OBJECTIVES/GOALS: It is estimated that 357,000 children have experienced a school shooting since 1999, yet due to limitations in the firearm violence field broadly, the sequalae are not well understood. The objective of this work is to examine the mental health impacts of school shootings, providing insight into the lasting effects of firearm violence on our communities. METHODS/STUDY POPULATION: We will first conduct a quasi-experimental study using controlled interrupted time series with repeated cross-sectional data to assess school shootings’ impact on US mental health. School shooting data is from the K-12 School Shooting Database, and mental health data will be collected via the Behavioral Risk Factor Surveillance System. Second, we will conduct focus groups with community organizations, school administrators, and the public. Interview guides will be developed to explore the mental health impacts of school shootings, to guide the quantitative results interpretation, and assess educational materials’ usefulness. Qualitative analysis will occur in NVivo software with codebook refinement through thematic analysis. Results will be triangulated through convergence coding. RESULTS/ANTICIPATED RESULTS: This research is situated within the context of the pervasive mental health challenges in the US, where mental illness poses significant health, social, and economic burdens. Thus, we anticipate finding an association between school shootings and decreased self-reported mental well-being among US adults. Literature suggests that there may be a stronger association among specific subgroups, such as parents with school-aged children or individuals living in close proximity to such incidents. We expect to find heterogeneity in the effect estimate based on school shooting attributes, such as the number of casualties. Through focus groups, we anticipate furthering our comprehension of the broad-ranging effects of school shootings on less quantifiable outcomes and the unique trajectories of recovery. DISCUSSION/SIGNIFICANCE: This project will contribute needed information on the impact of school shootings and mental health and assist in reducing the frequency and impact of school shootings. Furthermore, we aim to extend our findings beyond the scientific community, translating them into educational resources advocating for policy and public health interventions.

Background: The NHSN Antimicrobial Resistance (AR) Option is an important avenue for acute-care hospitals to electronically report facilitywide antibiogram data. The NEDSS Base System (NBS) is the statewide surveillance system for mandatory reporting of all carbapenem-resistant Enterobacteriaceae (CRE) cases. The state health department (SHD) validated CRE case data reported through the AR Option to assess completeness and accuracy. Methods: NHSN AR Option data from July 2020–December 2021 for 24 facilities were validated by comparing reported CRE and susceptibility results to CRE isolates reported via the NBS. Isolates were matched based on specimen date, sex, birth month and day, pathogen, and specimen source. NHSN susceptibility results were dichotomized as “not resistant” and “resistant” to match the NBS results. Susceptibility discordance (differing proportions of resistant isolates) of matched pairs were evaluated using the McNemar exact test in SAS version 9.4 software. Results: The SHD identified 270 CRE cases from the NHSN and 1,254 unique CRE isolates from the NBS. Of the NHSN events, 72 (26.67%) were matched to the NBS. Among matched isolates, discordance was significant for doripenem (0 resistant isolates in the NHSN vs 13 in the NBS; P < .001) and imipenem (5 resistant isolates in the NHSN vs 23 in the NBS; P < .0001). Discordance was not significant for ertapenem nor meropenem. Sensitivity analyses maximized the match rate at 30.74% (83 matches) when NBS isolates from unknown sources were included and matching factors were specimen date and date of birth ± 1 day, and pathogen. Among all 6,325 CRE isolates in NBS, 290 (4.58%) did not have a specimen source provided. Of all 47,348 NHSN events, 7,624 (16.10%) had impossible patient birthdays. Conclusions: Many NHSN isolates could not be matched to NBS due to either isolates being missing from NBS or to data differences across the systems. This mismatch highlights the need for data validation and standardization at the point of entry for both systems. Discordant susceptibility outcomes raise concerns about using the NHSN as a method for facility and regional antibiogram data.

Disclosures: None

Despite promising steps towards the elimination of hepatitis C virus (HCV) in the UK, several indicators provide a cause for concern for future disease burden. We aimed to improve understanding of geographical variation in HCV-related severe liver disease and historic risk factor prevalence among clinic attendees in England and Scotland. We used metadata from 3829 HCV-positive patients consecutively enrolled into HCV Research UK from 48 hospital centres in England and Scotland during 2012–2014. Employing mixed-effects statistical modelling, several independent risk factors were identified: age 46–59 y (ORadj 3.06) and ≥60 y (ORadj 5.64) relative to <46 y, male relative to female sex (ORadj 1.58), high BMI (ORadj 1.73) and obesity (ORadj 2.81) relative to normal BMI, diabetes relative to no diabetes (ORadj 2.75), infection with HCV genotype (GT)-3 relative to GT-1 (ORadj 1.75), route of infection through blood products relative to injecting drug use (ORadj 1.40), and lower odds were associated with black ethnicity (ORadj 0.31) relative to white ethnicity. A small proportion of unexplained variation was attributed to differences between hospital centres and local health authorities. Our study provides a baseline measure of historic risk factor prevalence and potential geographical variation in healthcare provision, to support ongoing monitoring of HCV-related disease burden and the design of risk prevention measures.

Adult sex ratios (ASRs) have proved to correlate with population trends, which make them potential useful indicators of a species’ population trajectory and conservation status. We analysed ASRs and proportion of juveniles in flocks of an endangered steppe bird, the Little Bustard Tetrax tetrax, using surveys made during the non-breeding period in seven areas within its Western European range (one in Portugal, four in Spain, and two in France). We found overall male-biased ASRs, as all the seven surveyed areas showed a male-biased ASR mean value. Five areas were below the threshold median value (female sex ratio = 0.4) considered to be consistent with an increased probability of extinction, according to earlier population viability analyses for the species. We also found a significant positive correlation between female ratio and the proportion of young individuals in the non-breeding flocks surveyed. Our results (strongly male-biased ASRs) support the hypothesis that the viability of Little Bustard populations in Western Europe is threatened by an excess of female mortality, something that should be quantified in the future, and emphasise the value of monitoring sex ratio as a population viability indicator in species where monitoring survival is difficult to achieve.

Americium is a man-made metal produced in very small quantities in nuclear reactors. Americium-241 is one of the radioactive isotopes of americium and has commercial applications, including use in smoke detectors. This is a case report of an occupational inhalation of americium-241, treated with both effective external decontamination and the use of diethylenetriamine pentaacetate to promote decorporation. This experience is significant because of the potential for americium or similar radionuclides to be used in “dirty” bombs or other radiological dispersion devices to cause large-scale radioactive contamination.

Background: In November 2020, bamlanivimab received emergency use authorization (EUA) to treat patients with early, mild-to-moderate COVID-19 who are at high risk of progression. Montefiore Medical Center serves an economically underserved community of >1.4 million residents in the Bronx, New York. Montefiore’s antimicrobial stewardship team (AST) developed a multidisciplinary treatment pathway for patients meeting EUA criteria: (1) outpatients and hospital associates and (2) acute-care patients (EDs or inpatient). Methods: The Montefiore AST established a centralized process for screening high-risk COVID-19 patients 7 days a week. Referrals were sent by e-mail from occupational health, primary care practices, specialty practices, emergency departments, and urgent care centers. Patients were screened in real time and were treated in the ED or a newly established infusion center within 24 hours. After infusion, all patients received phone calls from nurses and had an infectious diseases televisit. Demographics, clinical symptoms, subsequent ED visit or hospital admission, and timing from infusion to ED or hospitalization were obtained from the electronic health record. Results: In total, 281 high-risk patients (median age, 62 years; 57% female) received bamlanivimab at the infusion center or in the acute-care setting between December 2, 2020, and January 27, 2021 (Table 1). The number of treated patients increased weekly (Figure 1). Also, 62% were Hispanic or black, and 96% met EUA criteria. Furthermore, 51 (18%) were referred from occupational health, 205 (73%) were referred from the community, and 25 (9%) were inpatients (https://www.fda.gov/media/143605/download). All patients were successfully infused without adverse reactions. In addition, 23 patients (8.2%) were hospitalized and 6 (2.1%) visited EDs within 30 days of treatment. The average number of days between symptom onset and infusion was 4.9. The median age of admitted versus nonadmitted patients was 68 years versus 61.5 years (P = .07). Conclusions: An AST-coordinated bamlanivimab treatment program successfully treated multiple high-risk COVID-19 patients and potentially reduced hospitalizations. However, the effort, personnel, and resources required are significant. Dedicated hospital investment is necessary for maximal success.

Funding: No

Disclosures: None

Table 1.

Figure 1.

Susceptibility to infection such as SARS-CoV-2 may be influenced by host genotype. TwinsUK volunteers (n = 3261) completing the C-19 COVID-19 symptom tracker app allowed classical twin studies of COVID-19 symptoms, including predicted COVID-19, a symptom-based algorithm to predict true infection, derived from app users tested for SARS-CoV-2. We found heritability of 49% (32−64%) for delirium; 34% (20−47%) for diarrhea; 31% (8−52%) for fatigue; 19% (0−38%) for anosmia; 46% (31−60%) for skipped meals and 31% (11−48%) for predicted COVID-19. Heritability estimates were not affected by cohabiting or by social deprivation. The results suggest the importance of host genetics in the risk of clinical manifestations of COVID-19 and provide grounds for planning genome-wide association studies to establish specific genes involved in viral infectivity and the host immune response.

Poor diet and physical inactivity are leading modifiable causes of death and chronic disease. Robust evidence confirms that the Mediterranean diet (MedDiet) reduces mortality and cardiovascular disease risk, and promotes healthy longevity. However, MedDiet interventions are typically resource intensive, requiring regular face-to-face visits, in a one-on-one or small group setting. The rapid growth of Artificial-Intelligence (chatbot) technology has created new possibilities for low-cost, personalised health behaviour programs. We aimed to assess whether a 12-week MedDiet and physical activity intervention delivered entirely via technology (chatbot, website, wrist-worn activity tracker) could result in health behaviour change in 30 adults aged 57 ± 8 years. Volunteers’ height, body weight, waist circumference and blood pressure were measured in clinic at baseline, week 6 and 12. Introduction of the MedDiet and physical activity recommendations were conducted through a website with short videos and written sections assisted by the chatbot. Participants were encouraged to interact with the chatbot program at least weekly for 12-weeks. The MedDiet component of the program was modelled on the MedLey trial, whilst physical activity used step count goal-setting using a Garmin Vivofit 4 wrist-worn tracker. Diet and self-reported physical activity outcomes were measured using the 14-point MedDiet questionnaire and Active Australia Survey. The study achieved 93% retention over the 12-weeks and with excellent user engagement and satisfaction. There was a significant increase in the MedDiet score from 3 ± 3.5 (out of 14) at baseline, to 11 ± 3 at weeks 6 and 12, (p < 0.001). Weekly moderate-to-vigorous physical activity minutes increased from 135 ± 196 at baseline, to 210 ± 233 and 300 ± 433 mins, at weeks 6 and 12, respectively, (p < 0.001). Waist circumference decreased from 99 ± 28 to 98 ± 27 and 96 ± 25 cm, at weeks 6 and 12, respectively, (p < 0.001). BMI decreased from 29 ± 10 to 28 ± 9 at week 6 and 28 ± 10 at week 12 (P < 0.05). There was no change in blood pressure. Our pilot data confirm that the chatbot together with informational website and wearable intervention approach achieved excellent user satisfaction and preliminary efficacy of behaviour change across a 12-week period. Further research employing a randomized-controlled design, and high quality outcome measures is warranted to confirm efficacy and sustainability of behaviour change. However, these early results suggest that this innovative, comprehensive chatbot-based approach may be an appealing and feasible strategy suitable for mass-dissemination to assist dietary and physical activity related behaviour, leading to a widespread reduction in risk factors for chronic disease.