Background: Patients requiring mechanical circulatory support (MCS) during episodes of cardiogenic shock are at risk for hospital-acquired bloodstream infection (HABSI). Clinically MCS devices include extracorporeal membrane oxygenation (ECMO) devices, durable and temporary left ventricular-assist devices (VADs), and intra-aortic balloon pumps (IABPs). However, the MCS exclusion to the NHSN central-line–associated bloodstream infection (CLABSI) surveillance rules in 2018 did not include IABP as a qualifying device. We have described utilization and incidence of primary HABSI (pHABSI) in our patients requiring MCS. Methods: The setting for this study was 9 cardiothoracic and heart failure intensive care units with 131 total beds at the Cleveland Clinic Main Campus. Surveillance for HABSI to include determination of CLABSI was performed prospectively. MCS-associated pHABSI were patients who had ECMO, LVAD, or IABP present for >2 calendar days with device in place on the date of infection or removed the day before. A patient with 2 device types at time of infection was counted as a pHABSI for both groups. Patient, device, and MCS days were extracted from an electronic database. Non-MCS patient days were calculated as the difference between total patient days and total MCS days. The incidence of ECMO-, VAD-, and IABP-associated pHABSI were compared to each other and to non–MCS-associated pHABSI using OpenEpi version 3.01 software. Results: Surveillance results are shown in Table 1. During the observation period, there were 221 pHABSIs and 139,013 patient days. Moreover, 67 pHABSIs were associated with an MCS device over 17,044 total MCS days: 43 ECMO days, 18 VAD days, and 13 IABP days. Also, 9 patients had >1 type of eligible device and 7 (39%) of the IABP-associated pHABSIs were CLABSIs.

The cumulative incidences of pHABSI associated with ECMO, VAD, and IABP were 5.68, 4.59, and 2.34 per 1,000 MCS days, respectively. The incidence of IABP pHABSI was not significantly different from VAD pHABSI (P = .06), but it was different from ECMO pHABSI (P < .01). The pHABSI rate for non-MCS days was 1.26 per 1,000 patient days. Conclusions: In our patients requiring MCS, the risk of pHABSI associated with IABP was significantly greater than in patients without MCS and was similar to patients with VAD. MCS of all types should be considered a risk for HABSI in patients with cardiogenic shock beyond the presence of a central line. Protocols to further prevent HABSI morbidity in IABP patients are needed.

Disclosure: None

Though presidents often criticize organized interests, presidents also expend considerable effort engaging them. Using original elite interviews, a survey of lobbyists, and administrative data, I consider how this engagement manifests, why presidents engage interests, and with which interests presidents engage. Unlike in other institutions, presidents exercise substantial control over engagement with interests, and they engage to mobilize interests’ institutional resources in service of their goals. To optimize mobilization, presidents focus engagement on well-resourced interests and interests who share presidents’ preferences. Pairing over seven million White House visitor log entries from two administrations with lobbying and campaign finance records, I demonstrate that presidential engagement is informed by interests’ electoral and policy resources and partisan alignment, though these characteristics’ substantive effects are modest. My findings highlight coalition building with interests as an underappreciated source of presidential power and elucidate the degree to which presidents amplify the political voice of well-resourced and copartisan interests.

Capacity development is critical to long-term conservation success, yet we lack a robust and rigorous understanding of how well its effects are being evaluated. A comprehensive summary of who is monitoring and evaluating capacity development interventions, what is being evaluated and how, would help in the development of evidence-based guidance to inform design and implementation decisions for future capacity development interventions and evaluations of their effectiveness. We built an evidence map by reviewing peer-reviewed and grey literature published since 2000, to identify case studies evaluating capacity development interventions in biodiversity conservation and natural resource management. We used inductive and deductive approaches to develop a coding strategy for studies that met our criteria, extracting data on the type of capacity development intervention, evaluation methods, data and analysis types, categories of outputs and outcomes assessed, and whether the study had a clear causal model and/or used a systems approach. We found that almost all studies assessed multiple outcome types: most frequent was change in knowledge, followed by behaviour, then attitude. Few studies evaluated conservation outcomes. Less than half included an explicit causal model linking interventions to expected outcomes. Half of the studies considered external factors that could influence the efficacy of the capacity development intervention, and few used an explicit systems approach. We used framework synthesis to situate our evidence map within the broader literature on capacity development evaluation. Our evidence map (including a visual heat map) highlights areas of low and high representation in investment in research on the evaluation of capacity development.

In 2020 a group of U.S. healthcare leaders formed the National Organization to Prevent Hospital-Acquired Pneumonia (NOHAP) to issue a call to action to address non–ventilator-associated hospital-acquired pneumonia (NVHAP). NVHAP is one of the most common and morbid healthcare-associated infections, but it is not tracked, reported, or actively prevented by most hospitals. This national call to action includes (1) launching a national healthcare conversation about NVHAP prevention; (2) adding NVHAP prevention measures to education for patients, healthcare professionals, and students; (3) challenging healthcare systems and insurers to implement and support NVHAP prevention; and (4) encouraging researchers to develop new strategies for NVHAP surveillance and prevention. The purpose of this document is to outline research needs to support the NVHAP call to action. Primary needs include the development of better models to estimate the economic cost of NVHAP, to elucidate the pathophysiology of NVHAP and identify the most promising pathways for prevention, to develop objective and efficient surveillance methods to track NVHAP, to rigorously test the impact of prevention strategies proposed to prevent NVHAP, and to identify the policy levers that will best engage hospitals in NVHAP surveillance and prevention. A joint task force developed this document including stakeholders from the Veterans’ Health Administration (VHA), the U.S. Centers for Disease Control and Prevention (CDC), The Joint Commission, the American Dental Association, the Patient Safety Movement Foundation, Oral Health Nursing Education and Practice (OHNEP), Teaching Oral-Systemic Health (TOSH), industry partners and academia.

Understanding place-based contributors to health requires geographically and culturally diverse study populations, but sharing location data is a significant challenge to multisite studies. Here, we describe a standardized and reproducible method to perform geospatial analyses for multisite studies. Using census tract-level information, we created software for geocoding and geospatial data linkage that was distributed to a consortium of birth cohorts located throughout the USA. Individual sites performed geospatial linkages and returned tract-level information for 8810 children to a central site for analyses. Our generalizable approach demonstrates the feasibility of geospatial analyses across study sites to promote collaborative translational research.

Background: More than half of nursing home (NH) residents harbor a multidrug-resistant organism (MDRO), and MDRO contamination of the environment is common. Whether NH decolonization of residents reduces MDRO contamination remains unclear. The PROTECT trial was a cluster-randomized trial of decolonization versus routine care in 28 California NHs from April 2017 through December 2018. Decolonization involved chlorhexidine bathing plus nasal iodophor (Monday–Friday, every other week), and it reduced resident nares and skin MDRO colonization by 36%. Methods: We swabbed high-touch objects in resident rooms and common areas for MDROs before and after the 3-month decolonization phase-in (April–July 2017). Five high-touch objects (bedrail, call button and TV remote, doorknob, light switch, and bathroom handles) were swabbed in 3 resident rooms per NH based on care needs (Alzheimer’s disease and related dementias (ADRD), ie, total care; ADRD, ambulatory care; and short stay). Five high-touch objects were also swabbed in the common area (nursing station, table, chair, railing, and drinking fountain). Swabs were processed for methicillin-resistant S. aureus (MRSA), vancomycin-resistant Enterococcus (VRE), extended-spectrum β-lactamase (ESBL) producing Enterobacteriaceae, and carbapenem-resistant Enterobacteriaceae (CRE). We used generalized linear mixed models to assess the impact of decolonization on MDRO environmental contamination when clustering by NH and room and adjusting for room type and object because unclustered and unadjusted results are likely to be inaccurate. Results: A high proportion of rooms were contaminated with any MDRO in control NHs: 43 of 56 (77%) in the baseline period and 46 of 56 (82%) in the intervention period. In contrast, decolonization NHs had similar baseline contamination (45 of 56, 80%) but lower intervention MDRO contamination (29 of 48, 60%). When evaluating the intervention impact using multivariable models, decolonization was associated with significantly less room contamination for any MDRO (OR, 0.25; 95% CI, 0.06–0.96; P = .04) and MRSA (OR, 0.16; 95% CI, 0.05–0.55; P = .004) but nonsignificant reductions in VRE contamination (OR, 0.86; 95% CI, 0.23–3.13) and ESBL contamination (OR, 0.13; 95% CI, 0.01–1.62). CRE was not modeled due to rare counts (2 rooms total). In addition, room type was important, with common areas associated with 5-fold, 9-fold, and 3-fold higher contamination with any MDRO, MRSA, and VRE, respectively, compared with short-stay rooms. Conclusions: The high burden of MDROs in NHs calls for universal prevention strategies that can protect all residents. Although decolonization was associated with an 84% reduction in odds of MRSA contamination of inanimate room objects, significant reductions in VRE or ESBL contamination were not seen, possibly due to the lower proportion of baseline contamination due to these organisms. Multimodal strategies are needed to address high levels of MDRO contamination in NHs.

Funding: None

Disclosures: Gabrielle Gussin: Stryker (Sage Products): Conducting studies in which contributed antiseptic product is provided to participating hospitals and nursing homes. Clorox: Conducting studies in which contributed antiseptic product is provided to participating hospitals and nursing homes. Medline: Conducting studies in which contributed antiseptic product is provided to participating hospitals and nursing homes. Xttrium: Conducting studies in which contributed antiseptic product is provided to participating hospitals and nursing homes.

OBJECTIVES/GOALS: Natural killer (NK) cells are a potential cancer therapeutic but expanding NK cells efficiently in vitro is difficult. Natural killer cell deficiency (NKD), a primary immune deficiency affecting only NK cells, is caused by defects in several DNA replication proteins. By studying NKD we will achieve better NK cell in vitro differentiation. METHODS/STUDY POPULATION: One patient with NKD has a compound heterozygous mutation in the essential DNA replication protein MCM10. We hypothesize that in individuals with NKD, dramatic telomere erosion from abnormal DNA replication leads to premature senescence and the loss of NK cells. To test our hypothesis, we will knockout one allele of MCM10 or over express MCM10 in NK cells isolated from blood. We will then monitor telomere length, expansion and cytotoxic activity of these NK cells. To understand the role of MCM10 in early stages of NK cell development we will deplete MCM10 in induced pluripotent stem cells and differentiate these cells into NK cells. During this differentiation we will monitor progression through NK cell developmental stages as well as telomere length and senescence markers. RESULTS/ANTICIPATED RESULTS: Telomeres insulate chromosomes and induce permanent growth arrest (senescence) when they are critically short. We have demonstrated that depletion of a DNA replication protein causes telomere erosion and increases senescence markers. NK cells have shorter telomeres and lower telomerase expression than other immune cells. We predict, this relatively poor telomere maintenance sensitizes NK cells to telomere loss upon depletion of replication proteins. During in vitro differentiation, we expect NK cell precursors to undergo premature senescence secondary to telomere shortening. Furthermore, we expect supplementation of DNA replication proteins will enhance NK cell expansion and maturation. DISCUSSION/SIGNIFICANCE OF IMPACT: NKD patients have provided the scientific community with clues as to what proteins NK cells rely on for their development. This project aims not only to understand why these proteins are critical, but to harness that information for cellular anti-cancer therapeutics.

The coronavirus disease 2019 (COVID-19) has greatly impacted health-care systems worldwide, leading to an unprecedented rise in demand for health-care resources. In anticipation of an acute strain on established medical facilities in Dallas, Texas, federal officials worked in conjunction with local medical personnel to convert a convention center into a Federal Medical Station capable of caring for patients affected by COVID-19. A 200,000 square foot event space was designated as a direct patient care area, with surrounding spaces repurposed to house ancillary services. Given the highly transmissible nature of the novel coronavirus, the donning and doffing of personal protective equipment (PPE) was of particular importance for personnel staffing the facility. Furthermore, nationwide shortages in the availability of PPE necessitated the reuse of certain protective materials. This article seeks to delineate the procedures implemented regarding PPE in the setting of a COVID-19 disaster response shelter, including workspace flow, donning and doffing procedures, PPE conservation, and exposure event protocols.

The need for hollow microneedle arrays is important for both drug delivery and wearable sensor applications; however, their fabrication poses many challenges. Hollow metal microneedle arrays residing on a flexible metal foil substrate were created by combining additive manufacturing, micromolding, and electroplating approaches in a process we refer to as electromolding. A solid microneedle with inward facing ledge was fabricated with a two photon polymerization (2PP) system utilizing laser direct write (LDW) and then molded with polydimethylsiloxane. These molds were then coated with a seed layer of Ti/Au and subsequently electroplated with pulsed deposition to create hollow microneedles. An inward facing ledge provided a physical blocking platform to restrict deposition of the metal seed layer for creation of the microneedle bore. Various ledge sizes were tested and showed that the resulting seed layer void could be controlled via the ledge length. Mechanical properties of the PDMS mold was adjusted via the precursor ratio to create a more ductile mold that eliminated tip damage to the microneedles upon removal from the molds. Master structures were capable of being molded numerous times and molds were able to be reused. SEM/EDX analysis showed that trace amounts of the PDMS mold were transferred to the metal microneedle upon removal. The microneedle substrate showed a degree of flexibility that withstood over 100 cycles of bending from side to side without damaging. Microneedles were tested for their fracture strength and were capable of puncturing porcine skin and injecting a dye.

Florpyrauxifen-benzyl is a new synthetic auxin herbicide that will provide a novel site of action in rice production. In many areas of the United States it is common practice to plant soybeans in rotation with rice, thereby introducing the potential for herbicide carryover. Multiple field experiments were conducted in 2014 and repeated in 2015 to evaluate potential plant-back restrictions for soybean and other row crops following an application of florpyrauxifen-benzyl. In the first experiment, treatments comprised florpyrauxifen-benzyl applied at 40 followed by 40 g ai ha–1, 80 fb 80 g ai ha–1, and a nontreated check. In 2014, herbicides were applied to a silt loam soil near Stuttgart and Colt, AR, and fields remained fallow following application. The following year, corn, cotton, soybean, grain sorghum, and sunflower were planted within the previously treated area. Stand counts, crop heights, and visual injury assessments were done for each crop following planting, and aboveground biomass data were collected 28 d after planting. No significant differences were observed among the treatments for any of the parameters assessed, highlighting the rotational flexibility of common row crops 1 yr following a florpyrauxifen-benzyl application. In the second experiment, florpyrauxifen-benzyl was applied at 30 and 60 g ai ha–1 at 56, 28, 14, and 0 d before planting soybean. Injury assessments corresponded to the highest concentration of florpyrauxifen-benzyl and its metabolites recovered from soil at the time of planting. Conversely, soybean injury was reduced when florpyrauxifen-benzyl was applied at increasing intervals before planting. At the end of each season, soybean yield was similar to the nontreated control when florpyrauxifen-benzyl at 30 or 60 g ai ha–1 was applied 56 d before planting, whereas all other treatments reduced yield. These results support a relatively short replant interval for soybean after florpyrauxifen-benzyl application to rice.

Florpyrauxifen-benzyl is a new active ingredient that represents an additional tool in rice (Oryza sativa L.) weed control by providing an alternative mechanism of action. Studies were conducted to evaluate soil moisture influences on florpyrauxifen-benzyl absorption, translocation, and metabolism in three problematic weeds. In the absorption/translocation study, barnyardgrass [Echinochloa crus-galli (L.) P. Beauv.], hemp sesbania [Sesbania herbacea (Mill.) McVaugh], and yellow nutsedge (Cyperus esculentus L.) were treated with [14C]florpyrauxifen-benzyl under two soil moisture regimes (7.5% and 60% field capacity). Greater absorption occurred under moist conditions (60% soil moisture content). More translocation of the herbicide to the area above the treated leaf occurred under moist versus dry soil across all weed species. Sesbania herbacea translocated 25% of the absorbed herbicide above the treated leaf, a result greater than that of the other two weed species at 60% soil moisture. However, no differences in translocation occurred among the weed species at the 7.5% soil moisture regime. In the metabolism study, 95% of the herbicide recovered was in its acid form under the high soil moisture regime for S. herbacea, a species that shows extreme sensitivity to even low doses of this herbicide, and soil moisture influenced the amount of acid form found in all species. While these data provide a limited view into the physiological processes being affected, they do suggest that for E. crus-galli, S. herbacea, and C. esculentus, soil moisture content in the field will likely play a significant role in absorption, translocation, and metabolism of florpyrauxifen-benzyl.

In a greenhouse experiment, soybean, cotton, corn, grain sorghum, and sunflower were subjected to 1/10 (3 g ai ha-1), 1/100 (0.3 g ai ha-1), or 1/500 (0.06 g ai ha-1) of the 1X rate of florpyrauxifen-benzyl. Visible injury 14 days after treatment (DAT) was the greatest with soybean (96%) when exposed to the highest drift rate of 1/10x or 3 g ai/ha-1 of florpyrauxifen-benzyl and was significantly higher than all other crops and drift rates. Cotton and sunflower were also injured 85 and 83%, respectively, by the 1/10x rate but had less injury when a 1/100x or 1/500x rate was applied (injury ranging from 9 to 33%). It was concluded that the negative effects on soybean, cotton, and sunflower primarily resulted from exposure to the highest rate tested (1/10x) and only soybean expressed negative effects even at the lower rate of 1/100x. A field study was also conducted to (1) evaluate the sensitivity of soybean to low concentrations of florpyrauxifen-benzyl during vegetative and reproductive development and (2) compare soybean injury and yield following applications of florpyrauxifen-benzyl and dicamba across various growth stages and concentrations. Soybean plants were treated with 1/10, 1/20, 1/40, 1/80, 1/160, 1/320, or 1/640 of the 1X rate of florpyrauxifen-benzyl (30 g ai/ ha-1) or dicamba (560 g ae ha-1) at the V3 and R1 growth stage. Florpyrauxifen-benzyl applied at a rate of 1/10 to 1/40X caused foliar injury and subsequent height reduction. In comparison, dicamba applied at the same rates caused slightly less injury and growth reductions. As rate of florpyrauxifen-benzyl decreased from 1/10 to 1/640X, the level of soybean injury dissipated rather quickly. However, this was not the case with dicamba, as substantial injury was observed with rates as low as 1/640X.

Florpyrauxifen-benzyl is a new herbicide being developed for rice. Research is needed to understand its spectrum of control and optimal tank-mix partners. Multiple greenhouse and field experiments were conducted to evaluate florpyrauxifen-benzyl efficacy and tank-mix compatibility. In greenhouse experiments, florpyrauxifen-benzyl at 30 g ai ha–1 provided ≥75% control of all weed species evaluated (broadleaf signalgrass, barnyardgrass, Amazon sprangletop, large crabgrass, northern jointvetch, hemp sesbania, pitted morningglory, Palmer amaranth, yellow nutsedge, rice flatsedge, smallflower umbrellasedge), and control was similar to or better than other herbicide options currently available in rice. Barnyardgrass was controlled 97% with florpyrauxifen-benzyl at 30 g ha–1, ultimately reducing height (86%) and aboveground biomass (84%). In these field studies at 30 g ha–1, no antagonism was observed when florpyrauxifen-benzyl was tank-mixed with contact (acifluorfen, bentazon, carfentrazone, propanil, and saflufenacil) or systemic (2,4-D, bispyribac, cyhalofop, fenoxaprop, halosulfuron, imazethapyr, penoxsulam, quinclorac, and triclopyr) rice herbicides. Although not every tank-mix or weed species was evaluated, the lack of antagonistic interactions herein highlights the flexibility and versatility of this new herbicide. Once florpyrauxifen-benzyl becomes commercially available, it will be beneficial to tank-mix this new herbicide with others without sacrificing efficacy, so as to apply multiple sites of action together and thus lessen the risk for evolution of herbicide resistance.

Florpyrauxifen-benzyl is a new herbicide under development in rice that will provide an alternative mode of action to control barnyardgrass. Multiple greenhouse experiments evaluated florpyrauxifen-benzyl efficacy on barnyardgrass accessions collected in rice fields across Arkansas, and to evaluate its efficacy on herbicide-resistant biotypes. In one experiment, florpyrauxifen-benzyl was applied at the labeled rate of 30 g ai ha−1 to 152 barnyardgrass accessions collected from 21 Arkansas counties. Florpyrauxifen-benzyl at 30 g ai ha−1 effectively controlled barnyardgrass and subsequently reduced plant height and aboveground biomass. In a dose-response experiment, susceptible-, acetolactate synthase (ALS)-, propanil-, and quinclorac-resistant barnyardgrass biotypes were subjected to nine rates of florpyrauxifen-benzyl ranging from 0 to 120 g ai ha−1. The effective dose required to provide 90% control, plant height reduction, and biomass reduction of the susceptible and resistant biotypes fell below the anticipated labeled rate of 30 g ai ha−1. Based on these results, quinclorac-resistant barnyardgrass as well as other resistant biotypes can be controlled with florpyrauxifen-benzyl at 30 g ai ha−1. Overall, results from these studies indicate that florpyrauxifen-benzyl can be an effective tool for controlling susceptible and currently existing herbicide-resistant barnyardgrass biotypes in rice. Additionally, the unique auxin chemistry of florpyrauxifen-benzyl will introduce an alternative mechanism of action in rice weed control thus acting as an herbicide-resistance management tool.