Comparing fitness of herbicide-resistant and herbicide-susceptible weed biotypes is important for managing herbicide resistance. Previous research suggests there is little to no fitness penalty from amplification of the 5-enolpyruvylshikimate-3-phosphate synthase (EPSPS) gene (a mechanism of glyphosate resistance) in Palmer amaranth (Amaranthus palmeri S. Watson) in controlled studies in the greenhouse or growth chamber. A field study was conducted in North Carolina at three locations naturally infested with A. palmeri to determine vegetative, reproductive, and germination fitness of plants with and without EPSPS amplification grown season-long with cotton (Gossypium hirsutum L.). Seed number was not correlated with EPSPS copy number. However, when plants were binned into two groups, those having an EPSPS copy number ≥2 (relative to reference genes) and those having an EPSPS copy number <2, plant fresh weight and seed number were 1.4 and 1.6 times greater, respectively, for plants with fewer than 2 EPSPS copies. Amaranthus palmeri height and seed germination, and yield of cotton, did not differ when comparing the two binned groups. These data suggest that A. palmeri plants with EPSPS amplification are relatively less fit in the absence of glyphosate, but this reduced fitness does not translate into differences in interference with cotton.

In this study, we evaluated the impact of a microbiology nudge on de-escalation to first-generation cephalosporins in hospitalized patients with urinary tract infections secondary to Escherichia coli, Klebsiella pneumoniae, and Proteus mirabilis isolates with minimum inhibitory concentrations (MICs) ≤ 16 µg/mL. De-escalation to first generation-cephalosporins was uncommon at MICs = 4–16 µg/mL.

OBJECTIVES/GOALS: Early clinical case reports have described incidental epileptiform changes during electrophysiological monitoring. The objective of this study was to perform a systematic review of all existing investigations of epileptiform activity during sevoflurane use in pediatric anesthesia. The heterogenous EEG data will be analyzed in a meta analysis METHODS/STUDY POPULATION: A targeted, PICO-based clinical question was crafted and registered a priori on PROSPERO on 3/19/21. Under the guidance of a librarian from the Albert Einstein College of Medicine, a boolean search string was generated to search articles and gray literature for terms such as pediatric, sevoflurane and electroencephalogram in PubMed, OVID, Cochrane, Google Scholar, etc. We utilized the software platform tool COVIDENCE to manage our review. 495 references were imported for initial screening. 56 English-language, full-text studies were included for further review. The final 13 references were included in data extraction and Newcastle-Ottawa bias assessment. The characteristics of the studies and their primary outcomes were collected in tabular form. Strategies for data synthesis were discussed weekly. RESULTS/ANTICIPATED RESULTS: Epileptiform changes reported in the literature during pediatric sevoflurane anesthesia ranged from 0 - 95%. EEG data were acquired using a variety of recording systems with variable number of leads and heterogeneous outcomes reported. The periods of anesthesia monitoring were also heterogeneous. Characteristics of the studies are presented in Table 1. 495 references were imported for screening with 13 final references for data extraction. EEG abnormalities were reported in 204/649 (31.4%) subjects ranging in age from neonate to 18 years; the majority of studies utilized less than 16 channels of (10/13, 76.9%) (Table 1). There was variability in sevoflurane dosing, premedication (e.g., midzolam, hydroxyzine), and periods of anesthesia monitored. DISCUSSION/SIGNIFICANCE: There was heterogeneity noted across reviewed literature including study design, phases of anesthesia, ventilation methods, number of EEG leads recorded and adjuvant anesthetics administered. Nevertheless, this review rigorously classified epileptiform activity during Sevoflurane thereby influencing modern anesthesia.

Electroencephalographic (EEG) abnormalities are greater in mild cognitive impairment (MCI) with Lewy bodies (MCI-LB) than in MCI due to Alzheimer’s disease (MCI-AD) and may anticipate the onset of dementia. We aimed to assess whether quantitative EEG (qEEG) slowing would predict a higher annual hazard of dementia in MCI across these etiologies. MCI patients (n = 92) and healthy comparators (n = 31) provided qEEG recording and underwent longitudinal clinical and cognitive follow-up. Associations between qEEG slowing, measured by increased theta/alpha ratio, and clinical progression from MCI to dementia were estimated with a multistate transition model to account for death as a competing risk, while controlling for age, cognitive function, and etiology classified by an expert consensus panel.

Over a mean follow-up of 1.5 years (SD = 0.5), 14 cases of incident dementia and 5 deaths were observed. Increased theta/alpha ratio on qEEG was associated with increased annual hazard of dementia (hazard ratio = 1.84, 95% CI: 1.01–3.35). This extends previous findings that MCI-LB features early functional changes, showing that qEEG slowing may anticipate the onset of dementia in prospectively identified MCI.

Knotweed (Fallopia spp.) is an herbaceous perennial from East Asia that was brought to Europe and North America and, despite control efforts, subsequently spread aggressively on both continents. Data are available on knotweed’s modes of sexual and asexual spread, historical spread, preferred habitat, and ploidy levels. Incomplete information is available on knotweed’s current global geographic distribution and genetic diversity. The chemical composition of knotweed leaves and rhizomes has been partially discovered as related to its ability to inhibit growth and germination of neighboring plant communities via phytochemicals. There is still critical information missing. There are currently no studies detailing knotweed male and female fertility. Specifically, information on pollen viability would be important for further understanding sexual reproduction as a vector of spread in knotweed. This information would help managers determine the potential magnitude of knotweed sexual reproduction and the continued spread of diverse hybrid swarms. The potential range of knotweed and its ability to spread into diverse habitats makes studies on knotweed seed and rhizome cold tolerance of utmost importance, yet to date no such studies have been conducted. There is also a lack of genetic information available on knotweed in the upper Midwest. Detailed genetic information, such as ploidy levels and levels of genetic diversity, would answer many questions about knotweed in Minnesota, including understanding its means of spread, what species are present in what densities, and current levels of hybridization. This literature review summarizes current literature on knotweed to better understand its invasiveness and to highlight necessary future research that would benefit and inform knotweed management in the upper Midwest.

There is substantial evidence that voters’ choices are shaped by assessments of the state of the economy and that these assessments, in turn, are influenced by the news. But how does the economic news track the welfare of different income groups in an era of rising inequality? Whose economy does the news cover? Drawing on a large new dataset of US news content, we demonstrate that the tone of the economic news strongly and disproportionately tracks the fortunes of the richest households, with little sensitivity to income changes among the non-rich. Further, we present evidence that this pro-rich bias emerges not from pro-rich journalistic preferences but, rather, from the interaction of the media’s focus on economic aggregates with structural features of the relationship between economic growth and distribution. The findings yield a novel explanation of distributionally perverse electoral patterns and demonstrate how distributional biases in the economy condition economic accountability.

Distinguished Oral

Background: Shared Healthcare Intervention to Eliminate Life-threatening Dissemination of MDROs in Orange County, California (SHIELD OC) was a CDC-funded regional decolonization intervention from April 2017 through July 2019 involving 38 hospitals, nursing homes (NHs), and long-term acute-care hospitals (LTACHs) to reduce MDROs. Decolonization in NH and LTACHs consisted of universal antiseptic bathing with chlorhexidine (CHG) for routine bathing and showering plus nasal iodophor decolonization (Monday through Friday, twice daily every other week). Hospitals used universal CHG in ICUs and provided daily CHG and nasal iodophor to patients in contact precautions. We sought to evaluate whether decolonization reduced hospitalization and associated healthcare costs due to infections among residents of NHs participating in SHIELD compared to nonparticipating NHs. Methods: Medicaid insurer data covering NH residents in Orange County were used to calculate hospitalization rates due to a primary diagnosis of infection (counts per member quarter), hospital bed days/member-quarter, and expenditures/member quarter from the fourth quarter of 2015 to the second quarter of 2019. We used a time-series design and a segmented regression analysis to evaluate changes attributable to the SHIELD OC intervention among participating and nonparticipating NHs. Results: Across the SHIELD OC intervention period, intervention NHs experienced a 44% decrease in hospitalization rates, a 43% decrease in hospital bed days, and a 53% decrease in Medicaid expenditures when comparing the last quarter of the intervention to the baseline period (Fig. 1). These data translated to a significant downward slope, with a reduction of 4% per quarter in hospital admissions due to infection (P < .001), a reduction of 7% per quarter in hospitalization days due to infection (P < .001), and a reduction of 9% per quarter in Medicaid expenditures (P = .019) per NH resident. Conclusions: The universal CHG bathing and nasal decolonization intervention adopted by NHs in the SHIELD OC collaborative resulted in large, meaningful reductions in hospitalization events, hospitalization days, and healthcare expenditures among Medicaid-insured NH residents. The findings led CalOptima, the Medicaid provider in Orange County, California, to launch an NH incentive program that provides dedicated training and covers the cost of CHG and nasal iodophor for OC NHs that enroll.

Funding: None

Disclosures: Gabrielle M. Gussin, University of California, Irvine, Stryker (Sage Products): Conducting studies in which contributed antiseptic product is provided to participating hospitals and nursing homes. Clorox: Conducting studies in which contributed antiseptic product is provided to participating hospitals and nursing homes. Medline: Conducting studies in which contributed antiseptic product is provided to participating hospitals and nursing homes. Xttrium: Conducting studies in which contributed antiseptic product is provided to participating hospitals and nursing homes.

During the COVID-19 pandemic, the antimicrobial stewardship module in our electronic medical record was reconfigured for the management of COVID-19 patients. This change allowed our subspecialist providers to review charts quickly to optimize potential therapy and management during the patient surge.

Glyphosate-resistant (GR) Palmer amaranth continues to be challenging to control across the U.S. cotton belt. Timely application of POST herbicides and herbicides applied at planting or during the season with residual activity are utilized routinely to control this weed. Although glyphosate controls large Palmer amaranth that is not GR, herbicides such as glufosinate used in resistance management programs for GR Palmer amaranth must be applied when weeds are small. Dicamba can complement both glyphosate and glufosinate in controlling GR and glyphosate-susceptible (GS) biotypes in resistant cultivars. Two studies were conducted to determine Palmer amaranth control, weed biomass, and cotton yield, as well as to estimate economic net return when herbicides were applied 2, 3, 4, and 5 wk after planting (WAP). In one experiment POST-only applications were made. In the second experiment PRE herbicides were included. In general, Palmer amaranth was controlled at least 98% by herbicides applied at least three times regardless of timing of application or herbicide sequence. Glyphosate plus dicamba applied at 4 and 5 WAP controlled Palmer amaranth similarly compared to three applications by 8 WAP; however, yield was reduced 23% because of early-season interference. The inclusion of PRE herbicides benefited treatments that did not include herbicides applied 2 or 3 WAP. Glyphosate plus dicamba applied as the only herbicides 5 WAP provided 69% control of Palmer amaranth. PRE herbicides increased control to 96% for this POST treatment. Economic returns were similar when three or more POST applications were applied, with or without PRE herbicides.

The study analysed the HIV/AIDS situation in Zambia six years after the onset of mass campaigns of Voluntary Medical Male Circumcision (VMMC). The analysis was based on data from Demographic and Health Surveys (DHS) conducted in 2001, 2007 and 2013. Results show that HIV prevalence among men aged 15–29 (the target group for VMMC) did not decrease over the period, despite a decline in HIV prevalence among women of the same age group (most of their partners). Correlations between male circumcision and HIV prevalence were positive for a variety of socioeconomic groups (urban residence, province of residence, level of education, ethnicity). In a multivariate analysis, based on the 2013 DHS survey, circumcised men were found to have the same level of infection as uncircumcised men, after controlling for age, sexual behaviour and socioeconomic status. Lastly, circumcised men tended to have somewhat riskier sexual behaviour than uncircumcised men. This study, based on large representative samples of the Zambian population, questions the current strategy of mass circumcision campaigns in southern and eastern Africa.

Off-target movement of dicamba and 2,4-D may injure and reduce the yield of many fruit and vegetable crops, impacting specialty crop producers and herbicide applicators alike. Two field experiments were established, using plant growth regulator–resistant soybean herbicide technologies, to evaluate drift and carryover risks to horseradish production. The drift experiment was conducted in 2015 and 2016 to evaluate impact of dicamba and 2,4-D simulated drift on horseradish production with a mid-POST application in soybean. Simulated drift rates were 1/10,000X, 1/1,000X, and 1/100X, with 1/2X, 1X, and 2X of standard application rates. Injury and yield loss was greater following application of 2,4-D than with dicamba. Yield reductions were observed beginning at the 1/1,000X rate of 2,4-D, with complete crop loss occurring when rates exceed 1/2X. In comparison, dicamba only reduced yields when applied at the 1X and 2X rates. Only horseradish roots from plants treated with dicamba at the 2X rate had greater dicamba residue than the nontreated control, and the amount detected, 0.32 parts per billion (ppb), was lower than the EPA tolerance of 100 ppb in root crops. There was little to no harvestable tissue for 2,4-D residue analysis for plants treated with 2,4-D at rates above 1/2X. The carryover experiment was a 2-yr rotational evaluation conducted in 2014, 2015, and 2016 to assess dicamba carryover to horseradish following application to dicamba-resistant soybean the previous season. Observations taken at 4, 6, and 8 wk after planting indicated no significant horseradish injury, nor was height, stand, or root weight reduced. These results suggest that horseradish growers should have few concerns about injury from dicamba drift or carryover. While 2,4-D applicators may need to be cautious when making applications near horseradish fields, 2,4-D may be an effective tool for controlling volunteer horseradish in 2,4-D–resistant soybean.