OBJECTIVES/GOALS: Antibiograms are used to guide empiric antibiotic selection. However, it is unclear if antibiotic profiles differ between symptomatic urinary tract infections (UTIs) and asymptomatic bacteriuria (ASB). We aimed to compare antibiotic susceptibility profiles of urinary E. coli isolates from patients with a symptomatic UTI to those with ASB. METHODS/STUDY POPULATION: We conducted a cohort study of 1,140 urinary E. coli isolates from unique patients that received care through Vanderbilt University Medical Center (VUMC) from Nov 2020 – Jun 2021. We included any patient that was seen at VUMC as an inpatient, outpatient or at the emergency department with ≥ 105 colony forming units/mL E. coli detected from a clinical urine specimen. Chart abstractions were performed to capture reported UTI symptoms and demographic information. Descriptive statistics were conducted to compare antibiotic susceptibility profiles (i.e., susceptible, intermediate, resistant) between symptomatic and ASB groups. The risk of detection of a multidrug-resistant organism (MDRO) (intermediate, or resistant to at least one antibiotic in three or more classes) was assessed between groups. RESULTS/ANTICIPATED RESULTS: Among 1,140, 1,018 (89%) and 122 (11%) were symptomatic and ASB, respectively. When comparing symptomatic and ASB, the median ages were 50 and 46. Groups had similar proportions of no indwelling catheter (94% v. 95%) and without diabetes (87% v. 88%). The collection setting between inpatient, emergency department, and outpatient were similar with most being outpatient (79% v. 83%). The proportion of patients who were pregnant, immuno compromised, or had a structural/functional urinary tract abnormality were higher in the symptomatic group. The proportion of isolates resistant and susceptible to tested antibiotics were similar between groups, with only ciprofloxacin showing slightly higher resistance among ASB (16% v. 25%). The risk of MDRO detection was similar between groups (RR: 0.858, 95% CI: 0.64, 1.15). DISCUSSION/SIGNIFICANCE: Antibiotic susceptibility comparison demonstrated similar profiles, which suggests antibiogram use as appropriate to guide ASB treatment. Results offer insight on whether traditional methods for assessing antibiotic susceptibility on population-levels could benefit from further refinement by patient-specific clinical parameters.

The US government invests substantial sums to control the HIV/AIDS epidemic. To monitor progress toward epidemic control, PEPFAR, or the President’s Emergency Plan for AIDS Relief, oversees a data reporting system that includes standard indicators, reporting formats, information systems, and data warehouses. These data, reported quarterly, inform understanding of the global epidemic, resource allocation, and identification of trouble spots. PEPFAR has developed tools to assess the quality of data reported. These tools made important contributions but are limited in the methods used to identify anomalous data points. The most advanced consider univariate probability distributions, whereas correlations between indicators suggest a multivariate approach is better suited. For temporal analysis, the same tool compares values to the averages of preceding periods, though does not consider underlying trends and seasonal factors. To that end, we apply two methods to identify anomalous data points among routinely collected facility-level HIV/AIDS data. One approach is Recommender Systems, an unsupervised machine learning method that captures relationships between users and items. We apply the approach in a novel way by predicting reported values, comparing predicted to reported values, and identifying the greatest deviations. For a temporal perspective, we apply time series models that are flexible to include trend and seasonality. Results of these methods were validated against manual review (95% agreement on non-anomalies, 56% agreement on anomalies for recommender systems; 96% agreement on non-anomalies, 91% agreement on anomalies for time series). This tool will apply greater methodological sophistication to monitoring data quality in an accelerated and standardized manner.

In this three-generation longitudinal study of familial depression, we investigated the continuity of parenting styles, and major depressive disorder (MDD), temperament, and social support during childrearing as potential mechanisms. Each generation independently completed the Parental Bonding Instrument (PBI), measuring individuals’ experiences of care and overprotection received from parents during childhood. MDD was assessed prospectively, up to 38 years, using the semi-structured Schedule for Affective Disorders and Schizophrenia (SADS). Social support and temperament were assessed using the Social Adjustment Scale – Self-Report (SAS-SR) and Dimensions of Temperament Scales – Revised, respectively. We first assessed transmission of parenting styles in the generation 1 to generation 2 cycle (G1→G2), including 133 G1 and their 229 G2 children (367 pairs), and found continuity of both care and overprotection. G1 MDD accounted for the association between G1→G2 experiences of care, and G1 social support and temperament moderated the transmission of overprotection. The findings were largely similar when examining these psychosocial mechanisms in 111 G2 and their spouses (G2+S) and their 136 children (G3) (a total of 223 pairs). Finally, in a subsample of families with three successive generations (G1→G2→G3), G2 experiences of overprotection accounted for the association between G1→G3 experiences of overprotection. The results of this study highlight the roles of MDD, temperament, and social support in the intergenerational continuity of parenting, which should be considered in interventions to “break the cycle” of poor parenting practices across generations.

Nektaspids are Palaeozoic non-biomineralized euarthropods that were at the peak of their diversity during the Cambrian Period. Post-Cambrian nektaspids are a low-diversity group with only a few species described so far. Here we describe Tariccoia tazagurtensis, a new species of small-bodied nektaspid from the Lower Ordovician Fezouata Shale of Morocco. The new species differs from the type (and only other known) species from the Ordovician strata of Sardinia (Italy), Tariccoia arrusensis, in possessing more pointed genal angles, a cephalon with marginal rim, a pygidium with anterior margin curved forwards, a rounded posterior margin, and longer and more curved thoracic tergites. The two specimens of T. tazagurtensis sp. nov. show remains of digestive glands that are comparable to those seen in the Cambrian nektaspid Naraoia. The rare occurrence of T. tazagurtensis sp. nov. in the Fezouata Shale and the distribution of other liwiids suggest that these liwiids were originally minor members of open-marine communities during the Cambrian Period, and migrated into colder brackish or restricted seas during the Ordovician Period.

Archaeocyaths are the most abundant sponges from the Cambrian period, having formed the first animal reef communities more than 500 million years ago. The Archaeocyatha are index fossils for correlating rocks of similar ages globally because of their abundance, extensive geographic distribution, detailed anatomy, and well-established taxonomy. Their ecological significance remains incompletely explored, yet they are known to have strongly competitively interacted, unlike modern sponges. This study examines the feeding ecology of the fossil remains of Siberian archaeocyath assemblages. As suspension feeders, archaeocyaths filtered plankton from the water column through pores in their outer wall. Here we outline a new method to estimate the limit on the upper size of plankton that could be consumed by an archaeocyath during life. The archaeocyaths examined were predominantly feeding on nanoplankton and microplankton such as phytoplankton and protozooplankton. Size-frequency distributions of pore sizes from six different Siberian archaeocyath assemblages, ranging from Tommotian to Botoman in age, reveal significantly different upper limits to the prey consumed at each locality. Some of the assemblages contain specimens that could have fed on larger organisms extending into the mesoplankton, including micro-invertebrates as a possible food resource. These results show that during the establishment of the first animal reef systems, prey partitioning was established as a way of reducing competition. This method has applicability for understanding the construction and the functioning of the first reef systems, as well as helping to understand modern reef systems and their development though time and space.

Background: Almost all patients admitted at acute crisis to a psychiatric ward experience clinically significant symptoms of insomnia. Ward environments pose challenges to both sleep and the delivery of therapy. Despite this, there is no description of how to adapt cognitive behavioural therapy (CBT) for insomnia to overcome these challenges. Aims: (i) To describe the key insomnia presentations observed in the Oxford Ward Sleep Solution (OWLS) trial and (ii) outline key adaptations aimed to increase accessibility and hence effectiveness of CBT for insomnia for a ward setting. Methods: Trial therapists collaboratively agreed the key insomnia presentations and therapy adaptations based on their individual reflective logs used during the trial. Results: Three key insomnia presentations are outlined. These are used to illustrate the application of 10 CBT for insomnia therapy adaptations. These include use of sleep monitoring watches to engage patients in treatment, stabilizing circadian rhythms, reducing the impact of night-time observations and managing discharge as a sleep challenge. Conclusions: Whilst inpatient wards bring challenges for sleep and therapy delivery, creative adaptations can increase the accessibility of evidence based CBT for insomnia techniques. This therapy has proven popular with patients.

Background: Our view is that sleep disturbance may be a contributory causal factor in the development and maintenance of psychotic experiences. A recent series of randomized controlled intervention studies has shown that cognitive-behavioural approaches can improve sleep in people with psychotic experiences. However, the effects of psychological intervention for improving sleep have not been evaluated in young people at ultra-high risk of psychosis. Improving sleep might prevent later transition to a mental health disorder. Aims: To assess the feasibility and acceptability of an intervention targeting sleep disturbance in young people at ultra-high risk of psychosis. Method: Patients were sought from NHS mental health services. Twelve young people at ultra-high risk of psychosis with sleep problems were offered an eight-session adapted CBT intervention for sleep problems. The core treatment techniques were stimulus control, circadian realignment, and regulating day-time activity. Participants were assessed before and after treatment and at a one month follow-up. Results: All eligible patients referred to the study agreed to take part. Eleven patients completed the intervention, and one patient withdrew after two sessions. Of those who completed treatment, the attendance rate was 89% and an average of 7.6 sessions (SD = 0.5) were attended. There were large effect size improvements in sleep. Post-treatment, six patients fell below the recommended cut-off for clinical insomnia. There were also improvements in negative affect and psychotic experiences. Conclusion: This uncontrolled feasibility study indicates that treating sleep problems in young people at ultra-high of psychosis is feasible, acceptable, and may be associated with clinical benefits.

Several theoretical studies have suggested that large samples of randomly ascertained siblings can be efficiently used to ascertain phenotypically extreme individuals and increase power to detect genetic linkage. Phenotypes that can be reliably measured by questionnaire are of obvious utility for such selection strategies, as large numbers of individuals can be contacted without laborious individual interview. As the first step in developing a large randomly-ascertained family cohort in southwest England, a sample of 88 000 individuals, including more than 34 000 sibling pairs in 20 000 sibships, was administered the Eysenck Personality Questionnaire (EPQ) by commercial mailing. The sample age ranges were 20–67 years and comprised 59% males and 41% females. Descriptive properties of the EPQ scales are similar to those reported from other large family cohorts. Test–retest correlations on 1681 probands in the sample are substantial for the N-scale (r = 0.93), but somewhat more modest for the other scales (range r = 0.70–0.88). Phenotypic and sibling correlations correspond quite closely to those of twin studies. Twin Research (2000) 3, 310–315.