Background: Group B Streptococcus (GBS) is one of the most common causes of bacterial sepsis in newborns. In 2002, the Center for Disease Control and Prevention (CDC) recommended universal screening of all pregnant women for GBS colonization and administering intrapartum prophylaxis to colonized pregnant women to prevent GBS infection in newborns. To identify racial disparities in GBS infections in Tennessee, we compared the incidence of early-onset GBS infection among Black and White infants from 2005-2021. Methods: GBS infections identified from normally sterile sites are reportable in Tennessee. We analyzed GBS data reported to surveillance systems from 2005 to 2021. We linked the surveillance data with the population data to calculate incidence rates. We excluded cases with unknown race status (9%) and other races (0.2%) as we do not have denominator data to calculate the incidence rate. Database linkage and data analyses were performed in SAS V.9.4. Results: A total of 399 early-onset GBS cases were reported from 2005–2021; 150 (37.59%) were Black, 212 (53.13%) were White, and 36 (9.02%) were of unknown race, and one (0.20%) reported as Other for race. While the incidence rates of early-onset GBS for all races declined from 0.23 per 1000 live births in 2005 to 0.18 per 1000 live births in 2021, Blacks experienced the largest decline in incidence from 0.6 per 1000 live births in 2005 to 0.37 in 2021. Among Whites, there was a slight decline in 2021 (0.13/1000 live births) compared to the rate in 2005 (0.21/1000 live births). The mean incidence rate of early onset GBS among Blacks (0.52 per 1000 live births) is significantly higher than the mean rates among Whites (0.20 per 1000 live births) (p value < 0 .001) from 2005 to 2021. Shelby County, one of the 95 counties in Tennessee, is predominantly Black (54.6%) and reported 27.8% of all early-onset GBS. Conclusion: There was a significant decline in early-onset GBS infections among Blacks and some reductions among Whites, indicating the effectiveness of the prevention strategies. However, Blacks have significantly higher rates than their White counterparts. In addition, 27.8% of the cases are reported from one county, signaling geographic disparities as well. Further investigation is warranted to identify risk factors and causes of observed racial and geographic disparities to help reduce the infection rate among vulnerable populations and high-risk geographic areas.

Background: The Uganda Ministry of Health (MoH) and implementing partners instituted an infection prevention and control (IPC) response strategy during the Uganda SVD outbreak in 2022 that involved rapid enhancement of screening capacity at HCFs. Rapid scale-up of screening for infectious diseases, such as SVD, is critical for early identification and triage of suspected or confirmed cases in HCFs. We describe the rapid deployment of a multimodal IPC strategy implemented in response to the SVD outbreak and the resulting impact on screening measures at HCFs. Methods: We implemented a multimodal IPC strategy in HCFs from five high risk districts to improve screening practices from November 2022–January 2023. The strategy included training health workers (HCWs) identified as IPC mentors; establishing screening areas; and providing screening supplies and communication materials. The three-day training utilized an MoH standardized training package with didactic and practice sessions. The mentors then cascaded screening information and skills to other HCWs through onsite trainings and mentorships and established screening areas. Baseline and endline (3 months after baseline) cross-sectional assessments were conducted using the MoH IPC Assessment Tool adapted from the WHO Ebola IPC Scorecard. The five main screening parameters assessed included presence of ≥ 1 meter distance between screener and the person screened, availability of a functional handwashing facility and infrared thermometer, correct record of each person’s temperature, and appropriate referral process for those suspected of having SVD to holding areas. IPC capacity was measured through the summation of each of these parameter results and calculated as an overall percentage. IBM SPSS Statistics 20 software was used for data analysis and a paired t-test done to determine any significant findings between mean scores (percentage) at baseline and endpoint. Results: A total of 296 IPC mentors were trained, screening information was cascaded to 3,899 HCWs, and screening areas were established in 1,135 HCFs. Based on the screening results from the MoH IPC assessment tool, capacity improved from 44% (SD=37) at baseline to 67% (SD=34) at endpoint. Screening capacity improved from baseline to endpoint among level II and public HCFs from 33% (SD=35) to 60% (SD=35) (p < 0 .05) and from 54% (SD=38) to 76% (SD=31) (p < 0 .05), respectively. Conclusion: Rapid implementation of a multimodal IPC strategy was successful in enhancing screening capacity across Uganda’s HCFs during a SVD response, which is critical for early identification of infected patients to interrupt transmission. This multimodal approach should be recommended for future response actions.

Background: Outbreaks of carbapenemase-producing (CP) organisms (CPOs), including carbapenem-resistant Enterobacterales (CRE), in neonatal intensive care units (NICUs) are not well documented. The Centers for Disease Control and Prevention (CDC) identifies CP-CRE as an urgent threat to United States (US) healthcare facilities. Wadsworth Center, the New York State (NYS) Department of Health’s (NYSDOH’s) public health laboratory, participates in CDC’s Antimicrobial Resistance Laboratory Network to provide CPO identification, characterization, and surveillance. NYSDOH investigated an outbreak of CP-CRE Escherichia coli (E. coli) infections in NICU patients reported by one hospital. Method: Hospital A reported a CRE E. coli outbreak in their NICU to NYSDOH, as required by NYS Sanitary Code. In response, epidemiologists reviewed case data, conducted case finding, and provided infection control guidance to the hospital. Hospital A continued NICU clinical surveillance and conducted colonization screening to detect additional cases of CRE E. coli. The Wadsworth Center Antimicrobial Resistance Laboratory Network tested isolates from affected patients for CP genes and performed whole genome sequencing (WGS) to determine the CP gene variant, multilocus sequence type (MLST), and relatedness by mutation event (ME) analysis. NYSDOH epidemiologists assessed Hospital A’s infection control practices in affected areas and provided recommendations. Result: Hospital A identified two CRE E. coli infections in NICU patients with overlapping admissions in June-July 2023. Retrospective surveillance identified a third CRE E. coli case in an adult medical intensive care unit patient on admission to Hospital A in June 2023, with prior hospitalization April-May 2023. WGS analysis identified the blaNDM-5 gene in all three CRE E. coli patient isolates. The two NICU patients’ isolates had the same MLST (361/650) and differed by 9 MEs, indicating relatedness to each other and not the adult patient’s (MLST 167/2). NICU patient colonization screening identified no additional blaNDM-5 E. coli cases. NYSDOH’s NICU infection control assessment found that both cases were in adjacent isolettes within three feet of each other. Clean isolettes, equipment, and supplies for new admissions were stored in the clinical care space, not in a separate clean area. Conclusion: CP-CRE is an urgent threat to US healthcare facilities, including hospital NICUs. Though the incidence and prevalence of CP-CRE blaNDM-5 E. coli are not well-defined in NY, single healthcare-associated cases in NICU populations represent an outbreak. The Wadsworth Center Antimicrobial Resistance Laboratory Network’s contributions complement traditional epidemiologic surveillance and investigation methods to provide more specific, comprehensive infection

Predation can have cascading, regulatory effects across ecological communities. Knowledge of the diet of predators can therefore provide important information regarding their ecology and conservation, as well as their impacts on prey populations. Using scats collected during 2019–2023 and estimates of prey abundance from aerial surveys, we characterized prey consumption and preferences of the Vulnerable African lion Panthera leo population in Tsavo, Kenya. Biomass models applied to prey frequencies in scats revealed that > 85% of lion diet comprised large ungulates weighing > 150 kg. The Critically Endangered hirola Beatragus hunteri and Endangered Grevy's zebra Equus grevyi (species that were introduced in Tsavo as part of ex situ conservation programmes in the 1960s) were amongst the seven prey species, of 16 detected, that were preferred by lions. Our results potentially indicate a disproportionate impact of lion predation on the small hirola and Grevy's zebra populations. Preferential predation, coupled with high availability of alternative prey, may trap the small populations of hirola and Grevy's zebra within a predator pit. Our findings provide a better understanding of lion diet, optimal foraging and the potential effects predators can have on threatened and rare prey species in an important conservation landscape. Based on our findings, we recommend an observational study of the predation ecology of lions and other predators in this system, to provide information on age- and sex-specific predation rates on hirola and Grevy's zebra for a population viability analysis, to support the management of these two threatened and rare herbivores in Tsavo.

Australia’s education system is one of the most developed globally and also one of the most privatised. Despite the substantial expenditure by state governments and the federal government, it is profoundly unequal with respect to access, funding, resources, and results from early childhood education to university. The inequality has class and spatial features, and Indigenous Australians are at the bottom of the rung. Drawing on Bourdieu’s concepts of cultural, social, and economic capital, I show that the education system, whilst certainly allowing for some mobility, facilitates the reproduction of the existing class structure. Children from low-income households are more likely to not attend childcare, to attend a school that lacks resources and where going on to university is viewed as exceptional rather than the rule. In contrast, the economic capital of wealthier households allows them to access childcare and elite private schools. The cultural and social capital of these schools reproduces a born to rule ethos, and progression to an elite university is an assumed path.

Regional variation in the historic development of agricultural societies in South-west Asia is increasingly apparent. Recent investigations at the wetland site of Balıklı (c. 8300–7900 BC) provide new insights into the initial processes of sedentism in Central Anatolia and the interaction of early communities within local and larger-scale networks. Located near major obsidian sources, excellent architectural preservation and faunal and botanical records at Balıklı suggest cultural connections to the upper Middle Euphrates region, yet inhabitants of the site do not appear to have participated in the wider South-west Asian obsidian-exchange networks and largely relied on wild resources.

Irritable bowel syndrome (IBS) is a chronic and relapsing gastrointestinal condition which negatively impacts quality of life(1). Dietary triggers are common and dietary management is central to the IBS treatment pathway with dietitians being the main education providers for patients(2). The aim of this study was to explore the perceptions of dietitians towards current practices in IBS services in clinical settings across the UK.

Qualitative semi-structured interviews were undertaken to explore current practices, barriers, and facilitators to dietetic practice and expected treatment outcomes. Eligible participants were dietitians specialising in IBS and working in the National Health System (NHS) in the UK. Interviews were held virtually. Audio was recorded and transcribed following intelligent transcription. Data were analysed using template analysis (3).

Thirteen dietitians (n=12 female) specialising in gastroenterology consented to participate in the study. Dietitians were working in various NHS Trusts across the country (Southeast England n=3; Southwest England n=3; Northwest England n=2; Northeast England n=1; West Midlands n=1; Southwest Wales n=1 and Southcentral Scotland n=2). Ten out of 13 dietitians had more than five years of experience in IBS management. Three main themes emerged: 1) Dietetic services as part of IBS referral pathways; 2) Practices in relation to dietetic services and 3) Implications of services on patients’ expectations and feelings. Each main theme had subthemes to facilitate the description and interpretation of data. The increasing number of IBS referrals to dietitians and the need for accurate and timely IBS diagnosis and specialist IBS dietitians was reported, alongside the use of digital innovation to facilitate practice and access to dietetic care. The use of Internet as a source of (mis)information by patients and the limited time available for educating patients were identified as potential barriers to dietetic practice. Dietitians follow a patient-centred approach to dietary counselling and recognise the negative implications of perceived IBS-related stigma by patients on their feelings and treatment expectations.

The study identified areas and practices which can facilitate access to dietetic services and patient- centred care in IBS management as outlined in guidelines (4).

Two articles by Garenne (2023a,b) argue that voluntary medical male circumcision does not reduce human immunodeficiency virus transmission in Africa. Here we point out key evidence and analytical flaws that call into question this conclusion.

Multilocus enzyme electrophoresis was used to compare specimens of the parasitic nematode Cloacina obtusa from the stomach of the eastern grey kangaroo, Macropus giganteus and the western grey kangaroo, M. fuliginosus. Allelic variation among nematodes was detected at 17 (85%) of 20 loci, but there was only a single fixed genetic difference (at the locus for isocitrate dehydrogenase, IDH) between C. obtusa from M. fuliginosus and those from M. giganteus in areas where each host occurred in allopatry. However, this fixed difference was not apparent within the zone of host sympatry. Although electrophoretic data indicate genetic divergence among allopatric populations of C. obtusa in the two host species, the magnitude of the electrophoretic difference (5%) between these populations does not refute the hypothesis that C. obtusa represents a single species. The ’usual’ situation for parasitic helminths of grey kangaroos is that pairs of parasite species occur in the two host species. This situation differs for C. obtusa, where there has been a lack of speciation following a speciation event in its macropodid marsupial hosts. This finding suggests that a speciation event in the host does not necessarily lead to a speciation event for all its parasites and further highlights our lack of understanding of which processes drive speciation in parasites.

OBJECTIVES/GOALS: We have evaluated the primary factors behind successful expansion of the predoctoral TL1 training grant at OHSU to all research-intensive universities in the state, evaluating the precepts that were key to integration. We also evaluate inclusion of social and behavioral sciences in clinical and translational science training, METHODS/STUDY POPULATION: OHSU contains three professional schools (medicine, nursing, and dentistry) as well as graduate studies in science. There are also three research-intensive universities in Oregon: Portland State University (PSU); Oregon State University (OSU) in Corvallis; and the University of Oregon (UO). We report evaluation of our 7-year experience with a predoctoral TL1 program and the precepts behind successful implementation of statewide outreach. We have tracked applicants from each university and program, trainee feedback, and success of the applicants as measured by persistence in research, inclusion of translational methods, additional training acquired, and subsequent research funding. We also evaluate participation by behavioral and social scientists. RESULTS/ANTICIPATED RESULTS: The predoctoral TL1 has included 40 scholars over 7 years, with 65% PhD graduate students and 35% MD students who pursue an additional research degree (PhD, MCR). Of PhD graduate students, the distribution is similar among universities: OHSU 31%, PSU 19%, OSU 27%, UO 23%. 38% of all graduate student trainees are in behavioral or social science. Key precepts behind success include: concentration on specific graduate programs at each university; implementing a common curriculum based on the MCR curriculum; interinstitutional mentor teams; leadership team that spans universities; required core TL1 activities; and a competitive application process with an interinstitutional review committee. Applicants are required to identify how translational science education enhances their research career. DISCUSSION/SIGNIFICANCE: Creating a statewide resource for TL1 translational science training has increased opportunities to expand translational research throughout Oregon through providing new opportunities to enhance excellence through disseminating resources and training across the universities.

OBJECTIVES/GOALS: The Oregon Clinical and Translational Research Institute (OCTRI) Clinical Research Navigator program provides a single point of entry for clinical and translational research services, support, advice and guidance. We provide data to illustrate the Navigator model at OHSU and examine continued opportunities to optimize research resources. METHODS/STUDY POPULATION: Requests and activities performed by the OCTRI Navigator program, staffed by 3 FTE (2 Assistant Navigators and 1 Assistant Director) were analyzed. Navigator receives requests through multiple methods: a digital form (REDCap®), email, phone calls. Requests for services and support include focused need for a core or a broad request for multiple services for start-up: informatics, the clinical and translational research center, regulatory knowledge and support, recruitment, qualitative methods, community research, biostatistics or broad consultations. Requests are tracked in SPARCRequest. Navigator also supports wayfinding to institutional resources outside of the CTSA, matchmaking for sponsors seeking investigators, and serves as a connector and facilitator across programs. RESULTS/ANTICIPATED RESULTS: OCTRI Clinical Research Navigator triaged an average of 964 research requests for 613 projects with 388 unique investigators annually between 2018-2022. Navigator also fields more than 80 calls each year that are unrelated to CTSA projects. Project requests are examined to illustrate trends in projects requesting multiple services and display how Navigator simplifies project intake and connects researchers to resources they may have not recognized they needed. Project attributes including funding type and funding status are included in this review. DISCUSSION/SIGNIFICANCE: CTSA resources are essential to the infrastructure available to researchers. While absolute numbers of requests provide little insight into the impact each CTSA hub may have, the timing and clustering trends of projects with multiple program requests shows how a combination of technology and experienced staff can efficiently support researchers.

OBJECTIVES/GOALS: Super refractory status epilepticus (SRSE) is associated with high mortality, often due to withdrawal of life sustaining therapy (WLST) based on perceived poor neurological prognosis. Factors influencing decision making are underreported and poorly understood. We surveyed clinicians who treat SRSE to identify factors that influence WLST. METHODS/STUDY POPULATION: Health care providers (HCP), including physicians, pharmacists, and advanced practice providers, who treat SRSE answered a 51-question survey on respondent demographics, institutional characteristics and SRSE management that was distributed though professional societies. Respondents described approaches to prognostication and rated the importance of clinical factors in the management of two hypothetical clinical cases followed by their prediction of recovery potential for the same two cases. Neurointensivists and other HCP responses were compared using descriptive statistics to differentiate group characteristics; a p-value <0.05 was considered significant. Logistical regression models were employed to identify associations between clinician specific factors and prognostication. RESULTS/ANTICIPATED RESULTS: One-hundred and sixty-four respondents were included in the analysis. Compared to other HCPs (neurologists, epileptologists, neurosurgeons, other intensivists; n=122, 74%), neurointensivists (n=42, 26%) [Odds ratio (OR) 0.3, 95% confidence interval (CI) 0.14-0.68), p=.004)] were less likely to use prognostic severity scores and were less likely to prognosticate likelihood of good functional recovery (OR: 0.28 (95% CI: 0.13-0.62), p=.002) compared to non-neurointensivist HCPs, controlling for potential confounders including professional degree, years of experience, country of practice, and annual volume of SRSE cases. There was, however, significant overlap in factors deemed necessary for determining futility in care escalation. DISCUSSION/SIGNIFICANCE: Neurointensivists value similar clinical factors to other HCPs when evaluating medical futility in SRSE but are less likely to predict definitive outcomes. Pending final survey results, future studies aimed at understanding why neurointensivists may be less likely to decisively prognosticate (i.e. avoiding nihilism) in SRSE may be warranted.

OBJECTIVES/GOALS: We developed institution-wide RCR training to include all required elements; support trainees to identify key ethical questions that arise in research; and to identify methods to identify a solution; and disseminate results. METHODS/STUDY POPULATION: In 2011, we participated in developing an experimental model of RCR training led by the University of Michigan. We continue to offer this training model to career development awardees in clinical and translational research at OHSU across the institution. Interactive discussion in faculty and trainee groups includes responsibilities of a researcher and a systematic process to address real world research ethics issues. Each participant identifies a key research issue they have encountered and presents a poster at the final session. We have tracked post-training assessment of participant confidence in ethical decision making and in the range of topics identified by participants. RESULTS/ANTICIPATED RESULTS: Since 2012, 227 scholars and trainees have participated in the program with 44 faculty mentors facilitating. We will describe the current curriculum as it has evolved over the past 12 years, presenting trainees with an approach to identify ethical challenges that arise in their research and identify approaches to find a practical solution. We will report on the specific challenges in research ethics identified by participants over this period and how they have evolved. We will also present pre- and post-training data about confidence in ethical decision making. DISCUSSION/SIGNIFICANCE: This approach to RCR training is well-received, has evolved over time, and has led to dissemination. Success is attributed to allowing choice in topics relevant to trainees and practicality of the stepwise approach that is transferable to any situation.