CDC Estimates Research Articles

Abstract 3735: Regulation of HPV gene expression by 5-azacytidine treatment in head and neck cancer

Abstract Human papillomavirus (HPV) causes approximately 80% of head and neck squamous cell carcinoma (HNSCC) in the oropharynx, and its incidence is now higher than uterine cervical cancer in the US. The CDC estimates that this common sexually transmitted disease accounts for nearly 13,000 HPV+ HNSCC patients per year in the United States. Despite having a higher cure rate than HPV- HNSCC, the recurrence rate is approximately 30%. These patients have few therapeutic options since resistance to treatment arises from all known therapeutic modalities. Initial therapy for HPV+ HNSCC is aggressive and often results in negative lifelong side effects. The substantial recurrence rate and high morbidity of primary therapy suggest the need for new treatments. Global genome hypermethylation in HPV+ HNSCC, compared to HPV-, prompted our lab to explore demethylation as a therapeutic option. 5-azacytidine (5-aza) and 5-aza-2′-deoxycytidine (decitabine) are synthetic cytidine analogs that cause DNA demethylation by trapping methyltransferases to chromatin. These demethylating agents are FDA approved for the treatment of myelodysplasia and acute myeloid leukemia. Recently, we found that HPV+ HNSCC cells are more sensitive than HPV- cells to 5-aza, that low doses of 5-aza delayed HPV+ xenograft tumor growth, and that HPV+ tumor samples from patients treated with 5-aza in a window trial had increased apoptosis. We also observed a marked downregulation of HPV gene expression after 5-aza. Decreased HPV E6 expression, followed by reactivation of tumor suppressor p53, induced p53-dependent apoptosis in HPV+ HNSCC. Thus, decreased expression of HPV genes is an important component of 5-aza-associated toxicity toward HPV+ HNSCC; therefore, we further explored mechanisms through which demethylation negatively regulates the expression of HPV genes. First, we determined that 5-aza regulates transcription of HPV genes, but not the stability of HPV transcripts. Second, we found that transcriptional regulation of HPV genes after 5-aza depends on the proto-oncogene JunB, a component of the transcription factor Activator Protein 1 (AP-1). Moreover, our experiments revealed that clonogenic survival of HPV+ head and neck cancer cells is dependent on JunB expression. In summary, our study provides an improved mechanistic understanding of the regulation of HPV gene transcription in HNSCC and identifies a novel HPV+ HNSCC dependency on JunB, potentially providing a basis for a new rational targeted therapy. Citation Format: Hina Rehmani, Natalia Isaeva, Wendell G. Yarbrough. Regulation of HPV gene expression by 5-azacytidine treatment in head and neck cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 3735.

Risk factors for death and illness in dogs imported into the United States, 2010-2018.

CDC estimates 1 million dogs are imported into the United States annually. With the movement of large numbers of animals into the United States the risk of disease importation, especially emerging diseases, and animal welfare issues are of concern. Dogs that arrive to the United States ill or dead are investigated by public health authorities to ensure dogs are not infected with diseases of concern (such as rabies). We identified factors associated with illness and death in imported dogs and estimated the initial investigation cost to public health authorities. Dog importation data from the CDC’s Quarantine Activity Reporting System were reviewed from 2010 to 2018. The date of entry, country of origin, port of entry, transportation method and breed were extracted to examine factors associated with illness and death in dogs during international travel. Costs for public health investigations were estimated from data collected by the Bureau of Labor Statistics and Office of Personal Management. Death or illness was more likely to occur in brachycephalic breeds (aOR = 3.88, 95%CI 2.74–5.51). Transportation of dogs via cargo (aOR = 2.41, 95%CI 1.57–3.70) or as checked baggage (aOR = 5.74, 95%CI 3.65–9.03) were also associated with death or illness. On average, 19 dog illnesses or deaths were reported annually from 2010 to 2018. The estimated annual cost to public health authorities to conduct initial public health assessments ranged from $2,071 to $104,648. Current regulations do not provide adequate resources or mechanisms to monitor the rates of morbidity and mortality of imported dogs. There are growing attempts to assess animal welfare and communicable disease importation risks. However, because the responsibility for dogs’ health and wellbeing is overseen by multiple agencies it is challenging to coordinate implementation and enforcement measures. A joint federal agency approach to identify interventions that reduce dog morbidity and mortality during flights while continuing to protect US borders from public health and foreign animal disease threats could be beneficial.

Geriatric Psychiatry and Palliative Care: Not-So-Strange Bedfellows

More Americans are living longer and entering old age than ever before. The number of adults age 65 years and older in the United States (US) is projected to grow to more than 83.7 million by 2050. Today's 65-year-olds can expect to live, on average, another 19.4 years. However, the outcomes of extending longevity have not kept pace with the outcomes of prolonging physical, mental, and cognitive wellness. The 2012 Institute of Medicine (IOM) report estimates that 14%–20% of the elderly population is afflicted by a mental health or substance use condition, including dementia-related behavioral and psychiatric symptoms, while the CDC estimates that 22.2% of those over 65 are in fair or poor overall health. Despite this clear growing demographic need, the number of physicians formally trained in geriatric psychiatry and geriatric medicine is shrinking while those pursuing training in hospice/palliative care medicine is increasing.This session will cover several aspects of how geriatric psychiatry and palliative care may overlap in meeting the growing needs of the geriatric population through discussion of the direct clinical utility of applying palliative care concepts and techniques when caring for individuals with neurocognitive disorders and their families/caregivers, how early referrals to palliative care specialists may improve patient care/outcomes while alleviating some of the workforce burden that geriatric psychiatry and geriatric medicine providers face, and how the construction of a dedicated palliative care rotation for geriatric psychiatry fellows may better facilitate collaboration between specialties while also filling a current gap in training for geriatric psychiatrists.

Twindemic - An emerging concern in Pakistan.

Dear Madam, As winter approaches, people succumb to a myriad of winter illnesses. Seasonal Influenza (Flu) is predominantly prevalent in the USA and Pakistan. CDC reported 20,000 deaths and 380,000 hospitalizations from flu in 2019 till 2020(1). According to Dr Ebell, we are likely less immune, since we are not exposed to flu for twenty months or even more. There is uncertainty regarding flu strains since it can undergo antigenic shifts and antigenic drift that can cause the evolution of new strains (2). Therefore, CDC estimates that approximately seven hundred thousand people would get hospitalized in the upcoming flu-season (3). Flu season paired with covid-19 classically presents as “Twindemic”. Although influenza (Flu) and Covid share similar clinical symptoms, both can have severe, mild or moderate effects, mode of transmission and preventive strategies, but they still differ in their treatment modalities and vaccines. Therefore, during the covid era it has become challenging to report influenza cases as both diseases present with similar symptoms making clinical diagnosis difficult. However, some studies suggest that preventive measures used for Covid were also effective against the prevention of flu. Hence, the number of flu cases were reported to be lower than expected for the year 2020-2021. People infected with Covid and Influenza at the same time, are more prone to develop severe illness. To keep the pressure off healthcare systems, vaccination programmes are imperative. CDC has issued new guidelines for this potential twindemic this winter, stating that flu vaccines must protect against all 4 influenza virus strains that were noy t the recommendation in prior years. However, in Pakistan Flu shots are not prioritized. Even though CDC recommends a flu shot annually, there is no national influenza vaccination policy in Pakistan. Low levels of vaccination are due to little knowledge regarding the importance of influenza prevention, misinformation about its side effects and lack of public awareness (4), due to which the death toll of influenza was reported to be 42.03 per 100,000 of population as per 2018 data (5). Despite the serious health and economic consequences faced due to influenza, vaccination rates remain low. Pakistan Government must play a pivotal role to include influenza vaccination in its EPI schedule in order to make it available for the citizens at low costs. The risk of co-infection is estimated to be higher as the season changes. ---Continue

Abstract 106: Twenty Year Trends In US Stroke Mortality In Younger Vs Older Adults

Introduction: After decades of consistent declines, stroke mortality started to level off beginning in 2013, with increases seen in younger stroke patients. Methods: We performed a post hoc analysis of county-level stroke death rate per 100,000 adults, for ischemic and hemorrhagic stroke, from 1999-2018 using CDC estimates. We stratified by age 35-64 (young) and ≥65 (old), and by county-level geographic factors and unemployment rate. Results: We included data from over 3,000 counties. Figure 1 shows stroke mortality began to increase for younger patients in 2013-14, but continued to decline for older patients. The second row shows that the disparity in stroke death rate for younger rural patients was no longer significant from 2005-13 (overlapping 95% CIs), but from 2014-18, younger rural patients had a significantly higher rate of stroke death compared to urban/suburban patients. Younger patients in counties with more unemployment (vs. less) or in the South (vs. other Census regions) had higher rates of stroke death. Figure 2 shows county-level changes by 5-year periods (e.g. 1999-2003 vs. 2004-08), which highlight the spread over time of increased stroke death rate in all regions of the contiguous United States for younger patients. Conclusions: The trend of consistently decreasing stroke death rate stabilized in 2013, with subsequent increase seen for younger adults aged 35-64, particularly in rural, Southern, and high unemployment counties.

School Safety, Masking, and the Delta Variant.

School Safety, Masking, and the Delta Variant.

Estimating pediatric cases of COVID-19 over time in the United States: Filling in a gap in public use data

BackgroundCOVID-19 continues to disturb nearly all aspects of life, leaving us striving to reach herd immunity. Currently, only weekly standardized incidence rate data per age group are publicly available, limiting assessment of herd immunity. Here, we estimate the time-series case counts of COVID-19 among age groups currently ineligible for vaccination in the USA.MethodsThis was a secondary analysis of publicly available data. COVID-19 case counts by age groups were computed using incidence rate data from the CDC and population estimates from the US Census Bureau. We also created a web-based application to allow on demand analysis.ResultsA total of 78 weeks of data were incorporated in the analysis, suggesting the highest peak in cases within the 5–11-year age group on week ending 2021-01-09 (n = 61,095) followed by the 12-15-year age group (n = 58,093). As of July 24, 2021, case counts in the 5-11-year age group have expanded beyond other groups rapidly.DiscussionThis study suggests it is possible to estimate pediatric case counts of COVID-19. National agencies should report COVID-19 time series case counts for pediatric age cohorts. These data will enhance our ability to estimate the population at risk and tailor interventions accordingly.

Three Dimensional Brain Reconstruction Optimizes Surgical Approaches and Medical Education in Minimally Invasive Neurosurgery for Refractory Epilepsy.

Epilepsy is a prevalent condition that affects 1–3% of the population or about 50–65 million people worldwide (WHO estimates) and about 3.5 million people in the USA alone (CDC estimates). Refractory epilepsy refers to patients that respond inadequately to medical management alone (at least two anti-seizure medications at appropriate doses) and are appropriate candidates for other interventions such as brain surgery or the use of neurostimulators for their epilepsy. Minimally invasive techniques like stereotactic EEG electrodes offer excellent investigational abilities to study the diagnostic attributes of the seizure networks, while therapies like laser ablations and neurostimulators permit intervention and modulation of these networks to offer seizure control with minimal cognitive compromise and surgical morbidity. The accuracy of these techniques is highly contingent on precise anatomical correlation between the location of the electrodes and their proximity to relevant structures of the brain. Ensuring good anatomical correlation using 3-dimensional (3D) reconstructions would permit precise localization and accurate understanding of the seizure networks. Accurate localization of stereotactic electrodes would enable precise understanding of the electrical networks and identify vital nodes in the seizure network. These reconstructions would also permit better understanding of the proximity of these electrodes to each other and help confirm arrangement of neurostimulators to maximize modulatory effects on the networks. Such reconstructions would enable better understanding of neuroanatomy and connectivity to improve knowledge of brain structures and relations in neurological conditions. These methods would enable medical students and doctors-in-training to better their understanding of neurological disease and the necessary interventions.

Program for Reducing Obesity (PRO): An institutional review of an insurance-based weight loss program utilizing shared medical appointments.

BackgroundBased on CDC estimates in the United States, the prevalence of obesity was 42.4% in 2017–2018, and the annual cost of obesity was $147 billion in 2008. Yet studies estimate that only 20–40% of adults with obesity received counseling from their primary care providers. Recent studies using shared medical appointments (SMA), where patients are seen by a multidisciplinary team, have shown promising results in obesity management. We developed an insurance‐based weight loss program incorporating SMA, called the Program for Reducing Obesity (PRO), and report our findings here.MethodsEnrollment began in January 2019 at the UCLA Health Thousand Oaks clinic. Patients age ≥18 years with BMI ≥30 kg/m2 were eligible by referral to PRO, a program consisting of individual visits and SMAs with an obesity medicine board certified endocrinologist and registered dietitian. Primary outcomes were change in weight after 3, 6, and 12 months. Secondary outcomes included proportion that achieved ≥5% weight loss, change in percent body fat, HbA1c, HDL, triglycerides, and blood pressure.Results102 patients (mean age 59.7 years, 72% women, mean weight 103.6 kg, mean BMI 36.6 kg/m2) have been analyzed, with 91 patients completing at least 12 months of the program. Patients achieved significant weight loss: 3.0%, 5.0%, and 7.8% of their baseline weight after 3, 6, and 12 months respectively. 52% of patients lost ≥5% of their baseline weight after 12 months. Patients had significant reductions in body fat: 2.1%, 7.4%, and 6.7% of their baseline (all p ≤ 0.01) after 3, 6, and 12 months respectively. Improvements were also seen in HbA1c (p ≤ 0.01), triglycerides (p ≤ 0.04), and systolic blood pressure (p ≤ 0.07) after 12 months although not all results achieved statistical significance.ConclusionOur institutional review of PRO, an insurance‐based obesity program utilizing SMA, demonstrates a successful approach to promoting weight loss in a community‐based setting.

Divergence in the epidemiological estimates of traumatic brain injury in the United States: comparison of two national databases.

Traumatic brain injury (TBI) is a leading cause of morbidity and mortality in the US, but the true incidence of TBI is unknown. The National Trauma Data Bank National Sample Program (NTDB NSP) was queried for 2007 and 2013, and population-based weighted estimates of TBI-related emergency department (ED) visits, hospitalizations, and deaths were calculated. These data were compared to the 2017 Centers for Disease Control and Prevention (CDC) report on TBI, which used the Healthcare Cost and Utilization Project's National ("Nationwide" before 2012) Inpatient Sample and National Emergency Department Sample. In the NTDB NSP the incidence of TBI-related ED visits was 59/100,000 in 2007 and 62/100,000 in 2013. However, in the CDC report there were 534/100,000 in 2007 and 787/100,000 in 2013. The CDC estimate for ED visits was 805% higher in 2007 and 1169% higher in 2013. In the NTDB NSP, the incidence of TBI-related deaths was 5/100,000 in 2007 and 4/100,000 in 2013. In the CDC report, the incidence was 18/100,000 in both years. The CDC estimate for deaths was 260% higher in 2007 and 325% higher in 2013. The databases disagreed widely in their weighted estimates of TBI incidence: CDC estimates were consistently higher than NTDB NSP estimates, by an average of 448%. Although such a discrepancy may be intuitive, this is the first study to quantify the magnitude of disagreement between these databases. Given that research, funding, and policy decisions are made based on these estimates, there is a need for a more accurate estimate of the true national incidence of TBI.

Shingles Occurs in Only 0.5% of Myeloma Patients on Any Dose of Antiviral Prophylaxis

Background: CDC estimates that approximately 30% of persons in the U.S. will experience shingles during their lifetimes (http://www.cdc.gov/shingles/surveillance.html). The incidence among people 60 years of age and older is about 10 cases per 1,000 U.S. population annually. With a median age of 70 y.o. and frequent proteasome inhibitor use (Kim SJ et al, Clinical lymphoma & myeloma, 2008), multiple myeloma patients often receive scheduled prophylaxis for shingles with acyclovir or valacyclovir; however, there are currently no guidelines on the appropriate dosage for the prevention of shingles. Recent studies have used antiviral doses of acyclovir 2400mg/day to as low as acyclovir 200 mg/day to prevent shingles (Pour L et al., Clinical lymphoma & myeloma 2009; Kim SJ et al., Jpn J Clin Oncol 2011), but doses of 200-800 mg acyclovir per day are common in clinical practice. By reviewing all myeloma patients treated over the last 6 years, we hypothesized that a less than 1% failure rate can be achieved using the equivalent of acyclovir 400 mg twice daily in a patient with normal renal function. In addition, based on the findings of a recent study (Dosani T et al., Blood, 2017), which demonstrated that ALC/AMC ratio at time of multiple myeloma diagnosis can be used as an indicator of baseline immune status, we hypothesized in this present study that multiple myeloma patients who had shingles have a significantly lower ALC/AMC ratio on average than patients who did not have shingles.Methods: A retrospective chart review was conducted on 1,210 multiple myeloma patients treated at The Ohio State University Wexner Medical Center. In addition to demographic information on age, gender, age at multiple myeloma diagnosis, multiple myeloma stage and karyotype, and length of survival, information on the presence of shingles after the diagnosis of multiple myeloma, medication and dosage of prophylactic antivirals, and compliance to medication was also collected. For patients who developed shingles and were compliant with prescribed antiviral medication, their effective dose of antiviral was determined by dividing their dose of antiviral per day by their estimated GFR at the time of shingles diagnosis. Valacyclovir was converted to an equivalent dose of acyclovir (acyclovir 400 mg = valacyclovir 250 mg). GFR was determined by the CKD-EPI method, using serum creatinine and weight values taken near the time of shingles diagnosis. ALC/AMC ratios were estimated using ALC and AMC values taken near the time of multiple myeloma diagnosis. Patients with shingles were compared to an equal number of age- and gender-matched controls using a Wilcoxon rank-sum test, and patients with no ALC or AMC values taken near time of diagnosis were excluded from final comparison.Results: Demographic information on the patients included in this study can be found in Table 1. Out of 1210 multiple myeloma patients, 127 patients (10.5%) developed shingles after diagnosis, and of these, only 6 patients (0.5%) were both prescribed a prophylactic antiviral (acyclovir or valacyclovir) and were compliant with their antiviral medication (Figure 1). Most patients (77%) were not receiving antiviral prophylaxis, and even if antivirals were prescribed, only 21% were compliant. The average time from multiple myeloma diagnosis to shingles diagnosis was 1.7 years. For patients prescribed acyclovir prophylaxis, doses ranged 0-2400 mg/day, with most patients (62%) taking 800mg/day and 49% of patients taking 400mg/day (Table 2). Percentages do not add up to 100% since many patients had their doses changed over time. ALC/AMC ratios were not significantly different (p=0.78) between patients with shingles vs controls (Figure 2).Discussion: Shingles occurred in 10% of myeloma patients during the retrospective period. Only twenty percent of myeloma patients that suffered a shingles exacerbation were prescribed an antiviral, and, if they were prescribed an antiviral, only 6 of 127 (4.7%) patients who developed shingles were taking prophylactic antivirals as prescribed. Given a compliance rate of 20.7% among patients diagnosed with shingles, compliance more than dose should be emphasized in preventing shingles exacerbations. This highlights the value of patient education and compliance strategies to decrease patient morbidity in clinical practice (Bender BG, JAMA Pediatr, 2015). [Display omitted] DisclosuresHofmeister:Janssen: Research Funding; Thrassos: Honoraria, Membership on an entity's Board of Directors or advisory committees; Adaptive Biotechnologies: Honoraria, Membership on an entity's Board of Directors or advisory committees; Roche: Research Funding; Takeda: Research Funding; Karyopharm: Research Funding; Bristol-Myers Squibb: Research Funding; Celgene: Research Funding.

Calcitonin (FORTICAL, MIACALCIN) for the treatment of vertebral compression fractures.

Osteoporosis is a common condition affecting the musculoskeletal system. It carries with it increased risks of fracture in many areas of the body, leading to reduced quality of life, limited mobility, and other long-term implications such as chronic pain. Vertebral compression fractures are a common development in patients with osteoporosis. Current treatment options focus on reducing pain; preventative methods are somewhat limited and focus on minimizing risk factors for the development of osteoporosis. In this review, we explore the use of calcitonin (FORTICAL, MIACALCIN) to treat vertebral compression fractures (VCFs). Osteoporosis had a prevalence of more than 10% in the United States in 2010. The CDC estimates that nearly 25% of women over age 65 have findings of osteoporosis, which include low spinal bone mass. The condition is highly prevalent and, in an aging U.S. population, quite clinically relevant. Risk factors for development include advanced age, cigarette smoking, medications, reduced physical activity, and low calcium and vitamin D intake. Family history may also play a role. Diagnosis is made based on bone mineral density.Standard therapy for VCFs in osteoporosis includes analgesic medications, such as NSAIDs and biphosphonates, and surgical intervention. NSAIDs address the chronic pain that is a common long-term effect of VCFs. Biphosphonates have recently been used to attempt to halt the progression and provide prevention. Surgical interventions such as balloon kyphoplasty and vertebroplasty are typically reserved for patients who have failed other methods.Calcitonin is a peptide naturally produced by the human body, released from the parathyroid gland. It binds to osteoclasts, inhibiting them from inducing bone resorption. By relatively unknown mechanisms, it also appears to cause endorphin release and mitigate pain. Clinical data has shown safety and efficacy for exogenous calcitonin in reducing bone turnover and reducing VCF-induced pain. Osteoporosis is a common condition that can lead to complications such as vertebral compression fractures. It can significantly impact the quality of life in many elderly Americans. There is currently no singular treatment, but calcitonin has recently been explored as a possible option for minimizing pain and reducing disease progression. Further studies are needed to understand its preventative benefits fully.

Microbiome Dysbiosis in Obese Adolescents: A Potential Contributor to Inflammation

Introduction Adolescent obesity remains a public health concern, as the CDC estimates that 1 in 5 adolescents is obese. The development of obesity during childhood not only increases the chance of obesity-related death, but also increases the risk of obesity-related chronic diseases such as type 2 diabetes mellitus, hypertension, and dyslipidemia. Increased inflammation is associated with adipose tissue in obesity and is a main contributor to the development of obesity-related disease. Dysbiosis of the gut microbiome may also contribute to obesity-related systemic inflammation. In this study, patients were educated on dietary habits and exercise in an effort to understand the effect of lifestyle changes on inflammatory markers in the urine. Furthermore, we investigated the gut microbiome profiles of obese adolescents to determine if differences existed from that of healthy adolescents. Methods The study was performed at the Department of Pediatrics at TTUHSC, Amarillo. IRB approval was obtained, and informed consent/assent were signed by the parents and adolescents. Twenty-two obese adolescents ages 8-18 (BMI >25) and 16 healthy adolescents (BMI <25) were recruited into the study. At the start of the study, patients were educated on dietary changes and exercise. Urine samples were collected at enrollment, and at 3- and 6-months post-enrollment visits. Urine samples were analyzed for the presence of pro-inflammatory cytokines TNF-a and IL-6, as well as the marker for endothelial dysfunction, ET-1. Stool samples were procured at the time of enrollment and 16s metagenome sequencing was performed to determine microbiome composition. Results Adolescents with obesity exhibited higher levels of pro-inflammatory TNF-α and IL-6 (3.4 and 1.6-fold increase, respectively) in urine compared to healthy controls. Furthermore, we noted a 1.4-fold increase in urinary ET-1 of obese adolescents. Interestingly, TNF-a, IL-6, and ET-1 levels in the urine decreased in obese adolescents over a period of 6 months, suggesting that changes in diet and exercise may have contributed to these changes. Analysis of the 16s metagenome indicated a difference in the presence of 80 bacterial species between the gut microbiomes of healthy and obese adolescents, as healthy adolescents had 63 bacterial species that exhibited at least a 2-fold higher amount than obese adolescents. Conclusions Obesity is a preventable condition that can result in systemic inflammation and chronic disease. In this study, we found that obese adolescents exhibited higher levels of urinary inflammatory cytokines and altered gut microbiome composition compared to healthy controls. Furthermore, we noted that lifestyle changes over 6 months resulted in decreased urinary inflammatory markers in obese adolescents. The results of this study suggest that the altered gut microbiomes of obese adolescents may be responsible for increased urinary inflammatory cytokine levels and that lifestyle changes may attenuate urinary inflammatory cytokines.

Differential neuropathology and functional outcome after equivalent traumatic brain injury in aged versus young adult mice

The CDC estimate that nearly 3 million Americans sustain a traumatic brain injury (TBI) each year. Even when medical comorbidities are accounted for, age is an independent risk factor for poor outcome after TBI. Nonetheless, few studies have examined the pathophysiology of age-linked biologic outcomes in TBI. We hypothesized that aged mice would demonstrate more severe neuropathology and greater functional deficits as compared to young adult mice after equivalent traumatic brain injuries. Young adult (14-week-old) and aged (80-week-old) C57BL/6 male mice underwent an open-head controlled cortical impact to induce TBI or a sham injury. At 30-days post-injury groups underwent behavioral phenotyping, magnetic resonance imaging, and histologic analyses. Contrary to our hypothesis, young adult TBI mice exhibited more severe neuropathology and greater loss of white matter connectivity as compared to aged mice after TBI. These findings correlated to differential functional outcomes in anxiety response, learning, and memory between young adult and aged mice after TBI. Although the mechanisms underlying this age-effect remain unclear, attenuated signs of secondary brain injury in aged TBI mice point towards different inflammatory and repair processes between age groups. These data suggest that age may need to be an a priori consideration in future clinical trial design.

962. Linkage to Care Outcomes among Known HIV-Positive Patients at a High Prevalence Urban Hospital Emergency Department

BackgroundRetention in care of persons with HIV (PWH) is essential for achieving viral suppression and decreasing community transmission. CDC estimates that the 23% of known PWH not retained in care account for 43% of all new transmissions. This study seeks to describe the impact of an opt-out ED screening with navigator-assisted linkage to care (LTC) protocol for out of care PWH.MethodsAn IRB-approved retrospective chart review was conducted among PWH (prior positive) inadvertently retested in the ED between 2015 and 2018. Univariate and multivariate logistic regression was used to identify factors associated with LTC with patient navigator (PN) support. Factors with p ≤ 0.1 were included in the multivariate analysis as were age and sex at birth. Patients who died were excluded from statistical analyses.ResultsAmong 464 patients who tested positive, 338 (73%) were known positive with 120 (35%) of those out of care at the time of screening. Mean age for this group was 47 (SD 11.9); 57% male, 81% non-Hispanic black, 10% Hispanic, and 6% non-Hispanic white. Fifty-five (46%) patients were successfully LTC, 54 (45%) referred to the state for linkage, and 11 (9%) died. A total of 109 patients were included in the analysis. Univariate analysis was performed for age (F(1, 107) = 0.98, p = 0.324) and female sex at birth (OR = 1.42 [95% CI 0.66, 3.05], p = 0.373) as well as Hispanic race (OR = 3.33 [95% CI 0.84, 13.04], p = 0.085), heterosexual HIV risk (OR = 2.76 [95% CI 1.27, 5.99], p = 0.011), IDU (OR = 0.49 [95% CI 0.21, 1.11], p = 0.088), and other SUD (OR = 0.42 [95% CI 0.19, 0.94], p = 0.035). Only heterosexual HIV risk (OR = 3.01 [95% CI 1.23, 7.32], p = 0.015) maintained significance in the final multivariate model.ConclusionOpt-out ED screening revealed >30% of known positive PWH were out of care at the time of testing; of whom nearly 50% were LTC with PN support. It is possible that persons reporting heterosexual HIV risk may feel less stigmatized and therefore are more likely to LTC. Similarly, the association with SUD, albeit non-significant, may reflect underrepresentation of individuals with SUD in remission among patient navigators. Future opt-out ED screening protocols should build upon diverse care teams to further engage patients with SUD and those at risk for non-heterosexual HIV transmission.Disclosures All Authors: No reported disclosures

142. Implementing an Antimicrobial Stewardship Program in the Outpatient Setting

BackgroundAntimicrobial-resistant infections lead to increased morbidity, mortality, and healthcare costs. Among the most facile modifiable risk factors for developing resistance is inappropriate prescribing. The CDC estimates that 47 million (or ≥30% of) outpatient antibiotic prescriptions in the United States are unnecessary. This has provided impetus for expanding our antimicrobial stewardship program (ASP) into the outpatient setting. Initial goals included the following: continuous evaluation and reporting of antibiotic prescribing compliance; minimize underuse of antibiotics from delayed diagnoses and misdiagnoses; ensure proper drug, dose, and duration; improve the percentage of appropriate prescriptions.MethodsTo achieve these goals, we first sent a baseline survey to outpatient prescribers, assessing their understanding of stewardship and antimicrobial resistance. Questions were modeled from the Illinois Department of Public Health (IDPH) Precious Drugs & Scary Bugs Campaign. The survey was sent to prescribers at 19 primary care and three immediate/urgent care clinics. Compliance rates for prescribing habits were subsequently tracked via electronic health records and reported to prescribers in accordance with IRB approval.ResultsPrescribers were highly knowledgeable about what constitutes appropriate prescribing, with verified compliance rates highly concordant with self-reported rates. However, 74% of respondents reported intense pressure from patients to inappropriately prescribe antimicrobials. Compliance rates have been tracked since December 2018 and comparing pre- with post-intervention rates shows improvement in primary care since reporting rates to prescribers in August 2019.ConclusionReporting compliance rates has been helpful in avoiding inappropriate antimicrobial therapy. However, the survey data reinforce the importance of behavioral interventions to bolster ASP efficacy in the outpatient setting. Going forward, posters modeled off of the IDPH template will be conspicuously exhibited in exam rooms, indicating institutional commitment to the enumerated ASP guidelines. Future studies will allow for comparison of pre- and post-intervention knowledge and prescriber compliance.Disclosures All Authors: No reported disclosures

Pneumococcal Pneumonia Vaccination Among Older African American and Hispanic Men With Chronic Conditions

The CDC estimates that 70% of adults ages 65 years and older received the pneumococcal pneumonia vaccination (PPV). However, documented PPV rates are substantially lower for men, especially non-white men. This study examined common and unique factors associated with PPV among racial/ethnic minority men age 65 and older with one or more chronic conditions. Data were analyzed from a national sample of 470 African American (n=267) and Hispanic (n=203) males using an internet-delivered questionnaire. Two binary logistic regression models were fitted to compare factors associated with PPV. On average, participants were age 70.1(±4.5) years and reported 3.9(±2.6) chronic conditions. PPV rates were 56.8% and 43.2% among African American and Hispanic males, respectively. Across models, men who received vaccines for influenza (P<0.001) and shingles (P<0.01) were more likely to receive the PPV; whereas, those who reported more disease self-care barriers were less likely to receive the PPV (P<0.05). Among African American males, those who were widowed (OR=3.80, P=0.022) and had an annual eye examination (OR=3.10, P=0.001) were more likely to receive the PPV; whereas, divorced/separated men were less likely to receive the PPV (OR=0.33, P=0.003). Among Hispanic males, those who took more medications daily (OR=1.36, P=0.005), reported higher disease self-management efficacy (OR=1.15, P=0.011), and had a colon cancer test in the past 12 months (OR=3.55, P=0.007) were more likely to receive the PPV. Findings suggest the need for culturally tailored education and self-management interventions to increase PPV and preventive healthcare service utilization among older racial/ethnic minority men.

Characterization of Fall and Refall Risk Factors in the Elderly Presenting to the Emergency Department: Retrospective Chart Review Protocol

Background/Objective: Falls are a major contributor to morbidity and mortality of the elderly population. Aside from the direct burden of falls on the patients, the CDC estimates falls cost around $50 billion annually, most of which is covered by Medicare/Medicaid. There are, however, fall prevention clinics that are focused on prevention and fall avoidance training in order to decrease the risk of falls. The goal of this work is to identify the population that is at a heightened risk of falls and analyze how this risk is mitigated with completion of a fall prevention program. &#x0D; Methods: Men and women over the age of 65 who presented to the ED from January 2015- January 2019 were considered for the chart review. Approximately 480 charts are to be analyzed assuming 10% loss due to lack of data in chart or expiration of the patient. Medical history, fall history, and demographics will be input into a data collection tool designed by the researchers. Statistical significance will be identified by Fishers test, unpaired t-test, Χ2 test appropriately. Fall risk factors that are identified as significant will be used in univariate and multivariate logistic regression to test for predictive value. &#x0D; Results: This work produced an IRB submission draft, RedCap data collection tool and is pending approval by Parkview Health IRB for Fall 2020. The researchers anticipate beginning work on the study in Spring 2021. &#x0D; Impact and Implications: Identification of risk factors associated with falls and refall events may be used to better distinguish the patient population that would benefit from a fall clinic referral. Increased knowledge of risk factors and protocolization of referrals may lead to decreased morbidity and mortality among the elderly as well as relieve some.

The ICEL Healthcare-Associated Infection Probability Equation

Backround: In American hospitals alone, the CDC estimates that hospital acquired infections (HAIs) account for an estimated 1.7 million infections and 99,000 associated deaths each year.1 Although the United states and most industrialized nations have made strides in lowering the overall HAI rate by taking critical steps to reduce HAIs, an overall formula that combines a global risk assessment per patient for HAI acquisition has yet to be established. To address this issue, we developed the ICEL equation. This equation uses a probabilistic argument to estimate the likelihood of HAI acquisition and to promote infection control dialogue among healthcare practitioners from diverse healthcare disciplines. Methods: We defined HAI risk using the ICEL acronym as follows: HAI risk = (I + C + E + L), where I is invasive devices present; C is patient-specific characteristics; E is the average number of pathogenic organisms in the patient environment; and L is the length of stay. A simple scale of 1–10 points is subjectively assigned for each of the following categories:I = (number of invasive devices / surgeries / % body surface areas open)C = Patient specific characteristics (immune system integrity / immunomodulators / radiation exposure / chemotherapy, etc)E = Environmental conditions / cleaning (average number of pathogenic bacteria in room, 100% hand hygiene compliance, patient / staff colonization, etc)L = Length of stay days risk, where 0–3 days is low risk, 4–7 is moderate risk, and 8–10+ is high riskSumming the points for each of the 4 categories, the greatest possible total is 40. A total score of 0–10 indicates low risk of HAI; 11–20 indicates low-to-medium risk of HAI; 20–30 indicates a high risk of HAI; and 30–40 indicates a very high risk of HAI. Results:This equation was designed to stimulate thought and encourage multidisciplinary cooperation among providers, nursing, environmental services, and facilities departments rather than provide an exact number for HAI risk. All of these categories are key players in the determining patient risk of acquiring an HAI. If any of the 4 hospital departments mentioned fails in their duties, the patient is at higher risk of HAI. Conclusions: This categorical HAI risk assessment relies on the subjective medical and environmental knowledge of the assessor to assign risk across the continuum of the healthcare environment. Although it is nearly impossible to provide exact numbers regarding total risk in these risk categories, the goal of the scoring system is to encourage clinical dialogue among hospital staff so that they communicate and collaborate within their specialties and with their peers to assure that each category poses as low a risk as possible, thus driving the total risk for HAI lower.1. https://www.cdc.gov/hai/data/portal/progress-report.htmlFunding: NoneDisclosures: None

Taking steps to slow the upswing in oral and pharyngeal cancers

The CDC estimates that 70% of these cancers are caused by HPV. And yet, in 2018, only about two-thirds of adolescents had received 1 or more doses of HPV vaccine.