OBJECTIVES/GOALS: Supported by the State of Alabama, the Alabama Genomic Health Initiative (AGHI) is aimed at preventing and treating common conditions with a genetic basis. This joint UAB Medicine-HudsonAlpha Institute for Biotechnology effort provides genomic testing, interpretation, and counseling free of charge to residents in each of Alabama’s 67 counties. METHODS/STUDY POPULATION: Launched in 2017, as a state-wide population cohort, AGHI (1.0) enrolled 6,331 Alabamians and returned individual risk of disease(s) related to the ACMG SF v2.0 medically actionable genes. In 2021, the cohort was expanded to include a primary care cohort. AGHI (2.0) has enrolled 750 primary care patients, returning individual risk of disease(s) related to the ACMG SF v3.1 gene list and pre-emptive pharmacogenetics (PGx) to guide medication therapy. Genotyping is done on the Illumina Global Diversity Array with Sanger sequencing to confirm likely pathogenic / pathogenic variants in medically actionable genes and CYP2D6 copy number variants using Taqman assays, resulting in a CLIA-grade report. Disease risk results are returned by genetic counselors and Pharmacogenetics results are returned by Pharmacists. RESULTS/ANTICIPATED RESULTS: We have engaged a statewide community (>7000 participants), returning 94 disease risk genetic reports and 500 PGx reports. Disease risk reports include increased predisposition to cancers (n=38), cardiac diseases (n=33), metabolic (n=12), other (n=11). 100% of participants harbor an actionable PGx variant, 70% are on medication with PGx guidance, 48% harbor PGx variants and are taking medications affected. In 10% of participants, pharmacists sent an active alert to the provider to consider/ recommend alternative medication. Most commonly impacted medications included antidepressants, NSAIDS, proton-pump inhibitors and tramadol. To enable the EMR integration of genomic information, we have developed an automated transfer of reports into the EMR with Genetics Reports and PGx reports viewable in Cerner. DISCUSSION/SIGNIFICANCE: We share our experience on pre-emptive implementation of genetic risk and pharmacogenetic actionability at a population and clinic level. Both patients and providers are actively engaged, providing feedback to refine the return of results. Real time alerts with guidance at the time of prescription are needed to ensure future actionability and value.

Gaps in the implementation of effective interventions impact nearly all cancer prevention and control strategies in the US including Massachusetts. To close these implementation gaps, evidence-based interventions must be rapidly and equitably implemented in settings serving racially, ethnically, socioeconomically, and geographically diverse populations. This paper provides a brief overview of The Implementation Science Center for Cancer Control Equity (ISCCCE) and describes how we have operationalized our commitment to a robust community-engaged center that aims to close these gaps. We describe how ISCCCE is organized and how the principles of community-engaged research are embedded across the center. Principles of community engagement have been operationalized across all components of ISCCCE. We have intentionally integrated these principles throughout all structures and processes and have developed evaluation strategies to assess whether the quality of our partnerships reflects the principles. ISCCCE is a comprehensive community-engaged infrastructure for studying efficient, pragmatic, and equity-focused implementation and adaptation strategies for cancer prevention in historically and currently disadvantaged communities with built-in methods to evaluate the quality of community engagement. This engaged research center is designed to maximize the impact and relevance of implementation research on cancer control in community health centers.

Among nursing home outbreaks of coronavirus disease 2019 (COVID-19) with ≥3 breakthrough infections when the predominant severe acute respiratory coronavirus virus 2 (SARS-CoV-2) variant circulating was the SARS-CoV-2 δ (delta) variant, fully vaccinated residents were 28% less likely to be infected than were unvaccinated residents. Once infected, they had approximately half the risk for all-cause hospitalization and all-cause death compared with unvaccinated infected residents.

Background: Previously, we reported decreasing postadmission urine-culture rates in hospitalized patients between 2012 and 2017, indicating a possible decrease in hospital-onset urinary tract infections or changes in diagnostic practices in acute-care hospitals (ACHs). In this study, we re-evaluated the trends using more recent data from 2017–2020 to assess whether new trends in hospital urine-culturing practices had emerged. Method: We conducted a longitudinal analysis of monthly urine-culture rates using microbiology data from 355 ACHs participating in the Premier Healthcare Database in 2017–2020. All cultures from the urinary tract collected on or before day 3 were defined as admission urine cultures and those collected on day 4 or later were defined as postadmission urine cultures. We included discharges from months where a hospital reported at least 1 urine culture with microbiology and antimicrobial susceptibility test results. Annual estimates of rates of admission culture and postadmission urine-culture rates were assessed using general estimating equation models with a negative binomial distribution accounting for hospital-level clustering and adjusting for hospital bed size, teaching status, urban–rural designation, discharge month, and census division. Estimated rate for each year (2018, 2019, and 2020) was compared to previous year’s estimated rate using rate ratios (RRs) and 95% confidence intervals (CIs) generated through the multivariable GEE models. Results: From 2017 to 2020, we included 8.7 million discharges and 1,943,540 urine cultures, of which 299,013 (15.4%) were postadmission urine cultures. In 2017–2020, unadjusted admission culture rates were 20.0, 19.6, 17.9, and 18.2 per 100 discharges respectively; similarly, unadjusted postadmission urine-culture rates were 8.6, 7.8, 7.0, and 7.5 per 1,000 patient days. In the multivariable analysis, adjusting for hospital characteristics, no significant changes in admission urine-culture rates were detected during 2017–2019; however, in 2020, admission urine-culture rates increased 6% compared to 2019 (RR, 1.06; 95% CI, 1.02–1.09) (Fig. 1). Postadmission urine-culture rates decreased 4% in 2018 compared to 2017 (RR, 0.96; 95% CI, 0.91–0.99) and 8% in 2019 compared to 2018 (RR, 0.92; 95% CI, 0.87–0.96). In 2020, postadmission urine-culture rates increased 10% compared to 2019 (RR, 1.10; 95% CI, 1.06–1.14) (Fig. 2). Factors significantly associated with postadmission urine-culture rates included discharge month and hospital bed size. For admission urine cultures, discharge month was the only significant factor. Conclusions: Between 2017–2019, postadmission urine-culture rates continued a decreasing trend, while admission culture rates remained unchanged. However, in 2020 both admission and postadmission urine culture rates increased significantly in comparison to 2019.

Funding: None

Disclosures: None

From 2014 to 2020, we compiled radiocarbon ages from the lower 48 states, creating a database of more than 100,000 archaeological, geological, and paleontological ages that will be freely available to researchers through the Canadian Archaeological Radiocarbon Database. Here, we discuss the process used to compile ages, general characteristics of the database, and lessons learned from this exercise in “big data” compilation.