Objectives: The International Psychogeriatric Association (IPA) definition of agitation in cognitive disorders set standard guidance for recognizing agitation behaviors in research and clinical care. Patients and caregivers were involved in developing a vocabulary to describe these behaviors and, per the IPA, additional studies will offer insights into application of the criteria in diverse cultural and linguistic populations. Based on the IPA criteria, the Agitation in Alzheimer’s Screener for Caregivers (AASC™) was developed in collaboration with clinical experts, patient advocates, and caregivers of individuals with Alzheimer’s dementia to support caregivers and healthcare professionals (HCPs) in communication and recognition of agitation in Alzheimer’s dementia. This study aims to translate and linguistically validate the AASC™ in Spanish, Simplified Chinese, and Traditional Chinese in US populations.

Methods: According to best practices outlined by the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) (Figure 1), linguistic validation of the AASC™ includes translation and validation through cognitive debriefing interviews for each target language. This process applies rigorous Methods to obtain translations that are conceptually relevant to the original tool, culturally relevant to each target language, and easily understood by those to whom the tool will be administered. For each target language, lay subjects (n = 5) over 40 years old and representative of the target population (e.g., reside in the US and fluent in Spanish, Traditional Chinese, or Simplified Chinese) will be recruited for cognitive debriefing.

Results: The specific Methods will be used to produce the linguistically validated versions of the AASC™ tool in Spanish, Traditional Chinese, and Simplified Chinese. Translatability review, forward and back translations, clinician and linguist review, harmonization, and cognitive debriefing will ensure the accuracy and consistency of the translated tool. If needed, the original tool language will be updated to account for cultural differences.

Conclusions: The AASC™ is the first screener developed for agitation in Alzheimer’s dementia based on the IPA criteria. Translation and linguistic validation of the AASC™ in Spanish and Traditional and Simplified Chinese aim to ensure clear and culturally relevant translations for each target language. Ongoing and future studies will optimize the effectiveness and cultural acceptance of the AASC™ tool.

This 2021 ASA Presidential Lecture combines sociopolitical history with personal reflections on Black Harlem during African decolonization. It begins at the turn of the twentieth century and traces Harlem’s transformation into an international center of pan-Africanist activism and cultural production. Brown explores solidarities that grew as Harlem politicians, grassroots leaders, and residents encountered political exiles and cultural leaders from the continent, the diaspora, and aligned political movements worldwide. These alliances and modes of protest facilitated a hardening of militant activist traditions and cultural cohesion that shaped an anti-imperialist pan-African movement and ultimately a multinational Black political movement in the 1960’s to 1990s.

This comparison of institutions of science advice during COVID-19 between the Westminster systems of England/UK and Ontario/Canada focuses on the role of science in informing public policy in two central components of the response to the pandemic: the adoption of non-pharmaceutical interventions (NPIs) and the procuring of vaccines. It compares and contrasts established and purpose-built bodies with varying degrees of independence from the political executive, and shows how each attempted to manage the tensions between scientific and governmental logics of accountability as they negotiated the boundary between science and policy. It uses the comparison to suggest potential lessons about the relative merits and drawbacks of different institutional arrangements for science advice to governments in an emergency.

ABSTRACT IMPACT: This research shows that physical intimate partner violence was associated with never testing for HIV while verbal intimate partner violence was associated with increased testing for HIV suggesting that HIV testing interventions should consider intimate partner violence prevention. OBJECTIVES/GOALS: HIV incidence is higher among women who experience intimate partner violence (IPV). However, few studies have assessed the association between HIV testing (regardless of the result) and the experience of IPV. Our objective was to assess the relationship between IPV and HIV testing among women from rural southwestern Uganda. METHODS/STUDY POPULATION: We conducted a whole-population, cross-sectional study including women ?18 years of age who were permanent residents in 8 villages of Rwampara District, southwestern Uganda from 2011-2012 who reported having a primary partner in the past 12 months. We surveyed participants to assess their exposure to 12 different forms of verbal, physical, and/or sexual IPV, and whether they had ever been tested for HIV. We used three separate modified Poisson regression models, clustering by village, to estimate the association between each type of IPV and ever testing for HIV, adjusting for categorical age, completion of more than primary education, and any food insecurity measured by the nine-item Household Food Insecurity Access Scale. RESULTS/ANTICIPATED RESULTS: Among 496 women with a primary partner (>95% response rate), 64 (13%) had never tested for HIV, 297 (60%) reported verbal IPV, 81 (16%) reported physical IPV, and 131 (26%) reported sexual IPV. Further, among these women, 208 (42%) were aged <30 years, 378 (76%) had a primary or no education, and 390 (79%) experienced food insecurity. Never having been tested for HIV was positively associated with physical IPV (adjusted risk ratio (ARR): 1.61, 95% confidence interval (CI): 1.02-2.56) and negatively associated with verbal IPV (ARR: 0.67, 95% CI: 0.44-0.99), but not sexual IPV (ARR: 1.05, 95% CI: 0.51-2.12). DISCUSSION/SIGNIFICANCE OF FINDINGS: Among this population of adult women with partners in Uganda, physical IPV was associated with never testing for HIV while verbal IPV was associated with increased testing for HIV. Evidence suggests that HIV testing interventions should consider IPV prevention, and future studies should focus on why certain IPV types impact HIV testing rates.

Background: In June 2019, 3 people were diagnosed with Ebola virus disease (EVD) in Kasese district, Uganda, all of whom had come from the Democratic Republic of Congo (DRC). Although no secondary transmission of Ebola occurred, an assessment of infection prevention and control (IPC) using the WHO basic IPC facility assessment checklist revealed significant gaps. Robust IPC systems are critical for the prevention of healthcare-associated infections like EVD. A rapid intervention was developed and implemented in Kasese to strengthen IPC capacity in high-risk facilities. Methods: Of 117 healthcare facilities, 50 were considered at high risk of receiving suspected EVD cases from DRC based on population movement assessments. In August 2019, IPC mentors were selected from 25 high-risk facilities and assigned to support their facility and a second high-risk facility. Mentors ensured formation of IPC committees and implemented the national mentorship strategy for IPC preparedness in non-EVD treatment facilities. This effort focused on screening, isolation, and notification of suspect cases: 4 mentorship visits were conducted (1 per week for 1 month). Middle and terminal assessments were conducted using the WHO IPC checklist 2 and 4 weeks after the intervention commenced. Results were evaluated against baseline data. Results: Overall, 39 facilities had data from baseline, middle, and end assessments. Median scores in facility IPC standard precautions increased from baseline 50% (IQR, 39%–62%) to 73% (IQR, 67%–76%) at the terminal assessments. Scores increased for all measured parameters except for water source (access to running water). Greatest improvements were seen in formation of IPC committees (41% to 75%), hand hygiene compliance (47% to 86%), waste management (51% to 83%), and availability of dedicated isolation areas (16% to 42%) for suspect cases. Limited improvement was noted for training on management of suspect isolated cases and availability of personal protective equipment (PPE) (Fig. 1). No differences were noted in scores for facilities with nonresident mentors versus those with resident mentors at baseline (48% vs 50%) and end assessments (72% vs 74%). Conclusions: This intervention improved IPC capacity in health facilities while avoiding the cost and service disruption associated with large-scale classroom-based training of health workers. The greatest improvements were seen in activities relying on behavior change, such as hand hygiene, IPC committee, and waste management. Smaller changes were seen in areas requiring significant investments such as isolation areas, steady water source, and availability of personal protective equipment (PPE). Mentorship is ongoing in moderate- and lower-risk facilities in Kasese district.

Funding: None

Disclosures: Mohammed Lamorde reports contract research for Janssen Pharmaceutica, ViiV, Mylan.

Background: Carbapenemase-producing organisms (CPOs) are a growing antibiotic resistance threat. Colonization screening can be used to identify asymptomatically colonized individuals for implementation of transmission-based precautions. Identifying high-risk patients and settings to prioritize screening recommendations can preserve facility resources. To inform screening recommendations, we analyzed CPO admission screens and screening conducted on point-prevalence surveys (PPSs) performed through the Antibiotic Resistance Laboratory Network’s Southeast Regional Laboratory (SE AR Lab Network). Methods: During 2017–2019, the SE AR Lab Network collected data via a REDCap survey for a subset of CPO screens on a limited set of easily determined patient risk factors. Rectal swabs were collected and tested with the Cepheid Carba-R. Specimens collected within 2 days of admission were classified as admission screening and the remainder were classified as PPS. Index cases were excluded from analyses. Odd ratios (ORs) and 95% confidence intervals were calculated, and a value of 0.1 was used for cells with a value of zero. Results: In total, 520 screens were conducted, which included 366 admission screens at 2 facilities and 154 screens from 27 PPSs at 8 facilities. CPOs were detected in 14 (2.7%) screens, including in 10 (2.7%) admission screens and in 4 (2.6%) contacts during PPSs; carbapenemases detected were Klebsiella pneumoniae carbapenemase (KPC) (n = 12), New Delhi Metallo-β-lactamase (NDM) (n = 1) and Verona Integron-Encoded Metallo-β-lactamase (VIM) (n = 1). One long-term acute care hospital (LTACH) performed universal admission screening, which accounted for 96% of admission screens and all 10 CPOs detected by admission screening. Mechanical ventilation (OR, 5.0; 95% CI, 1.4–18.0) and the presence of a tracheostomy (OR, 5.4; 95% CI, 1.5–19.4) were associated with a positive admission screen. Moreover, 8 facilities conducted PPSs: 4 acute care hospitals, 2 long-term acute care hospitals, and 2 nursing homes. CPO prevalence in long-term acute care hospitals was 4.8% (2 of 42), 2.4% (1 of 41) in acute care hospitals, and 1.5% (1 of 69) in nursing homes. Requiring assistance with bathing (OR, 4.8; 95% CI, 1.6–8.0) and stool incontinence (OR, 16.6; 95% CI, 13.4–19.8) were associated with a positive screen on PPSs. All 7 roommates of known cases tested negative for CPO colonization. Conclusions: Findings suggest that patients with certain easily assessed characteristics, such as mechanical ventilation, tracheostomy, or stool incontinence or who require bathing assistance, may be associated with CPO positivity during screening. Further data collection and analysis of such risk factors may provide insight for the development of more targeted admission and contact screening strategies.

Funding: None

Disclosures: None

Despite the significant health benefits of breastfeeding for the mother and the infant, economic class and race disparities in breastfeeding rates persist. Support for breastfeeding from the father of the infant is associated with higher rates of breastfeeding initiation. However, little is known about the factors that may promote or deter father support of breastfeeding, especially in fathers exposed to contextual adversity such as poverty and violence. Using a mixed methods approach, the primary aims of the current work were to (1) elicit, using qualitative methodology, the worries, barriers and promotive factors for breastfeeding that expectant mothers and fathers identify as they prepare to parent a new infant, and (2) to examine factors that influence the parental breastfeeding intentions of both mothers and fathers using quantitative methodology. A sample (N=95) of expectant, third trimester mothers and fathers living in a low-income, urban environment in Midwestern USA, were interviewed from October 2013 to February 2015 about their infant feeding intentions. Compared with fathers, mothers more often identified the benefits of breastfeeding for the infant’s health and the economic advantage of breastfeeding. Mothers also identified more personal and community breastfeeding support resources. Fathers viewed their own support of breastfeeding as important but expressed a lack of knowledge about the breastfeeding process and often excluded themselves from discussions about infant feeding. The results point to important targets for interventions that aim to increase breastfeeding initiation rates in vulnerable populations in the US by increasing father support for breastfeeding.

This article focuses on the varied workforce in and around the Enugu Government Colliery, located in south-eastern Nigeria and owned by the British colonial state. Opened in 1915 at Udi and in 1917 at Iva Valley and Obwetti, the mines were in a region with a long history of slave raids, population shifts, colonization, and ensuing changes in local forms of political organization. The mines brought together an eclectic mixture of forced and voluntary unskilled labor, prisoners, unskilled contract workers, and voluntary clerical workers and artisans. Moreover, the men were from different ethno-linguistic groups. By taking into account this complex background, the article describes the gradual process by which this group of inexperienced coalminers used industrial-protest strategies that reflected their habituation to the colonial workplace. They organized strikes against the village men, who, as supervisors, exploited them in the coalmines. Their ability to reach beyond their “traditional” rural identities as “peasants” to attack the kinsmen who exploited them indicates the extent to which the complex urban and industrial environment challenged indigenous identities based on locality as well as rural status systems and gender ideologies. One of the major divisions to overcome was the one between supposedly backward “locals”, men who came from villages close to the mine, and more experienced “foreigners” coming from more distant areas in Nigeria: the work experience as “coalmen” led “locals” to see themselves as “modern men” too, and to position themselves in opposition to authoritarian village leaders. The article thus traces the contours of the challenges confronting a new working class as it experimented with unfamiliar forms of affiliation, trust, and association with people with whom it shared new, industrial experiences. It investigates the many ways that “local” men maneuvered against the authoritarian control of chiefs, forced labor, and workplace exploitation by “native” and expatriate staff.