OBJECTIVES/GOALS: At the Saturday Clinic for the Uninsured (SCU), a Milwaukee student-run free clinic affiliated with the Medical College of Wisconsin, we screened patients for food insecurity and evaluated associations of food security status with nine separate social determinants of health (SDOH) needs and eight chronic medical conditions influenced by diet. METHODS/STUDY POPULATION: This cross-sectional study took place from October 2021-April 2022 at SCU, which only sees uninsured patients. We added the USDA six-item food insecurity form to the clinic’s larger SDOH survey, which screens for medication financing, housing stability, energy assistance, legal issues, educational/work opportunities, substance use, mental health, health insurance options, and dental care needs. We then completed chart review for demographic, diagnostic, lab, and medication information pertaining to obesity, hypertension, diabetes, dyslipidemia, chronic kidney disease (CKD), gastroesophageal reflux disease (GERD), anxiety, and depression. We conducted descriptive statistics on demographics and measured associations using both Kendall’s tau correlation and odds ratios from binomial regression. RESULTS/ANTICIPATED RESULTS: Of the 157 patients seen during this time, most were middle-aged (mean age = 49.4 years ± 14.5 years), female (n = 98, 62.4%), Black or African American (n = 66, 42%) and resided in Milwaukee County (n = 144, 92.9%). 22 (16%) screened as food insecure and had greater odds and positively correlated with needing resources for medication financing (OR = 7.28, I2 = 0.33), housing (OR = 129.99, I2 = 0.28), energy assistance (OR = 3.94,I2= 0.2), mental health (OR = 4.54, I2= 0.28), insurance (OR = 2.86, I2= 0.18), and dental care (OR=3.65,I2= 0.28), but not legal concerns, education/work opportunities, or substance use. Food insecure patients had higher odds and positively correlated with having anxiety (OR = 3.26,I2= 0.23) or depression (OR = 2.88,I2= 0.19), but not obesity, hypertension, diabetes, dyslipidemia, CKD, or GERD. DISCUSSION/SIGNIFICANCE: Patients without health insurance and experiencing food insecurity were more likely to have multiple SDOH needs and mental health diagnoses. Risk factors separate from food security status may explain associations with other chronic medical conditions, including uninsured status, socioeconomic status, eating behaviors, or food accessibility.

Background:Clostridioides difficile infection (CDI) is the leading cause of healthcare-associated diarrhea. Significant risk factors for CDI include antibiotic use and healthcare exposure. Antibiotics are often administered before, during and/or after surgery to prevent postsurgical infection. The contribution of surgery-related antibiotics to the overall CDI burden has not been well described, and assessment of the appropriateness of surgical antibiotic use is complicated by complex clinical guidelines. We have described surgical antibiotic prophylaxis history among adult with CDI in Minnesota in 2018. Method: The Minnesota Department of Health (MDH) performs 5-county active population- and laboratory-based CDI surveillance as a CDC Emerging Infections Program site. Incident CDI was defined as stool positive for C. difficile by toxin or molecular assay from a person aged ≥18 years with no positive test in the preceding 8 weeks. History of CDI was defined as having had a previous CDI episode in the 2009–2018 surveillance data set. Medical records were reviewed for 12 weeks prior to incident CDI test date to identify antibiotic prescriptions. Antibiotics with documented indication for surgical-site infection prevention or surgical prophylaxis were classified as “surgical antibiotic prophylaxis” (SPPX). SPPX type (eg, intraoperative, postoperative), appropriateness of SPPX, and clinical guideline adherence were not assessed. Results: During 2018, 812 incident CDIs were reported to MDH among 736 patients. SPPX preceded 84 (10.3%) cases, non-SPPX antibiotic use preceded 465 cases (57.3%), and 263 cases (32.4%) had no documented prior antibiotic use. The median age of incident CDIs with preceding SPPX was 68 years (IQR, 54–79.5). In 25 incident CDI cases with preceding SPPX (29.8%), there were no other antibiotic exposures. Among incident CDIs with preceding SPPX, 11 (13.1%) had >1 surgery event with SPPX. Prior CDI was identified for 13 (15.7%) with SPPX. Among 99 procedures with preceding SPPX, orthopedic surgeries (n = 27, 27.3%), gastrointestinal surgeries (n = 26, 26.3%), and cardiovascular surgeries (n = 22, 22.2%) were most common. In total 18 SPPX prescriptions (18.2%) originated in outpatient settings. SPPX drugs included cefazolin (n = 67, 67.7%), ceftriaxone (n = 7, 7.1%), ertapenem (n = 6, 6.1%), and clindamycin (n = 6, 6.1%). Median SPPX duration was 1 day (IQR, 1–2), and the median number days between surgery and specimen collection date was 19 (IQR, 7–49). Conclusions: Antibiotic stewardship programs should assess surgical prescribing, including in outpatient centers. Even short antibiotic duration for surgery could put patients at risk for CDI. More data are needed to evaluate the appropriateness of SPPX prescribing and to describe the impact of SPPX on CDI.

Funding: None

Disclosures: None

Healthcare personnel with severe acute respiratory coronavirus virus 2 (SARS-CoV-2) infection were interviewed to describe activities and practices in and outside the workplace. Among 2,625 healthcare personnel, workplace-related factors that may increase infection risk were more common among nursing-home personnel than hospital personnel, whereas selected factors outside the workplace were more common among hospital personnel.

Acute change in mental status (ACMS), defined by the Confusion Assessment Method, is used to identify infections in nursing home residents. A medical record review revealed that none of 15,276 residents had an ACMS documented. Using the revised McGeer criteria with a possible ACMS definition, we identified 296 residents and 21 additional infections. The use of a possible ACMS definition should be considered for retrospective nursing home infection surveillance.

Field bindweed (Convolvulus arvensis L.) is a persistent, perennial weed species that infests a variety of temperate habitats around the globe. To evaluate the efficacy of general management approaches and impacts on crop yield and to identify research gaps, we conducted a series of meta-analyses using published studies focusing on C. arvensis management in annual cropping and perennial systems. Our analysis of 48 articles (560 data points) conducted in annual systems indicated that 95% of data points measured efficacy over short time frames (within 2 yr of treatment). Furthermore, only 27% of data points reported impacts of C. arvensis management on crop yield. In annual systems, herbicide control dominated the literature (~80% of data points) and was an effective management technique up to 2 yr posttreatment. Integrated management, with or without herbicides, and three nonchemical techniques were similarly effective as herbicide at reducing C. arvensis up to 2 yr posttreatment. In addition, integrated approaches, with or without herbicides, and two nonchemical techniques had positive effects on crop yield. There were few differences among herbicide mechanism of action groups on C. arvensis abundance in annual systems. There were only nine articles (28 data points) concerning C. arvensis management in perennial systems (e.g., pasture, rangeland, lawn), indicating more research effort has been directed toward annual systems. In perennial systems, biocontrol, herbicide, and non-herbicide integrated management techniques were equally effective at reducing C. arvensis, while competition and grazing were not effective. Overall, our results demonstrate that while chemical control of C. arvensis is generally effective and well studied, integrated and nonchemical control practices can perform equally well. We also documented the need for improved monitoring of the efficacy of management practices over longer time frames and including effects on desired vegetation to develop sustainable weed management programs.

Hoary alyssum [Berteroa incana (L.) DC.] is a nonnative invasive forb that is noxious in California, Idaho, Michigan, Montana, Oregon, Washington, Wyoming, Alberta, British Columbia, and Saskatchewan. Managing B. incana is difficult, because it has an extended flowering period, during which plants simultaneously flower and produce seeds. Consequently, poorly timed herbicide applications may kill B. incana flowers but not prevent viable seed production. We examined how different herbicide management practices used by invasive plant managers affected B. incana seed production and viability the year of application as well as population density 1 yr after application. Professional invasive plant managers sprayed B. incana with various herbicides as part of their current management practices at six sites in southwestern Montana in summer 2016. We collected B. incana plants at 4 wk postapplication for seed biology analyses. Across the six sites, nonsprayed B. incana produced 5 to 1,855 seeds plant−1 and averaged 429 seeds plant−1. Seed production was reduced by 64% to 99% with 7 of the 11 herbicide applications. Berteroa incana seed viability in nonsprayed areas averaged 53% and ranged from 36% to 73% across the sites. Nine of the 10 herbicide applications used by invasive plant managers reduced seed viability 49% to 100%. Few of the herbicide management practices reduced B. incana’s population density the following growing season, suggesting that managers should expect reoccurring infestations at least 1 yr after application. Our results show that invasive plant managers can reduce B. incana viable seed production even when spraying plants that have flowered and formed seed pods. However, sites may need to be monitored for additional years to treat reoccurring infestations.

We distributed a 16-question survey concerning noxious weed abundance, impacts, and management to livestock producers grazing on privately owned or leased grazing lands in Montana. The noxious weeds most commonly reported as being present on respondents’ grazing units were Canada thistle [Cirsium arvense (L.) Scop.] (64% of grazing units) and leafy spurge (Euphorbia esula L.) (45% of grazing units), and these species also reportedly caused the greatest reductions in livestock forage. Houndstongue (Cynoglossum officinale L.) was more prevalent than either spotted knapweed (Centaurea stoebe L.) or diffuse knapweed (Centaurea diffusa Lam.) (39% vs. 32% and 10%, respectively, of grazing units), but collectively C. stoebe and C. diffusa were reported to cause greater forage reductions than C. officinale. The top three strategies used to manage noxious weeds were chemical control, grazing, and biological control. Combining survey responses with forage-loss models derived from field data for C. stoebe and E. esula, we estimated the combined cost of noxious weed management and forage losses on privately owned rangeland to be $3.54 ha−1 yr−1, or $7,243 annually for an average size grazing unit (i.e., 2,046 ha [5,055 ac]). Our estimates of economic losses are lower than many estimates from previous studies, possibly because we focused only on direct costs related to private grazing land, while other studies often consider indirect impacts. Nonetheless, our estimates are substantial; for example, our estimated loss equates to 24% of the average per-hectare lease rate for Montana grazing land.

Although stand-alone and integrated management techniques have been cited as viable approaches to managing Canada thistle [Cirsium arvense (L.) Scop.], it continues to impact annual cropping and perennial systems worldwide. We conducted meta-analyses assessing effectiveness of management techniques and herbicide mechanism of action groups for controlling C. arvense using 55 studies conducted in annual cropping systems and 45 studies in perennial systems. Herbicide was the most studied technique in both types of systems and was effective at reducing C. arvense. However, integrated multitactic techniques, with or without herbicides, were more effective than sole reliance on herbicides for long-term control in both annual cropping and perennial systems. A variety of management techniques such as biocontrol, crop diversification, mowing, and soil disturbance provided control similar to that of herbicide. Our results suggest that many management techniques aimed at reducing C. arvense can also improve crop yield or abundance of desired plants. This study highlights the need to devote more research to nonchemical and integrated management approaches for C. arvense control.

We determine elemental abundances of He, N, O, Ne, S, and Ar in Magellanic Cloud planetary nebulae (PNe) using direct methods and a large set of observed ions, minimizing the need for ionization correction factors. In contrast to prior studies, we find a clear separation between Type I and non-Type I PNe in these low-metallicity environments, and no evidence that the O-N nucleosynthesis cycle is active in low-mass progenitors. We find that the S/O abundance ratio is anomalously low compared to H ii regions, confirming the “sulfur anomaly” found for Galactic PNe. We also found that Ne/O is elevated in some cases, raising the possibility that Ne yields in low-mass AGB stars may be enhanced at low metallicity.