The global food system puts enormous pressure on the environment. Managing these pressures requires understanding not only where they occur (i.e., where food is produced), but also who drives them (i.e., where food is consumed). However, the size and complexity of global supply chains make it difficult to trace food production to consumption. Here, we provide the most comprehensive dataset of bilateral trade flows of environmental pressures stemming from food production from producing to consuming nations. The dataset provides environmental pressures for greenhouse gas emissions, water use, nitrogen and phosphorus pollution, and the area of land/water occupancy of food production for crops and animals from land, freshwater, and ocean systems. To produce these data, we improved upon reported food trade and production data to identify producing and consuming nations for each food item, allowing us to match food flows with appropriate environmental pressure data. These data provide a resource for research on sustainable global food consumption and the drivers of environmental impact.

Shiga toxin-producing Escherichia coli (STEC) is a group of bacteria that causes gastrointestinal illness and occasionally causes large foodborne outbreaks. It represents a major public health concern due to its ability to cause severe illness which can sometimes be fatal. This study was undertaken as part of a rapid investigation into a national foodborne outbreak of STEC O145. On 22 May 2024, United Kingdom (UK) public health agencies and laboratories identified an increase in stool specimens submissions and patients testing positive for Shiga toxin-producing E. coli (STEC). Whole genome sequencing (WGS) identified serotype O145:H28 stx2a/eae belonging to the same five single nucleotide polymorphism (SNP) single linkage cluster as the causative agent. By 3 July 2024, 288 cases had been linked to the cluster. Most cases were adults (87%) and females (57%), 49% were hospitalized with a further 10% attending emergency care. Descriptive epidemiology and analytical studies were conducted which identified consumption of nationally distributed pre-packed sandwiches as a common food exposure. The implicated food business operators voluntarily recalled ready-to-eat sandwiches and wraps containing lettuce on 14 June 2024.

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.

We recently reported on the radio-frequency attenuation length of cold polar ice at Summit Station, Greenland, based on bi-static radar measurements of radio-frequency bedrock echo strengths taken during the summer of 2021. Those data also allow studies of (a) the relative contributions of coherent (such as discrete internal conducting layers with sub-centimeter transverse scale) vs incoherent (e.g. bulk volumetric) scattering, (b) the magnitude of internal layer reflection coefficients, (c) limits on signal propagation velocity asymmetries (‘birefringence’) and (d) limits on signal dispersion in-ice over a bandwidth of ~100 MHz. We find that (1) attenuation lengths approach 1 km in our band, (2) after averaging 10 000 echo triggers, reflected signals observable over the thermal floor (to depths of ~1500 m) are consistent with being entirely coherent, (3) internal layer reflectivities are ≈–60$\to$–70 dB, (4) birefringent effects for vertically propagating signals are smaller by an order of magnitude relative to South Pole and (5) within our experimental limits, glacial ice is non-dispersive over the frequency band relevant for neutrino detection experiments.

While quantum accelerometers sense with extremely low drift and low bias, their practical sensing capabilities face at least two limitations compared with classical accelerometers: a lower sample rate due to cold atom interrogation time; and a reduced dynamic range due to signal phase wrapping. In this paper, we propose a maximum likelihood probabilistic data fusion method, under which the actual phase of the quantum accelerometer can be unwrapped by fusing it with the output of a classical accelerometer on the platform. Consequently, the recovered measurement from the quantum accelerometer is used to estimate bias and drift of the classical accelerometer which is then removed from the system output. We demonstrate the enhanced error performance achieved by the proposed fusion method using a simulated 1D accelerometer precision test scenario. We conclude with a discussion on fusion error and potential solutions.

In March 2018, the US Food and Drug Administration (FDA), US Centers for Disease Control and Prevention, California Department of Public Health, Los Angeles County Department of Public Health and Pennsylvania Department of Health initiated an investigation of an outbreak of Burkholderia cepacia complex (Bcc) infections. Sixty infections were identified in California, New Jersey, Pennsylvania, Maine, Nevada and Ohio. The infections were linked to a no-rinse cleansing foam product (NRCFP), produced by Manufacturer A, used for skin care of patients in healthcare settings. FDA inspected Manufacturer A's production facility (manufacturing site of over-the-counter drugs and cosmetics), reviewed production records and collected product and environmental samples for analysis. FDA's inspection found poor manufacturing practices. Analysis by pulsed-field gel electrophoresis confirmed a match between NRCFP samples and clinical isolates. Manufacturer A conducted extensive recalls, FDA issued a warning letter citing the manufacturer's inadequate manufacturing practices, and federal, state and local partners issued public communications to advise patients, pharmacies, other healthcare providers and healthcare facilities to stop using the recalled NRCFP. This investigation highlighted the importance of following appropriate manufacturing practices to minimize microbial contamination of cosmetic products, especially if intended for use in healthcare settings.

Over the last 25 years, radiowave detection of neutrino-generated signals, using cold polar ice as the neutrino target, has emerged as perhaps the most promising technique for detection of extragalactic ultra-high energy neutrinos (corresponding to neutrino energies in excess of 0.01 Joules, or 1017 electron volts). During the summer of 2021 and in tandem with the initial deployment of the Radio Neutrino Observatory in Greenland (RNO-G), we conducted radioglaciological measurements at Summit Station, Greenland to refine our understanding of the ice target. We report the result of one such measurement, the radio-frequency electric field attenuation length $L_\alpha$. We find an approximately linear dependence of $L_\alpha$ on frequency with the best fit of the average field attenuation for the upper 1500 m of ice: $\langle L_\alpha \rangle = ( ( 1154 \pm 121) - ( 0.81 \pm 0.14) \, ( \nu /{\rm MHz}) ) \,{\rm m}$ for frequencies ν ∈ [145 − 350] MHz.

Directly funded (DF) home care provides funding to home care recipients to coordinate their own care and supports, and is available across all Canadian provinces. Current research on DF home care focuses on the experiences of adults with disabilities self-directing their own care, but less is known about the experiences of family members managing services for adults 55 years of age and older. This article presents findings from a qualitative analysis of 24 semi-structured interviews with older adults and caregivers using the DF program in Manitoba, Canada, focusing on family manager experiences. We identify three themes in the interview data: (1) DF home care enhances choice and flexibility for older people and their caregivers, (2) choice and flexibility reduce caregiver strain, and (3) agency services reduce administrative burden. We discuss the importance of care relationships and the role of family managers. We recommend that traditional home care systems learn from DF, and that increased administrative support would reduce caregiver strain.

Recent efforts to improve attitudes toward outgroups and reduce support for extremists in violent settings report mixed results. Donors and aid organizations have spent millions of dollars to amplify the voices of moderate religious figures to counter violent extremism in West Africa, the Middle East, and South Asia. Despite this investment, we know little about whether such messaging persuades the primary recruits of violent extremist organizations: at-risk youth in fragile settings. In this paper, we consider whether pro-peace religious messaging can promote social cohesion among school-age respondents in Burkina Faso. Using a survey experiment, we find little evidence that such messages affect reported attitudes or behaviors toward religious extremism and find instead that it can have the unintended effect of increasing intolerance toward ethnic others. Our findings carry lessons about the inadvertent priming of ethnic identities that can result in a backlash effect among certain societal segments.

In this study, we use aerial photographs, satellite imagery and field observations to quantify changes in the area, terminus length, snowline elevation and surface elevation of eight glaciers in the Alexandra Fiord region, eastern Ellesmere Island, between 1959 and 2019. Comparisons to written and pictorial descriptions from the British Arctic Expedition extend the record of change in terminus position and surface elevation to 1875 for Twin Glacier. Glacier area at Alexandra Fiord decreased by a total of 15.77 ± 0.65 km2 (11.77 ± 0.49%) between 1959 and 2019, the mean end of summer snowline increased in elevation by 360 ± 84 m (8 ± 2 m a−1) between 1974 and 2019, and the glaciers thinned at an average rate of 0.60 ± 0.06 m a−1 between 2001 and 2018. Annual rates of terminus retreat were ~3–5 times higher over the period 1974–2019 compared to 1875–1974, and rates of thinning were ~2–3 times higher over 2001–18 compared to 1875–2001. Our results are consistent with rates of change determined for other glaciers of similar size on Ellesmere Island, and with accelerated rates of ice loss coincident with regional increases in air temperature of ~1.5°C since the early 1980s.

Background: Effective strategies to improve diagnostic stewardship around C. difficile infection (CDI) remain elusive. Electronic medical record-based solutions, such as ‘hard’ and ‘soft’ stops, have been associated with reductions in testing, but may not be sustainable due to alert fatigue. Additionally, data on the potential for undertesting, missed diagnoses, and the implications regarding patient harm or clusters of transmission are limited. In this study, we assessed the efficacy of a behavioral approach to diagnostic stewardship, while monitoring for unintended consequences. Methods: This quality improvement study was conducted January 2018–May 2019; baseline period: January–April 2018, implementation period: May–December 2018, sustainment period: January 2019–May 2019. First, we conducted an internal analysis and identified 3 barriers to appropriate testing: clinician’s perceived risk of CDI, inconsistent definition of diarrhea, and lack of involvement of nurses in diagnostic stewardship. A multidisciplinary team to address these barriers was then convened. The team utilized the Bristol stool scale to improve the reliability of diarrhea description, and created a guideline-concordant testing algorithm with clinicians and nurses. The primary outcome was the number of tests ordered. The secondary outcomes were the proportion of inappropriate tests and the proportion of delayed tests. Delayed tests were defined as CDI-compatible diarrhea based on the algorithm where the test was sent >24 hours after symptom onset. Results: During the baseline period, we detected no significant change in number of tests ordered month to month, with 194.2 tests ordered per month on average. During the postimplementation period, the number of tests ordered decreased by ~4.5 each month between January 2018 and May 2019 (P < .0001). The proportion of inappropriate tests steadily decreased from 54% to 30% across the 3 study periods, and the number of delayed testing changed from 11% to 1% then increased to 20% in the sustainment period. There were no cases of toxic megacolon associated with delayed testing. Conclusions: The decision to test for CDI is complex. Interventions that address this issue as a simple ‘right’ and ‘wrong’ fail to address the root cause of CDI overdiagnosis, and they have no embedded mechanism to detect unintended consequences. Our study demonstrates that by taking a behavioral approach and addressing clinicians’ safety concerns, we were able to sustain a significant reduction in testing. We could not determine the significance of the increase in delayed testing given the low numbers; however, further studies are needed to evaluate the safety of CDI reduction strategies through diagnostic stewardship only.

Funding: None

Disclosures: None

Background: The current approach to measuring hand hygiene (HH) relies on human auditors who capture <1% of HH opportunities and rapidly become recognized by staff, resulting in inflation in performance. Our goal was to assess the impact of group electronic monitoring coupled with unit-led quality improvement on HH performance and prevention of healthcare-associated transmission and infection. Methods: A stepped-wedge cluster randomized quality improvement study was undertaken across 5 acute-care hospitals in Ontario, Canada. Overall, 746 inpatient beds were electronically monitored across 26 inpatient medical and surgical units. Daily HH performance as measured by group electronic monitoring was reported to inpatient units who discussed results to guide unit-led improvement strategies. The primary outcome was monthly HH adherence (%) between baseline and intervention. Secondary outcomes included transmission of antibiotic resistant organisms such as methicillin resistant Staphylococcus aureus (MRSA) and other healthcare-associated infections. Results: After adjusting for the correlation within inpatient units, there was a significant overall improvement in HH adherence associated with the intervention (IRR, 1.73; 95% CI, 1.47–1.99; P < .0001). Monthly HH adherence relative to the intervention increased from 29% (1,395,450 of 4,544,144) to 37% (598,035 of 1,536,643) within 1 month, followed by consecutive incremental increases up to 53% (804,108 of 1,515,537) by 10 months (P < .0001). We identified a trend toward reduced healthcare-associated transmission of MRSA (0.74; 95% CI, 0.53–1.04; P = .08). Conclusions: The introduction of a system for group electronic monitoring led to rapid, significant, and sustained improvements in HH performance within a 2-year period.

Funding: None

Disclosures: None

Objective: We investigated whether whole-genome sequencing (WGS) data altered interpretations of clonal transmission as determined by conventional epidemiology and pulsed-field gel electrophoresis (PFGE) at a tertiary-care hospital (hospital Z, HZ). Methods: We included all carbapenemase-producing Enterobacterales (CPE)–colonized or –infected patients identified via population-based surveillance from 2007 through 2018, who were admitted to HZ during and/or in the year prior to or following CPE detection. HZ reported clonal transmission clusters using epidemiology and PFGE for CPE identified at HZ or reported to HZ by other hospitals as potentially acquired at HZ. We assessed single-nucleotide polymorphism (SNP) phylogenies and case epidemiology. Results: Overall, 85 CPE-colonized or -infected patients were included: 50 were detected at HZ and 35 were detected at another local hospital but were admitted to HZ in the previous or following year. HZ reported 6 transmission clusters (Table 1). SNP analyses confirmed clusters B, C, E, and F. In cluster A, SNP analyses cast doubt on 2 of 9 cases (possibly representing plasmid transmission) but also identified 2 additional cases with isolates highly related (0–3 SNP differences) to other isolates. One case may be the index case: a travel-related case who stayed on the same unit as case 1, 4 months before case 1 detection. The second case stayed in a room previously occupied by 5 cluster A cases. In cluster D, SNP analyses found 1 additional case whose isolate was highly related (ie, 17–19 SNP differences) to other isolates. This case was identified a year before cluster D at another hospital that shares patients with HZ; however, the case’s admission to HZ was after all cluster D cases were detected and no direct epidemiologic link was identified. Conclusions: WGS data can identify cases belonging to transmission clusters that conventional epidemiologic methods missed.

Funding: None

Disclosures: Allison McGeer reports funds to her institution from Pfizer and Merck for projects for which she is the principal investigator. She also reports consulting fees from Sanofi-Pasteur, Sunovion, GSK, Pfizer, and Cidara