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Background Sexually transmitted infections (STIs) disproportionally affect individuals living in underserved areas and Emergency Departments (ED) can play a major role in STI screening. Given the overlapping risk factors for STIs, patients screened for gonorrhea and chlamydia should also be screened for syphilis and HIV. Rates of syphilis/HIV screening in the ED are very low and barriers include lack of knowledge about the risk/prevalence, difficulty with results interpretation, and concerns about follow-up. Methods The main study objective was to improve rates of syphilis/HIV screening in a community-based ED in Columbus, OH. A team of clinical providers, case managers, and social workers was formed to address barriers to screening. Using root cause analysis and data feedback, a multistep intervention that included provider education along with expert review of syphilis/HIV results was implemented to ensure proper screening, treatment and rapid linkage to care. Syphilis/HIV screening rates in the ED were compared between two periods: 2012–2017 (pre-intervention) and November 2018–April 2019 (post-intervention). Results Between 2012 and 2017, there were 24,427 ED encounters where any STI test was ordered. There were 23,652 (97%) tests for chlamydia, 23,637 (97%) for gonorrhea, 254 (1%) for syphilis, and 466 (2%) for HIV. Twenty-four (0.1%) encounters had screening that included all four tests. Six months after starting the intervention, there were 1,590 encounters where any STI test was ordered. There were 1,444 (91%) tests for chlamydia, 1,446 (91%) for gonorrhea, 493 (31%) for syphilis and 591 (37%) for HIV. Four hundred thirty-eight (28%) of encounters had screening that included all four tests. Conclusion Collaborative and practical interventions aimed at improving syphilis/HIV testing have resulted in dramatic increases in syphilis, HIV, and comprehensive STI screening (31-, 19-, 280-fold, respectively) over a relatively short post-intervention period. Additional steps are planned with the goal to further increase screening rates and improve linkage to prevention and treatment programs. Disclosures All authors: No reported disclosures.

Background A rapid and accurate meningitis/encephalitis diagnostic test can have a significant clinical impact and improve utilization of antimicrobial agents. The FilmArray Meningitis/Encephalitis Panel, a multiplex PCR meningitis/encephalitis panel (MEP) (bioMérieux, Marcy l’Etoile, France) requires only 200 μL of cerebral spinal fluid (CSF) and takes less than 1 hour to simultaneously detect 14 pathogens. The objective of the study was to evaluate the outcome of MEP at our medical center. Methods Retrospective review of 433 patients with an MEP performed from April 2017 to March 2018. Demographics characteristics, signs and symptoms, immune status, laboratory and radiology results and antibiotic use were collected. Results Twenty-nine unique patients with positive CSF samples (Table 1). The mean age was 41 years old with 55% female predominance. The most common presentations were headache (65%) and fever (38%). Patients with H. influenzae and Group B Strepmeningitis had positive blood culture (CX) but negative CSF CX. Both the CSF and the blood CX were negative for the patient with L. monocytogenes. MEP identified six Cryptococcus sp. with concurrent positive CSF CX and Cryptococcus antigen. However, three patients had CSF Cryptococcus CX positive but MEP was negative. Only one of six patients with HHV-6 received treatment. Table 1. Pathogen Identified With FilmArray ME Panel Pathogen Detected # Positive MEP Human herpes virus-6 (HHV6)* 6 Cryptococcus gattii/neoformans* 5 Enterovirus 5 Human simplex virus (HSV)-2 4 Cytomegalovirus 3 Varicella zoster 2 HSV-1 1 Streptococcus agalactiae 1 Haemophilus influenzae 1 Escherichia coli K1 1 Listeria Monocytogenes 1 Streptococcus pneumoniae 0 Human parechovirus 0 Neisseria meningitis 0 *One patient with Cryptococcus and HHV-6 co-infection Conclusion The FilmArray MEP can rapidly diagnose ME infections, help to target therapy and allow for discontinuation of unnecessary empiric agents. Paired cultures are needed for drug susceptibility tests and in patients suspected of Cryptococcusmeningitis due to false negative MEP results. Majority of patients with HHV-6 did not receive treatment and attributed the positive result due to possibly chromosomal integration of HHV6. Multiple Pathogen Detected # of Patients Epstein–Barr Virus + HHV 6 1 Cryptococcus + HHV 6 1 Disclosures R. Hasbun, Biofire: Speaker’s Bureau, Speaker honorarium. Biomeriaux: Consultant, Consulting fee.

The workshop-hackathon was convened by the Global Biodiversity Information Facility (GBIF) at its secretariat in Copenhagen over 22-24 May 2013 with additional support from several projects (RCN4GSC, EAGER, VertNet, BiSciCol, GGBN, and Micro B3). It assembled a team of experts to address the challenge of adapting the Darwin Core standard for a wide variety of sample data. Topics addressed in the workshop included 1) a review of outstanding issues in the Darwin Core standard, 2) issues relating to publishing of biodiversity data through Darwin Core Archives, 3) use of Darwin Core Archives for publishing sample and monitoring data, 4) the case for modifying the Darwin Core Text Guide specification to support many-to-many relations, and 5) the generalization of the Darwin Core Archive to a “Biodiversity Data Archive”. A wide variety of use cases were assembled and discussed in order to inform further developments.

An important Data Management and Communication (DMAC) goal is to enable a multi-disciplinary view of the ocean environment by facilitating discovery and integration of data from various sources, projects and scientific domains. United States Integrated Ocean Observing System (U.S. IOOS) DMAC functional requirements are based upon guidelines for standardized data access services, data formats, metadata, controlled vocabularies, and other conventions. So far, the data integration effort has focused on geophysical U.S. IOOS core variables such as temperature, salinity, ocean currents, etc. The IOOS Biological Observations Project is addressing the DMAC requirements that pertain to biological observations standards and interoperability applicable to U.S. IOOS and to various observing systems. Biological observations are highly heterogeneous and the variety of formats, logical structures, and sampling methods create significant challenges. Here we describe an informatics framework for biological observing data (e.g. species presence/absence and abundance data) that will expand information content and reconcile standards for the representation and integration of these biological observations for users to maximize the value of these observing data. We further propose that the approach described can be applied to other datasets generated in scientific observing surveys and will provide a vehicle for wider dissemination of biological observing data. We propose to employ data definition conventions that are well understood in U.S. IOOS and to combine these with ratified terminologies, policies and guidelines.

In “Learning How To Read Slowly Again,” Williams Grimes commends Francine Prose’s Reading Like A Writer because it gets “the electricity flowing the right way again” by “zeroing in on single words, then sentences, then paragraphs, teasing out the specifics that transmute raw language into style and an artistically meaningful form.” Similarly, Edward Mendelson’s Things That Matter “gets right down,” Grimes says, “to the heavy work of close reading” and comes up with “riches.” To this list Grimes could easily have added Harold Bloom’s How to Read and Why (2001), Thomas Foster’s How to Read Literature Like a Professor (2003), John Sutherland’s How to Read a Novel (2006), and many similar books. These normative accounts of reading have grown explosively since the 1990s, when various critics dismissed the theoretical and cultural methods of the 1970s and 1980s and celebrated the pleasures of close reading or the value of aesthetic ideals.1

In Chapter 6, changing reading practices, especially the emergence of black feminism, show that, contrary to traditional accounts, Light in August and Jazz both subvert the conventions of detective and naturalist fiction. In these novels violent outsiders do not amount to criminals or justify the conventional norms of justice. More fully than Light in August, which preserves the modernist pessimism of Absalom, Absalom!, Jazz emphasizes, at the same time, the characters’ ability to overcome the past and improve their lives and undermines the distinctions between the individual and the community, the narrator and the characters, and the city and the country.

Acknowledgements Introduction 1.Theoretical Accounts of Reception 2.Literary Critical Studies of Reception 3.Reception Study and the History of the Book 4.Reception Study, Cultural Studies, and Mass Communication 5.Limitations and Difficulties of Reception Study

HealthPASS is a Philadelphia-based health insur ance organization (HIO), owned and operated by the Penn Health Corporation, a subsidiary of Maxicare, the large for-profit health maintenance organization (HMO) company based in California. In a contractual agreement with the Pennsylvania Department of Public Welfare (DPW), Maxicare contracts primary care physician services on a capitated basis, and other services on a fee basis, to about 96,000 Medicaid enrollees in certain zip codes in Philadelphia. Al though HealthPASS does not provide care directly, it contracts with providers for these medical services. HealthPASS serves a primarily poor, minority, and inner city population with high rates of drug abuse, alcoholism, and mental illness. Currently, the enrol lees are served by a network of providers including more than 40 participating hospitals and over 500 primary care providers (PCPs) in the community. HealthPASS is unique as previous HIOs in Kentucky and Arizona both failed. This paper describes the quality assurance and uti lization review (QA-UR) system implemented by HealthPASS with specific examples of case discus sions and a detailed look at the structure and function of the internal review process. Before outlining the QA-UR system, a brief history is provided of the recent controversial trend toward managed care for Medicaid recipients, as there have been marked fail ures in this arena nationally. The HealthPASS system is described—what it is, how it is staffed, who it serves, and the health services it offers. Discussion of the QA-UR system follows. Lastly, some of the thorny political issues that remain, such as the effort by HealthPASS to educate physicians about managed care, to develop protocols of care, and to coordinate QA-UR for so many physicians and hospitals, are examined.

THE PHYSICIAN is often called on to puncture the veins of an infant, either to obtain a sample of blood for diagnostic purposes or to administer therapy. As a rule, the antecubital veins are too small for this procedure unless a vein is exposed through an incision in the skin. In order to avoid this difficulty larger calibered veins are employed, such as the longitudinal dural sinus beneath the fontanels or the femoral or the internal jugular veins; the last-mentioned vessel is usually the one of choice. This vein, however, lies in close lateral proximity to the trachea and tracheal perforation in connection with such venipuncture can readily occur. Such accidents have not been thus far recorded in the literature. It is, therefore, my purpose in this paper to report 2 cases of accidental fatal perforation of the trachea in infants during venipuncture of the internal jugular vein and to

THIS REPORT deals with sudden and unexpected natural death in 29 cases in which the cause of death was spontaneous rupture of a saccular aneurysm of the intrapericardial portion of the ascending aorta into the pericardial cavity, with resultant hemopericardium and cardiac tamponade. The pathologist, in performing an autopsy, attempts to determine the cause of death. One of the least difficult diagnoses is that of a large hemorrhage into the pericardial cavity. If the pericardium is healthy, the hemorrhage may occur in various ways: ( a ) from spontaneous rupture of the heart wall, from chronic cardiac aneurysm or from necrosis of the myocardium after occlusion of a coronary artery; ( b ) from rupture of a dissecting aneurysm of the aorta into the pericardial cavity; ( c ) from an aneurysm of the otherwise normal coronary artery or of the pulmonary artery or from rupture of an atheromatous coronary artery; ( d ) from trauma, such as