In this single-center, retrospective cohort study of 1169 patients requiring outpatient parenteral antimicrobial therapy, complications (i.e., bloodstream infections or venous thrombosis) occurred more frequently in patients with midlines (6.4 per 1,000 line-days) than peripherally inserted central catheters (1.1 per 1,000 line-days), adjusted hazard ratio 3.60 (95% confidence interval 1.66–7.81).

Background: The safety of midlines (MLs) versus peripherally inserted central catheters (PICCs) in the context of outpatient parenteral antimicrobial therapy (OPAT) is still debated. The Infectious Diseases Society of America guidelines currently offer a weak recommendation to consider MLs for antibiotic durations of <14 days. The purpose of this study was to quantify the ML complication rate compared to PICCs for OPAT. Methods: We performed a single-center, retrospective cohort study of MLs and PICCs placed by the bedside vascular access team for OPAT as recommended by the infectious diseases consult service at a 670-bed urban academic medical center. Between July 2019 and June 2022, 1351 catheters were placed in 1252 unique patients for OPAT. The primary exposure was the placement of a ML versus PICC, informed by selection guidelines from the Infusion Nurses Society. The primary outcome was any bloodstream infection (BSI) or superficial or deep venous thromboembolism (VTE) while the catheter was present. We estimated the hazard ratio (HR) of developing the outcome among MLs compared to PICCs using Cox proportional hazards models, accounting for multiple episodes of OPAT-related catheter placement over time in the same patient and adjusting for confounding by planned antibiotic duration of ≥14 days and the use of vancomycin. We tested whether planned antibiotic duration modified the association between catheter type and the outcome using an interaction term. Results Demographic and clinical characteristics are in Table 1. The ML complication rate was 6.1 per 1000 line-days (26 [3 BSI, 23 VTE] of 322 MLs) versus 1.2 per 1000 line-days for PICCs (40 [11 BSI, 30 VTE] of 1029 PICCs), with a higher complication rate for MLs (adjusted HR [aHR] 2.97, 95% confidence interval [CI] 1.32-6.70, p=0.01). Adjusted survival curves are given in Figure 1. The aHR was 0.97 (95% CI 0.30-3.11, p=0.96) among catheters with a planned antibiotic duration of ≤14 days and 4.11 (95% CI 2.08-8.16, p<0.01) for <14 days (p-interaction=0.03). Conclusion In this study of patients receiving OPAT, complications were uncommon but significantly more frequent for MLs than PICCs. This association appeared to differ by planned antibiotic durations of <14 days than ≤14 days. Our study calls into question the safety of MLs for OPAT, especially for prolonged durations of therapy.

Background: Previous studies demonstrated that the addition of anterior nares to axilla/groin skin testing substantially improved the detection of Candidozyma auris colonization (Proctor et al., Nature Medicine, 2021; Sansom et al., CID, 2024), but these observations were limited by small sample sizes and reflected mostly nursing home residents. We aimed to assess the benefit of adding nares testing to axilla/groin testing among hospitalized patients participating in C. auris point prevalence surveys (PPSs). Methods We conducted a prospective observational study at three long-term acute care hospitals (LTACHs) in the Chicago region, one of which also included distinct inpatient rehabilitation floors. Facilities participated in quarterly public health-led C. auris PPSs from May 2024 to October 2025. Patients underwent swab sampling at two sites: composite bilateral axillae/groin (swab 1) and bilateral anterior nares (swab 2). Samples were processed at a central laboratory for C. auris detection by PCR using a validated assay with enzymatic preprocessing and automated DNA extraction. Primary analyses were restricted to patients with results available from both sampling sites; a positive C. auris test from either body site was considered the reference standard. Analyses were performed using R v4.5.2 (www.r-project.org) and Stata/SE v18.0 (Stata Corp., College Station, TX). Results Across 18 PPSs, 769 of 867 (89%) eligible patients participated. The overall C. auris prevalence was 46% (317/685) among LTACH patients and 15% (13/84) among rehabilitation patients. Among all patients who tested positive for C. auris, 64% were in Contact Precautions for any reason at time of PPS and 34% were previously known to be C. auris colonized. After excluding 16 patients who were missing a body site specimen, 753 patients were eligible for analysis (670 LTACH, 83 rehabilitation). Among 320 patients with C. auris detected at any body site, 301 were detected by axilla/groin screening (94% sensitivity; 95% confidence interval 91% to 96%) and 234 (73%) tested positive at the anterior nares for C. auris. Inclusion of nares swabbing identified 19 additional patients who would have been missed by axilla/groin screening alone, corresponding to an incremental increase of 6%. Conclusion Among LTACH and rehabilitation patients, C. auris colonization was common and PPSs identified a substantial number of patients not previously known to be colonized. The incremental benefit of adding nares screening was modest compared to axilla/groin screening alone. Testing more body sites can identify more C. auris colonized patients, but facilities should balance benefit versus cost of expanded screening approaches.

We evaluated Clostridioides difficile admission screening in a cancer unit. Admission screening was associated with a non-significant decrease in hospital-onset C. difficile infection (CDI) incidence and a significant decrease in community-onset CDI incidence, which may reflect, in part, the artifactual impact of screening on subsequent provider testing behavior.

In a retrospective cohort study at three Chicago academic medical centers, 22/81 (27.2%) patients with a clinically adjudicated positive C. difficile test result were colonized. Recent antibiotic usage predicted true infection (adjusted odds ratio: 4.38 for infection). Restriction endonuclease analysis(REA) group Y (29.3%) replaced BI (9.3%) as the dominant strain.

Paleontology provides insights into the history of the planet, from the origins of life billions of years ago to the biotic changes of the Recent. The scope of paleontological research is as vast as it is varied, and the field is constantly evolving. In an effort to identify “Big Questions” in paleontology, experts from around the world came together to build a list of priority questions the field can address in the years ahead. The 89 questions presented herein (grouped within 11 themes) represent contributions from nearly 200 international scientists. These questions touch on common themes including biodiversity drivers and patterns, integrating data types across spatiotemporal scales, applying paleontological data to contemporary biodiversity and climate issues, and effectively utilizing innovative methods and technology for new paleontological insights. In addition to these theoretical questions, discussions touch upon structural concerns within the field, advocating for an increased valuation of specimen-based research, protection of natural heritage sites, and the importance of collections infrastructure, along with a stronger emphasis on human diversity, equity, and inclusion. These questions offer a starting point—an initial nucleus of consensus that paleontologists can expand on—for engaging in discussions, securing funding, advocating for museums, and fostering continued growth in shared research directions.

Background: Admission screening for CRO carriage may prevent transmission, but there is a lack of consensus on the best targeted approach. Using a well-characterized cohort of medical intensive care unit (MICU) patients prospectively screened for CRO carriage at time of admission (MAriMbA cohort), we compared the effectiveness of common targeted strategies (singly and in combination) available to hospitals in Illinois to identify MICU patients at risk for CRO carriage, including: (a) screening patients transferred from external facilities (e.g., short- and long-term acute care hospitals); (b) screening patients with a tracheostomy or pressure ulcer; or (c) querying the Illinois XDRO registry for prior CRO history. Methods: Results of rectal swab samples collected within 48 hours of MICU admission during 1/2017-1/2018 and cultured for CROs (carbapenem-resistant Enterobacterales [CRE], CR Pseudomonas aeruginosa [CRPA], and CR Acinetobacter baumannii [CRAB]) were used as the reference standard. Patients’ status as direct transfer from an external healthcare facility and presence of tracheostomy or pressure ulcer were collected prospectively during the MAriMbA study. History of CRO colonization before MICU admission was queried retrospectively from the Illinois XDRO Registry (xdro.org), with the limitation that most reports available during the study period were restricted to CRE. We evaluated each predictors’ independent association with admission CRO status and combined variables in a planned logistic regression modeling approach. Results: CRO colonization was detected in 37 (2.6%; including 26 CRE, 10 CRPA, and 1 patient co-colonized with CRE and CRAB) of 1,423 unique MICU admissions. For univariate analyses, presence of a tracheostomy (OR 9.32, 95% CI 4.29-20.27), presence of pressure ulcer (OR 3.07, 95% CI 1.42-6.64), transfer from an external healthcare facility (OR 1.97, 95% CI 1.02-3.82), and prior CRO history reported to the Illinois XDRO Registry (OR 72.96, 95% CI 25.83-206.07) were associated with higher odds of CRO colonization. A model combining these variables improved the predictive capability (AUC 0.73) (Table). Prior CRO history reported to the Illinois XDRO Registry identified 27% of CRO cases, with number needed to screen (NNS) of only 2 patients. Adding tracheostomy, pressure ulcer, and external facility transfer together improved detection of admission CRO cases to 68%, with NNS of 20 patients (Figure). Conclusion: In a region with well-established inter-facility communication of CRO history via the Illinois XDRO Registry, the addition of screening patients with a tracheostomy, transfer from an external facility, or pressure ulcer may improve early identification of CRO carriage at time of MICU admission.

Background: Clostridioides difficile infection (CDI) disproportionately impacts hematology-oncology patients. In June 2022, our hospital implemented screening of asymptomatic patients admitted to the hematology-oncology unit to reduce CDI rates by early identification and isolation of C. difficile carriers. We evaluated the impact of admission screening on rates of CDI and compared incidence of diarrhea and subsequent symptomatic testing stratified by asymptomatic admission testing result. Method: During the intervention period (July 2022 – July 2024), asymptomatic patients admitted to the hematology-oncology unit were tested for C. difficile (perirectal swab, Cepheid GeneXpert®, Sunnyvale, CA). Guidelines for C. difficile symptomatic testing (unformed stool, Cepheid GeneXpert®) and treatment did not change between the baseline (May 2020 – May 2022) and intervention periods. Monthly CDI rates were calculated using CDC definitions based on clinical symptoms and positive C. difficile testing (community onset [CO] if positive in the first three hospital days, hospital-onset [HO] if day 4 or later). We performed an interrupted time-series analysis adjusted for repeated measures to compare CO-CDI and HO-CDI rates per 10,000 patient-days between baseline and intervention periods. The risk of developing diarrhea through hospital day 14 or being tested for symptomatic CDI during the intervention’s first year (July 2022 – June 2023) was analyzed using a cohort of asymptomatic C. difficile carriers and non-carriers in a 1:2 ratio, matched on hospital length of stay and date of admission. Result: The incidence rate ratio was 0.45 (P=0.10) for HO-CDI (Figure 1) and 0.15 (P=0.049) for CO-CDI (Figure 2) after screening implementation. During the first year of the intervention, 25 individuals were identified as asymptomatic C. difficile carriers by positive admission screen and were matched to a cohort of 50 asymptomatic non-carriers. There were no significant differences in development of diarrhea during hospital days 1-3 or days 4-14 between carriers and non-carriers (Table). None of the carriers received symptomatic C. difficile testing during hospitalization, compared to 20% of matched non-carriers (P=0.03). Conclusion: There was no significant change in HO-CDI rates and a statistically significant reduction in CO-CDI rates after implementation of C. difficile admission screening. Patients identified as carriers at time of admission were less likely to be tested for CDI during hospitalization than non-carriers, despite similar rates of diarrhea. Admission screening for C. difficile may reduce CDI rates through a variety of mechanisms; changes in provider testing behavior for patients previously screened for C. difficile may play a role.

We present the Evolutionary Map of the Universe (EMU) survey conducted with the Australian Square Kilometre Array Pathfinder (ASKAP). EMU aims to deliver the touchstone radio atlas of the southern hemisphere. We introduce EMU and review its science drivers and key science goals, updated and tailored to the current ASKAP five-year survey plan. The development of the survey strategy and planned sky coverage is presented, along with the operational aspects of the survey and associated data analysis, together with a selection of diagnostics demonstrating the imaging quality and data characteristics. We give a general description of the value-added data pipeline and data products before concluding with a discussion of links to other surveys and projects and an outline of EMU’s legacy value.

Objectives/Goals: Identifying and indexing rare disease studies is labor intensive, especially in research centers with a large number of trials. To address this gap, we applied natural language processing (NLP) and visualization techniques to develop an efficient pipeline and user-friendly web interface. Our goal is to offer the rare disease study identification (RDSI) tool for adoption by other sites. Methods/Study Population: The RDSI retrieves study information (short and long titles, study abstract) from the IRB system. These descriptive fields are then processed by the MetaMap Lite NLP program for identifying disease terms and standardizing them to UMLS concepts. By terminology identifier mapping, the diseases intersecting with concepts in rare disease databases (Genetic and Rare Disease program and Orphanet) are further scored to pinpoint studies that focus on a rare disease. The web interface displays a scatter bubble chart as an overview of all the rare diseases, with each bubble size proportional to the number of studies for that disease. In addition to the visual navigation, users can search studies by disease name, PI, or IRB number. Search results contain detailed study information as well as the evidence used by algorithms of the pipeline. Results/Anticipated Results: The RDSI identification results and functions were verified manually and spot-checked by several study investigators. The web interface is a self-contained solution available to our staff for various use cases like reporting or environment scan. We have built in a versioning mechanism that logs the date of each major result in the process. Therefore, even as the rare disease data sources evolve over time, we will be able to preserve any historical context or perform updates as needed. The RDSI outputs are replicated to Mayo Clinic’s enterprise data warehouse daily, allowing tech-savvy users to leverage any useful intermediate results at the backend. We anticipate the performance of the rare disease identification to be further enhanced by employing the advancements in AI technology. Discussion/Significance of Impact: The RDSI represents an informatics solution that offers efficiency in identifying and navigating rare disease clinical studies. It features the use of public databases and open-source tools, manifesting return on investment from the broad translational science ecosystem. These considerations are informative and adoptable by other institutions.

Objectives/Goals: The operation of a clinical trials unit involves multifaceted tasks and stakeholders. A competent information system is critical to daily operations while ensuring smooth conduct of clinical research. We share 15 years of experience in the design and implementation of such a system at Mayo Clinic to inform other institutions with similar interests. Methods/Study Population: The Informatics team collaborated closely with nurse leaders and elicited input from additional stakeholders including nurse unit coordinators, lab managers, schedulers, investigators, study coordinators, and regulatory specialists throughout the phases of system design, development and continuous enhancements, and expansion. The stakeholders offered insights on the corresponding requirements throughout the study life cycle, from engaging with the study sponsor, operational review for protocol execution, development of study budgets, human subject protection and risk mitigation, data management and integration, to outcome monitoring, and regulatory reporting. The activities were then translated into functional components and implemented as a seamless and effective solution. Results/Anticipated Results: Patient safety, scientific rigor, operation automation, efficiency, and regulatory requirements were all considered in developing an integrated system, or the clinical research trials unit (CRTU) Tools. Our institution has leveraged the system for essential tasks from the study start-up, visit scheduling and execution, specimen collection and tracking, to individual protocol metrics and billing. We adopted a measure-as-we-go methodology so that data such as visit census, resource usage, and protocol deviation are tracked and collected during routine use of the system. Specifically, an issues/concerns/exceptions (ICE) tool is used for quality control and patient safety. Moreover, data quality greatly benefits from a task dictionary, standardizing the study activities that can be ordered and executed. Discussion/Significance of Impact: The implementation of a well-rounded clinical trials unit information system not only improves the operation efficiency and team productivity but also ensures scientific rigor and contributes to patient safety. We believe the experience can be informative to other institutions. More details will be shared in the poster.

Members of norsethite-type carbonate solid solutions with the compositions Ba(Mg1–xMnx)(CO3)2, (x = 0, 0.25, 0.50 and 0.75) have been synthesised under high-pressure and -temperature conditions (3GPa, 800°C) for the first time. The synthetic transparent crystals gradually changed their appearance from colourless to blue lustre with the increasing Mn2+ content (XMn). The results of the crystal structure analyses reveal that the lattice parameters (a, c, unit-cell volume, Mg/Mn–O bond lengths and Ba–O bond lengths) complied with a linear increase with XMn. In contrast, the C–O bond lengths and O–C–O bond angles decreased, because the CO32– group was squeezed by the expansion of the (Mg/Mn)O6 octahedra. Moreover, the Raman and infrared vibrations, except for the lattice mode T, shift to low frequency with the increasing XMn, and the slight corresponding variations of the atomic positions were also determined. These new results demonstrate the impact of Mg2+–Mn2+ substitution on the crystal chemistry of norsethite-type solid solutions, with further implications for the natural occurrence and environmental of norsethite-type and dolomite/ankerite-type carbonates.