A systematic theory of the asymptotic expansion of the magnetohydrostatics (MHS) equilibrium in the distance from the magnetic axis is developed to include arbitrary smooth currents near the magnetic axis. Compared with the vacuum and the force-free system, an additional magnetic differential equation must be solved to obtain the pressure-driven currents. It is shown that there exist variables in which the rest of the MHS system closely mimics the vacuum system. Thus, a unified treatment of MHS fields is possible. The mathematical structure of the near-axis expansions to arbitrary order is examined carefully to show that the double-periodicity of physical quantities in a toroidal domain can be satisfied order by order. The essential role played by the leading-order Birkhoff–Gustavson normal form in solving the magnetic differential equations is highlighted. Several explicit examples of vacuum, force-free and MHS equilibrium in different geometries are presented.

Background: Infection prevention and control assessments in healthcare settings serve as a primary resource for obtaining data and providing recommendations based on safety, compliance, and quality assurance guidelines. In Puerto Rico (PR), surgical site infections are underreported in the Epi Info platform used by the Puerto Rico Department of Health (PRDOH), mainly due to the complexity of their identification. By focusing on evaluating Operating Rooms/Sterile Processing and Distribution (OR/SPD) units in acute care facilities (ACFs), our goal is to generate new data within the Healthcare-Associated Infection/Antibiotic Resistance (HAI/AR) Program, specifically related to patient management throughout preoperative, intraoperative, and postoperative phases, as well as reprocessing practices. Methods: Nineteen evaluations of ACFs' OR/SPDs were conducted from May through December 2023. Direct observations, file reviews, and personnel assessments were performed using an infection control assessment and response (ICAR) tool developed collaboratively by a team from an acute facility in PR and the HAI/AR Program staff. This ICAR Tool was customized based on guidelines from the certified Board for Sterile Processing and Distribution (CBSPD), the Association of periOperative Registered Nurses (AORN), and the Association for the Advancement of Medical Instrumentation (AAMI), among other regulatory agencies. The Division of Health Quality Promotion (DHQP) reviewed and approved the tool for use in these evaluations. Results: Key findings indicate that 32% of Sterile Processing Department (SPD) units restrict access to dedicated personnel with available manufacturer’s instructions, yet only 36% of SPD personnel are certified in CBSPD and packaging practices. Only 10% of facilities had a water treatment system for sterilization and Immediate Use Steam Sterilization (IUSS) policies. Notably, 84% of endoscopy areas require additional equipment for cultivating endoscopes, and no facility possessed a borescope for visually inspecting endoscope lumens. Tray inspection occurred in 21%, and only 31% of staff knew the Spaulding Classification and Class V Indicators. Conclusion: These data underscore the necessity of evaluating OR/SPD units in ACFs to provide updated recommendations and mitigate the incidence of surgical site infections (SSI). They offer insight into the structural and functional status of OR/SPD units in Puerto Rico, aligning reporting with OR/SPD practices to enhance patient care and minimize infection risks.

Introduction: Social determinants of health can impact healthcare-associated infections. Hospital-onset bacteremia (HOB) may lead to poor outcomes, increased length of stay, and increased cost of care. We explored the association of social determinants of health and HOB. Methods: We retrieved blood culture data at Stanford Health Care from May 2019 to October 2023. We identified blood cultures ordered ≥4 days of admission. To evaluate the association between social determinants of health and HOB, we employed an unsupervised machine learning approach (K-Means clustering) to discern patterns in HOB rates based on the Social Vulnerability Index (SVI). The SVI indicates the relative vulnerability of every U.S. Census tract. It ranks the tracts on 16 measures of vulnerability across 4 themes: socioeconomic factors, household characteristics, racial and ethnic minority status, and housing/transportation aspects. The number of clusters was determined using the Elbow Method (Figure 1). Results: Out of 209,947 blood cultures from 23,938 unique patients with a California address, we identified 81,653 blood cultures collected after 4 days (40%). The K-Means clustering algorithm identified 3 distinct clusters within the Californian census tracts, suggesting heterogeneity in the relationship between SVI and HOB (Figure 2). Cluster 1 had a higher SVI (median 0.73, range 0.46 – 0.99), with logistic regression indicating a positive SVI-HOB association (OR 4.84, 95% CI 4.02 – 4.81, p <.001). Cluster 2, had a median SVI of 0.29 (range 0.0009 – 0.78), also showed a positive association between SVI and HOB (OR 1.67, 95% CI 1.4 – 1.89, p <.001), aligning with trends of higher infection risks in more vulnerable groups. In contrast, Cluster 3 had a median SVI of 0.22 (range 0.002 –0.84). In this cluster, the SVI showed a negative association with HOB (OR 0.24, 95% CI 0.18 – 0.31, p <.001). Cluster 3 was the cluster with the least number of subjects (15,000, versus 21,761 for Cluster 1 and 29,762 for Cluster 2). Most subjects in Cluster 3 resided in Santa Clara County, whereas those in Clusters 1 and 2 were spread across Santa Clara, San Mateo, Alameda, Merced, and Sacramento Counties (Figure 3). Conclusions: Advanced techniques can be used to explore the complex interplay between social determinants of health and healthcare-associated infections and could guide the development of community-specific strategies to improve outcomes.

Introduction: Many central line-associated bloodstream infections are identified in patients nearing the end of life. Stanford Health Care recently introduced the General Inpatient Hospice program. This program offers inpatient hospice care for patients who, due to uncontrolled symptoms, cannot be discharged to a hospice facility or receive home hospice care. We investigated whether this program would impact blood cultures practices near the time of death. Methods: We performed a retrospective cohort study at Stanford Health Care using records of blood culture events from May 2019 to October 2023. We defined a blood culture near-death as those collected within 2 days before the date of death. We performed an interrupted time series linear regression before and after the implementation of the General Inpatient Hospice program on July 1, 2022 to assess blood culture intensity near-death. Blood culture intensity was defined as the proportion of cultures collected near-death in relation to the total number of blood cultures. Additionally, we calculated blood culture positivity rate, which was defined as the proportion of positive blood cultures among all those collected during our study period. Results: Out of 220,269 blood cultures from 24,955 unique patients, a total of 6,147 cultures (9%) were obtained near the time of death. Among these subjects, the median age was 65 years (range 20–102), with 43% identifying as being of White race-ethnicity and 57% as male. Of these cultures, 3044 were positive (49.5%), with Escherichia coli (618, 24%), Klebsiella pneumoniae (341, 13%), and Staphylococcus aureus (166, 10%) being the most common organisms. After the implementation of the General Inpatient Hospice program, the median enrollment was 12 patients (range 3–18) and the median mortality rate was 2.3% (range 2–3%). The blood culture intensity near death decreased by 0.81%, a change that was not statistically significant (95% CI -2.4% to 0.8%, p=.32; Figure 1). Subsequently, the blood culture intensity showed a non-significant increasing trend of 0.05% (95% CI -0.1% to 0.2%, p=0.53). The blood culture positivity rate near the time of death increased by 16% following the intervention, but this increase was not statistically significant (95% CI – 11.8% to 43.3%, p=.26; Figure 2), and it was followed by a non-significant downtrend of 1.9% (95% CI -3.9% to 1.4%, p=.36). Conclusion: We found no significant association between the implementation of an inpatient hospice program and blood culture practices near the time of death, likely due to low patient enrollment.

Introduction: There is a need to optimize blood culture (BC) utilization among hospitalized adults. A previous study showed an evidence-based BC algorithm improved BC utilization in a medical intensive care unit (MICU) at a large academic center. Our aim is to evaluate the impact of an intervention based on this algorithm on blood culture utilization in the MICU at Stanford Health Care, a referral center known for its high volume of solid organ transplants. Methods: We conducted a before-after study evaluating the impact of a BC diagnostic stewardship program in the MICU at Stanford Health Care, a 20-bed unit with an average of 20% lung transplant patients per day. All patients ≥18 years of age admitted to the unit during the study period were included. We adopted a previously published evidence-based algorithm detailing syndromes with low and high risk for bacteremia, which was referenced during patient rounds. Additionally, education and feedback to providers about BC utilization and indication inappropriateness was performed during leadership meetings every other month. We performed an interrupted time series analysis using historical data 17 months before the implementation of the blood culture stewardship program on April 1, 2022 and 8 months after. We assessed changes on BC utilization adjusted to patient days and crude mortality rate during the same period as a balancing measure. Results: Before the implementation of the program, the median BC utilization was 216 per 1,000 patient days (range 150–250 per 1,000 patient days). Following the introduction of the program, there was a significant decrease in blood culture utilization by 5% (95% CI -10% to -1%, p=.02; Figure 1). Post-intervention, the blood culture stabilized, with no significant increase observed (0.09% increase, 95% CI -0.7% to 1%, p=.81). The mortality rate, prior to the implementation of the program, had shown a significant downward trend of 1.4% over time (95% CI -3% to -0.2%, p=.02). After the intervention, a nonsignificant decrease of 8% was observed (95% CI -44% to 27%, p=.62; Figure 2), followed by a nonsignificant upward trend of 6% (95% CI -1% to 13%, p=.10). Conclusion: We observed a significant reduction in BC utilization after implementing the BC diagnostic stewardship program in a MICU frequented by a high number of lung transplant patients.

Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) are widely recognised as two prevalent sexually transmitted infections that can have detrimental effects on women’s reproductive health. Previous research has concentrated on studying high-risk populations, resulting in limited epidemiological data regarding the general population. Therefore, the objective of this study was to estimate the prevalence of CT and NG among women attending public primary health care in Tlaxcala, Mexico. The study sample included 2,396 women already participating in the cervical cancer screening programme, from July to November 2014. After obtaining informed consent, the CT and NG tests were conducted on cervical samples, using a nucleic acid amplification test. We estimate the prevalence with 95% confidence intervals (CIs). Women who tested positive were promptly notified and provided with appropriate treatment. In our study population, CT and NG prevalences were 3.2 (95% CI: 2.6–4.0) and 0.01 (95% CI: 0.01–0.03), respectively. CT prevalence was higher in younger women (age < 40), although the results indicate a low prevalence; due to the potentially significant impact of CT and NG on women’s health, we require adequate surveillance, and guaranteeing rapid referral to the correct treatment is a priority for the control of these diseases.

Background: Many hospitals have implemented admission SARS-CoV-2 testing to evaluate for the need for transmission-based precautions. However, a positive test in an asymptomatic patient may represent (1) active infection, signifying infectiousness; (2) false positivity; or (3) past infection with prolonged viral shedding. We used a strand-specific SARS-CoV-2 reverse real-time polymerase chain reaction (rRT-PCR) assay to assess infectivity among asymptomatic patients with a positive SARS-CoV-2 PCR admission test. Methods: We used a 2-step rRT-PCR specific to the minus strand of the SARS-CoV-2 envelope gene. We reviewed records of patients with a positive SARS-CoV-2 PCR who were also tested for the strand-specific SARS-CoV-2 PCR within 2 days of admission at Stanford Health Care during July 2020–April 2022. We restricted our analysis to each patient’s first test. We calculated the percentage of detectable minus strand-specific tests among asymptomatic patients over time and gathered descriptive statistics for age, sex, and immunocompromised state. Results: In total, 848 admitted patients had strand-specific SARS-CoV-2 assays performed. Of 532 patients with a strand-specific assay done within 2 days of admission, 242 (45%) were asymptomatic. Among asymptomatic patients, the mean age was 56 years (range, 19–99), 133 (55%) were male, 50 (21%) had immunocompromising conditions, and 30 (12%) were admitted for a surgical procedure. In total, 21 (9%; range, 4%–25% per quarter) had detectable minus strand-specific assays (Fig. 1). Conclusions: Most asymptomatic patients tested for SARS-CoV-2 on admission were not infectious. Hospitals using SARS-CoV-2 PCR admission testing may need to re-evaluate the continued use of this practice.

Fig. 1. Minus strand-specific SARS-CoV-2 assay percentage positivity per quarter among asymptomatic patients tested within 2 days of admission. The peak positivity in November 2021–January 2022 quarter coincided with the SARS-CoV-2 omicron variant surge in our county.

Disclosure: None

Background: SARS-CoV-2 viral load decreases over time after illness onset. However, immunocompromised patients may take longer for viral load decrease or have a more erratic viral-load trajectory. We used strand-specific assay data from admitted patients to evaluate viral-load trajectories after illness onset. Methods: We reviewed records of hospitalized patients with a positive SARS-CoV-2 PCR and tested using the strand-specific SARS-CoV-2 PCR during July 2020–April 2022. At Stanford Healthcare, we use a 2-step reverse real-time polymerase chain reaction (rRT-PCR) assay specific to the minus strand of the SARS-CoV-2 envelope gene to assess infectivity. Restricting our analysis to each patient’s first strand-specific assay, we used logistic regression models to compare patients with single versus multiple assays. Among patients with multiple tests, we compared those who had an upward trajectory in cycle threshold (Ct) values (a surrogate of decreasing viral load) versus those who did not. We analyzed presence of symptoms, immunocompromised state, immunosuppression reason, and severe COVID-19 leading to ICU care in univariate and multivariate models that further adjust for additional covariates. Significant differences were assessed using logistic regression odds ratios and an α level of 0.05. Results: In total, 848 inpatients were included. Among them, 703 were tested only once and 145 were tested 2–6 times. The longest duration of minus-strand detection was 163 days. In univariate analyses, patients with a single minus-strand assay had lower odds of being symptomatic (OR, 0.55), of being immunocompromised (OR, 0.58), and of being admitted to the ICU with severe COVID-19 (OR, 0.49). In the multivariate analysis, being admitted to the ICU with severe COVID-19 was the only significant variable associated with having >1 test (OR, 2.44). Among patients who had multiple strand-specific SARS-CoV-2 assays, 119 had upward minus-strand trends of Ct values (as expected) and 26 did not. Being immunocompromised was associated with nonrising minus-strand CT values (OR, 33.3) when holding all other covariates in the model constant. Conclusions: Immunocompromised patients with COVID-19 tend to actively replicate for longer and have unexpected viral trajectories compared to immunocompetent patients. Among immunocompromised patients, suspension of transmission-based precautions may require a case-by-case evaluation.

Disclosures: None

We used a strand-specific RT-qPCR to evaluate viral replication as a surrogate for infectiousness among 242 asymptomatic inpatients with a positive severe acute respiratory coronavirus virus 2 (SARS-CoV-2) admission test. Only 21 patients (9%) had detectable SARS-CoV-2 minus-strand RNA. Because most patients were found to be noninfectious, our findings support the suspension of asymptomatic admission testing.

Severe acute respiratory coronavirus virus 2 (SARS-CoV-2) real-time reverse-transcription polymerase chain reaction (rRT-PCR) strand-specific assay can be used to identify active SARS-CoV-2 viral replication. We describe the characteristics of 337 hospitalized patients with at least 1 minus-strand SARS-CoV-2 assay performed >20 days after illness onset. This test is a novel tool to identify high-risk hospitalized patients with prolonged SARS-CoV-2 replication.

Image-processing pipelines require the design of complex workflows combining many different steps that bring the raw acquired data to a final result with biological meaning. In the image-processing domain of cryo-electron microscopy single-particle analysis (cryo-EM SPA), hundreds of steps must be performed to obtain the three-dimensional structure of a biological macromolecule by integrating data spread over thousands of micrographs containing millions of copies of allegedly the same macromolecule. The execution of such complicated workflows demands a specific tool to keep track of all these steps performed. Additionally, due to the extremely low signal-to-noise ratio (SNR), the estimation of any image parameter is heavily affected by noise resulting in a significant fraction of incorrect estimates. Although low SNR and processing millions of images by hundreds of sequential steps requiring substantial computational resources are specific to cryo-EM, these characteristics may be shared by other biological imaging domains. Here, we present Scipion, a Python generic open-source workflow engine specifically adapted for image processing. Its main characteristics are: (a) interoperability, (b) smart object model, (c) gluing operations, (d) comparison operations, (e) wide set of domain-specific operations, (f) execution in streaming, (g) smooth integration in high-performance computing environments, (h) execution with and without graphical capabilities, (i) flexible visualization, (j) user authentication and private access to private data, (k) scripting capabilities, (l) high performance, (m) traceability, (n) reproducibility, (o) self-reporting, (p) reusability, (q) extensibility, (r) software updates, and (s) non-restrictive software licensing.

This study addresses the incompatibility question between the corporate organization of industry and a system based on the general recognition of economic rights and freedoms in continental western Europe. A dissociation/identification model based on a comparative analysis verifies the consistency of the premise that makes the emergence of economic rights possible only after suppressing the corporations of trades. The model stems coherently from the ideas of eighteenth-century political economists and crystallizes in reform policies aimed at eliminating corporate elements contrary to economic freedoms. The results directly link the intellectual model and the actual expressions of economic rights within the declarations written at the end of the old regime. While dissociation creates an opportunity for corporate continuity within a framework of recognized economic freedoms, the French identification model implies the suppression of corporations.

OBJECTIVES/GOALS: To summarize baseline characteristics and risk factors for major adverse cardiovascular events (MACEs) and develop a prediction model by testing the association between genetic variants and MACEs in Caribbean Hispanic patients on clopidogrel using machine-learning (ML) techniques. METHODS/STUDY POPULATION: This is a secondary analysis of available clinical and genomic data from an existing database of 600 Caribbean Hispanic cardiovascular (CV) patients on clopidogrel. MACEs is defined as the composite of all-cause death, myocardial infarction, stroke and stent thrombosis over 6 months. Dataset is divided into training (60%) and testing (40%) sets, respectively. Two different supervised ML approaches (i.e. multiclass classification and regression algorithms) are applied to the study dataset using Python v3.5 and WEKA, and tested by receiver operating curve (ROC) analysis. A case-control association analysis between MACEs at 6 months and genotypes is performed by using chi-squared test. RESULTS/ANTICIPATED RESULTS: Average age of participants was 68 years-old, 55% males, with high prevalence of risk factors (i.e., overweight: 28.4 kg/m2; hypertension: 83.8%; hypercholesterolemia: 71.9% and diabetes: 54.8%). MACEs rate is 13.8%, with 33.5% resistant to clopidogrel. Logistic regression, KNN and gradient boosting showed the best performance, as suggested by ROC analysis and AUC CV scores of 0.6-0.7. A significant association between MACE occurrence and ≥3 risk alleles was found (OR=8.17; p=0.041). We anticipate that these genetic variants (CYP2C19*2, rs12777823, PON1-rs662, ABCB1-rs2032582, PEAR1-rs12041331) will uniquely contribute to clopidogrel resistance and MACEs in Caribbean Hispanics. DISCUSSION/SIGNIFICANCE: Our findings help address in part the long-standing problem of excluding minorities from research, which entails a gap of knowledge about clopidogrel pharmacogenomics in Puerto Ricans. This study provides a possible ML model that integrates clinical and pharmacogenomics for MACE risk estimation.

OBJECTIVES/GOALS: The clinical management of differences of sex development (DSDs) aims to guarantee best practices in medical care while addressing concerns related to non-reversible surgeries. Rhetorical analysis was conducted to study the balance between science policy and patient advocacy related to DSD surgeries as depicted in medical education materials METHODS/STUDY POPULATION: Unrestricted transcripts of two educational videos and text from all chapters of a handbook addressed to medical learners and faculty by the Association of American Medical Colleges (AAMC) were submitted to automated word cloud analysis (NVivo, QSR International®). Words with a weighted percentage > 0.19% from total words of a given source were defined as words of frequent use and were selected for further analysis after exclusion of words as conjunctions, prepositions, pronouns, or conversational fillers. Words sharing noun, adjective and adverb forms were coded and weighed as a single word following the Oxford dictionary. Discrepancies on word selection, exclusion or coding were resolved between four raters. The rhetorical context of most frequent words was identified. RESULTS/ANTICIPATED RESULTS: The word cloud analysis of the video resource intended for medical learners (n=104 words of frequent use) and the video intended for medical faculty (n= 94 words of frequent use) depicts a patient-centered approach (word people’) that is based on expert opinion (word [I] think’). The handbook (n= 998 words of frequent use) makes reiterated reference to patients’; lgbt’; gender’; health’; and caring’ while underscoring health concerns that are unrelated to genital variance (health’; caring’ and medical’). The noun surgery’ did not figure among the most frequent words in spoken language nor in written text even when summing its adjective and adverb forms. DISCUSSION/SIGNIFICANCE: Educational materials by the AAMC on DSDs accentuate patient-centered care within a medical humanism framework. However, the lack of discussion of DSD surgeries is an educational gap that should be addressed by key science policy and patient advocacy stakeholders.

This paper presents MHeTRep, a multilingual medical terminology and the methodology followed for its compilation. The multilingual terminology is organised into one vocabulary for each language. All the terms in the collection are semantically tagged with a tagset corresponding to the top categories of Snomed-CT ontology. When possible, the individual terms are linked to their equivalent in the other languages. Even though many NLP resources and tools claim to be domain independent, their application to specific tasks can be restricted to specific domains, otherwise their performance degrades notably. As the accuracy of NLP resources drops heavily when applied in environments different from which they were built, a tuning to the new environment is needed. Usually, having a domain terminology facilitates and accelerates the adaptation of general domain NLP applications to a new domain. This is particularly important in medicine, a domain living moments of great expansion. The proposed method takes Snomed-CT as starting point. From this point and using 13 multilingual resources, covering the most relevant medical concepts such as drugs, anatomy, clinical findings and procedures, we built a large resource covering seven languages totalling more than two million semantically tagged terms. The resulting collection has been intensively evaluated in several ways for the involved languages and domain categories. Our hypothesis is that MHeTRep can be used advantageously over the original resources for a number of NLP use cases and likely extended to other languages.