Hybrid whole genome sequencing was used to investigate if nosocomial Verona integron-encoded metallo-β-lactamase (VIM) carbapenemase transmission occurred between two patients without epidemiological links or common pathogens. Challenges in genomic methodology and appropriate analytical depth for mobile carbapenemase outbreaks are described including how inappropriate choices can mislead results and impact infection control practices.

Few studies have examined the genetic population structure of vector-borne microparasites in wildlife, making it unclear how much these systems can reveal about the movement of their associated hosts. This study examined the complex host–vector–microbe interactions in a system of bats, wingless ectoparasitic bat flies (Nycteribiidae), vector-borne microparasitic bacteria (Bartonella) and bacterial endosymbionts of flies (Enterobacterales) across an island chain in the Gulf of Guinea, West Africa. Limited population structure was found in bat flies and Enterobacterales symbionts compared to that of their hosts. Significant isolation by distance was observed in the dissimilarity of Bartonella communities detected in flies from sampled populations of Eidolon helvum bats. These patterns indicate that, while genetic dispersal of bats between islands is limited, some non-reproductive movements may lead to the dispersal of ectoparasites and associated microbes. This study deepens our knowledge of the phylogeography of African fruit bats, their ectoparasites and associated bacteria. The results presented could inform models of pathogen transmission in these bat populations and increase our theoretical understanding of community ecology in host–microbe systems.

This study delves into Industry 5.0's Human Centric Manufacturing and Systems (HCM and HCS), emphasizing worker welfare and sustainability. Industry 5.0 advocates a human-centric approach, built upon three foundational pillars safety, inclusivity, and empowerment. The paper highlights the successful integration of Design and Systems Thinking in HCM and proposes a workshop at MADE COMPETENCE CENTRE proving the effectiveness in raising awareness and promoting Human-Centric principles throughout the system life cycle and in achieving Human-Centric Systems (HCS).

The moderation of user-generated content on online platforms remains a key solution to protecting people online, but also remains a perpetual challenge as the appropriateness of content moderation guidelines depends on the online community that they aim to govern. This challenge affects marginalized groups in particular, as they more frequently experience online abuse but also end up falsely being the target of content-moderation guidelines. While there have been calls for democratic, community-moderation, there has so far been little research into how to implement such approaches. Here, we present the co-creation of content moderation strategies with the users of an online platform to address some of these challenges. Within the context of AutSPACEs—an online citizen science platform that aims to allow autistic people to share their own sensory processing experiences publicly—we used a community-based and participatory approach to co-design a content moderation solution that would fit the preferences, priorities, and needs of its autistic user community. We outline how this approach helped us discover context-specific moderation dilemmas around participant safety and well-being and how we addressed those. These trade-offs have resulted in a moderation design that differs from more general social networks in aspects such as how to contribute, when to moderate, and what to moderate. While these dilemmas, processes, and solutions are specific to the context of AutSPACEs, we highlight how the co-design approach itself could be applied and useful for other communities to uncover challenges and help other online spaces to embed safety and empowerment.

“All or none” approaches to the use of contact precautions for methicillin-resistant Staphylococcus aureus (MRSA) both fail to recognize that transmission risk varies. This qualitative study assessed healthcare personnel perspectives regarding the feasibility of a risk-tailored approach to use contact precautions for MRSA more strategically in the acute care setting.

Surface height changes above three previously undetected subglacial lakes in northeastern Greenland are documented using CryoSat, DEMs and ICESat-2. Between 7 February and 6 March 2012, the central ice region (22.6 km2) above the largest lake dropped by ~37 m followed by a further drop of 12 m in the following 29 days. This implies a subglacial water outflow, or jökulhlaup, of at least 1 km3 at rates of hundreds of cubic meters per second. A comparable outflow occurred again between 23 July and 15 September 2019, with smaller outflows in the fall of 2014 and 2016. In contrast, a second smaller subglacial lake at a higher elevation had two subglacial outbursts of ~0.3 km3 in 2012 and 2019 but the lake filling was gradual and not strongly seasonal or episodic. Water remained in both lakes after the outflows but this may not be the case for the third smallest and lowest subglacial lake. While there appears to be some hydrological link between the three lakes, the flux of water moving under the ice in this area appears to be larger than would be expected from local summer melt. However, the source of the excess water remains uncertain.

OBJECTIVES/GOALS: ICD-10 coding inconsistencies hinder timely recognition and treatment of metabolic syndrome (MetS), posing a significant risk for cardiometabolic disease progression. This study employed a digital phenotype for MetS and compared odds for medication and lifestyle intervention compared to those coded for MetS. METHODS/STUDY POPULATION: MetS is a cluster of cardiometabolic risk factors that increase risk for numerous adverse clinical outcomes. Patients with MetS were identified through electronic medical records on TriNetX LLC using the standard ICD-10 code or through a digital phenotype, involving grouping codes for the individual components. Percentage of patients with MetS not captured with the standard code was identified. In addition, disparities in blood pressure, glucose, lipid-lowering medication, and lifestyle intervention between the coding schemas were assessed, shedding light on healthcare inequities and informing targeted interventions. Odds ratios (RR) were presented for all outcomes. RESULTS/ANTICIPATED RESULTS: Patient demographics and lab values were similar between the standard code and digital phenotype cohorts. Of the 4.3 million individuals aged 50 to 80 identified as having MetS using the digital phenotype in the TriNetX research network, only 1.78% of participants shared the standard code. Individuals with the digital phenotype for MetS were at lower odds in receiving glucose lowering medication (OR: 2.11, 95% CI: 1.98–2.13, p <0.001) and exercise or nutrition-based intervention advice (OR: 1.76, 95% CI: 1.55–1.96, p <0.001) after controlling for demographics and lab values for each MetS component. DISCUSSION/SIGNIFICANCE: This project utilized TriNetX to create a digital phenotype for MetS, and suggests most patients are not coded for it using the standard ICD-10 system. This is troublesome given those with the standard code are less likely to receive certain interventions.

OBJECTIVES/GOALS: Metabolic syndrome (MetS), defined as a cluster of cardiometabolic disease risk factors, is seldom coded using the ICD-10 system in electronic medical records (EMR). The goal of this study was to use EMR to construct MetS with a digital phenotype to amplify the pool of patients available to assess risk for neurocognitive disease in this population. METHODS/STUDY POPULATION: A digital phenotype using the EMR platform TriNetX (n=38 million patients between age 50 and 80) was created by clustering codes for the individual components of MetS (insulin resistance, hypertension, dyslipidemia, and central adiposity). The research network database on TriNetX was utilized to elucidate risk ratios for neurocognitive decline, Alzheimer’s disease and related dementias (ADRDs), and cerebrovascular disease between a preclinical sample of older adults with and without MetS. Propensity score matching was used to match cohorts on demographic variables, medication use, and relevant comorbidities. Risk ratios (RR) and confidence intervals (95% CI) were presented for all outcomes. RESULTS/ANTICIPATED RESULTS: The digital phenotype for MetS expanded the sample from 29,830 to 274,703, a 10-fold increase. Sensitivity to the standard MetS ICD-10 code was 95.1%, showing strong agreement between coding schema. Older adults with MetS had higher risk of cognitive decline (RR: 1.30, 95% CI: 1.15–1.48, p <0.001), ADRDs (RR: 1.48, 95% CI: 1.25–1.75, p <0.001), and cerebrovascular issues (RR: 1.62, 95% CI: 1.55–1.70, p <0.001) when controlling for demographics, medication, and comorbidities. MetS individuals with cerebrovascular dysfunction had even greater risks for neurocognitive decline (RR: 1.70, 95% CI: 1.38–2.08, p < 0.001) and ADRDs (RR: 2.09, 95% CI: 1.56–2.80, p < 0.001) than those with only MetS. DISCUSSION/SIGNIFICANCE: Implementing a digital MetS phenotype in EMR effectively increased sample size and power for analyses. Older adults with MetS have higher risk for neurocognitive decline, especially among those with cerebrovascular dysfunction, highlighting a critical intervention window prior to overt cardiometabolic disease.

Using statewide surveillance, we describe candidemia in Connecticut during 2019–2020. Mortality was high among individuals with candidemia, and the readmission rate was high among survivors. Mortality and readmission were associated with hospital-onset candidemia. Understanding risk factors for mortality and readmission can optimize prevention strategies to reduce mortality and readmissions.

There are numerous challenges pertaining to epilepsy care across Ontario, including Epilepsy Monitoring Unit (EMU) bed pressures, surgical access and community supports. We sampled the current clinical, community and operational state of Ontario epilepsy centres and community epilepsy agencies post COVID-19 pandemic. A 44-item survey was distributed to all 11 district and regional adult and paediatric Ontario epilepsy centres. Qualitative responses were collected from community epilepsy agencies. Results revealed ongoing gaps in epilepsy care across Ontario, with EMU bed pressures and labour shortages being limiting factors. A clinical network advising the Ontario Ministry of Health will improve access to epilepsy care.

The clay mineralogy of tuffs from Yucca Mountain, Nevada, the potential site of the nation's first high-level radioactive waste repository, has been studied in order to understand the alteration history of the rocks and to predict potential future alterations. Bulk-rock samples and clay-mineral separates from three drill holes at Yucca Mountain (USW G-1, USW G-2, and USW GU-3/G-3) were studied using X-ray powder diffraction, and supporting temperature information was obtained using fluid inclusion data from calcite. Twelve K/Ar dates were obtained on illite/smectite (I/S) separated from the tuffs from the two northernmost drill holes, USW G-1 and G-2. The predominant clay minerals in the Yucca Mountain tuffs are interstratified I/S, with minor amounts of chlorite and interstratified chlorite/smectite. The I/S reactions observed as a function of depth are similar to those observed for pelitic rocks; I/S transforms from R = 0 interstratifications through R = 1 and R ≥ 3 interstratifications to illite in USW G-2 and to R ≥ 3 I/S in USW G-1. The R = 0 I/S clays in USW GU-3/G-3 have not significantly transformed. K/Ar dates for the I/S samples average 10.4 my. These data suggest that the rocks at depth in the northern portion of Yucca Mountain were altered 10.0-11 my ago, soon after creation of the Timber Mountain caldera to the north. Both I/S geothermometry and fluid inclusion data suggest that the rocks at depth in USW G-2 were subjected to postdepositional temperatures of at least 275°C, those in USW G-1 reached 200°C, and rocks from USW GU-3/G-3 probably did not exceed 100°C. These data suggest that no significant hydrothermal alteration has occurred since Timber Mountain time, ~ 10.7 my ago.

Estimates of the temperature of formation of illite/smectites yield probable stability limits for several minerals at Yucca Mountain. Clinoptilolite apparently became unstable at about 100°C, mordenite was not a major phase above 130°C, and analcime transformed to albite above 175°-200°C. It appears that cristobalite transformed to quartz at 90°-100°C in USW G-2 but must have reacted at considerably lower temperatures (and for longer times) in USW GU-3/G-3. The reactions with increasing depth appear coupled, and clinoptilolite and cristobalite disappear approximately simultaneously, supporting aqueous silica activity as a controlling variable in the clinoptilolite-to-analcime reaction. The reaction of clinoptilolite to analcime also coincides with the appearance of calcite, chlorite, and interstratified chlorite/smectite. Although the hydrothermal fluids may have been a source for some cations, breakdown of clinoptilolite (and mordenite) probably provided the source of some of the Ca for calcite, Mg for chlorite, K for the I/S found deeper in the section, and Na for analcime and albite.

Using the rocks in USW G-1, G-2, and GU/G-3 as natural analogs to repository-induced thermal alteration suggests that the bulk of the clinoptilolite- and mordenite-bearing rocks in Yucca Mountain will not react to less sorptive phases such as analcime over the required lifetime of the potential repository. The zeolites in zeolite interval I, directly underlying the proposed repository horizon, may transform at the predicted repository temperatures. However, the reaction of clinoptilolite to analcime in interval I may require the transformation of all of the abundant opal-CT and glass to quartz, an unlikely scenario considering the unsaturated nature of these rocks and the predicted temperatures of <100°C.

Political campaigns increasingly conduct experiments to learn how to persuade voters. Little research has considered the implications of this trend for elections or democracy. To probe these implications, we analyze a unique archive of 146 advertising experiments conducted by US campaigns in 2018 and 2020 using the platform Swayable. This archive includes 617 advertisements produced by 51 campaigns and tested with over 500,000 respondents. Importantly, we analyze the complete archive, avoiding publication bias. We find small but meaningful variation in the persuasive effects of advertisements. In addition, we find that common theories about what makes advertising persuasive have limited and context-dependent power to predict persuasiveness. These findings indicate that experiments can compound money’s influence in elections: it is difficult to predict ex ante which ads persuade, experiments help campaigns do so, but the gains from these findings principally accrue to campaigns well-financed enough to deploy these ads at scale.

To investigate the symptoms of SARS-CoV-2 infection, their dynamics and their discriminatory power for the disease using longitudinally, prospectively collected information reported at the time of their occurrence. We have analysed data from a large phase 3 clinical UK COVID-19 vaccine trial. The alpha variant was the predominant strain. Participants were assessed for SARS-CoV-2 infection via nasal/throat PCR at recruitment, vaccination appointments, and when symptomatic. Statistical techniques were implemented to infer estimates representative of the UK population, accounting for multiple symptomatic episodes associated with one individual. An optimal diagnostic model for SARS-CoV-2 infection was derived. The 4-month prevalence of SARS-CoV-2 was 2.1%; increasing to 19.4% (16.0%–22.7%) in participants reporting loss of appetite and 31.9% (27.1%–36.8%) in those with anosmia/ageusia. The model identified anosmia and/or ageusia, fever, congestion, and cough to be significantly associated with SARS-CoV-2 infection. Symptoms’ dynamics were vastly different in the two groups; after a slow start peaking later and lasting longer in PCR+ participants, whilst exhibiting a consistent decline in PCR- participants, with, on average, fewer than 3 days of symptoms reported. Anosmia/ageusia peaked late in confirmed SARS-CoV-2 infection (day 12), indicating a low discrimination power for early disease diagnosis.