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In March 2018, the US Department of Defense (DOD) added the smallpox vaccination, using ACAM2000, to its routine immunizations, increasing the number of persons receiving the vaccine. The following month, Fort Hood reported a cluster of 5 myopericarditis cases. The Centers for Disease Control and Prevention and the DOD launched an investigation.
The investigation consisted of a review of medical records, establishment of case definitions, causality assessment, patient interviews, and active surveillance. A 2-sided exact rate ratio test was used to compare myopericarditis incidence rates.
This investigation identified 4 cases of probable myopericarditis and 1 case of suspected myopericarditis. No alternative etiology was identified as a cause. No additional cases were identified. There was no statistically significant difference in incidence rates between the observed cluster (5.23 per 1000 vaccinated individuals, 95% CI: 1.7–12.2) and the ACAM2000 clinical trial outcomes for symptomatic persons, which was 2.29 per 1000 vaccinated individuals (95% CI: 0.3–8.3).
Vaccination with ACAM2000 is the presumptive cause of this cluster. Caution should be exercised before considering vaccination campaigns for smallpox given the clinical morbidity and costs incurred by a case of myopericarditis. Risk of myopericarditis should be carefully weighed with risk of exposure to smallpox.
OBJECTIVES/SPECIFIC AIMS: Patients with undiagnosed obstructive sleep apnea (OSA) will often present to an otolaryngologist with symptoms of chronic rhinosinusitis (CRS). Differentiating CRS from OSA may help obviate unnecessary and costly work-up for CRS. This study analyzes symptom profiles of such patients to help identify which require polysomnography. METHODS/STUDY POPULATION: This is a three-year retrospective analysis of adult patients seen in an academic practice with a rhinologic chief complaint. The 22-Item Sinonasal Outcomes Test (SNOT-22) survey, which is a validated patient-reported outcome measure widely adopted for CRS featuring a symptom scale of 1 (least severe) to 5 (most severe), was completed by patients with untreated OSA confirmed on polysomnography without CRS (OSA group) and a control group of CRS patients (CRS group). Results were compared using Chi-square test (categorical) and Wilcoxon rank-sum test (continuous) with Bonferroni correction, and multiple logistic regression. RESULTS/ANTICIPATED RESULTS: 43 patients were included in the OSA group [mean apnea-hypopnea index: 27.9 (SD: 21.2)] and 124 patients were included in the CRS group. The CRS group demonstrated significantly higher scores in nasal (p < 0.001), extra-nasal (p < 0.001) and ear/facial symptom domains (p = 0.001) while the OSA group reported higher psychological (p = 0.028) and sleep symptom domain scores (p = 0.052). As for the cardinal symptoms of CRS, nasal discharge and loss of smell were significantly higher in the CRS group (both p < 0.001), whereas facial pain (p = 0.117) and nasal obstruction (p = 0.198) were not significantly different between the two groups. After adjustment, for every 1-point increase in a patient’s score for ear pain, thick nasal discharge and loss of smell or taste, their odds of having CRS increased by a factor of 3.18 [(95% CI 1.61-6.29), p = 0.001], 1.60 [(95% CI 1.22-2.10], p = 0.001] and 1.36 [(95% CI 1.04-1.78), p = 0.025], respectively, compared to having OSA. OSA patients were more likely to choose a sleep-related symptom as a “most important complaint” (MIC) (p < 0.001). Facial pain and nasal obstruction were the most common MIC in the rhinologic domain for OSA patients, whereas thick nasal discharge and post-nasal discharge were the most common MIC for CRS patients. DISCUSSION/SIGNIFICANCE OF IMPACT: For patients presenting with rhinologic symptoms, the SNOT-22 can help identify those with undiagnosed OSA. OSA should be suspected in patients with sleep and psychological dysfunction as their primary complaints without the significant nasal drainage and anosmia that characterizes CRS.
Palaeochannels of lowland rivers provide a means of investigating the sensitivity of river response to climate-driven hydrologic change. About 80 palaeochannels of the lower Macquarie River of southeastern Australia record the evolution of this distributive fluvial system. Six Macquarie palaeochannels were dated by single-grain optically stimulated luminescence. The largest of the palaeochannels (Quombothoo, median age 54 ka) was on average 284 m wide, 12 times wider than the modern river (24 m) and with 21 times greater meander wavelength. Palaeo-discharge then declined, resulting in a younger, narrower, group of palaeochannels, Bibbijibbery (125 m wide, 34 ka), Billybingbone (92 m, 20 ka), Milmiland (112 m, 22 ka), and Mundadoo (86 m, 5.6 ka). Yet these channels were still much larger than the modern river and were continuous downstream to the confluence with the Barwon-Darling River. At 5.5 ka, a further decrease in river discharge led to the formation of the narrow modern river, the ecologically important Macquarie Marshes, and Marra Creek palaeochannel (31 m, 2.1 ka) and diminished sediment delivery to the Barwon-Darling River as palaeo-discharge fell further. The hydrologic changes suggest precipitation was a driving forcing on catchment discharge in addition to a temperature-driven runoff response.
Recent evidence suggests that exercise plays a role in cognition and that the posterior cingulate cortex (PCC) can be divided into dorsal and ventral subregions based on distinct connectivity patterns.
To examine the effect of physical activity and division of the PCC on brain functional connectivity measures in subjective memory complainers (SMC) carrying the epsilon 4 allele of apolipoprotein E (APOE 4) allele.
Participants were 22 SMC carrying the APOE ɛ4 allele (ɛ4+; mean age 72.18 years) and 58 SMC non-carriers (ɛ4–; mean age 72.79 years). Connectivity of four dorsal and ventral seeds was examined. Relationships between PCC connectivity and physical activity measures were explored.
ɛ4+ individuals showed increased connectivity between the dorsal PCC and dorsolateral prefrontal cortex, and the ventral PCC and supplementary motor area (SMA). Greater levels of physical activity correlated with the magnitude of ventral PCC–SMA connectivity.
The results provide the first evidence that ɛ4+ individuals at increased risk of cognitive decline show distinct alterations in dorsal and ventral PCC functional connectivity.
A wide range of Arthurian material is discussed here, reflecting its diversity, and enduring vitality. Geoffrey of Monmouth's best-selling Historia regum Britannie is discussed in the context of Geoffrey's reception in Wales and the relationship between Latin and Welsh literary culture. Two essays deal with the Middle English Ywain and Gawain: the first offers a comparative study of the Middle English poem alongside Chrétien's Yvain and the Welsh Owein, while the second considers Ywain and Gawain with the Alliterative Morte Arthure in their northern English cultural and political context, the world of the Percys and the Nevilles. It is followed by a discussion of Edward III's recuperation of his abandoned Order of the Round Table, which offers an intriguing explanation for this reversal in the context of Edward's victory over the French at Poitiers. The final essay is a comparison of fifteenth- and twentieth-century portrayals of Camelot in Malory and T.H. White, as both idea and locale, and a centre of hearsay and gossip. The volume is completed with a unique and little-known medieval Greek Arthurian poem, presented in facing-page edition and modern English translation.
Elizabeth Archibald is Professor of English Studies at Durham University, and Principal of St Cuthbert's Society; David F. Johnson is Professor of English at Florida State University, Tallahassee.
Contributors: Christopher Berard, Louis J. Boyle, Thomas H. Crofts, Ralph Hanna, Georgia Lynn Henley, Erich Poppe
This volume of Arthurian Literature ranges from the reception of Geoffrey of Monmouth in Wales to the Camelot of T. H. White. Georgia Henley discusses Latin literary culture in medieval Wales, evaluating the intellectual and literary context in which Geoffrey of Monmouth's seminal Historia regum Britanniae was received. She makes the case for discarding the binary distinction of ‘Welsh vs Latin’ in favour of a view of medieval Wales as a multilingual culture in which Latin and Welsh existed side-by-side and the classical tradition had a significant influence on Welsh literature.
We are pleased to be able to publish a revised version of Prof. Erich Poppe's 2016 O'Donnell Lecture in Celtic Studies, in which he shines a bright comparative light (in terms of both plot and lexis) on Chrétien's Ivain, the Middle English Ywain and Gawain and the Middle Welsh Owein, otherwise known as Chwedyl Iarlles y Ffynnawn (The Tale of the Lady of the Well / Countess of the Spring). In his reading of these poems, Poppe effectively demonstrates Peter Clemoes’ axiom that to read ‘Medieval Welsh literature alongside that of Middle English’ is to recognize how great a debt English literature owes to the Celtic tradition for its Arthurian inspirations.
Christopher Berard returns to the subject of Edward III's abandoned Order of the Round Table to argue that, while Edward's ‘un-Arthurian’ tactics at Crécy made his association with the legendary king problematic, his victory at Poitiers and the capture of the flower of French knighthood – and of Jean II of France himself – rendered that association apt once more. Portraying himself as an Arthurian ‘King of Kings’ enabled Edward to negotiate a treaty with, and seek ransom for, the French king without undermining his own claim to that throne.
Ralph Hanna considers Ywain and Gawain and the Alliterative Morte Arthure in the cultural and political context of the turbulent history of the borders and of two great northern families, the Percys and the Nevilles. In spite of the popular image of the ‘uncouth / violent North’, he argues that northern romances diverge from the popular insular pattern of usurpation, exile and return, focusing instead on more domestic themes and on ‘the failure of mere martial prowess to offer meaningful achievement’. He sees Ywain and Gawain as a response to criticism of romance in texts such as Cursor mundi, stressing the importance of both time and ‘trowth’.
Although beta-amyloid, anxiety and depression have been linked cross-sectionally to reduced memory function in healthy older adults without dementia, prospective data evaluating these associations are lacking. Using data from an observational cohort study of 178 healthy older adults without dementia followed for 3 years, we found that anxiety symptoms significantly moderated the relationship between beta-amyloid level and decline in verbal (Cohen's d = 0.65) and episodic (Cohen's d = 0.38) memory. Anxiety symptoms were additionally linked to greater decline in executive function, irrespective of beta-amyloid and other risk factors. These findings suggest that interventions to mitigate anxiety symptoms may help delay memory decline in otherwise healthy older adults with elevated beta-amyloid.
The Australian Imaging, Biomarkers and Lifestyle (AIBL) Flagship Study of Ageing is a prospective study of 1,112 individuals (211 with Alzheimer's disease (AD), 133 with mild cognitive impairment (MCI), and 768 healthy controls (HCs)). Here we report diagnostic and cognitive findings at the first (18-month) follow-up of the cohort. The first aim was to compute rates of transition from HC to MCI, and MCI to AD. The second aim was to characterize the cognitive profiles of individuals who transitioned to a more severe disease stage compared with those who did not.
Eighteen months after baseline, participants underwent comprehensive cognitive testing and diagnostic review, provided an 80 ml blood sample, and completed health and lifestyle questionnaires. A subgroup also underwent amyloid PET and MRI neuroimaging.
The diagnostic status of 89.9% of the cohorts was determined (972 were reassessed, 28 had died, and 112 did not return for reassessment). The 18-month cohort comprised 692 HCs, 82 MCI cases, 197 AD patients, and one Parkinson's disease dementia case. The transition rate from HC to MCI was 2.5%, and cognitive decline in HCs who transitioned to MCI was greatest in memory and naming domains compared to HCs who remained stable. The transition rate from MCI to AD was 30.5%.
There was a high retention rate after 18 months. Rates of transition from healthy aging to MCI, and MCI to AD, were consistent with established estimates. Follow-up of this cohort over longer periods will elucidate robust predictors of future cognitive decline.