bluuebunny/crossref_metadata_2025 huggingface dataset:
Emotion recognition of morphed facial expressions in presymptomatic and symptomatic frontotemporal dementia, and Alzheimer’s dementia
Authors: Jiskoot Lize C. , Poos Jackie M. , Vollebergh Manon E. , Franzen Sanne , van Hemmen Judy , Papma Janne M. , van Swieten John C. , Kessels Roy P. C. , van den Berg Esther
Published: July 2020

Background

The emotion recognition task (ERT) was developed to overcome shortcomings of static emotion recognition paradigms, by identifying more subtle deficits in emotion recognition across different intensity levels. In this study, we used the ERT to investigate emotion recognition deficits across the frontotemporal (FTD) and Alzheimer’s Dementia (AD) spectrum.

Methods

With the ERT, we assessed the recognition of facial emotional expressions (anger-disgust-fear-happiness-sadness-surprise) across four intensities (40–60–80–100%) in patients with behavioural variant FTD (bvFTD; n = 32), and AD (n = 32), presymptomatic FTD mutation carriers (n = 47) and controls (n = 49). We examined group differences using multilevel linear regression with age, sex and education level as covariates, and performed post hoc analyses on presymptomatic (MAPT, GRN and C9orf72) mutation carriers. Classification abilities were investigated by means of logistic regression.

Results

Lowest ERT total scores were found in patients with bvFTD and AD, whereas equal highest performance was found in presymptomatic mutation carriers and controls. For all emotions, significantly lower subscores were found in patients with bvFTD than in presymptomatic mutation carriers and in controls (highest p value = 0.025). Patients with bvFTD performed lower than patients with AD on anger (p = 0.005) and a trend towards significance was found for a lower performance on happiness (p = 0.065). Task performance increased with higher emotional intensity, and classification was better at the lowest than at the highest intensity. C9orf72 mutation carriers performed worse on recognizing anger at the lowest intensity than GRN mutation carriers (p = 0.047) and controls (p = 0.038). The ERT differentiated between patients with bvFTD and controls, and between patients with AD and controls (both p < 0.001).

Discussion

Our results demonstrate emotion recognition deficits in both bvFTD and AD, and suggest the presence of subtle emotion recognition changes in presymptomatic C9orf72-FTD. This highlights the importance of incorporating emotion recognition paradigms into standard neuropsychological assessment for early differential diagnosis, and as clinical endpoints in upcoming therapeutic trials.
Environmental factors influencing fine-scale distribution of Antarctica’s only endemic insect
Authors: Potts Leslie J. , Gantz J. D. , Kawarasaki Yuta , Philip Benjamin N. , Gonthier David J. , Law Audrey D. , Moe Luke , Unrine Jason M. , McCulley Rebecca L. , Lee Richard E. , Denlinger David L. , Teets Nicholas M.
Published: July 2020

Species distributions are dependent on interactions with abiotic and biotic factors in the environment. Abiotic factors like temperature, moisture, and soil nutrients, along with biotic interactions within and between species, can all have strong influences on spatial distributions of plants and animals. Terrestrial Antarctic habitats are relatively simple and thus good systems to study ecological factors that drive species distributions and abundance. However, these environments are also sensitive to perturbation, and thus understanding the ecological drivers of species distribution is critical for predicting responses to environmental change. The Antarctic midge, Belgica antarctica, is the only endemic insect on the continent and has a patchy distribution along the Antarctic Peninsula. While its life history and physiology are well studied, factors that underlie variation in population density within its range are unknown. Previous work on Antarctic microfauna indicates that distribution over broad scales is primarily regulated by soil moisture, nitrogen content, and the presence of suitable plant life, but whether these patterns are true over smaller spatial scales has not been investigated. Here we sampled midges across five islands on the Antarctic Peninsula and tested a series of hypotheses to determine the relative influences of abiotic and biotic factors on midge abundance. While historical literature suggests that Antarctic organisms are limited by the abiotic environment, our best-supported hypothesis indicated that abundance is predicted by a combination of abiotic and biotic conditions. Our results are consistent with a growing body of literature that biotic interactions are more important in Antarctic ecosystems than historically appreciated.
The effect of smoking on bariatric surgical 30-day outcomes: propensity-score-matched analysis of the MBSAQIP
Authors: Janik Michał R. , Aryaie Amir H.
Published: July 2020

Background

The exact impact of smoking within the last 12 months on the safety outcome of sleeve gastrectomy and Roux-Y gastric bypass is not well known. The study aimed to assess the effects of smoking on 30-day surgical outcomes.

Methods

Preoperative characteristics and outcomes from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program dataset 2015–2018 were selected for all patients who underwent primary sleeve gastrectomy or Roux-Y gastric bypass. 30-day postoperative outcomes were assessed. We used propensity score matching to control for potential confounding.

Results

In laparoscopic sleeve gastrectomy group, 29 165 pairs were included in the analysis. Smoking increased risk for inpatients readmission rate (3.67% vs. 3.10%; RR, 1.18; 95%CI 1.08–1.29, p < 0.001), intervention rate (1.03% vs. 0.84%; RR, 1.22; 95%CI 1.00–1.24, p = 0.020), reoperation rate (0.99% vs. 0.79%; RR, 1.25; 95%CI 1.05–1.48, p = 0.010), and leak rate (0.59% vs. 0.32%; RR, 1.83; 95%CI 1.43–2.37, p < 0.001). In laparoscopic Roux-Y gastric bypass cohort,11 895 pairs were included in the ultimate analysis. Smoking increased risk for inpatients readmission rate (7.54% vs. 5.88%; RR, 1.28; 95%CI 1.16–1.41, p < 0.001), intervention rate (3.53% vs. 2.30%; RR, 1.54; 95%CI 1.32–1.80, p < 001), reoperation rate (3.17% vs. 1.86%; RR, 1.70; 95%CI 1.45–2.00, p < 0.001), leak rate (1.05% vs. 0.59%; RR, 1.78; 95%CI 1.33–2.39, p < 0.001), bleed rate (2.03% vs. 1.45%; RR, 1.39; 95%CI 1.15–1.69, p < 0.001), and morbidity (4.20% vs. 3.38%; RR, 1.24; 95%CI 1.09–1.41, p = 0.001).

Conclusion

Smoking cigarettes at any point within the 12 months before admission for surgery increased the risk for surgical short-term complications in bariatric patients. The effect was the most significant regarding leaks.
Delivery of a nutritional prescription by enteral tube feeding in children with chronic kidney disease stages 2–5 and on dialysis—clinical practice recommendations from the Pediatric Renal Nutrition Taskforce
Authors: Rees Lesley , Shaw Vanessa , Qizalbash Leila , Anderson Caroline , Desloovere An , Greenbaum Laurence , Haffner Dieter , Nelms Christina , Oosterveld Michiel , Paglialonga Fabio , Polderman Nonnie , Renken-Terhaerdt José , Tuokkola Jetta , Warady Bradley , Walle Johan Van de , Shroff Rukshana ,   on behalf of the Pediatric Renal Nutrition Taskforce
Published: July 2020

The nutritional prescription (whether in the form of food or liquid formulas) may be taken orally when a child has the capacity for spontaneous intake by mouth, but may need to be administered partially or completely by nasogastric tube or gastrostomy device (“enteral tube feeding”). The relative use of each of these methods varies both within and between countries. The Pediatric Renal Nutrition Taskforce (PRNT), an international team of pediatric renal dietitians and pediatric nephrologists, has developed clinical practice recommendations (CPRs) based on evidence where available, or on the expert opinion of the Taskforce members, using a Delphi process to seek consensus from the wider community of experts in the field. We present CPRs for delivery of the nutritional prescription via enteral tube feeding to children with chronic kidney disease stages 2–5 and on dialysis. We address the types of enteral feeding tubes, when they should be used, placement techniques, recommendations and contraindications for their use, and evidence for their effects on growth parameters. Statements with a low grade of evidence, or based on opinion, must be considered and adapted for the individual patient by the treating physician and dietitian according to their clinical judgement. Research recommendations have been suggested. The CPRs will be regularly audited and updated by the PRNT.
Does health securitization affect the role of global surgery?
Authors: Metelmann Isabella B. , Flessa Steffen , Busemann Alexandra
Published: July 2020

Aim

More and more frequently outbreaks of infectious diseases force the international community to urgent health action and lead to an increasing security focus on global health. Considering the limiting character of resource allocation, all other medical conditions must compete with the top spot of health security matters, as we currently see with the outbreak of COVID-19. Surgery is an integral part of universal health offering life-saving therapy for a variety of illnesses. Amidst the increasing nexus of infectious diseases and health security and in the view of Public Health Emergencies of International Concern (PHEIC), is there a risk of global surgery falling behind?

Subject and Methods

While the global undersupply of surgical care is well recorded, contextual explanations are absent. Our research introduces the constructivist concept of securitization according to the Copenhagen School to explain the structural handicap of global surgery and by that presents a structural explanation. We investigate the securitizing potential of surgical diseases in comparison to infectious diseases.

Results

Surgical conditions are non-contagious without the risk for disease outbreaks, hardly preventable and their treatment is often infrastructurally demanding. These key features mark their low securitizing potential. Additionally, as PHEIC is the only securitizing institution in the realm of health, infectious diseases have a privileged role in health security.

Conclusion

Surgery substantially lacks securitizing potential in comparison to communicable diseases and by that is structurally given an inferior position in a securitized health order.
MaxHadoop: An Efficient Scalable Emulation Tool to Test SDN Protocols in Emulated Hadoop Environments
Authors: Calcaterra Claudio , Carmenini Alessio , Marotta Andrea , Bucci Ubaldo , Cassioli Dajana
Published: July 2020

This paper presents MaxHadoop, a flexible and scalable emulation tool, which allows the efficient and accurate emulation of Hadoop environments over Software Defined Networks (SDNs). Hadoop has been designed to manage endless data-streams over networks, making it a tailored candidate to support the new class of network services belonging to Big Data. The development of Hadoop is contemporary with the evolution of networks towards the new architectures “Software Defined.” To create our emulation environment, tailored to SDNs, we employ MaxiNet, given its capability of emulating large-scale SDNs. We make it possible to emulate realistic Hadoop scenarios on large-scale SDNs using low-cost commodity hardware, by resolving a few key limitations of MaxiNet through appropriate configuration settings. We validate the MaxHadoop emulator by executing two benchmarks, namely WordCount and TeraSort, to evaluate a set of Key Performance Indicators. The tests’ outcomes evidence that MaxHadoop outperforms other existing emulation tools running over commodity hardware. Finally, we show the potentiality of MaxHadoop by utilizing it to perform a comparison of SDN-based network protocols.
Prospective Pathways to Depressive Symptoms and Disordered Eating in Adolescence: A 7-Year Longitudinal Cohort Study
Authors: Lewis-Smith Helena , Bray Isabelle , Salmon Debra , Slater Amy
Published: July 2020

Eating pathology and depressive symptoms increase during adolescence, yet predictive pathways remain predominantly unexplored, despite their implications for prevention. The present study aimed to identify shared risk factors for eating pathology and depressive symptoms by evaluating an adapted Dual-Pathway Model of disordered eating, which postulated that higher BMI would predict disordered eating and depressive symptoms via pathways between body dissatisfaction, later BMI, depressive symptoms, and visible indicators of puberty (breast development for girls, height for boys). The participants were 8915 children (49% girls) from the Avon Longitudinal Study of Parents and Children, a population-based cohort study of British children, who were assessed at different intervals between the age of 7 to 14 years. Path analyses revealed that, for girls, childhood BMI exerted indirect effects on disordered eating via body dissatisfaction, depressive symptoms, and more advanced breast development, with indirect pathways identified to depressive symptoms via earlier depressive symptoms and more advanced breast development. For boys, childhood BMI had indirect effects on disordered eating via later BMI and body dissatisfaction, while only earlier depressive symptoms were found to have an independent and direct effect on adolescent depressive symptoms. This study reveals shared and independent risk factors for eating pathology and depressive symptoms in adolescence and suggests targets for preventative interventions, including higher BMI, body dissatisfaction, and depressive symptoms, in addition to advanced breast development, for girls.
A quantum approach to twice-repeated $$2\times 2$$ game
Authors: Rycerz Katarzyna , Frąckiewicz Piotr
Published: July 2020

This work proposes an extension of the well-known Eisert–Wilkens–Lewenstein scheme for playing a twice repeated $$2\times 2$$

2
×
2

game using a single quantum system with ten maximally entangled qubits. The proposed scheme is then applied to the Prisoner’s Dilemma game. Rational strategy profiles are examined in the presence of limited awareness of the players. In particular, the paper considers two cases of a classical player against a quantum player game: the first case when the classical player does not know that his opponent is a quantum one and the second case, when the classical player is aware of it. To this end, the notion of unawareness was used, and the extended Nash equilibria were determined.
Impact of Resection Volume/Stapler Firings-Ratio on Perioperative Complications and Weight Loss After Laparoscopic Sleeve Gastrectomy
Authors: Della Penna Andrea , Lange Jessica , Archid Rami , Hönes Felix , Königsrainer Alfred , Quante Markus
Published: July 2020

Background

Major postoperative morbidity after laparoscopic sleeve gastrectomy (LSG) is often related to staple line leaks (SLL). Of note, a recent study suggested a central role of the absolute numbers of stapler firings as a predictive factor for postoperative morbidity due to SLL. In addition, a larger gastric remnant volume could be responsible for lower weight loss after LSG, and nevertheless, the gastric resection volume (GRV) is strictly related to the residual volume.

Methods

Prospectively, collected data of 384 consecutive patients with complete follow-up at 12 months after LSG at our institution were retrospectively analyzed. Patients were stratified according to three different variables (i.e., number of stapler firings, GRV, and GRV/stapler firings-ratio), and respective impact on postoperative complications and weight loss was analyzed.

Results

High absolute number of stapler firings was linked to increased intraoperative and postoperative bleeding and prolonged hospitalization, but was not associated with SLL, transfusion rate or revisional procedures. Absolute GRV showed no impact on both complications and outcome after LSG. Interestingly, higher ratio of GRV/stapler firings was not only linked to decreased intraoperative bleeding and shorter hospital stay but also to higher Excess Body Mass Index Loss (EBMIL) at 12 months after LSG.

Conclusions

Here, we introduce GRV/stapler firings-ratio as a simple predictive factor for identifying patients at risk for postoperative complications and impaired weight loss that is superior compared with absolute number of stapler firings or GRV alone.
Impact of MindUP Among Young Children: Improvements in Behavioral Problems, Adaptive Skills, and Executive Functioning
Authors: Crooks Claire V. , Bax Karen , Delaney Andrea , Kim Haesoo , Shokoohi Mostafa
Published: July 2020

Objectives

We evaluated the impacts of a mindfulness-based social and emotional learning (SEL) program on behavioral problems, adaptive skills, and executive functioning among kindergarten students.

Methods

A total of 23 classrooms were assigned to the intervention group, in which the teachers implemented MindUP, and 19 classrooms were assigned to the comparison group, in which the teachers delivered their classes as usual. Teachers assessed the behavior of students (N = 584; intervention n = 261; comparison n = 323) both pre- and post-intervention with two measures: the Behavior Assessment System for Children, Third Edition, Teacher Rating Scales (BASC-3 TRS) and the Behavior Rating Inventory of Executive Function-Preschool and Child Version (BRIEF-P; BRIEF-2).

Results

Students who received the intervention demonstrated an improvement in adaptive skills and reduction in behavioral symptoms, internalizing composite, and externalizing composite outcomes. Additionally, there was a significant decrease in executive functioning deficits among students who participated in MindUP. There were no gender differences regarding changes in any of the five study outcomes.

Conclusions

The study suggests that mindfulness-based SEL intervention can improve psychosocial and behavioral outcomes in young children.
Differences in honey bee bacterial diversity and composition in agricultural and pristine environments – a field study
Authors: Muñoz-Colmenero Marta , Baroja-Careaga Igor , Kovačić Marin , Filipi Janja , Puškadija Zlatko , Kezić Nikola , Estonba Andone , Büchler Ralph , Zarraonaindia Iratxe
Published: July 2020

Agrochemicals and biocides are suspected to cause a dysbiosis of honey bee microbiota, decreasing colonies ability to respond to the environment. As a first step to investigate agriculture and beekeeping impact, hives bacteriomes from an anthropized environment (Agri-env) were compared to that of pristine’s (Prist-env). 16S rRNA sequencing evidenced differences in richness and composition between sample types (Gut (G), Brood (B), Bee-bread (BB)) and environments. Higher opportunist loads and shifts toward taxa capable of metabolizing insecticides were observed in G and B at Agri-env, while beneficial bacteria were enriched in Prist-env. Bacteria in BB did not differ, the acidity of the niche outweighing the influence of external factors. Results showed the environment plays a major role in shaping honey bee microbiota, the agricultural realm inducing a bacterial disruption that would let to colonies vulnerability. In contrast, a less susceptible bee will be promoted in less anthropized locations.
Pomegranate peel as a new low-cost adsorbent for ammonium removal
Authors: Bellahsen N. , Varga G. , Halyag N. , Kertész S. , Tombácz E. , Hodúr C.
Published: July 2020

Since adsorption is one of the best ammonium removal methods, great efforts have been made to identify new low-cost and efficient adsorbents from agricultural waste and by-products due to their abundant availability, low-cost and eco-friendly advantages, in addition to the possibility of recycling ammonium back into agricultural processes. In this study, a series of batch experiments were performed to detect new bio-adsorbents for ammonium ions removal. Among the materials tested, pomegranate peel powder showed a high affinity to adsorb ammonium ions and, furthermore, available information on ammonium adsorption by this biomaterial is still missing from the literature. First, pomegranate peel powder was characterized by the determination of different parameters such as zeta potential, iodine number, Fourier-transform infrared spectroscopy analysis, scanning electron microscopy, particle size distribution and porosity. Then, the impact of various parameters, such as pH, contact time, stirring speed, adsorbent dose and adsorbate concentration in the adsorption process, was investigated. The highest ammonium removal capacity was obtained at pH = 4 using 400 mg of pomegranate peel powder and a stirring speed of 150 rpm for an initial concentration of ammonium of 30 mg/L. The system (adsorbent, adsorbate and solution) reached equilibrium after 2 h and the data fit well with the Langmuir model with a maximum monolayer adsorption capacity of 6.18 mg/g, while kinetics were well described by the pseudo-second-order model. These results introduce pomegranate peel powder as a promising bio-adsorbent to remove and recover ammonium from aqueous solutions.
How Many Tiers Do We Need? Type I Errors and Power in Multiple Baseline Designs
Authors: Lanovaz Marc J. , Turgeon Stéphanie
Published: July 2020

Design quality guidelines typically recommend that multiple baseline designs include at least three demonstrations of effects. Despite its widespread adoption, this recommendation does not appear grounded in empirical evidence. The main purpose of our study was to address this issue by assessing Type I error rate and power in multiple baseline designs. First, we generated 10,000 multiple baseline graphs, applied the dual-criteria method to each tier, and computed Type I error rate and power for different number of tiers showing a clear change. Second, two raters categorized the tiers for 300 multiple baseline graphs to replicate our analyses using visual inspection. When multiple baseline designs had at least three tiers and two or more of these tiers showed a clear change, the Type I error rate remained adequate (< .05) while power also reached acceptable levels (> .80). In contrast, requiring all tiers to show a clear change resulted in overly stringent conclusions (i.e., unacceptably low power). Therefore, our results suggest that researchers and practitioners should carefully consider limitations in power when requiring all tiers of a multiple baseline design to show a clear change in their analyses.
Equity, Culture, and Place in Teaching Paleontology
Authors: Visaggi Christy C.
Published: July 2020

The diversity crisis in paleontology refers not to modern biota or the fossil record, but rather how our discipline lacks significant representation of individuals varying in race, ethnicity, and other aspects of identity. This Element is a call to action for broadening participation through improved classroom approaches as described in four sections. First, a brief review of the crisis and key concepts are presented. Next, culturally responsive pedagogy and related practices are introduced. Third, specific applications are offered for drawing cultural connections to studying the fossil record. Finally, recommendations including self-reflection are provided for fostering your own cultural competency. Our discipline offers much for understanding earth history and contributing new knowledge to a world impacted by humans. However, we must first more effectively welcome, support, and inspire all students to embrace meaning and value in paleontology; it is critical for securing the future of our field.
The Value of Neurological Assessment for Prediction of Subtle Cerebral Infarction
Authors: Horev Anat , Serlin Yonatan , Eshel Ron , Leker Ronen , Star Michael , Honig Asaf , Ifergane Gal
Published: July 2020

We examined to what extent clinical assessment alone can predict subtle acute cerebral infarction on magnetic resonance imaging (MRI). Of the 72 patients presented to the emergency department (ED) with transient neurological deficits, 26 (36.1%) were predicted to be “positive” and 46 (63.9%) “negative” for transient ischemic attack/minor stroke by two independent neurologists. Twenty patients (27.8%) had acute restricted diffusion on MRI. Clinical assessment showed substantial agreement with MRI findings (Kappa = 0.75), sensitivity (95.0%), specificity (86.5%), positive-likelihood ratio 7.06, and negative-likelihood ratio 0.06. Neurological assessment has an excellent predicting value for MRI-confirmed acute cerebral infarction and a key role in the facilitation of effective patient care in the ED.
4234 Association of age at menopause with incident heart failure in the Southern Community Cohort Study
Authors: Pike Mindy , Akwo Elvis A. , Robinson-Cohen Cassianne , Wellons Melissa , Blot William , Ikizler T. Alp , Wang Thomas J. , Gupta Deepak K. , Lipworth Loren
Published: July 2020

OBJECTIVES/GOALS: Early age at menopause has been linked to increased risk of cardiovascular disease; however, there is limited evidence for a relationship between early menopause and heart failure (HF). We examined whether early menopause is associated with incident HF among women in the southeastern United States. METHODS/STUDY POPULATION: The Southern Community Cohort Study enrolled ~86,000 low-income black and white adults from 2002 to 2009. Participants for this analysis were 11,948 women who were postmenopausal at enrollment, had no history of HF, and were on Medicaid or Medicare. HF events were ascertained using ICD-9 codes 428.x via linkage of the cohort with CMS Research Identifiable Files through December 31, 2010. Early menopause was defined as self-reported age at menopause less than 45 years. Hazard ratios (HRs) and 95% confidence intervals (CIs) were computed from multivariable Cox regression models, overall and by race, adjusting for demographic, lifestyle, and reproductive factors, including reason for menopause. RESULTS/ANTICIPATED RESULTS: At baseline, mean age was 58±9 years, and 65% of participants were black. Among women with early menopause, 76% (n = 4,836) had menopause due to hysterectomy or oophorectomy. In women with later menopause, 74% (n = 4,102) reported natural menopause. During a median follow-up of 5.0 years (range 3.1-6.7), 2,157 incident HF events occurred. Compared with women with later onset of menopause, those with early menopause had increased HF risk (HR: 1.27, 95% CI: 1.10–1.47). Risk of HF associated with early menopause was similar in white and black women (p-value for interaction: 0.13). DISCUSSION/SIGNIFICANCE OF IMPACT: In this largely low-income population, early menopause was associated with an increased risk of developing HF. Women with early menopause represent a potential target population for future interventions to decrease risk of HF and cardiovascular risk factors.
4180 CD4 count is a prognostic marker in persons living with HIV and non-small cell lung cancer in the Bronx
Authors: Klugman Madelyn , Fazzari Melissa , Ginsberg Mindy , Rohan Thomas , Hanna David , Shuter Jonathan , Hosgood H. Dean
Published: July 2020

OBJECTIVES/GOALS: There is a high burden of lung cancer in persons living with HIV (PLWH). The role that HIV status, by levels of immune function and viral load, has on survival from lung cancer is not fully understood. The study’s objectives were to assess 1) the association of HIV with survival in non-small cell lung cancer (NSCLC) and 2) prognostic factors in PLWH with NSCLC. METHODS/STUDY POPULATION: Participants were from a cohort of lung cancer patients diagnosed between 2004-2017 in the Bronx, NY, with vital status ascertainment at least annually. We compared survival from NSCLC diagnosis between HIV-negative patients (HIV-, N = 2881) and PLWH (N = 88), using Cox regression, accounting for clinical and sociodemographic factors including smoking status. In three separate comparisons to HIV-, PLWH were dichotomized by CD4 count (<200 vs. ≥200 cells/μL), CD4/CD8 ratio (median, <0.43 vs. ≥0.43) and HIV viral load (VL) suppression (<75 vs. ≥75 copies/mL). In PLWH only, we assessed the relationships of CD4 count, CD4/CD8 ratio, and VL at diagnosis with survival adjusting for age, sex, and cancer stage. CD4 count and CD4/CD8 ratio were also examined as time-varying variables using a counting process approach. RESULTS/ANTICIPATED RESULTS: PLWH were younger (median 56 years, IQR 51-52 vs. 68, IQR 60-76) and more likely to be current smokers (58% vs. 37%) at diagnosis than HIV- patients. Median survival was lower in PLWH [1.1 years, 95% confidence interval (95%CI): 0.6-1.3] than in HIV- [1.6 (1.5-1.7)]. Survival comparing PLWH with higher CD4/CD8 to HIV- was similar [hazard ratio (HR), 95%CI: 0.63 (0.37-1.07)], but those with lower CD4/CD8 experienced worse survival (HR = 1.74, 95%CI: 1.07-3.89). Among PLWH, having a CD4 count < 200 cells/μL was associated with over twice the risk of death compared to those with CD4 ≥ 200 cells/μL (HR = 2.37, 95%CI: 1.14-4.92). VL and CD4/CD8 ratio were not associated with survival. Lower time-updated CD4 count was also associated with worse survival (HR = 2.19 for CD4 <200 vs. >200 cells/μL, 95%CI: 1.16-4.13). DISCUSSION/SIGNIFICANCE OF IMPACT: Among persons with NSCLC, CD4/CD8 ratio nearest diagnosis was shown to distinguish mortality risk in PLWH compared with HIV- patients. In addition, PLWH with low CD4 had worse prognosis than PLWH who had higher CD4 counts. These results suggest HIV immune status to be an essential component influencing survival in lung cancer.
4100 Chronic Pain in Refugee Torture Survivors
Authors: Kaur Gunisha
Published: July 2020

OBJECTIVES/GOALS: An estimated 87% of torture survivors, or 27 million people globally, suffer from chronic pain such as brachial plexopathy from upper extremity suspension or lumbosacral plexus injury from leg hyperextension. However, a vast majority of pain is undetected by evaluators due to a lack of diagnostic tools and confounding psychiatric illness. This diagnostic gap results in exclusive psychological treatment rather than multimodal therapies, substantially limiting rehabilitation, placing vulnerable individuals at higher risk of drug abuse, and increasing healthcare expenditures. We hypothesized that the novel application in torture survivors of a validated pain screen can supplement the UNIP and improve its sensitivity for pain from approximately 15% to 90%, as compared to the reference standard. METHODS/STUDY POPULATION: In this prospective, blind comparison to gold standard study, 25 patients who survived torture by World Medical Association definition first received the standard evaluation protocol for torture survivors (United Nations Istanbul Protocol, UNIP) by a trained evaluator, and subsequently received a validated pain screen (Brief Pain Inventory Short Form, BPISF) followed by a non-invasive examination by a pain specialist physician (reference standard). The primary outcome was the diagnostic and treatment capability of the standard protocol (index test) versus the validated pain screen (BPISF), as compared to the reference standard. RESULTS/ANTICIPATED RESULTS: Providers using only the UNIP detected and treated pain in a maximum of 16% of patients as compared to 85% of patients who were diagnosed with pain by the reference standard. When employed, the validated pain screen had a sensitivity of 100% [95% CI: 72% - 100%] and a negative predictive value of 100%, as compared to a sensitivity of 24% [95% CI: 8% - 50%] and negative predictive value of 19% by the index test. The difference in the sensitivity of the UNIP as compared to the BPISF was significant, with p < 0.001. DISCUSSION/SIGNIFICANCE OF IMPACT : These data indicate that the current global standard assessment of torture survivors, the United Nations Istanbul Protocol, should be supplemented by the use of a validated pain screen to increase the accuracy of chronic pain diagnosis. This would change the standard medical assessment of 70.8 million people globally, a number that continues to rise by nearly 45,000 people each day. ClinicalTrials.gov protocol number NCT03018782.
4536 Identification of the most salient risk factors of preterm birth in the US using geospatial mapping
Authors: Layden Alexander J , Catov Janet
Published: July 2020

OBJECTIVES/GOALS: Preterm birth is the most common birth complication in the United States. To date, there are no effective public health strategies to reduce the burden of prematurity. Using geospatial information system (GIS) mapping, we identified the most salient risk factors of preterm birth across US counties targetable for future interventions. METHODS/STUDY POPULATION: Risk factors of preterm birth were identified from the perinatal health nonprofit organization, March of Dimes, and included factors such as obesity, smoking, insurance coverage and poverty. US 2013 county-level data on sociodemographic characteristics, behavioral risk factors and preterm birth were extracted and combined from the American Census, Center for Disease Control, and US Health Resources and Services Administration. Spatial autocorrelation and multivariate spatial regression were used to determine the risk factors most strongly associated with preterm birth. These models were adjusted for race, given well-documented race disparities for preterm birth. As a case-study comparison, we mapped risk factors in the two states with the highest and lowest proportion of preterm births in 2013. RESULTS/ANTICIPATED RESULTS: In our preliminary analysis, obesity was the factor most strongly associated with preterm birth (ß = 7.32, SE: 1.13, p<0.001) at the US county-level. Surprisingly, smoking was not found to be significantly associated with preterm birth. In 2013, Vermont had the lowest prevalence of preterm birth at 7.6% and Mississippi had the highest prevalence of preterm birth at 13.1%. Health insurance coverage and obesity were the two risk factors that differed between Vermont and Mississippi. The median proportion of uninsured individuals in Mississippi counties was four times higher than that of Vermont counties (26.3% vs 10.9%, p<0.01). Similarly, the median obesity prevalence in Mississippi counties was significantly higher than the median obesity prevalence in Vermont counties (38.8% vs. 25.2%). DISCUSSION/SIGNIFICANCE OF IMPACT: Public health efforts aimed at reducing obesity and increasing health insurance coverage may have the greatest impact at addressing the US burden of preterm birth. Further, geospatial mapping is a powerful analytic tool to identify regions in the US where preterm birth interventions would be most beneficial.
4451 On the loss of individual joint controllability and the organization of muscle synergies in the impaired arm following a stroke: A pilot study
Authors: Kim Dongwon , Koh Kyung , Baghi Raziyeh , Lo Li-Chuan , Zhang Chunyang , Xu Dali , Zhang Li-Qun
Published: July 2020

OBJECTIVES/GOALS: Damage to the sensorimotor cortex areas or/and motor/sensory pathways after a stroke could lead the motor system to a loss of controllability for joints. We investigate the loss of individual joint controllability called a loss of individualization during arm movement, which would provide an insight into abnormal motor coordination. METHODS/STUDY POPULATION: We recruit 12 chronic stroke survivors with Fugl-Meyer score between 26 and 50. A robotic exoskeleton with minimum mechanical resistance is equipped to measure the movements of the shoulder, elbow and wrist joints, respectively. Surface EMGs on muscles related to the joints are recorded using 11 wireless pre-amplified electrodes. Participants are asked to move the shoulder, elbow, or wrist joint individually throughout their range of motion, without moving the other joints voluntarily. RESULTS/ANTICIPATED RESULTS: It would be expected that participants show more difficulty in individualization of the distal joint in comparison with the proximal joint. A reduced joint range of motion would be observed in a descending order of the wrist, elbow and shoulder. These results are in line with the proximal-to-distal gradient of motor deficits after a stroke. Intention of moving the distal joint would induce a greater deviation in the position of the proximal joint than that of the distal joint when moving the proximal joint. A non-negative matrix factorization algorithm would reveal a decreased number of muscle synergies in the groups with a loss of individuation in comparison with the groups with no loss. DISCUSSION/SIGNIFICANCE OF IMPACT: We demonstrate that a stroke leads to a lack of individual joint controllability, with a greater deficits on the distal joint, and that it is related to a decreased number of muscle synergies across the corresponding joints. CONFLICT OF INTEREST DESCRIPTION: N/A.
4273 An innovative rib construct for treatment of pediatric spinal deformity
Authors: Bonthius Daniel
Published: July 2020

OBJECTIVES/GOALS: The rib construct is a novel device for treating childhood hyperkyphosis and kyphoscoliosis. The purpose of this study was to investigate the biomechanics, mechanism, and clinical outcomes of this device. The overarching hypothesis was that the rib construct is safe and effective for correcting hyperkyphotic spinal deformity. METHODS/STUDY POPULATION: Biomechanical evaluation: An ex vivo porcine spine biomechanical study compared traditional pedicle screw proximal fixation to the rib construct in terms of proximal fixation strength and construct stiffness. Porcine model hyperkyphosis correction with rib construct: An in vivo hyperkyphotic porcine model was used to study the ability of the rib construct to correct hyperkyphosis in the developing porcine spine. Human hyperkyphotic correction with rib construct: A retrospective study was conducted to examine the radiographic outcomes, complication rates, procedure times, and blood losses experienced by human patients that received rib construct surgery. RESULTS/ANTICIPATED RESULTS: Biomechanical evaluation: The rib construct was significantly less prone to proximal fixation failure and less stiff compared to pedicle screws. Porcine model hyperkyphosis correction with rib construct: The average T6-T14 thoracic kyphosis was 35.8 ± 3.2° at the time of hyperkyphosis creation surgery. In response to corrective surgery with the rib-hook construct, T6-T14 thoracic hyperkyphosis decreased immediately post-op to 11.3 ± 7.8° and continued to decrease to 7.8 ± 7.6° until final follow-up 8 weeks post-op (n = 3). Human hyperkyphosis correction with rib construct: Pre-op sagittal Cobb angle was 81 ± 31° and fell to 43 ± 24° post-op and to 38 ± 24° at final follow-up; indicating ~100% correction (normal thoracic kyphosis is 40°). DISCUSSION/SIGNIFICANCE OF IMPACT: The results suggest that the rib construct is a highly effective technique and superior to existing methods.
4524 Fighting Malaria, One Image at a Time: Using Computer Vision to Develop an Automated Vector Speciation Tool
Authors: Diaz Sophia , Ford Tristan , Slinowsky Monet , Gersch Kiley , Armah Ebenezer , Frank Karina , Buono Zachary , Glancey Margaret , Goodwin Adam , Acharya Soumyadipta
Published: July 2020

OBJECTIVES/GOALS: Rapid and accurate identification of primary malaria vector species from collected specimens is the most critical aspect of effective vector surveillance and control. This interdisciplinary team of engineers aims to automate identification using a deep learning computer vision algorithm. METHODS/STUDY POPULATION: The team spent August of 2019 observing and participating in control and surveillance activities in Zambia and Uganda. They conducted >65 interviews with key stakeholders across 9 malaria control and surveillance sites, ranging from field and community health workers, to malaria researchers and Ministry of Health employees. Stakeholder feedback validated the need for a more accurate and efficient method of vector identification in order to more effectively deploy targeted malaria interventions. The team set forth in designing and prototyping a portable, automated field tool that could speciate mosquito vectors to the complex level using artificial intelligence. RESULTS/ANTICIPATED RESULTS: The team’s research demonstrated that accuracy, cost effectiveness, and ease of use would be critical to the successful adoption of the tool. Results of initial prototyping, usability studies, and stakeholder surveys were used to determine the tool’s minimal user specifications: 1) the ability to distinguish between Anopheles Gambiae and Anopheles Funestus, the two principal malaria vectors in the countries visited, 2) achieving an identification accuracy of ≥90% to the complex level, and 3) accessibility to the speciation data 3-7 days following vector collection. Next steps include optimizing the tool to deploy a minimal viable product for testing in Kenya by the summer of 2020. DISCUSSION/SIGNIFICANCE OF IMPACT: The accurate, high-quality surveillance enabled by this device would allow malaria control programs to scale surveillance to remote regions where an entomologist may not be available, allowing malaria programs to deploy effective interventions, monitor results, and prevent disease.
4497 Accessible False Discovery Rate Computation
Authors: Hollister Megan C , Blume Jeffrey D.
Published: July 2020

OBJECTIVES/GOALS: To improve the implementation of FDRs in translation research. Current statistical packages are hard to use and fail to adequately convey strong assumptions. We developed a software package that allows the user to decide on assumptions and choose the hey desire. We encourage wider reporting of FDRs for observed findings. METHODS/STUDY POPULATION: We developed a user-friendly R function for computing FDRs from observed p-values. A variety of methods for FDR estimation and for FDR control are included so the user can select the approach most appropriate for their setting. Options include Efron’s Empirical Bayes FDR, Benjamini-Hochberg FDR control for multiple testing, Lindsey’s method for smoothing empirical distributions, estimation of the mixing proportion, and central matching. We illustrate the important difference between estimating the FDR for a particular finding and adjusting a hypothesis test to control the false discovery propensity. RESULTS/ANTICIPATED RESULTS: We performed a comparison of the capabilities of our new p.fdr function to the popular p.adjust function from the base stats-package. Specifically, we examined multiple examples of data coming from different unknown mixture distributions to highlight the null estimation methods p.fdr includes. The base package does not provide the optimal FDR usage nor sufficient estimation options. We also compared the step-up/step-down procedure used in adjusted p-value hypothesis test and discuss when this is inappropriate. The p.adjust function is not able to report raw-adjusted values and this will be shown in the graphical results. DISCUSSION/SIGNIFICANCE OF IMPACT: FDRs reveal the propensity for an observed result to be incorrect. FDRs should accompany observed results to help contextualize the relevance and potential impact of research findings. Our results show that previous methods are not sufficient rich or precise in their calculations. Our new package allows the user to be in control of the null estimation and step-up implementation when reporting FDRs.
4320 Acral, Head and Neck Melanoma Subtype Classification Performance Using A Convolutional Neural Network (CNN) Trained On a Public Dataset
Authors: Shah Payal , Arya Sameer , Rangel Lauren , Aphinyanaphongs Yindalon
Published: July 2020

OBJECTIVES/GOALS: Composition of demographics or image types in publicly available datasets may detract from deep learning (DL) diagnosis performance of underrepresented melanoma subtypes. We evaluate a DL model’s performance on melanoma subtypes (acral; head and neck) that have known association with poor prognosis. METHODS/STUDY POPULATION: We trained a CNN using a single InceptionV3 model for 30 epochs on dermoscopic images of pigmented lesions from the International Skin Imaging Collaboration (ISIC). The ISIC 2018 challenge training set had 10008 total images, with 1113 total nevi, 6705 total melanomas, 97 acral nevi, 10 acral melanomas, 256 head and neck (H&N) nevi, and 164 H&N melanomas. The non-acral test set had 117 melanomas and 200 nevi. The acral test set had 201 melanomas and 161 nevi. The H&N test set had 199 melanomas and 128 nevi. Area under the receiver operating curve (AUC) was calculated. The model was retrained with acral lesion oversampling (10x) and performance on the acral test set was re-evaluated. RESULTS/ANTICIPATED RESULTS: The model performed on the non-acral test with an AUC of 80.5%, on the acral test with an AUC of 76.3%, and on the head and neck test with an AUC of 83.8% After oversampling acral lesions within the training set, the model showed nearly the same performance as without oversampling on acral lesions: AUC of 75.6%. DISCUSSION/SIGNIFICANCE OF IMPACT: Diagnosis of high-risk melanoma subsets (acral; H&N) remains reliable despite underrepresentation during training, increasing validity for broad implementation of DL technology. Datasets for individual subtypes may not be warranted as findings suggest features may be learned from other skin lesions.
4489 Association between surgery with general anesthesia and cognitive decline in older adults: analysis using shared parameter models for informative dropout
Authors: Schulte Phillip , Devick Katrina , Sprung Juraj
Published: July 2020

OBJECTIVES/GOALS: Recent studies have assessed the association between surgery with general anesthesia and cognitive decline in longitudinal cohorts of older adults. Patients diagnosed with dementia more frequently drop out of these longitudinal studies or are unable to complete the test battery. We revisit this aim with focus on methods for informative dropout. METHODS/STUDY POPULATION: We use data from the Mayo Clinic Study of Aging (MCSA), a longitudinal epidemiological study of the prevalence, incidence, and risk factors for mild cognitive impairment (MCI) and dementia. Our primary outcome of interest was global cognitive z-score, assessed at study visits every 15 months. We implement linear mixed effects models to assess the association between post-enrollment exposure to surgery/anesthesia and subsequent cognitive decline trajectories. Demented patients more frequently drop out of MCSA, so, subjects with the worst cognitive outcomes are unobserved and missing data may be informative. Since this missingness may be missing not at random, we use shared parameter models to analyze continuous cognitive outcomes while jointly modeling time to dementia. RESULTS/ANTICIPATED RESULTS: A total 1948 subjects, non-demented at baseline, from the MCSA were included. Median age was 79, 51% of subjects were male, and 16% had MCI at enrollment. Among median follow-up of 4 study visits over median 5.4 years, 172 patients developed dementia and dropped out from further assessments of cognitive function. In adjusted linear mixed effects models, our data suggest post-enrollment exposure to surgery/anesthesia is associated with a decline in cognitive function over time (change in slope = −0.07 standard deviations of cognitive z-score per year, 95%CI = −0.08, −0.05, p<.001). After adjusting for informative dropout using shared parameter models, surgery/anesthesia is associated with greater cognitive decline (change in slope = −0.14 per year, 95%CI = −0.16, −0.12, p<.001). DISCUSSION/SIGNIFICANCE OF IMPACT: We revisited a prior analysis by our group with consideration of informative dropout. Subjects who dropout due to dementia may have different trajectories of cognitive decline compared to non-demented subjects. Shared parameter models estimate the association between surgery/anesthesia and cognitive decline accounting for informative dropout.