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and 2015. All adult patients who were discharged home from the ED with a diagnosis of pneumonia were included. Severity of pneumonia was graded based on the CRB-65 score as per the CAP guidelines. Primary outcome was type of antibiotic prescribed by the ED physician. Data was analyzed using simple descriptive statistics. Results: There were a total of 141 patients analyzed during the study period (N = 46 in 2013, N = 59 in 2014, N = 36 in 2015). Demographics and relevant comorbidities were similar across the years: age (2013: median = 53 years, range 20-92 years; 2014: 56, 21-83; 2015: 54, 20-81); preexisting lung disease (30%, 27%, 25% respectively); HIV positive status (9%, 7%, 17%). CRB-65 score was: low risk (0 points) = 70% in 2013, 66% in 2014, 75% in 2015; intermediate risk (1-2 points) = 30%, 34%, 25%; high risk (3-4 points) = 0% in all years. Percentage of patients discharged home with a documented prescription was 83%, 85%, and 94% respectively. In 2013, patients received azithromycin (AZM) (n = 17, 43% of antibiotic prescriptions that year); levofloxacin (LVX) (n = 10, 25%); AMC (n = 5, 13%); clarithromycin (CLR) (n = 5, 13%); trimethoprim-sulfamethoxazole (SXT) (n = 2, 5%); doxycycline (DOX) (n = 1, 3%). In 2014: AMC (n = 26, 51%); AZM (n = 12, 24%); LVX (n = 9, 18%); CLR (n = 2, 4%); DOX (n = 1, 2%); erythromycin (ERY) (n = 1, 2%). In 2015: AMC (n = 17, 47%); AZM (n = 12, 33%); LVX (n = 4, 11%); CLR (n = 1, 3%); SXT (n = 1, 3%); DOX (n = 1, 3%). Number of return ED visits within 2 weeks were: n = 16 (35%); n = 11 (19%); and n = 10 (28%) respectively. Conclusion: The results of this study show that there has been a change in antibiotic prescribing practices in the SMH ED since dissemination of the CAP guidelines, with AMC accounting for nearly half of antibiotic prescriptions. Further antimicrobial stewardship efforts will focus on evaluating factors influencing prescribing practices.

Introduction: Patients who present to the Emergency Department (ED) with a drug overdose often require long periods of monitoring. After their initial assessment and stabilization, they spend a significant amount of time in a high cost acute care bed in the ED for monitoring until they are medically cleared for psychiatric care or to be discharged. The shift length at this ED is a maximum of 8 hours; meaning any patients staying over 8 hours must be handed over between physicians, increasing the chance of medical errors. The objective of this study is to examine the total ED length of stay (LOS) of this patient group after physician initial assessment (PIA) to determine if there is there justification for the creation of a toxicology observation or short-stay unit for these patients. Methods: A single-centre, blinded retrospective chart review was conducted examining all adult patients presenting to the ED at an urban academic tertiary care centre with a drug overdose in 2018. Variables examined include: Disposition (home, admitted to acute care setting, admitted to non-acute care setting), time from PIA to disposition and total length of stay from PIA to discharge home or admission to hospital. The primary outcome is total length of stay in the ED after PIA.M Results: A total of 1006 patients presenting with an overdose were included. A total of 388 patients were admitted with 44% (172) having an ED LOS greater than 8 hours and 36% (138) staying 8 hours after PIA. The median [IQR] LOS in the ED for all patients was 343 minutes [191-565] while the median [IQR] time to PIA was 37 minutes [15-97]. The majority of these patients (54%) were discharged with no consulting services involved, 23% received a consult to psychiatry, 22% were consulted to internal medicine and 5% of patients were consulted to Critical Care Medicine. Conclusion: This demonstrates patients presenting to the ED with an overdose are seen in the ED by a physician quickly, however many stay in the department over 5 hours from their initial assessment in a monitored setting. While a majority of these patients are able to go home, 44% of admitted patients wait greater than 8 hours in the ED on monitors. The creation of a toxicology observation unit would be helpful for this population to increase patient safety and ease ED bed congestion.

Introduction: Emergency physicians (EP) often work at undesirable hours. In response to deleterious effects on quality of life for EPs, traditional 2300-0700 night shifts have been replaced at some centres with staggered 6-hour casino shifts (22:00-04:00 and 04:00-10:00). Though purported to allow for better sleep and recovery patterns, no evidence exists to support the benefits on sleep or quality of life that is used to justify a casino shift model. Using a before and after survey model, this study examines the impact of overhauling night work from a traditional 8-hour shift to casino shifts on the quality of life and job satisfaction of EPs working in an academic emergency department (ED). Methods: In 2010, an initial online, 37-item survey, was sent to all EPs working in the ED, just prior to the transition to casino shifts. 6 years following the transition, a slightly modified 37-item survey was again distributed to all current EPs working at that same centre. Participants rated their level of agreement on a 7-point Likert scale regarding questions related to night work. Results from the two surveys were compared. Results: 43 2010- and 47 2016-surveys were completed. In 2016, recovery to baseline function after a single early shift (22:00-04:00) was most common after 1 day at 52.4%, and after multiple early shifts was ≥2 days at 66.7%. Recovery after a single late shift (04:00-10:00) was most common at 1 day at 54.8%, and after multiple late shifts was ≥2 days at 59.5%. This was in contrast to 2010, when 55.8% recovered from a single traditional night shift after 1 day, and 95.3% required ≥2 days to recover from multiple traditional night shifts. In relation to casino shifts, 40.5% of respondents stated that night shifts are the greatest drawback of their job, compared to 79.1% previously. A minority of respondents felt that teaching (36.5%), diagnostic test interpretation (23.2%), and quality of handover (33.5%) were inferior on early and late night shifts compared to other shifts (74.4%, 58.1%, and 60.5% for traditional night shifts respectively).95.0% of respondents preferred casino over traditional night shifts. Conclusion: There were self-reported improvements in all domains following the implementation of casino shifts.

Since the start of COVID-19, reports of discrimination in the US against Asian Americans have increased approximately 150%. Prior research has demonstrated that victims of discrimination are more likely to experience physiological health concerns, possibly linked to sleep. The objective of this study was to determine if there was a relationship between disordered sleep and discrimination among Chinese older adults using data collected from the Population Study of ChINese Elderly (N=3124, 59% female). To assess, the experience of discrimination in nine settings (school, hiring, work, housing, medical, service, finance, public, and authority) and four indicators of sleep quality (duration, trouble falling asleep, insomnia, and self-reported sleep quality) were evaluated using logistic- and multinomial logistic regression. With an average age of 75 years, discrimination was experienced by 7.2% of participants. Experiencing any discrimination was associated with lower odds of longer sleep durations (>8 hours) compared to those sleeping 6-8 hours. Experiences of discrimination in housing (OR: 5.51 (95%CI:1.08-27.98)) and with authority figures (OR: 6.02 (95%CI:1.16-31.31)) were significantly associated with shorter sleep durations (<6 hours), compared to those sleeping 6-8 hours. Those who experienced discrimination in a school setting were less likely to have trouble falling asleep (OR: 0.28 (95%CI:0.09-0.88)), while discrimination in medical settings were more likely to experience insomnia (OR: 2.29 (95%CI:1.13-4.63)). All other relationships between discrimination and sleep measures were non-significant. Given mixed evidence and the increased relevancy of discrimination against Asian Americans, further research on how discrimination may impact health outcomes and sleep quality is warranted.

Signal transducer and activator of transcription 3 (STAT3) is a transcription factor that mediates signal transduction from the extracellular surface to the nucleus. Canonically, STAT3 is phosphorylated at Tyrosine 705 (Y705) by JAK family kinases, which promotes its dimerization and subsequent localization to the nucleus. However, the role of Serine 727 (S727) phosphorylation in regulating STAT3 activity varies across cell types and remains unclear in hematopoietic tissues particularly. Several studies indicate that phosphorylation at S727 is critical for optimal STAT3 function. For example, astrogliogenesis is regulated by enhancing STAT3 activity by phosphorylation of S727 by DYRK1A. Of note, DYRK1A is overexpressed in Down syndrome-acute lymphoblastic leukemia (DS-ALL), and has previously been found to phosphorylate substrates in order to prime them for downstream phosphorylation events. Given these findings, we hypothesized that the DYRK1A phosphorylation of STAT3 at S727 is critical for promoting DS-ALL. Furthermore, certain subtypes of ALL have high rates of JAK2 activation, namely DS-ALL and Philadelphia-like ALL (Ph-like ALL); we propose that STAT3 can effectively be targeted specifically in these subtypes. In order to elucidate the role of DYRK1A phosphorylation of STAT3, we treated cytokine-deprived murine pre-B cells with EHT1610, a selective DYRK1 inhibitor, or vehicle and then pulsed the cells with JAK-STAT activating cytokines. EHT1610-treated cells had diminished S727 phosphorylation compared to vehicle, regardless of cytokine pulse; however, only vehicle-treated cells regained Y705 phosphorylation after cytokine pulse. This suggests that S727 phosphorylation is cytokine-independent and is critical for maintenance of Y705 phosphorylation. We then generated flag-tagged STAT3 S727 phospho-mimetic (S727D/E) and phospho-deficient (S727A) alleles and transduced them into pre-B cells. We observed that the degree of Y705 phosphorylation is dependent on S727, as cells expressing S727A have reduced Y705 phosphorylation compared to wild-type STAT3. Additionally, overexpression of the phospho-deficient allele conferred a significant proliferative impairment compared to the phospho-mimetic alleles. As DS-ALL and Ph-like ALL often have JAK2-activating mutations, we next aimed to determine if loss of S727 phosphorylation would decrease ALL cell growth. Indeed, two human Ph-like ALL cell lines, MHH-CALL4 and MUTZ5, displayed decreased proliferation when overexpressing the S727A mutant. These cell lines were also sensitive to treatment with C188-9, a small molecule STAT3 inhibitor that is in clinical trials for various solid tumors. Additionally, we treated primary patient ALL samples with amplification of HSA21 segments ex vivo and found that DS-ALL samples were preferentially sensitive to STAT3 inhibition compared to HD-ALL or iAMP-ALL, suggesting that STAT3 is specifically a target in JAK2-activated ALL. Our study provides new and significant insights into the regulation of STAT3 by DYRK1A, and presents a new therapeutic target for ALL cells with JAK2 activating mutations. Disclosures Bourquin: Amgen: Other: Travel Support. Crispino:Scholar Rock: Research Funding; Forma Therapeutics: Research Funding.

A westernized diet, characterized by intake of foods high in fat and sugar, has been associated with several chronic conditions. However, the dietary pattern of US Chinese older adults is not well understood. The primary objective of this study was to determine the relationship between years of US residence and other demographic factors and the intake of foods high in fats and sugar. As part of the Population Study of Chinese Elderly, participants were given a 48-item food frequency questionnaire, which were further placed into primary food groups. Each group was then categorized into whether they consumed the food group at least once a week. The total sample was 59% female with an average age of 75, with 49% consuming fatty foods and 85% consuming sweets in the past week. Using logistic regression (N=3053), each additional year of US residence (range of 0-93 years) was associated with a higher dietary intake of fats (OR: 1.01 (95%CI:1.01-1.02)) and sweets (OR: 1.01 (95%CI:1.00-1.02)). Additionally, higher education was associated with lower consumption of fats (OR: 0.98 (95%CI:0.96, 0.99)) and higher income was associated with higher consumption of fats (OR: 1.11 (95%CI: 1.04, 1.18)). For sweets, women compared to men were 54% less likely to consume sweets in the last week (OR: 0.46 (95%CI:0.36, 0.59)), and higher education was associated a greater likelihood of consuming sweets (OR: 1.07 (95%CI: 1.05, 1.10)). Study findings suggest that immigration related factors and demographic factors may influence consumption of a westernized diet high in fats and sugars.