The authors offer reflections and lessons learned in a single pediatric tertiary center’s experience during a pediatric mass casualty incident (MCI). The MCI occurred at a holiday parade and the patients were brought to multiple community emergency departments for initial resuscitation prior to transfer to the Pediatric level 1 trauma center. In total, 18 children presented with severe blunt force trauma after a motor vehicle entered the parade route. Following initial triage in emergency departments, 10 of 18 children injured during the incident were admitted to the Pediatric Intensive Care Unit, collectively representing a system-wide stressor of emergency medicine, critical care, and surgical services. Institutional characteristics, activation of personnel and supplies, and psychosocial support for families during an MCI are important to consider in children’s hospitals’ disaster preparedness planning.

An estimated 129000 cases of Lyme borreliosis (LB) are reported annually in Europe. In 2022, we conducted a representative web-based survey of 28034 persons aged 18–65 years old in 20 European countries to describe tick and LB risk exposures and perceptions. Nearly all respondents (95.0%) were aware of ticks (range, 90.4% in the UK to 98.8% in Estonia). Among those aware of ticks, most (85.1%) were also aware of LB (range, 70.3% in Switzerland to 97.0% in Lithuania). Overall, 8.3% of respondents reported a past LB diagnosis (range, 3.0% in Romania to 13.8% in Sweden). Respondents spent a weekly median of 7 (interquartile range [IQR] 3–14) hours in green spaces at home and 9 (IQR 4–16) hours away from home during April–November. The most common tick prevention measures always or often used were checking for ticks (44.8%) and wearing protective clothing (40.2%). This large multicountry survey provided needed data that can be used to design targeted LB prevention programmes in Europe.

Food poverty is an acknowledged social determinant of health and is associated with significant adverse health outcomes(1,2). It is a growing issue on the Island of Ireland, due to a number of factors, including, the COVID-19 pandemic, chain supply issues, inflation and external geo-political events. As news media play a key role in shaping policy discourse(3)and public attitudes(4) towards health and social issues, understanding how the issue of food poverty is framed on the island of Ireland may help health promoters develop alternate framings to better advocate for effective policy measures. The overall aim of this research was to investigate the discursive construction of food poverty in the news media, and to explore public, policy and key stakeholder perceptions of food poverty.

A series of interlinked studies were conducted, including analysis of policy documents, analysis of print and broadcast news media reporting on food poverty, and qualitative interviews with news media professionals, members of the public, third sector community organisations and policymakers. In analysing how the topic is framed, the research drew on Entman’s Framing Theory. An integrated knowledge translation approach was adopted throughout the research process.

Findings from analysis of policy documents (n = 48), print (n = 81) and broadcast (n = 91) news media, and qualitative interviews with key stakeholders (n = 44) across the island of Ireland revealed four core inter-linked and over-lapping discursive frames, including: political dysfunction, economic dysfunction, social dysfunction, and individual dysfunction. A key finding included differing opinions between participants in the North and the Republic on whether lifestyle (individual dysfunction) or structural (political dysfunction) factors were salient drivers of food poverty. Those who leaned more towards understandings of food poverty that included individual dysfunction showed greater endorsement of individual and community level interventions, while those who leaned more towards understandings that included political dysfunction showed greater endorsement of policy-led interventions. This coherence was not evident in news media reporting, where media discourse more prominently highlighted community-led responses (e.g. charitable food aid), despite acknowledgement of its upstream drivers. Another key finding was the absence of the voices of those experiencing food poverty from news media reporting on the issue. While news media professionals expressed a need for case studies, third sector service providers raised questions about the ethical engagement with vulnerable populations.

The research findings highlight that the problem of food poverty is largely depicted through the lens of charity, which precludes obligations for state actors and says nothing of the right to food. Re-framing discussions of food poverty as a health and human rights issue may be a fruitful strategy in addressing the problem. Health promotors, researchers and other stakeholders interested in food poverty should move towards adopting rights-based messaging when translating knowledge, including to policymakers and the media.

Plant-based meat alternatives (PBMAs) are products made from manufactured ingredients such as protein isolates, to replicate the organoleptic and functional properties of meat(1). Traditional plant proteins (TPPs) such as tofu, tempeh and legume-based dishes are whole plant foods and have been longstanding components of the protein group of food-based dietary guidelines (FBDGs)(2). PBMAs have been added to some recently revised FBDGs(3,4), however, with considerable differences in ingredient composition, the objective of this study was to evaluate if these products are similar in terms of energy and macronutrients content.

An online audit of PBMAs available in Tesco and Sainsbury’s was completed (November 2023January 2024). On-pack information was extracted, and similar products were grouped. Within eligible categories (burgers, beef-style dishes and seafood), products were further grouped according to their classification as a PBMA or TPP. Categories such as tofu and tempeh were combined and compared with PBMA chicken fillets/chunks and beef/pork products separately. Mean energy and nutrient contents were compared using independent sample t-tests, with P values ≤ 0.05 considered statistically significant. A-scores from the UK’s Nutrient Profiling Model(5) were calculated and the EU threshold for protein claims (≥12% energy from protein)(6) was applied to determine the proportion of products within each category considered a protein source.

Within the burger category, PBMAs (n = 43) had a significantly higher mean energy (206.8 vs. 197.4 kcal/100g, P = 0.008), total fat (11.2 vs. 8.4 g/100g, P = 0.05), and saturated fat content (2.5 vs. 0.8 g/100g, P = 0.02), and significantly lower carbohydrate content (10.4 vs. 23.5 g/100g, P = 0.002) than TPPs (n = 14). Within the seafood category, PBMAs (n = 11) had a significantly lower total fat content (9.9 vs. 11.4 g/100g, P = 0.001) and significantly higher protein (6.6 vs. 4.5 g/100g, P = 0.04) and salt content (1.0 vs. 0.8 g/100g, P = 0.03) than TPPs (n = 5). PBMAs within the beef-style dishes category (n = 19) were significantly higher in energy (174.2 vs. 111.5 kcal/100g, P = 0.003) than TPPs (n = 20).

When PBMA chicken (n = 81) and beef/pork (n = 20) were compared with tofu, tempeh and jackfruit (n = 17 and 20 respectively), PBMA chicken had a significantly higher carbohydrate content (12.2 vs. 2.6 g/100g, P<0.001) and PBMA beef/pork had a significantly higher protein content (17.2 vs. 13.1 g/100g, P =0.005). PBMAs had higher mean A-scores (6.4 - 8.5) than TPPs (3.2 - 6.6) in 4/5 categories indicating they are ‘less healthy.’ Very few TPPs within the burger and seafood categories met the protein threshold compared to PBMAs.

Differences in energy, macronutrient content and A-scores, mean PBMAs and TPPs cannot be considered nutritionally equal.

The gut microbiome is impacted by certain types of dietary fibre. However, the type, duration and dose needed to elicit gut microbial changes and whether these changes also influence microbial metabolites remain unclear. This study investigated the effects of supplementing healthy participants with two types of non-digestible carbohydrates (resistant starch (RS) and polydextrose (PD)) on the stool microbiota and microbial metabolite concentrations in plasma, stool and urine, as secondary outcomes in the Dietary Intervention Stem Cells and Colorectal Cancer (DISC) Study. The DISC study was a double-blind, randomised controlled trial that supplemented healthy participants with RS and/or PD or placebo for 50 d in a 2 × 2 factorial design. DNA was extracted from stool samples collected pre- and post-intervention, and V4 16S rRNA gene sequencing was used to profile the gut microbiota. Metabolite concentrations were measured in stool, plasma and urine by high-performance liquid chromatography. A total of fifty-eight participants with paired samples available were included. After 50 d, no effects of RS or PD were detected on composition of the gut microbiota diversity (alpha- and beta-diversity), on genus relative abundance or on metabolite concentrations. However, Drichlet’s multinomial mixture clustering-based approach suggests that some participants changed microbial enterotype post-intervention. The gut microbiota and fecal, plasma and urinary microbial metabolites were stable in response to a 50-d fibre intervention in middle-aged adults. Larger and longer studies, including those which explore the effects of specific fibre sub-types, may be required to determine the relationships between fibre intake, the gut microbiome and host health.

Clostridioides difficile infection (CDI) research relies upon accurate identification of cases when using electronic health record (EHR) data. We developed and validated a multi-component algorithm to identify hospital-associated CDI using EHR data and determined that the tandem of CDI-specific treatment and laboratory testing has 97% accuracy in identifying HA-CDI cases.

Classic Maya history was rife with shifting political coalitions and disputes with the key antagonists, Tikal and the Kaan regime, at the center. Understanding how power dynamics and political shifts were experienced among subordinate polities is best viewed from multiple perspectives. We employ elements of Graeber and Sahlins' (2017) stranger-king model, focusing on exogamous marriage practices in relation to two Snake Queens ruling at Waka’. They served as direct links between the Kaan regime and the subordinate Wak polity. We focus on the political and diplomatic nature of their roles in crafting Waka's place in the overarching narratives of alliance and conquest during the sixth through the early part of the eighth centuries. The pairing of archaeological and textual data surrounding Ix Ikoom in the sixth century and Lady K'abel during the seventh century permit interrogation of women's prominence with respect to Kaan regime-building strategies during these centuries.

Background: Since 2009, the CDC has invested in nationwide outbreak response capacity through Healthcare-associated Infections and Antimicrobial Resistance (HAI/AR) Programs in public health departments. The unpredictable nature of outbreaks requires public health programs to be able to scale operations and adapt strategies to effectively respond to emerging challenges, as demonstrated by the COVID-19 pandemic. This analysis characterizes HAI/AR Programs response capacity in scalability, adaptability, and technical expertise. Method: We reviewed data from HAI/AR Programs in 50 state, 6 local, and 2 territorial health departments (August 2019–December 2022). HAI/AR responses were defined as specific public health actions to assess an acute risk and prevent further harm in the context of a confirmed or possible healthcare outbreak; responses were categorized as involving novel or targeted multi-drug resistant organisms (nMDROs), COVID-19, and HAIs or infection control breaches. Descriptive statistics were used to analyze reported responses in three domains: scalability (number of responses per year), adaptability (number of pathogens and healthcare facility types involved in responses), and technical expertise (number of responses involving onsite or remote infection control assessments). The annual number of responses conducted in 2019 was estimated based on five months of data (Aug–Dec); all other results were calculated directly. Results: From August 2019 to December 2022, 58 HAI/AR Programs reported 141,445 responses (87% COVID-19, 11% nMDROs, 2% other HAIs or infection control breaches). Annually, programs conducted an estimated 5,546 responses in 2019, and this figure rose to 42,359 in 2020, 49,124 in 2021, and 47,651 in 2022. Outbreak responses involved 110 different pathogens, including emerging infectious diseases (e.g., SARS-CoV-2, mpox), nMDRO (e.g., carbapenemase-producing organisms, Candida auris), and other pathogens (e.g., hepatitis viruses, Mycobacterium abscessus) across >20 setting types (e.g., acute care hospitals, skilled nursing facilities, ambulatory surgery centers, assisted living facilities). Additionally, programs responded to infection control breaches in the absence of identified patient infections, including drug diversion, medical device reprocessing, and injection safety breaches. Programs conducted 50,245 infection control assessments during reported responses. Conclusion: From 2019–2022, as the COVID-19 pandemic took hold, HAI/AR Programs effectively utilized CDC funding to scale their response operations with an 8-fold increase in annual response activity, including a 24% increase for non-COVID-19 responses. Programs adapted responses to various pathogens, including emerging infectious diseases, across various setting types. Health department staff utilized technical expertise to conduct infection control assessments. This analysis provides valuable insights into the resilience and impact of HAI/AR Programs nationwide.

Researchers increasingly rely on aggregations of radiocarbon dates from archaeological sites as proxies for past human populations. This approach has been critiqued on several grounds, including the assumptions that material is deposited, preserved, and sampled in proportion to past population size. However, various attempts to quantitatively assess the approach suggest there may be some validity in assuming date counts reflect relative population size. To add to this conversation, here we conduct a preliminary analysis coupling estimates of ethnographic population density with late Holocene radiocarbon dates across all counties in California. Results show that counts of late Holocene radiocarbon-dated archaeological sites increase significantly as a function of ethnographic population density. This trend is robust across varying sampling windows over the last 5000 BP. Though the majority of variation in dated-site counts remains unexplained by population density. Outliers reveal how departures from the central trend may be influenced by regional differences in research traditions, development-driven contract work, organic preservation, and landscape taphonomy. Overall, this exercise provides some support for the “dates-as-data” approach and offers insights into the conditions where the underlying assumptions may or may not hold.

OBJECTIVES/GOALS: In this study, we aim to report the role of porins and blaCTX-M β-lactamases among Escherichia coli and Klebsiella pneumoniae, focusing on emerging carbapenem resistant Enterobacterales (CRE) subtypes, including non-carbapenemase producing Enterobacterales (NCPE) and ertapenem-resistant but meropenem-susceptible (ErMs) strains. METHODS/STUDY POPULATION: Whole genome sequencing was conducted on 76 carbapenem-resistant isolates across 5 hospitals in San Antonio, U.S. Among these, NCP isolates accounted for the majority of CRE (41/76). Identification and antimicrobial susceptibility testing (AST) results were collected from the clinical charts. Repeat speciation was determined through whole genome sequencing (WGS) analysis and repeat AST, performed with microdilution or ETEST®. Minimum inhibitory concentrations (MIC) were consistent with Clinical and Laboratory Standards Institute (CLSI M100, ED33). WGS and qPCR were used to characterize the resistome of all clinical CRE subtypes, while western blotting and liquid chromatography with tandem mass spectrometry (LC-MS-MS) were used to determine porin expression and carbapenem hydrolysis, respectively. RESULTS/ANTICIPATED RESULTS: blaCTX-Mwas found to be most prevalent among NCP isolates (p = 0.02). LC-MS/MS analysis of carbapenem hydrolysis revealed that blaCTX-M-mediated carbapenem hydrolysis, indicating the need to reappraise the term, “non-carbapenemase (NCP)®” for quantitatively uncharacterized CRE strains harboring blaCTX-M. Susceptibility results showed that 56% of all NCPE isolates had an ErMs phenotype (NCPE vs. CPE, p < 0.001), with E. coli driving the phenotype (E. coli vs. K. pneumoniae, p < 0.001). ErMs strains carrying blaCTX-M, had 4-fold more copies of blaCTX-M than ceftriaxone-resistant but ertapenem-susceptible isolates (3.7 v. 0.9, p < 0.001). Immunoblot analysis demonstrated the absence of OmpC expression in NCP-ErMs E. coli, with 92% of strains lacking full contig coverage ofompC. DISCUSSION/SIGNIFICANCE: Overall, this work provides evidence of a collaborative effort between blaCTX-M and OmpC in NCP strains that confer resistance to ertapenem but not meropenem. Clinically, CRE subtypes are not readily appreciated, potentially leading to mismanagement of CRE infected patients. A greater focus on optimal treatments for CRE subtypes is needed.