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Background: Several studies have demonstrated a patient preference for physicians wearing a white coat associated with improved patient satisfaction. There are few studies on physicians’ perceptions of attire mainly done in the outpatient and surgical specialties. Objective: Assess non-surgical physicians’ perception of attire in the hospital and to identify if any difference in the choice of attire amongst generation X and millennial physicians. Methods: We surveyed 86 physicians in the hospital with six sets of pictures of commonly worn physician attires in the hospital setting with a two-part questionnaire. Key Results: Formal attire with a white coat was found to be most favored, followed by formal without a white coat. Casual attire without a white coat was the least preferred across the surveyed attributes. The results were similar in generation X and millennial physicians. Only 49% concordance was observed with what physicians preferred and what they wore. Conclusion: Our study showed that physicians felt wearing a white coat was the best to convey specific attributes like honesty, confidence, professionalism, among others, similar to prior studies done in patients. However, less than half of the physicians surveyed themselves followed the preferred attire.

BACKGROUND: The availability of accurate, reliable, and timely clinical data is crucial for clinicians, researchers, and policymakers so that they can respond effectively to emerging public health threats. This was typified by the recent SARS-CoV-2 pandemic and the critical knowledge and data gaps associated with novel Coronavirus 2019 disease (COVID-19). We sought to create an adaptive, living data mart containing detailed clinical, epidemiologic, and outcome data from COVID-19 patients in our healthcare system. If successful, the approach could then be used for any future outbreak or disease. METHODS: From 3/13/2020 onward, demographics, comorbidities, outpatient medications, along with 75 laboratory, 2 imaging, 19 therapeutic, and 4 outcome-related parameters, were manually extracted from the electronic medical record (EMR) of SARS-CoV-2 positive patients. These parameters were entered on a registry featuring calculation, graphing tools, pivot tables, and a macro programming language. Initially, two internal medicine residents populated the database, then professional data abstractors populated the registry. Clinical parameters were developed with input from infectious diseases and critical care physicians and using a modified COVID-19 worksheet from the U.S. Centers for Disease Control and Prevention (CDC). Registry contents were migrated to a browser-based, metadata-driven electronic data capture software platform. Eventually, we developed queries and used various business intelligence (BI) tools which enabled us to semi-automate data ingestion of 147 clinical and outcome parameters from the EMR, via a large U.S. hospital-based, service-level, all-payer database. Statistics were performed in R and Minitab. RESULTS: From March 13, 2020 to May 17, 2021, 549,691 SARS-CoV-2 test results on 236,144 distinct patients, along with location, admission status, and other epidemiologic details are stored on the cloud-based BI platform. From March 2020 until May 2021, extraction of clinical-epidemiologic parameter had to be performed manually. Of those, 543 have had >/=75 parameters fully entered in the registry. Ten clinical characteristics were significantly associated with the need for hospital admission. Only one characteristic was associated with a need for ICU admission. Use of supplemental oxygen, vasopressors and outpatient statin were associated with increased mortality. Initially, 0.5hrs −1.5 hours per patient chart (approximately 450-575 person hours) were required to manually extract the parameters and populate the registry. As of May 17, 2021, semi-automated data ingestion from the U.S. hospital all-payer database, employing user-defined queries, was implemented. That process can ingest and populate the registry with 147 clinical, epidemiologic, and outcome parameters at a rate of 2 hours per 100 patient charts. CONCLUSION: A living COVID-19 registry represents a mechanism to facilitate optimal sharing of data between providers, consumers, health information networks, and health plans through technology-enabled, secure-access electronic health information. Our approach also involves a diversity of new roles in the field, such as using residents, staff, and the quality department, in addition to professional data extractors and the health informatics team. Initially, due to the overwhelming number of infections that continues to accelerate, and the labor/time intense nature of the project, only a small fraction of all patients with COVID-19 had all parameters entered in the registry. Therefore, this report also offers lessons learned and discusses sustainability issues, should others wish to establish a registry. It also highlights the registry's local and broader public health significance. Beginning in June 2021, whole-genome sequencing results such as lineages harboring important viral mutations, or variants of concern will be linked to the clinical meta-data.

Purpose: The design-thinking intergenerational service-learning model (DTISLM) has structured ageing-related trainings on strategies to improve empathy among college students for intergenerational program development and promote positive relationships and wellbeing between younger and older generations in community-based settings. The objective of this study was to examine the effects of DTISLM on college students’ ageism, intergenerational relationships, and health. Method: Mixed-methods data were collected via pre–post surveys and after-class reflection notes from 142 students from three universities in Taiwan. Results: DTISLM significantly improved college students’ level of empathy toward older adults, age stereotypes, intergenerational relationships, wellbeing (i.e., life satisfaction), and health behaviors (i.e., exercise). This intervention promoted health awareness among college students. Discussion: Via hands-on trainings for empathy improvement, DTISLM empowered college students to develop intergenerational programs that promoted positive intergenerational relationships and healthy habits. This sheds new light on university–community partnerships involving intergenerational service needs to create age-friendly societies globally.

Objectives: To analyze treatment outcomes for patients with COVID-19 with and without compassionate use of Remdesivir. Methods: A retrospective review of electronic medical records for patients who did not receive Remdesivir due to unavailability. Match-population analysis based on inclusion criteria for compassionate use Remdesivir of the patient population who received Remdesivir as reported in literature and patients without Remdesivir. Results: Sixty-six percent of patients met the criteria for compassionate use Remdesivir, 41% required intensive care unit admission, 20% invasive ventilation, and 10% died. The median time of hospitalization for survivors was eight days. In the separate group of patients who did not meet the criteria for compassion use Remdesivir, mortality among patients with CrCl > 30 ml min, an exclusion criterion, was significantly higher as compared with patients with CrCl < 30 ml min. Conclusion: When compared with previously reported data from patients who received compassionate use Remdesivir, our population had notably fewer patients requiring invasive ventilation.

We present the first systematic, global stocktake of the academic literature on human adaptation. We screen 48,316 documents and identify 1,682 articles that present empirical research documenting human efforts to reduce risk from climate change and associated hazards. Coding and synthesizing this literature highlights that the overall extent of adaptation across global regions and sectors is low. Adaptations are largely local and incremental rather than transformative. Behavioural adjustments by individuals and households are more prevalent than any other type of response, largely motivated by drought and precipitation variability. Local governments and civil society are engaging in risk reduction across all sectors and regions, particularly in response to flooding. Urban technological and infrastructural adaptations to flood risk are prevalent in Europe, while shifts in farming practices dominate reporting from Africa and Asia. Despite increasing evidence of adaptation responses, evidence that these responses are reducing risks (observed and projected) remains limited.

Climate change adaptation responses are being developed and delivered in many parts of the world in the absence of detailed knowledge of their effects on public health. Here we present the results of a systematic review of peer-reviewed literature reporting the effects on health of climate change adaptation responses in low- and middle-income countries (LMICs). The review used the ‘Global Adaptation Mapping Initiative’ database (comprising 1682 publications related to climate change adaptation responses) that was constructed through systematic literature searches in Scopus, Web of Science and Google Scholar (2013–2020). For this study, further screening was performed to identify studies from LMICs reporting the effects on human health of climate change adaptation responses. Studies were categorised by study design and data were extracted on geographic region, population under investigation, type of adaptation response and reported health effects. The review identified 99 studies (1117 reported outcomes), reporting evidence from 66 LMICs. Only two studies were ex ante formal evaluations of climate change adaptation responses. Papers reported adaptation responses related to flooding, rainfall, drought and extreme heat, predominantly through behaviour change, and infrastructural and technological improvements. Reported (direct and intermediate) health outcomes included reduction in infectious disease incidence, improved access to water/sanitation and improved food security. All-cause mortality was rarely reported, and no papers were identified reporting on maternal and child health. Reported maladaptations were predominantly related to widening of inequalities and unforeseen co-harms. Reporting and publication-bias seems likely with only 3.5% of all 1117 health outcomes reported to be negative. Our review identified some evidence that climate change adaptation responses may have benefits for human health but the overall paucity of evidence is concerning and represents a major missed opportunity for learning. There is an urgent need for greater focus on the funding, design, evaluation and standardised reporting of the effects on health of climate change adaptation responses to enable evidence-based policy action.

Assessing global progress on human adaptation to climate change is an urgent priority. Although the literature on adaptation to climate change is rapidly expanding, little is known about the actual extent of implementation. We systematically screened >48,000 articles using machine learning methods and a global network of 126 researchers. Our synthesis of the resulting 1,682 articles presents a systematic and comprehensive global stocktake of implemented human adaptation to climate change. Documented adaptations were largely fragmented, local and incremental, with limited evidence of transformational adaptation and negligible evidence of risk reduction outcomes. We identify eight priorities for global adaptation research: assess the effectiveness of adaptation responses, enhance the understanding of limits to adaptation, enable individuals and civil society to adapt, include missing places, scholars and scholarship, understand private sector responses, improve methods for synthesizing different forms of evidence, assess the adaptation at different temperature thresholds, and improve the inclusion of timescale and the dynamics of responses. Determining progress in adaptation to climate change is challenging, yet critical as climate change impacts increase. A stocktake of the scientific literature on implemented adaptation now shows that adaptation is mostly fragmented and incremental, with evidence lacking for its impact on reducing risk.

We retrospectively compared outcomes between patients who received compassionate care Remdesivir and whose who met criteria for Remdesivir, but did not received it due to period of unavailability. We observed comparable mortality rate and significantly higher mortality rate among patients with CrCl < 30 ml per minute.

Summary Purpose To validate a conceptual short-form health literacy 12 items questionnaire (HL-SF12) in patient populations. Methods A cross-sectional study was conducted via a convenient sample of 403 patients from three departments of a community general hospital in the northern Taiwan. Patients' health literacy was assessed with a validated HL-SF12, derived from the full scale, the European Health Literacy Survey Questionnaire (HLS-EU-Q), as well as a single-item from Chew's Set of Brief Health Literacy Question. A reference population in Northern Taiwan ( n =928) via the HLS-EU-Q in 2013–2014 was used as a reference to compare the health literacy between that of the general public and the patients. Data was analyzed by confirmatory factor analysis (CFA), internal consistency analysis, correlation analysis, and linear regression models. Results Patients' health literacy assessed with the HL-SF12 was shown with high internal consistency (Cronbach α=.87), and moderately correlated with the single-item from Chew's Set of Brief Health Literacy Question, with satisfactory item-scale convergent validity (item-scale correlation ≥ .40), without floor/ceiling effect, and with satisfactory goodness of fit indices of the three-factor construct model for most of the patients. Their health literacy was significantly positively associated with female gender, higher income, and more often watching health-related TV programs. On the other hands, patients were reported with significantly higher healthcare health literacy than the general public, but not in general health literacy, disease prevention health literacy, or health promotion health literacy. Conclusion The comprehensive HL-SF12 was a valid and easy to use tool for assessing patients' health literacy in the hospitals to facilitate healthcare providers in enhancing patients' health literacy and healthcare qualities.

Background On June 19, 2020, the Academies of Sciences, Engineering, and Medicine hosted a public meeting on “Data Needs to Monitor the Evolution of SARS-CoV-2”. The Office of the Assistant Secretary for Preparedness and Response (ASPR/HHS) and other agencies are seeking to track and correlate viral genome sequences with clinical and epidemiological (CE) data. A crucial part of that framework is obtaining detailed CE data from frontline facilities. In response, we sought to contribute by creating a registry of detailed CE data from SARS-COV -2 infected patients at five hospitals, spanning eleven counties in Western New York. Methods In addition to the usual demographics, comorbidities, and categories of outpatient prescriptions, the registry has 75 laboratory, 2 imaging, 19 therapeutic, and 4 outcome-related parameters. Mann-Whitney U Test for continuous variables and Chi-squared and Fisher Exact Test for categorical variables were performed in R and Minitab. Results The registry currently includes data from 399 patients: 236 ambulatory and 163 inpatient. Several comorbidities were associated with requirement for admission compared to ambulatory status, including obesity and kidney, liver, and cardiovascular disease (all p < /= 0.01) (Table 1). Use of angiotensin inhibitors and receptor blockers, statins, and acid suppressants was higher in admitted vs. ambulatory patients (all p < /=0.001) (Table 1 and Figure). Diabetes mellitus and statin use were more common in patients who required intensive care, p=0.04 and 0.01 respectively (Table 2). Table 1 Figure Table 2 Conclusion The registry captures detailed clinical information from SARS-COV-2 infections, providing a valuable resource for researchers, planners, and policy makers. It also provides a framework for surge planning, predictive modeling, and linking CE data to whole genome sequencing data for precision epidemiology. As SARS-COV-2 reports from China, Italy, and New York City may not be fully generalizable to other regions, especially those not as severely affected or those in suburban and rural settings, reports from other areas are needed. To our knowledge, this is one of the largest U.S. case series outside of New York City. Disclosures All Authors: No reported disclosures

Colonoscopy is a commonly performed procedure for diagnosis and treatment of large bowel diseases. Recognized complications include bleeding and perforation. Splenic injury during colonoscopy is a rare complication. We report a case of a 73-year-old woman who presented with left-sided abdominal pain after colonoscopy with finding of splenic injury on CT scan. She was managed conservatively. We discuss the diagnostic and therapeutic approach to colonoscopic splenic injury.

Background: The rising prevalence of infections caused by extended-spectrum β-lactamase (ESBL)–producing bacteria increases reliance on carbapenems, which intensifies selection pressure for the emergence of carbapenem-resistant Enterobacteriaceae (CRE). Whether noncarbapenem (nC) antibiotics can be safely used in this setting remains incompletely understood. Objective: To examine the safety of carbapenem stewardship in this population, we compared outcomes of uncomplicated ESBL bacteremia treated with a carbapenem to those treated with a noncarbapenem regimen. Methods: A retrospective chart review of patients with ESBL bacteremia from 2014 to 2018 in a 5-hospital regional health system was conducted. Patients aged Clostridioides difficile infection (CDI) and adverse drug events, obtained by Wilcoxon rank-sum testing, χ2 test, and Fisher exact test, as applicable. Results: In total, 112 unique patients had ESBL bacteremia; 42 were excluded, leaving 70 for analysis. Of these, 57 were treated with a carbapenem regimen and 13 patients were treated with a noncarbapenem regimen: 9 ciprofloxacin, 3 gentamicin, 1 TMP-SMX. Patient baseline and antibiotic regimen characteristics were similar (Table 1). The most common organism was E. coli, and the most common source was urinary. A similar proportion of each group received ESBL-active empiric antibiotics. There were no significant differences in total effective antibiotic LOT, 30-day all-cause mortality, 90-day readmission, or recurrence of ESBL bacteremia (Table 2). A nonsignificant trend in hospital LOS was observed in the noncarbapenem group (11 vs 6 days; P = .055). Conclusions: Although the sample size was small, these multicenter data suggest that noncarbapenem treatment of ESBL bacteremia may be safe and effective. Pending confirmatory studies, ESBL bacteremia may be an important target for carbapenem stewardship.Funding: NoneDisclosures: None

Streptobacillus moniliformis is a pleomorphic bacillus found in the oral cavity of rodents. Rat bite can transmit these bacteria to humans and can lead to bacteremia as well as infective endocarditis. We present an unusual case rat-bite endocarditis and septic emboli. 24 year-old-female presented

Background The Gastrointestinal (GI) tract is considered as an important source of candidemia. Numerous studies indicate that the majority of patients with candidemia and cancer have an underlying solid tumor mostly of the GI tract. Widespread use of antifungal prophylaxis among patients with selected hematological malignancies resulted in a proportional redistribution of the frequency of candidemia among patients with various malignancies, but the incidence of candidemia among patients with GI solid malignancies is unknown. Methods A retrospective chart review of patients diagnosed with GI malignancies from 2010 to 2018 at Rochester Regional Health, Lipson Cancer Institute was conducted, and the incidence of candidemia was determined. Results A total of 2783 patients with GI malignancies were analyzed. Fifty-six percent were males, and a mean age was 67 years. Sites of malignancy included large intestine (n = 1269), pancreas (n = 394), any part of the mouth and associated organs (n = 282), liver and biliary system (n = 273), stomach (n = 235), esophagus (n = 135), small intestine (n = 110), and others (n = 85). Over the period of review, total mortality was 49%. Only 0.7% (n = 19) patients developed candidemia, with a total of 22 events. Nine episodes of candidemia happened prior to diagnosis of cancer, and 13 episodes developed after or at the time of diagnosis. There was no commonality in GI solid malignancy site among patients with candidemia. C. albicans was the most common isolate (9 episodes), followed by C. parapsilosis (8), C. glabrata (3), and C. dubliniensis (2). At the same time, there were 273 episodes of bacteremia in 230 patients (8%). Conclusion In our study candidemia among patients with GI solid-organ malignancies was very rare. Disclosures All authors: No reported disclosures.

Background TSEs present diagnostic and infection control (IC) challenges. Creutzfeldt-Jakob Disease (CJD) is the most common human TSE, occurring in 1–2/million/year in the United States, but other zoonotic factors or transmissions remain incompletely understood. Prompted by the occurrence of four suspected cases from November 2017 to April 2018, we present a case series of suspected CJD to illustrate its variable presentation and the need for more rapid identification for implementation of disease-specific disinfection, sterilization, and quarantine measures. Methods We defined a case as any patient with a rapidly progressive dementing or neurologic illness and laboratory tests for CJD. IC and laboratory databases, and electronic medical records were reviewed to identify possible cases from 2013 to 2018. Results Five patients met case definition. The average time to suspecting and confirming a diagnosis was 5.2 and 14.2 days, respectively. Case 1 2 3 4 5 Age/sex 61 M 65 F 51 F 61 F 80 M Cognitive symptoms Psychosis, schizophrenia, cognitive decline Dysphasia, depression, psychosis Vertigo, progressive encephalopathy Memory loss, aphasia Aphasia, dysarthria, dysphagia Motor symptoms Impaired gait Impaired gait Bilateral ataxia Impaired gait incontinence, abnormal muscle tone with paratonia Unilateral weakness, jerking movements EEG Triphasic pattern Abundant generalized discharges Occasional bi-frontal sharp wave discharges Generalized encephalopathy NSC MRI Increased T2 signal in the pulvinar of the thalamus and cortex (especially frontal lobes) NSC NSC NSC/small vessel infarcts NSC/small vessel infarcts RT-QuIC + + + – P 14-3-3 + + + – P T-tau 8,750 >4,000 >4,000 390 P Epidemiology Intake of squirrel brains Concurrent apheresis and GYN surgery Hotel Housekeeping Industrial ChemistResidence in UK, intake of dog food Janitor CJD V S S No P Days to suspecting diagnosis 1 13 2 4 6 Days to confirmation 16 12 18 12 >11 Months of Illness 5 3 >2 P P Outcome Dead Dead Alive Alive Alive NSC, nonspecific changes; P, pending; S, poradic; V, variant; RT-QulC, Realtime Quaking Induced Conversion. Conclusion Protean in presentation, the diagnosis of CJD can be delayed. Variant CJD and emerging zoonotic TSEs should be considered in differential diagnoses and IC measures. Improved empiric classification algorithms and tests with faster turnaround times are needed. Disclosures All authors: No reported disclosures.

Abstract 2790 Background: The development of more effective front-line regimens for lymphoma (e.g. R-CHOP, BEACOPP) has resulted in lower response rates to salvage regimens such as Ifosphamide, Carboplatin, Etoposide +/− Rituximab (RICE/ICE) and improved strategies are needed. Vorinostat (V) is a well-tolerated, oral pan-HDAC inhibitor approved for the treatment of cutaneous T cell lymphoma. In vitro data indicate that combinations of V at >2-5μM plus etoposide or platinum analogs yield synergistic anti-tumor activity, but these concentrations are not typically attained with standard dose regimens. We hypothesized that pulse high-dose V could safely augment the anti-tumor activity of ICE/RICE for patients with relapsed lymphoma. Here we present the final results of a multi-center Phase I trial defining the maximally tolerated dose (MTD) and pharmacokinetics of V that can be given with RICE or ICE. Methods: Eligibility included: relapsed/refractory lymphoma (untreated T-NHL or mantle cell lymphoma [MCL] allowed), age ≥18 years, performance status of 0–2, measurable disease, no active CNS involvement, ANC ≥ 1,500/μL, plts ≥ 100,000/μL, adequate hepatic/renal function, no known HIV. The primary objective was to define a maximally tolerated dose associated with a dose limiting toxicity (DLT) rate of ≤ 25%. DLT = gastrointestinal grade 3 NCI-CTCAE adverse event (AE) >7 days, any related non-hematologic grade ≥4 AE, inability to complete one full cycle of therapy due to toxicity, or any significant medical event at the discretion of the PI. Interpatient dose escalation was implemented using a “two stage” design (Storer et al) with single patient cohorts until a DLT was observed, followed by cohorts of 4 patients. Therapy consisted of V ranging from 400 mg daily to 700 mg BID days 1 to 5 in combination with standard ICE or RICE (CD20+ only) delivered on days 3 to 5 every 21 days for up to 2 cycles using G-CSF support. Results: Twenty-nine patients were treated, 9 in stage 1, 20 in stage 2. Baseline features: median age = 56 (range 23 to 69), median prior therapies 2 (range 0 – 7), refractory to last regimen = 14 (of 27 evaluable, 52%), and prior transplant 2 (7%). Histologies: Hodgkin Lymphoma (8), Diffuse large B-cell (7), MCL (5), T-NHL (4), Follicular (3), Marginal Zone (1), and Small Lymphocytic lymphoma (1). Fifteen patients received 2 cycles and 14 received 1 cycle due to a DLT (8), patient/MD choice (4), insurance denial (1), or progressive disease (1). Non-hematologic AEs ≥ grade 3 were observed in 25 patients with 14 experiencing grade 3 nausea, vomiting, diarrhea, and/or anorexia. The most common DLTs were infection (n=2), hypokalemia (n=2), transaminitis (n=2) (Table). The MTD was estimated to be 500mg BID × 5 days with full dose ICE/RICE. Responses were observed in 19 of 27 evaluable patients (70%) including 8 CR/CRU and 11 PR. Mobilization of peripheral blood stem cells was successful in 4 of 9 patients immediately following VICE/VRICE (median 5.52×106 CD34/kg), in all 4 attempting after prior unsuccessful VICE/VRICE mobilization (median 4.4 × 106 CD34/kg), and in all 12 others attempting after a subsequent regimen (median 7.5 × 106 CD34/kg). 25 (86%) patients are alive and 15 (52%) are progression-free with a median follow up of 5 months (range 1 – 23 months). Pharmacokinetic data indicated that the median peak V concentration day 3 was 4.5μM (range 4.2–6.0μM). Studies are underway evaluating the impact of high-dose V on histone acetylation patterns, BCL-2 family proteins, and gene expression profiles of patient-derived normal and tumor cells and will be reported. Conclusions: High-dose V can safely be delivered with ICE/RICE, achieves potentially synergistic drug levels, and responses are encouraging, though adequate prophylaxis and treatment of GI toxicity is required. The Phase II dose of V with ICE/RICE is defined as 500mg BID × 5 days and warrants further study. Disclosures: Budde: Merck: Research Funding. Off Label Use: Off label use of vorinostat. Shustov:Merck: Research Funding. Pagel:Merck: Research Funding. Gopal:Merck: Research Funding.