable information on variations in the strength of the monsoon across the TP during the Holocene.
Assessing the significance of current glacier loss on Kilimanjaro, Tanzania, demands a well-constrained temporal perspective. That context is provided by direct measurements, ancillary observations of the ice fields and the analyses of the ice cores collected from them. Ice retreat mechanisms observed there today are consistent with the preservation of the oldest ice, ~11.7 ka, in the central deepest part of the Northern Ice Field (NIF). This ice-core derived paleoclimate history published by Thompson and others (2002) is further confirmed by more recent paleoclimate records from tropical East Africa. Mounting evidence suggests that the (anticipated) loss of the entire NIF will be unprecedented within the past 10 000 years. New evidence bears directly on the mechanisms driving the current ice loss. Measurements made in 2000 on the NIF document that air temperature at 0.5 and 1.5 m above the surface remained below 5°C, while a surface temperature of 0.0°C was sustained for up to 8 hours d-1 under clear conditions, consistent with observations of melting on all Kilimanjaro summit ice fields. The linear relationship between oxygen and hydrogen isotopic ratios for all six ice cores drilled in 2000 lies very close to the global meteoric waterline and does not support sublimation (evaporation) as a major driver of ice loss today or in the past on Kilimanjaro.
Information about past atmospheric circulation and climate change can be revealed by the chemical constituents of ice cores. Based on the analytical results of Cl– and Na+ concentrations in an 18.5 m ice core, which contains 14 annual layers, from the Dasuopu glacier, central Himalaya, a significant correlation is found between Cl– and Na+ concentrations. This, along with the average Cl–/Na+ weight ratio of 1.9, indicates that moisture at the drilling site came mostly from oceans. Furthermore, there was a high positive correlation between the Cl–/Na+ ratio in the summer monsoon layers and the monsoon rainfall in northeast India, and there exists a teleconnection between the Cl– and Na+ concentrations in this shallow ice core and the North Atlantic Oscillation.
In this paper we review the interaction of El Niño Southern Oscillation (ENSO) variability and warming trends recorded in ice-core records from high-altitude tropical glaciers, discuss the implications of the warming trends for the glaciers and consider the societal implications of glacier retreat. ENSO has strong impacts on meteorological phenomena that directly or indirectly affect most regions on the planet and their populations. Many tropical ice fields have provided continuous annually resolved proxy records of climatic and environmental variability preserved in measurable parameters, especially oxygen and hydrogen isotopic ratios (δ18O, δD) and the net mass balance (accumulation). These records present an opportunity to examine the nature of tropical climate variability in greater detail and to extract new information on linkages between rising temperatures on tropical glaciers and equatorial Pacific sea surface temperatures in critical ENSO indicator regions. The long-term climate records from a collection of high-altitude tropical ice cores provide the longer-term context essential for assessing the significance of the magnitude and rate of current climate changes that are in large measure driving glacier retreat. The well-documented ice loss on Quelccaya in the Peruvian Andes, Naimona’nyi in the Himalaya, Kilimanjaro in eastern Africa and the ice fields near Puncak Jaya in Papua, Indonesia, presents a grim future for low-latitude glaciers. The ongoing melting of these ice fields (response) is consistent with model predictions for a vertical amplification of temperature in the tropics (driver) and has serious implications for the people who live in these areas.
An ice core from the Nevado Huascaran col in the Cordillera Blanca of northern Peru contains high-resolution time series of dust concentrations and size distributions since the end of the last glacial stage. A large dust peak, dated ∼4500 years ago, is contemporaneous with a widespread and prolonged drought that apparently extended from North Africa to eastern China, evidence of which occurs in historical, archeological and paleoclimatic records. This event may have been associated with several centuries of weak Asian/Indian/African monsoons, possibly linked with a protracted cooling in the North Atlantic. During the second half of the 20th century, high austral-summer dust concentrations in the Huascaran record are significantly correlated with atmospheric conditions, such as sea-level pressure and zonal wind velocities that are consistent with El Nino-Southern Oscillation (ENSO) and positive North Atlantic Oscillation (NAO) indices, and with aridity in North Africa, southwest Asia and the Middle East. Therefore, the dominant submicron fraction of the dust may have been transported by more intense northeasterly trade winds from the African dry regions across the tropical Atlantic during a period of frequent and/or intense ENSO activity. The proposed ENSO conditions that may have been linked with drought in the monsoon region may also have contributed to aridity in tropical South America, including the Cordillera Blanca.
Holocene tephrostratigraphy in Alaska provides independent chronology and stratigraphic correlation in a region where reworked old (Holocene) organic carbon can significantly distort radiocarbon chronologies. Here, we present new glass chemistry and chronology for Holocene tephras preserved in three Alaskan lakes: one in the eastern interior and two in the southern Brooks Range. Tephra beds in the eastern interior lake-sediment core are correlated with the White River Ash and the Hayes tephra set H (~4200–3700 cal yr BP), and an additional discrete tephra bed is likely from the Aleutian arc/Alaska Peninsula. Cryptotephras (nonvisible tephras) found in the Brooks Range include the informally named “Ruppert tephra” (~2700–2300 cal yr BP) and the Aniakchak caldera-forming event II (CFE II) tephra (~3600 cal yr BP). A third underlying Brooks Range cryptotephra is chemically indistinguishable from the Aniakchak CFE II tephra (4070–3760 cal yr BP) and is likely to be from an earlier eruption of the Aniakchak volcano.
To determine the impact of total household decolonization with intranasal mupirocin and chlorhexidine gluconate body wash on recurrent methicillin-resistant Staphylococcus aureus (MRSA) infection among subjects with MRSA skin and soft-tissue infection.
Three-arm nonmasked randomized controlled trial.
Five academic medical centers in Southeastern Pennsylvania.
Adults and children presenting to ambulatory care settings with community-onset MRSA skin and soft-tissue infection (ie, index cases) and their household members.
Enrolled households were randomized to 1 of 3 intervention groups: (1) education on routine hygiene measures, (2) education plus decolonization without reminders (intranasal mupirocin ointment twice daily for 7 days and chlorhexidine gluconate on the first and last day), or (3) education plus decolonization with reminders, where subjects received daily telephone call or text message reminders.
MAIN OUTCOME MEASURES
Owing to small numbers of recurrent infections, this analysis focused on time to clearance of colonization in the index case.
Of 223 households, 73 were randomized to education-only, 76 to decolonization without reminders, 74 to decolonization with reminders. There was no significant difference in time to clearance of colonization between the education-only and decolonization groups (log-rank P=.768). In secondary analyses, compliance with decolonization was associated with decreased time to clearance (P=.018).
Total household decolonization did not result in decreased time to clearance of MRSA colonization among adults and children with MRSA skin and soft-tissue infection. However, subjects who were compliant with the protocol had more rapid clearance
To identify risk factors for recurrent methicillin-resistant Staphylococcus aureus (MRSA) colonization.
Prospective cohort study conducted from January 1, 2010, through December 31, 2012.
Five adult and pediatric academic medical centers.
Subjects (ie, index cases) who presented with acute community-onset MRSA skin and soft-tissue infection.
Index cases and all household members performed self-sampling for MRSA colonization every 2 weeks for 6 months. Clearance of colonization was defined as 2 consecutive sampling periods with negative surveillance cultures. Recurrent colonization was defined as any positive MRSA surveillance culture after clearance. Index cases with recurrent MRSA colonization were compared with those without recurrence on the basis of antibiotic exposure, household demographic characteristics, and presence of MRSA colonization in household members.
The study cohort comprised 195 index cases; recurrent MRSA colonization occurred in 85 (43.6%). Median time to recurrence was 53 days (interquartile range, 36–84 days). Treatment with clindamycin was associated with lower risk of recurrence (odds ratio, 0.52; 95% CI, 0.29–0.93). Higher percentage of household members younger than 18 was associated with increased risk of recurrence (odds ratio, 1.01; 95% CI, 1.00–1.02). The association between MRSA colonization in household members and recurrent colonization in index cases did not reach statistical significance in primary analyses.
A large proportion of patients initially presenting with MRSA skin and soft-tissue infection will have recurrent colonization after clearance. The reduced rate of recurrent colonization associated with clindamycin may indicate a unique role for this antibiotic in the treatment of such infection.
Infect. Control Hosp. Epidemiol. 2015;36(7):786–793