Antimicrobial prescribing differences between physicians and nurse practitioners (NPs) remain poorly characterized. We compared prescribing practices at a safety-net hospital. NPs adhered more to pneumonia guidelines, while physicians had better adherence for abdominal and urinary infections. Ineffective therapy was more common for NPs. These gaps highlight important stewardship opportunities.

Item response theory posits “local independence,” or conditional independence of item responses given item parameters and examinee proficiency parameters. The usual definition of local independence, however, addresses the context of fixed tests, and initially appears to yield incorrect response-pattern probabilities in the context of adaptive testing. The paradox is resolved by introducing additional notation to deal with the item selection mechanism.

OBJECTIVES/GOALS: Childhood psychopathology is a worsening public health crisis leading to negative life outcomes, including self-harm and suicide. Difficulty in self-control as early as 3 years old predicts psychopathology, but the mediating mechanisms of brain function are unknown. Here, we tested one mechanism: functional connectivity (FC) integration. METHODS/STUDY POPULATION: We studied a sample of 204 children [53 F/149 M/2 NC; mean age (SD)=11 years (1.7)] with diverse self-control difficulties (e.g., attention deficit disorder [n=80]; autism spectrum disorders [n=91]). We extracted a general factor of psychopathology (“p-factor”) from the parent-reported Child Behavior Checklist. For participants with high quality fMRI data on 3 self-control tasks (n=79), testing flexibility, working memory, and inhibition, we calculated FC connectomes reflecting a general self-control state, and applied connectome predictive modeling (CPM) to reveal connections predicting overall task impairment. We then measured individual variance in cross-network integration of regions with the most predictive connections and tested for association with p-factor in a multiple linear regression. RESULTS/ANTICIPATED RESULTS: We repeated CPM 1,000 times with 10-fold cross validation to generate a distribution of accuracies for predicted vs. observed task impairment scores (mean r=0.25, permutation p=0.02). Connections selected a maximum of 10,000 times (10 folds * 1,000 repetitions) were strongly predictive of task impairment (r=-0.5, p<0.001), highlighting connectivity of canonical executive networks as well as the default mode network. Regions (n=22) with the top 5% most selected connections were in lateral parietal and frontal cortices and implicated motor control. Between-network integration, operationalized with the graph theory metric participation coefficient, of one of these regions in left posterior superior frontal gyrus significantly predicted p-factor (R2=0.26, F(22,56) = 0.87; B =-0.49, p<0.05). DISCUSSION/SIGNIFICANCE: A portion of dorsolateral prefrontal cortex, associated with executive control, explained individual variance in p-factor. We plan to test alternative predictive models. Identification of such a neuro behavioral mechanism underlying psychopathology may lead to novel intervention targets.

Observations of radiocarbon (14C) in Earth’s atmosphere and other carbon reservoirs are important to quantify exchanges of CO2 between reservoirs. The amount of 14C is commonly reported in the so-called Delta notation, i.e., Δ14C, the decay- and fractionation-corrected departure of the ratio of 14C to total C from that ratio in an absolute international standard; this Delta notation permits direct comparison of 14C/C ratios in the several reservoirs. However, as Δ14C of atmospheric CO2, Δ14CO2 is based on the ratio of 14CO2 to total atmospheric CO2, its value can and does change not just because of change in the amount of atmospheric14CO2 but also because of change in the amount of total atmospheric CO2, complicating ascription of change in Δ14CO2 to change in one or the other quantity. Here we suggest that presentation of atmospheric 14CO2 amount as mole fraction relative to dry air (moles of 14CO2 per moles of dry air in Earth’s atmosphere), or as moles or molecules of 14CO2 in Earth’s atmosphere, all readily calculated from Δ14CO2 and the amount of atmospheric CO2 (with slight dependence on δ13CO2), complements presentation only as Δ14CO2, and can provide valuable insight into the evolving budget and distribution of atmospheric 14CO2.

Cultures from urinary catheters are often ordered without indication, leading to possible misdiagnosis of catheter-associated urinary tract infections (CAUTI), increasing antimicrobial use, and C difficile. We implemented a diagnostic stewardship intervention for urine cultures from catheters in a community hospital that led to a reduction in cultures and CAUTIs.

Studies of pre-bomb mollusks live-collected around the Australian coastline have concluded that near-shore marine radiocarbon reservoir effects are small and relatively uniform. These studies are based on limited samples of sometimes dubious quality representing only selective parts of Australia’s lengthy coastline. We systematically examine spatial variability in the marine radiocarbon reservoir effect (ΔR) through analysis of 292 live-collected mollusk samples across the Australian mainland coasts and near-shore islands subject to strict selection criteria. This study presents 233 new ΔR values combined with an evaluation of 59 previously published values. Results demonstrate significant spatial variability in marine radiocarbon reservoir effects across the study region. ΔR values range from 68 ± 24 14C years off the Pilbara region of Western Australia to –337 ± 46 14C years in the southern Gulf of Carpentaria in Queensland. Most sets of local values exhibit internal consistency, reflecting the dominant influence of regional oceanography, including depletion in ΔR values southwards along the eastern Australian coastline coincident with the East Australian Current. Anomalous values are attributed to inaccurate documentation, species-specific relationships with the carbon cycle and/or short-term fluctuations in marine radiocarbon activities. To account for the heterogeneous distribution of marine 14C, we recommend using a location specific ΔR value calculated using the Australian ΔR Calculator, available at: https://delta-r-calc.jcu.io/.

The target backsheath field acceleration mechanism is one of the main mechanisms of laser-driven proton acceleration (LDPA) and strongly depends on the comprehensive performance of the ultrashort ultra-intense lasers used as the driving sources. The successful use of the SG-II Peta-watt (SG-II PW) laser facility for LDPA and its applications in radiographic diagnoses have been manifested by the good performance of the SG-II PW facility. Recently, the SG-II PW laser facility has undergone extensive maintenance and a comprehensive technical upgrade in terms of the seed source, laser contrast and terminal focus. LDPA experiments were performed using the maintained SG-II PW laser beam, and the highest cutoff energy of the proton beam was obviously increased. Accordingly, a double-film target structure was used, and the maximum cutoff energy of the proton beam was up to 70 MeV. These results demonstrate that the comprehensive performance of the SG-II PW laser facility was improved significantly.

OBJECTIVES/GOALS: Childhood psychiatric symptoms are highly comorbid. Their co-occurrence and association with negative life outcomes is partially explained by deficits in executive control, or processes enabling self-regulation. Here, we test a novel executive neural target in three fMRI tasks and its relevance to shared psychopathology. METHODS/STUDY POPULATION: We studied 60 children [15 F/45 M; mean age (SD)=11.6 years (1.62)] with diverse diagnoses including attention deficit disorder (n=26) and autism spectrum disorder (n=22). We extracted a latent general factor of psychopathology using principal component analyses applied to parent-report Child Behavior Checklist syndrome scores. Subjects completed 3 executive control fMRI probes, tapping adaptive control, working memory, and inhibition. Correlational psychophysiological interaction (cPPI) analysis measured correlations between executive control-related modulations of activity in 414 network-affiliated parcels. We selected parcels exhibiting control-related cross-network correlations as well as control-related activity across all tasks and tested them for association with psychopathology. RESULTS/ANTICIPATED RESULTS: cPPI connectivity matrices were thresholded and graphs were identified using the Network-Based Statistic toolbox (p90th percentile PC) as well as control-related activation (>10% activated voxels; p DISCUSSION/SIGNIFICANCE: Our results examine cross-network interactions between brain regions during 3 fMRI tasks and their role in explaining individual variation in psychopathology. As executive control links to both comorbidity and life outcomes, identifying the clinically-relevant neural correlates of controlled behavior may lead to transdiagnostic treatments.

Point-particle direct numerical simulations have been employed to quantify the turbulence modulation and particle responses in a turbulent particle-laden jet in the two-way coupled regime with an inlet Reynolds number based on bulk velocity and jet diameter $({D_j})$ of ~10 000. The investigation focuses on three cases with inlet bulk Stokes numbers of 0.3, 1.4 and 11.2. Special care is taken to account for the particle–gas slip velocity and non-uniform particle concentrations at the nozzle outlet, enabling a reasonable prediction of particle velocity and concentration fields. Turbulence modulation is quantified by the variation of the gas-phase turbulent kinetic energy (TKE). The presence of the particle phase is found to damp the gas-phase TKE in the near-field region within $5{D_j}$ from the inlet but subsequently increases the TKE in the intermediate region of (5–20)Dj. An analysis of the gas-phase TKE transport equation reveals that the direct impact of the particle phase is to dissipate TKE via the particle-induced source term. However, the finite inertia of the particle phase affects the gas-phase velocity gradients, which indirectly affects the TKE production and dissipation, leading to the observed TKE attenuation and enhancement. Particle response to the gas-phase flow is quantified. Particles are found to exhibit notably stronger response to the gas-phase axial velocity than to the radial velocity. A new dimensionless figure is presented that collapses both the axial and radial components of the particle response as a function of the local Stokes number based on their respective integral length scales.

This paper presents a compilation of atmospheric radiocarbon for the period 1950–2019, derived from atmospheric CO2 sampling and tree rings from clean-air sites. Following the approach taken by Hua et al. (2013), our revised and extended compilation consists of zonal, hemispheric and global radiocarbon (14C) data sets, with monthly data sets for 5 zones (Northern Hemisphere zones 1, 2, and 3, and Southern Hemisphere zones 3 and 1–2). Our new compilation includes smooth curves for zonal data sets that are more suitable for dating applications than the previous approach based on simple averaging. Our new radiocarbon dataset is intended to help facilitate the use of atmospheric bomb 14C in carbon cycle studies and to accommodate increasing demand for accurate dating of recent (post-1950) terrestrial samples.

Background: Antimicrobial resistance (AMR) is an increasingly critical global public health challenge. An initial step in prevention is the understanding of resistance patterns with accurate surveillance. To improve accurate surveillance and good clinical care, we developed training materials to improve the appropriate collection of clinical culture samples in Ethiopia. Methods: Specimen-collection training materials were initially developed by a team of infectious diseases physicians, a clinical microbiologist, and a monitoring and evaluation specialist using a training of trainers (ToT) platform. Revisions after each training session were provided by Ethiopian attendees including the addition of regional and culturally relevant material. The training format involved didactic presentations, interactive practice sessions with participants providing feedback and training to each other and the entire group as well as assessments of all training activities. Results: Overall, 4 rounds of training were conducted from August 2017 to September 2019. The first 2 rounds of training were conducted by The Ohio State University (OSU) staff, and Ethiopian trainers conducted the last 2 rounds. Initial training was primarily in lecture format outlining use of microbiology laboratory findings in clinical practice and steps for collecting specimens correctly. Appropriate specimen collection was demonstrated and practiced. Essential feedback from this early audience provided input for the final development of the training manual and visual aids. The ToT for master trainers took place in July 2018 and was conducted by OSU staff. In sessions held in February and August 2019, these master trainers provided training to facility trainers, who provide training to personnel directly responsible for specimen collection. In total, 144 healthcare personnel (including physicians, nurses, and laboratory staff), from 12 representative Ethiopian public and academic hospitals participated in the trainings. Participants were satisfied with the quality of the training (typically ranked >4.5 of 5.0) and strongly agreed that the objectives were clearly defined and that the information was relevant to their work. Posttraining scores increased by 23%. Conclusions: Training materials for clinical specimen collection have been developed for use in low- and middle-resource settings and with initial pilot testing and adoption in Ethiopia. The trainings were well accepted, and Ethiopian personnel were able to successfully lead the trainings and improve their knowledge and skills regarding specimen collection. The materials are being finalized in an online format for easier open access dissemination. Further studies are planned to determine the effectiveness of the trainings in improving the quality of clinical specimen submissions to the microbiology laboratory.

Funding: None

Disclosures: None

Early researchers of radiocarbon levels in Southern Hemisphere tree rings identified a variable North-South hemispheric offset, necessitating construction of a separate radiocarbon calibration curve for the South. We present here SHCal20, a revised calibration curve from 0–55,000 cal BP, based upon SHCal13 and fortified by the addition of 14 new tree-ring data sets in the 2140–0, 3520–3453, 3608–3590 and 13,140–11,375 cal BP time intervals. We detail the statistical approaches used for curve construction and present recommendations for the use of the Northern Hemisphere curve (IntCal20), the Southern Hemisphere curve (SHCal20) and suggest where application of an equal mixture of the curves might be more appropriate. Using our Bayesian spline with errors-in-variables methodology, and based upon a comparison of Southern Hemisphere tree-ring data compared with contemporaneous Northern Hemisphere data, we estimate the mean Southern Hemisphere offset to be 36 ± 27 14C yrs older.

Combinational creativity can play a significant role in supporting designers to produce creative ideas during the early stages of new product development. This paper explores conceptual distances in combinational creativity from computational perspectives. A study conducted indicates that different computational measurements show different conceptual distance results. However, the study suggests far-related ideas could lead to outcomes that are more creative than closely-related ones. This paper provides useful insights into exploring future computational design support tools.