bluuebunny/crossref_metadata_2025 huggingface dataset:
Evidence-based self-medication: development and evaluation of a professional newsletter concept for community pharmacies
Authors: Moritz Katharina , Seiberth Jasmin Mina , Schiek Susanne , Bertsche Thilo
Published: July 2020

Background Providing evidence-based care is recognized as a key competence for all healthcare professionals. In order to support community pharmacists in evidence-based self-medication counseling, the umbrella organization of German pharmacists initiated the development of a nationwide concept. The key element of the concept was a professional newsletter that should help pharmacists incorporate research findings into their daily counseling practice. Objective To develop, implement and evaluate the professional newsletter concept. Setting German community pharmacies. Method Clinical pharmacists from a German university compiled and synthesized clinical trial data in a professional newsletter that would supply community pharmacists with evidence-based information on common over-the-counter medicines as well as instructions for searching and appraising scientific literature. The electronic newsletter was offered to interested community pharmacists free of charge, once or twice a month, after they signed up for a subscription. About one year after the publication of the first newsletter issue, the subscribers were invited to take part in an anonymous cross-sectional online survey. In all, 21 newsletter issues were published through the end of the survey period. Main outcome measure Perceived value of the professional newsletter with 10 predefined objectives. Results A total of 1975 persons subscribed to the professional newsletter. Of those, 150 persons working in community pharmacies completed the survey. Most of them perceived the synthesized information as ‘useful’ (81–95%). They attributed positive changes in knowledge (89%), skills (87–91%), awareness (85%), and motivation (67–77%) to the newsletter. However, almost half of them (43%) found it difficult to incorporate reading the newsletter in their everyday working life. Free-text feedback suggested that further modifications should be considered to facilitate a better integration of the newsletter into everyday pharmacy practice. Conclusion A nationwide provided professional newsletter can play a vital part in supporting pharmacists in evidence-based self-medication counseling. However, the practicability of such a newsletter needs to be further improved and the newsletter should be accompanied by additional measures.
Counterfactual theories of causation and the problem of large causes
Authors: Harbecke Jens
Published: July 2020

As is well-known, David Lewis’ counterfactual theory of causation is subject to serious counterexamples in ‘exceptional’ cases. What has not received due attention in the literature so far is that Lewis’ theory fails to provide necessary and sufficient conditions for causation in ‘ordinary’ cases, too. In particular, the theory suffers from the ‘problem of large causes’. It is argued that this problem may be fixed by imposing a minimization constraint, whilst this solution brings along substantial costs as well. In particular, a precise formulation of minimization requires defining an ‘essential part of an event’ and/or an ‘essential subevent’. Although the possibility of such a definition is ultimately left open, some doubts are raised on whether the counterfactualists’ resources are fit for this purpose, and whether the challenge can be met without substantially departing from Lewis’ intention, which was to provide a reductive account of causation.
Cosmopolitan Sentiment: Politics, Charity, and Global Poverty
Authors: Hobbs Joshua
Published: July 2020

Duties to address global poverty face a motivation gap. We have good reasons for acting yet we do not, at least consistently. A ‘sentimental education’, featuring literature and journalism detailing the lives of distant others has been suggested as a promising means by which to close this gap (Nussbaum inUpheavals of Thought: The Intelligence of Emotions, CUP, Cambridge, 2001; Rorty inTruth and Progress: Philosophical Papers, vol. 3, CUP, Cambridge, 1998). Although sympathetic to this project, I argue that it is too heavily wed to a charitable model of our duties to address global poverty—understood as requiring we sacrifice a certain portion of our income. However, political action, aimed at altering institutions at both a global and a local level is likely to be necessary in order to provide effective long-term solutions to poverty globally. To rectify this, the article develops an alternative dialogical account of sentimental education, suitable for motivating support for political action to address global poverty.
Identifying 8 mm Radio Brightenings During the Solar Activity Minimum
Authors: Kallunki Juha , Tornikoski Merja , Björklund Irene
Published: July 2020

Strong solar radio brightenings have been extensively studied in the past, and their correlation to the sunspots and active regions are already well known. But even when the Sun is ostensibly quiet, there is practically always some activity that can be detected in the radio domain. In this article we investigate these semi-active features at 8 mm using the radio telescope at Aalto University Metsähovi Radio Observatory. The observations were made between May and September 2019 when the solar activity was very low, and for our detailed study we chose dates when no active regions were identified on the solar surface by the National Oceanic and Atmospheric Administration. The brightness temperature of these radio regions during this quiescent period of solar activity is at maximum approximately 250 K above the quiet-Sun level. We compared our millimeter data with data taken in extreme ultraviolet, and we found that these weak radio brightenings are mostly related to coronal hole features and magnetic bright points. We also found that there are two different categories of bright points: those with and without flux tube structure. The formation of the weak radio brightenings is comparable to the stronger radio brightenings: the rising fluxes from the weak photospheric features can be detected as a radio source.
Parallel sequential Monte Carlo for stochastic gradient-free nonconvex optimization
Authors: Akyildiz Ömer Deniz , Crisan Dan , Míguez Joaquín
Published: July 2020

We introduce and analyze a parallel sequential Monte Carlo methodology for the numerical solution of optimization problems that involve the minimization of a cost function that consists of the sum of many individual components. The proposed scheme is a stochastic zeroth-order optimization algorithm which demands only the capability to evaluate small subsets of components of the cost function. It can be depicted as a bank of samplers that generate particle approximations of several sequences of probability measures. These measures are constructed in such a way that they have associated probability density functions whose global maxima coincide with the global minima of the original cost function. The algorithm selects the best performing sampler and uses it to approximate a global minimum of the cost function. We prove analytically that the resulting estimator converges to a global minimum of the cost function almost surely and provide explicit convergence rates in terms of the number of generated Monte Carlo samples and the dimension of the search space. We show, by way of numerical examples, that the algorithm can tackle cost functions with multiple minima or with broad “flat” regions which are hard to minimize using gradient-based techniques.
Semantically Tied Paired Cycle Consistency for Any-Shot Sketch-Based Image Retrieval
Authors: Dutta Anjan , Akata Zeynep
Published: July 2020

Low-shot sketch-based image retrieval is an emerging task in computer vision, allowing to retrieve natural images relevant to hand-drawn sketch queries that are rarely seen during the training phase. Related prior works either require aligned sketch-image pairs that are costly to obtain or inefficient memory fusion layer for mapping the visual information to a semantic space. In this paper, we address any-shot,i.e. zero-shot and few-shot, sketch-based image retrieval (SBIR) tasks, where we introduce the few-shot setting for SBIR. For solving these tasks, we propose a semantically aligned paired cycle-consistent generative adversarial network (SEM-PCYC) for any-shot SBIR, where each branch of the generative adversarial network maps the visual information from sketch and image to a common semantic space via adversarial training. Each of these branches maintains cycle consistency that only requires supervision at the category level, and avoids the need of aligned sketch-image pairs. A classification criteria on the generators’ outputs ensures the visual to semantic space mapping to be class-specific. Furthermore, we propose to combine textual and hierarchical side information via an auto-encoder that selects discriminating side information within a same end-to-end model. Our results demonstrate a significant boost in any-shot SBIR performance over the state-of-the-art on the extended version of the challenging Sketchy, TU-Berlin and QuickDraw datasets.
Residual Stress Measurement of Suspension HVOF-Sprayed Alumina Coating via a Hole-Drilling Method
Authors: Owoseni T. A. , Bai M. , Curry N. , Lester E. H. , Grant D. M. , Hussain T.
Published: July 2020

The nature and magnitude of residual stresses in thermal-sprayed coatings determine their lifetime and failure mechanisms. The residual stresses of suspension high-velocity oxy-fuel (SHVOF) thermal sprayed alumina (Al2O3) coating were measured with hole-drilling and x-ray diffraction. The coating is dense and consists of amorphous and two crystalline phases: alpha and gamma. The residual stresses measured by hole-drilling in the Al2O3 coating was − 162 MPa (compression) in the longitudinal direction and − 104 MPa (compression) in the transverse direction. This is due to the peening stress and the high substrate–coating CTE ratio of ~ 2.1. The nature of the residual stress through the coating is related to the microstructure build-up shown from the cross section and the fracture surfaces of the coating.
‘If I Had My House, I’d Feel Free’: Housing and the (Re)Productions of Citizenship in Cape Town, South Africa
Authors: Millstein Marianne
Published: July 2020

While urban divisions are commonly emphasized in urban studies, there has been less emphasis on reproductions and contestations of divides within marginal urban spaces. This paper explores the dynamics of juxtaposed differences related to housing and urban citizenship in Delft, Cape Town. Delft is a microcosm of thirty years of official housing interventions in post-apartheid South Africa. It is also a space in which differences of urban formality and informality and of permanence and temporariness co-exist, and where housing is at the centre of community politics. This is driven by residents’ perceptions, interpretations and negotiations of differentiated housing rights and opportunities, residential categories and identities and notions of belonging. A particular manifestation of juxtaposed material and temporal differences in housing infrastructure is the construction of temporary relocation areas (TRAs). The multifaceted challenges with the TRAs in Delft illustrate the political nature of housing infrastructure as reported by (Lemanski 2019a, b) and how citizen-making is shaped in and through articulations of formality and informality, and of permanence and temporariness. This informs a politics of citizenship where the precariousness of permanent temporariness as reported by (Yiftachel 2009) for those living in the TRAs is set against those whose right to secure housing is realized, giving them recognition and permanence as ‘proper’ citizens. These dynamics may simultaneously inform rights-based claims to citizenship through collective struggles and individual actions, and localized forms of exclusion from the project of citizenship.
Inferring structure and parameters of dynamic system models simultaneously using swarm intelligence approaches
Authors: Usman Muhammad , Pang Wei , Coghill George M.
Published: July 2020

Inferring dynamic system models from observed time course data is very challenging compared to static system identification tasks. Dynamic system models are complicated to infer due to the underlying large search space and high computational cost for simulation and verification. In this research we aim to infer both the structure and parameters of a dynamic system simultaneously by particle swarm optimization (PSO) improved by efficient stratified sampling approaches. More specifically, we enhance PSO with two modern stratified sampling techniques, i.e., Latin hyper cube sampling (LHS) and Latin hyper cube multi dimensional uniformity (LHSMDU). We propose and evaluate two novel swarm-inspired algorithms, LHS-PSO and LHSMDU-PSO, which can be used particularly to learn the model structure and parameters of complex dynamic systems efficiently. The performance of LHS-PSO and LHSMDU-PSO is further compared with the original PSO and genetic algorithm (GA). We chose real-world cancer biological model called Kinetochores to asses the learning performance of LHSMDU-PSO and LHS-PSO in comparison with GA and the original PSO. The experimental results show that LHSMDU-PSO can find promising models with reasonable parameters and structure, and it outperforms LHS-PSO, PSO, and GA in our experiments.
A Novel Functional Link Network Stacking Ensemble with Fractal Features for Multichannel Fall Detection
Authors: Tahir Ahsen , Morison Gordon , Skelton Dawn A. , Gibson Ryan M.
Published: July 2020

Falls are a major health concern and result in high morbidity and mortality rates in older adults with high costs to health services. Automatic fall classification and detection systems can provide early detection of falls and timely medical aid. This paper proposes a novel Random Vector Functional Link (RVFL) stacking ensemble classifier with fractal features for classification of falls. The fractal Hurst exponent is used as a representative of fractal dimensionality for capturing irregularity of accelerometer signals for falls and other activities of daily life. The generalised Hurst exponents along with wavelet transform coefficients are leveraged as input feature space for a novel stacking ensemble of RVFLs composed with an RVFL neural network meta-learner. Novel fast selection criteria are presented for base classifiers founded on the proposed diversity indicator, obtained from the overall performance values during the training phase. The proposed features and the stacking ensemble provide the highest classification accuracy of 95.71% compared with other machine learning techniques, such as Random Forest (RF), Artificial Neural Network (ANN) and Support Vector Machine. The proposed ensemble classifier is 2.3× faster than a single Decision Tree and achieves the highest speedup in training time of 317.7× and 198.56× compared with a highly optimised ANN and RF ensemble, respectively. The significant improvements in training times of the order of 100× and high accuracy demonstrate that the proposed RVFL ensemble is a prime candidate for real-time, embedded wearable device–based fall detection systems.
The correlation between friction coefficient and areal topography parameters for AISI 304 steel sliding against AISI 52100 steel
Authors: Prajapati Deepak K. , Tiwari Mayank
Published: July 2020

Dry wear experiments provide an insight detail on how severely contacting surfaces change under unlubricated sliding condition. The theory of dry sliding wear is used for understanding mixed-lubrication regime in which asperity interactions play a significant role in controlling of the friction coefficient (f). The purpose of this work is to study the tribological behavior of AISI 304 steel in contact with AISI 52100 steel during wear. Both materials are used in rolling element bearings commanly. Experiments are carried out using a pin-on-disc tribometer under dry friction condition. The areal (three dimensional, 3D) topography parameters are measured using a 3D white light interferometer (WLI) with a 10× objective. After wear tests, wear mechanisms are analyzed utilizing scanning electron microscope (SEM). Factorial design with custom response surface design (C-RSD) is used to study the mutual effect of load and speed on response variables such as f and topography parameters. It is observed that the root mean square roughness (Sq) decreases with an increase in sliding time. Within the range of sliding time, Sq decreases with an increase in the normal load. Within the range of sliding speed and normal load, it is found that Sq, mean summit curvature (Ssc), and root mean square slope (Sdq) are positively correlated with f. Whereas, negative correlation is found between f and correlation length (Sal), mean summit radius (R), and core roughness depth (Sk).
The Role of Modeling and Synthesis in Creative Mitigation
Authors: Heilen Michael
Published: July 2020

In the 54 years since passage of the National Historic Preservation Act, more than 56 million ha of land have been surveyed in the United States, and nearly one million cultural resources have been identified and recorded. These efforts have produced hundreds of thousands of project reports, vast collections of data, and a wealth of descriptive information about the past. The accumulated data can be used to generate important new knowledge about the past, with many scientific and management implications, but remain largely untapped. Following current approaches, many resources will be damaged or lost before effective strategies for studying or preserving them can be developed. Synthesis and modeling are needed in creative mitigation efforts to identify which resources to preserve and study and how best to do so with limited time and funding. This article explores the potential for compiling and synthesizing large cultural and environmental datasets within a geographic information system to model the nature and distribution of cultural resources. It is argued that dedicated synthesis and modeling of cultural resource management data will allow development of more effective and proactive research and management strategies, providing lasting benefit to diverse scientific and traditional communities and the public.
Combustor-inlet interactions in a low-order dynamic model of ramjet engines
Authors: Liu K. , Cui T.
Published: July 2020

The coexistence of multiple stable states is indicative of self-organising processes occurring in the course of the combustor-inlet interactions in a ramjet engine and give rise to the appearance of various nonlinear phenomena. This paper provides a dynamic model that can describe the multiple stable states and the corresponding nonlinear effects to further investigate the dynamic interactions between combustor and inlet in a ramjet engine. Our study shows the whole engine can display distinct dynamic behaviours ranging from irreversibility to hysteresis and to various mode transitions, depending on different physical parameters. With the model, we also illustrate the role of the instability of the normal shock wave in impacting the whole engine’s nonlinear dynamics. Additionally, we extend the previous studies of the classification of combustor-inlet interactions from a static framework to a dynamic framework, which helps to clarify the transient processes of the nonlinear interactions. This work offers a quantitative illustration of the combustor-inlet interactions in a ramjet engine by revealing its nonlinear dynamics and associated characteristics, therefore advancing our understanding of the nonlinear phenomena that exhibit in ramjet engines.
4097 Transcriptome and molecular analysis of erythropoietin-induced hypertension
Authors: Kumar Nitin , birt Isabelle , Hunker Kristina L. , Ganesh Santhi K.
Published: July 2020

OBJECTIVES/GOALS: High blood-pressure (BP) is a common adverse effect of erythropoietin (EPO) therapy among patients with chronic kidney disease on hemodialysis, and even among otherwise healthy individuals who receive EPO. In human genetics, EPO is associated with not only red blood cell traits, but hypertension (HTN) as well. Currently, there is no vascular gene expression data available in the setting of EPO-induced HTN that may explain precise role of key cellular players in its hypertensive etiology. Our aim is to characterize vascular transcriptome to identify key cellular players in EPO-induced HTN. METHODS/STUDY POPULATION: 10-12 week C57BL/6 male and female mice were randomly divided into two groups 1. Vehicle (0.9% saline-VEH), 2. EPO, (N = 4). VEH and EPO were intraperitoneal administered (EPO 75U/30g, 3 times/week) for 20 days. Blood-pressure was measured non-invasively via tail-cuff plethysmography. We characterized in-vivo transcriptome response of mouse descending aorta to EPO-HTN and vehicle control group by high-throughput RNA-sequencing. RESULTS/ANTICIPATED RESULTS: Systolic blood pressure (SBP) was significantly higher in EPO treatment, compared to vehicle (males and females combined SBP VEH 116.29 ± 6.21, EPO 129.57 ± 4.59, mean ± s.d., adjusted P = 0.0012). Comparison of in-vivo transcriptional differences between vehicle and EPO-treated reveal statistically significant changes in cellular pathways consistent with hypertension such as upregulation of RAS signaling pathway and oxidative stress. In-vitro mouse aortic smooth muscle cells, EPO markedly increased phosphorylated-ERK activity, suggesting increased RAS activity. DISCUSSION/SIGNIFICANCE OF IMPACT: This study highlights the importance of previously unknown vascular key players and advances our understanding of the transcriptional events associated with EPO-induced hypertension.
4117 UNIQUE VAGINAL MICROBIOME POPULATIONS AND MICROBIAL GENE CONTENT AMONG WOMEN WHO NATURALLY CONTROL HIV PROGRESSION
Authors: Michel Katherine Gisella , Ma Bing , Weber Kathleen , McClellan Leah , Sheth Anandi , Gange Stephen , French Audrey , Ravel Jacques , Ofotokun Igho , Merenstein Daniel
Published: July 2020

OBJECTIVES/GOALS: The role of the vaginal microbiome (VM) in HIV disease progression is poorly understood. We examined VMs of HIV+ Elite Controllers (ECs) and HIV+ Long-Term Non-Progressors (LTNPs) compared to controls: HIV-positive antiretroviral (ARV) treated (HIV+ATs) and HIV-negative women in the Women’s Interagency HIV Study (DC/Chicago/Atlanta sites). METHODS/STUDY POPULATION: VMs were surveyed via both V3/V4 region of 16S rRNA gene amplicon sequencing and metagenomics sequencing in 67 women across 4 study groups: 1) LTNPs (CD4 >500 cells/mL for 5+ years without ARVs) (n = 7) and 2) ECs (HIV RNA <80 copies/mL for 2+ years without ARVs) (n = 8), matched with 3) HIV+ ATs (on ARVs for ≥1 year with CD4 increase ≥100 cells/mm3) (n = 34), and 4) HIV- women (n = 18). Metagenomes were characterized from specimens collected at two time points: 1) vaginal swabs collected 2016-2017 (n = 62) and 2) cervicovaginal lavage collected 2002-2016 (n = 35; DC/Chicago only). We used VIRGO (human vaginal non-redundant gene catalog), a newly developed referencing framework to comprehensively catalog VM gene content, taxonomy and functions. RESULTS/ANTICIPATED RESULTS: Women were 89% African American with a mean age of 46 years (SD 8.8). The most prevalent species were Gardnerella vaginalis (predominant in 34%), Lactobacillus iners (predominant in 21%), and L. crispatus (predominant in 14%). 90% of LTNP and 45% of EC samples were Lactobacillus-dominant vs. 28% of HIV- and 30% of HIV+ATs. L. crispatus and L. iners in ECs/LTNPs had significantly different gene content and greater gene richness vs. controls. G. vaginalis-predominant communities were found in 66% of HIV- and 68% of HIV+ATs, compared to 46% of EC and 0% of LTNP. The G. vaginalis strains present in EC/LTNP also showed significantly lower gene richness and different gene content vs. controls. DISCUSSION/SIGNIFICANCE OF IMPACT: These results suggest unique VM communities among EC/LTNP, and led us to hypothesize that differential regulation of vaginal immunity drives the observed differences. The similarity between VMs of HIV- and HIV+ATs warrants further study. Larger longitudinal VM studies are needed to assess associated functional pathways and understand the etiology of VM association with HIV progression. CONFLICT OF INTEREST DESCRIPTION: The authors have no conflicts of interest to disclose.
4439 Comparing the Impact of Adding an Educational Video Presentation to Universal Self-Consent for Remnant Clinical Biospecimens: A Single Blind Randomized-Control Trial
Authors: Kyle Andrew , Soares Stephanie E. , Wilson Machelle D. , Anderson Nicholas R. , Lopez Javier E.
Published: July 2020

OBJECTIVES/GOALS: BURRITO is an efficient strategy that provides full disclosure in the electronic medical record of a patient’s preference in real time. BURRITO uses printed materials only to inform patients and has a <50% rates of consent. We hypothesized that adding an informational video to the printed materials would increase donations. METHODS/STUDY POPULATION: This study was IRB-approved and was considered minimal risk. The BURRITO self-consent workflow process (Soares et. al, Biopreservation and Biobanking, IN PRINT) was developed in an outpatient cardiology clinic. In the same clinic, patients were randomized to receiving printed materials only (standard procedure) or the printed materials plus a 2.5-minute informational video (intervention) while waiting for the physician in the exam room. Randomization occurred at the level of the day in clinic. Patients were blinded to the nature of the study. Following the presentation of information, the patient’s decision on consent for donation was documented in the electronic record by ancillary clinical staff. Rates of consent were analyzed by a statistician not involved in the experiment and after completion of trial. RESULTS/ANTICIPATED RESULTS: Thirty-five clinic days were randomized to either intervention (17 days) or standard (18 days), and a total of 255 patients decided during their visit to either “opt-in” or “opt-out” to donating remnant biospecimens for future research. One hundred patients opted to defer deciding (28%). No significant demographic differences were noted between the study arms. The rate of consent was 73% vs. 58% in the intervention group and the control group, respectively (p-value = 0.014). This represents an increase in the odds of consenting with an informational video by 96% (OR = 1.96, 95% CI = 1.15 to 3.34). DISCUSSION/SIGNIFICANCE OF IMPACT: This is the first randomized trial to show that an informational video with printed materials is superior for when patients are self-consenting to opt-in for clinical remnant biospecimen donation. This result adds to the evidence that the BURRITO process plus video (BURRITOv) is an effective approach for biospecimen universal consenting.
4036 POSITIVE EXPERIENCE OF INFORMED CONSENT UNDERSTANDING AT A METROPOLITAN MULTI-INSTITUTIONS CTSA HUB
Authors: Otado Jane Anyasa , Magee Reyneir , Kwagyan John , Vittone Sarah , Ordor Debra , Loveland Amy , Hinkson MaryAnne
Published: July 2020

OBJECTIVES/GOALS: There is not much known on how to improve informed consent understanding and there are no effective interventions that have been identified to improve understanding rates of information. This study seeks to assess participants understanding of the informed consent. METHODS/STUDY POPULATION: We studied a non-probability sample of 245 participants, 57% female, with age range from 6 to 84, currently enrolled in clinical trials conducted at an urban city, multi CTSA institution. A self-administered questionnaire approved by IRB was utilized. Redcap database was utilized for data entry. The items in the questionnaire reflected understanding of the informed consent (e.g., purpose for the study, participants’ rights, risks, benefits). Participants completed the survey during their first visit to the research centers or on a follow-up visit. Data were collected from July 2018 to November 2019. Data were analyzed descriptively by summary statistics. RESULTS/ANTICIPATED RESULTS: African Americans were 44%, Non-Hispanic Whites were 36%, Hispanic 6%. Others 13%. 52% married, 12% completed High school, 74.8% completed College, 13% less High school. 91% read the form themselves. 99% knew the purpose of the study; 99% knew they could quit the study at any time. While (113) 47% indicated knowledge of the potential risk, only (12)10.6% could not list any associated risk. 98% stated they had information on who to call with questions regarding the study. (204)86% knew of a potential benefit, only (11)5% could not name some study benefit. 38% were unsure/did not know the total number of visits study required of them. 74% knew the duration of the study. DISCUSSION/SIGNIFICANCE OF IMPACT: Extended discussion and more time on one-one by the study teams in this CTSA tend to increase trust. This approach has been reported to be most effective in improving participant understanding of informed consent process and may result in the positive experience.
4332 Septic Shock Epidemiology and Sociodemographic Predictors of Mortality: Results from One Florida Data Trust Cohort
Authors: Black Lauren Page , Hopson Charlotte , DeVos Elizabeth , Fernandez Rosemarie , Guirgis Faheem , Garvan Cynthia
Published: July 2020

OBJECTIVES/GOALS: Septic shock is a lethal condition. Research suggests that overall sepsis mortality varies by race, but less is known about demographic differences in septic shock mortality. Our objectives were to describe the septic shock population using a large, state-wide data repository and identify demographic predictors of septic shock mortality. METHODS/STUDY POPULATION: This was a retrospective review of patients with septic shock in the One Florida Data Trust from 2012-2018. Patients were classified as having septic shock if they received vasopressors and had either 1) an ICD-9 or 10 code for septic shock or 2) an ICD-9 or 10 code for infection and an ICD-9 or 10 code for organ dysfunction. Demographic data and place of residence prior to admission was collected. The primary outcome was 90 day mortality. T-test and chi-square tests were used to test association of individual predictors and mortality. Multiple logistic regression was used to identify predictors of mortality after adjustment for other variables. Level of significance was set at 0.05. SAS v9.4 (Cary, NC) was used for analyses. RESULTS/ANTICIPATED RESULTS: There were 11,790 patients with septic shock. The mean(SD) age was 61(16) years. With regard to race/ethnicity 66% identified as white, 27% as black, 3.7% as Hispanic, and 3.5% as other races (non-white, non-black, non-Hispanic). Most came from home (57%). Overall, 39% died. Mortality varied by race (p<0.01): white 39%, black 39%, Hispanic 31%, other races 51%. In the logistic regression model, age, race, and residence were significant predictors of mortality, after adjustment for other variables. Each additional year of age had a 2.7% increased odds of mortality (OR 1.03; 95% CI 1.02-1.03; p<0.01). Compared to white patients, odds of death were 1.6 times higher for other races (95% CI 1.3-2.0; p <0.01) and non-significantly higher for black patients (OR 1.1; 95% CI 1.0-1.2; p = 0.05). Compared to those from home, odds of death were highest for those from a skilled nursing facility (OR 1.5; p<0.01). DISCUSSION/SIGNIFICANCE OF IMPACT: Patients who identified as other races had increased mortality from septic shock compared to white patients after adjusting for other variables. Septic shock mortality also increased with age and varied by residence. Further analyses are needed to examine racial disparities and control for comorbidities, severity of illness, and aspects of resuscitation. CONFLICT OF INTEREST DESCRIPTION: The authors report no conflicts of interest, except for Dr. Fernandez, who reports personal payment from Physio-Control, Inc. for speaker fees.
4236 Sleep Disorders and Diabetic Complications
Authors: Shaheen Magda , Nocera Meleesa , Teklehaimanot Senait
Published: July 2020

OBJECTIVES/GOALS: Diabetes is a prevalent chronic illness that imposes health-related burdens including nephropathy, retinopathy and sleep disorders. The goal of this study was to examine the relation between both sleep disorders and sleep duration and diabetic chronic kidney disease (CKD) and retinopathy. METHODS/STUDY POPULATION: We analyzed data from the National Health and Nutrition Examination Survey 2005-2016 related to diabetic nephropathy and retinopathy, sleep disorders and duration, demographics, and risk factors among diabetics. The subjects were adults with diabetes type 2. Multiple logistic regression analysis was performed to look at the relationship between diabetic complications (CKD and retinopathy) and sleep disorders and sleep duration adjusting for demographics and risk factors. RESULTS/ANTICIPATED RESULTS: Of the 4087 diabetics, 45% had CKD, 19% had retinopathy, and 15% had sleep disorders. CKD and retinopathy were not associated with sleep disorders (p>0.05) but CKD was associated with sleep duration (Adjusted odds ration = 1.014, 95% confidence interval = 1.001-1.027, p<0.05). Cardiovascular disease was a predictor of both CKD and nephropathy (P<0.05). Other predictors of CKD and nephropathy were age >60 years, Non-Hispanic Black, hypertension, low education level, and living under 200% of the Federal Poverty Level (P<0.05). DISCUSSION/SIGNIFICANCE OF IMPACT : Among diabetics, CKD and retinopathy were not associated with sleep disorders, and only CKD was associated with sleep duration. These findings may impact the management of diabetes in the future, since it has effects on a range of other health conditions.
4438 Twenty-four-hour Urinary Sodium Excretion Estimated from a Spot Urine Sample May Be Used as an Indicator of Intake in CKD Patients
Authors: Lobene Andrea , Stremke Elizabeth , Moorthi Ranjani , Moe Sharon , Gallant Kathleen M Hill
Published: July 2020

OBJECTIVES/GOALS: Sodium (Na) intake can elevate blood pressure and is a factor in developing chronic kidney disease (CKD). Twenty-four-hour urinary Na (24hUNa) is the gold standard for assessing Na intake but is burdensome. Validated equations estimate 24hUNa (e24hUNa) from a spot urine sample, but these estimations are not validated against a known Na intake in CKD. METHODS/STUDY POPULATION: The current study is a secondary analysis of a 9-day controlled feeding study in moderate CKD patients matched to healthy adults. Only CKD patients were used for the current analyses (n = 8). Participants consumed a controlled diet for 9 days, providing ~2400 mg Na/d as determined by inductively coupled plasma optical emission spectroscopy (ICP). On days 7 and 8, participants collected all urine in an inpatient setting, beginning with a fasting sample on day 7. Urine sample mineral analyses were performed by ICP and urinary creatinine by the Jaffe reaction. The day 7 fasting urine sample was used to calculate e24hUNa using 6 published equations. Log-transformed Na intake, measured 24hUNa, and e24hUNa were compared by repeated-measures ANOVA with planned contrasts using SAS. RESULTS/ANTICIPATED RESULTS: Fifty percent of the CKD patients (n = 4) were female; 63% (n = 5) were white, and 37% (n = 3) were black. On average, participants were aged 56.6 ± 13.8 y with a BMI of 31.7 ± 9.4 kg/m2 and eGFR of 40.7 ± 7.9 mL/min. Based on actual food intake, average Na intake on day 7 was 2024 ± 388 mg. Average measured 24hUNa was 2529 ± 1334 mg. The main ANOVA was significant (p = 0.02). Results from the planned contrasts found that e24hUNa from the SALTED cohort, an equation developed specifically for CKD patients, was significantly higher than both Na intake (p<0.001) and measured 24hUNa (p = 0.007). For the remaining 5 equations, e24hUNa was not significantly different from measured 24hUNa nor dietary Na intake. DISCUSSION/SIGNIFICANCE OF IMPACT : Our results suggest that e24hUNa calculated using most published equations may provide a reliable and low-burden method of assessing dietary Na intake in moderate CKD patients. These findings should be confirmed in larger samples. Additional studies are needed to validate or dispute the use of the SALTED equation for estimating Na intake.
4393 Translational Characterization of Blood Pressure Changes Following the DASH Diet– from Nutrition to Electrolytes to Exosomes
Authors: Bielopolski Dana , Ronning Andrea , Vasquez Dacia , George-Alexander Glenis , Walker Jeanne , Tobin Jonathan N. , Kost Rhonda G
Published: July 2020

OBJECTIVES/GOALS:

1.

analyze urinary protein exosome content pattern before and during DASH diet.

2.

characterize urine electrolyte changes associated with changes in protein profiles, and hormonal changes before/after DASH diet.

3.

analyze the association of these changes to the DASH-related BP response.

METHODS/STUDY POPULATION: In this proof of concept study, hypertension stage 1 volunteers will receive a DASH based menu during 14 consecutive days of elective admission to the RU research hospital. Participants will complete a food frequency questionnaire (VioScreen) with a bionutritionist. Throughout the intervention period, participants will be assessed for blood pressure, plasma renin and aldosterone, and 24 hour urines for electrolytes, creatinine, protein, albumin and first morning urine collected for exosomes. Exosome analysis will be performed by a commercial lab. Proteome analysis will be conducted in the RU Mass-spectrometry service. RESULTS/ANTICIPATED RESULTS: The causal pathway we will elucidate hypothesizes that: 1) changes in diet affect blood electrolytes, and through these, aldosterone. 2) Aldosterone alters the expression of specific transporter proteins in the renal tubule; protein expression will be reflected in the urine exosome. 3) These transporters affect the excretion of electrolytes, as reflected by urinary ratio of sodium (Na) to Potassium (K). During consumption of the Western diet, the Na/K ratio is approximately 2-2.5, whereas we expect the urinary sodium/potassium ratio to be <1, when the participant is eating a DASH based diet. DISCUSSION/SIGNIFICANCE OF IMPACT: This assay provides a clinical tool to assess dietary adherence, and the project will provide insights into the mechanism whereby DASH reduces blood pressure.
4227 Closing the cross-institutional referral loop: Applying human factors to improve consultations
Authors: Savoy April , Weiner Michael , Damush Teresa
Published: July 2020

OBJECTIVES/GOALS: Although referrals for specialty consultations are a core clinical process, they are prone to coordination and communication breakdowns that have led to adverse clinical outcomes. This project’s objective is to improve timely documentation, transmission, access, and quality of consultation notes across healthcare systems. METHODS/STUDY POPULATION: There are two specific aims for this project. In Aim 1, we will characterize clinical workflows and information flow during cross-institutional referrals. In Aim 2, we will develop and test a prototype leveraging electronic health information exchange (HIE) to increase closing the loop for cross-institutional referrals and improve the quality of consultation notes. To accomplish these aims, we will use human factors methods, including data analytics, medical-record reviews, semi-structured interviews of consultants, rapid prototyping, and usability evaluations. RESULTS/ANTICIPATED RESULTS: Results will inform the design and integration of clinician-facing technologies into clinical workflows to close the referral loop and improve diagnostic processes. Aim 1 will provide quantitative evidence about the quality of cross-institutional referrals, inform the eventual implementation of our prototype, and identify user interface features required for successful electronic health information exchange. Based on the results from Aim 1, reports and visual representations will be generated to illustrate information flows and clinical workflows. This will prioritize design efforts for the intervention’s prototype. Aim 2 will translate clinicians’ requirements into prototype features and assess clinicians’ experience with the prototype. DISCUSSION/SIGNIFICANCE OF IMPACT: The use and usefulness of HIE has been limited due to usability and implementation issues. Cross-institutional referrals are complex and dependent on HIE due to EHRs’ lack of interoperability. This project will provide evidence-based recommendations for the use of Fast Healthcare Interoperability Resources (FHIR) to improve HIE during referrals.
4088 Longitudinal Assessment of Metabolic Syndrome as a Modifiable Risk factor of World Trade Center Particulate Matter Exposure Associated Lung Disease
Authors: Kwon Sophia , Lee Myeonggyun , Schwartz Theresa , Zeig-Owens Rachel , Prezant David , Liu Mengling , Nolan Anna
Published: July 2020

OBJECTIVES/GOALS: Metabolic syndrome (MetSyn) is a risk for World Trade Center-Lung Injury (WTC-LI; defined as developing FEV1<lower limit of normal [LLN]). Metabolic health is a modifiable disease risk factor. We propose to characterize how time-dependent covariates of MetSyn are longitudinally associated with WTC-LI. METHODS/STUDY POPULATION: WTC-particulate exposed firefighters, consented, with pre-9/11 FEV1 LLN (N = 5,746). Data assessed from last pre-9/11 till August 1, 2017. Longitudinal MetSyn characteristics were assessed using 3 models: i. A linear mixed effect model to assess the effect size of longitudinal MetSyn and its components on longitudinal FEV1% predicted as an outcome; ii. a time-dependent Cox regression to assess the associations of MetSyn to time of onset of WTC-LI; iii. a novel, partially linear single index regression model with repeatedly measured MetSyn to assess their joint effects and delineate their relative contribution on the longitudinal lung function in the WTC-FDNY cohort. RESULTS/ANTICIPATED RESULTS: In Model I, BMI 30 kg/m2 had the largest effect size compared to ever-smoking, with −2.524 (95%CI: −2.708,−2.340) compared to −1.681(−2.325,−1.038) respectively. Having MetSyn, defined as 3/5 risk factors, had an effect size of −2.319(−2.526,−2.112). In Model II, hazards of triglycerides 150mg/dL were highest at 1.497(1.336, 1.677), followed by BMI 30 kg/m2 at 1.406(1.256, 1.575), and HDL<40mg/dL 1.355(1.176-1.561), compared to ever-smoking (1.201, p = 0.002). Having high exposure to PM by being present in the morning of 9/11 was a significant covariate only in Model II investigating HDL<40mg/dL or triglycerides 150mg/dL. Model III The proposed methods will be applied to our cohort study. DISCUSSION/SIGNIFICANCE OF IMPACT: MetSyn is both a predictor and concurrent marker of WTC-LI. The single index model can not only reduce dimensionality of the covariates, but also provides efficient estimates of the joint MetSyn effects, allowing linear or nonlinear effects. Future studies will investigate dietary intervention as a potential disease-modifying factor. CONFLICT OF INTEREST DESCRIPTION: NA, nothing to disclose.
4183 Micro-consults: An effective tool for meeting statistical support needs in an academic medical research center
Authors: Taylor Sandra , Stewart Susan L.
Published: July 2020

OBJECTIVES/GOALS: Access to biostatistics expertise is essential for a successful clinical and translational research program. However, demand for statistical support at academic research centers can strain the capacity of biostatistics units. Our objective was to efficiently increase access to statistical expertise. METHODS/STUDY POPULATION: In cooperation with the Cancer Center Biostatistics Shared Resource, we replaced an informal 1-hour drop-in consultation program with structured office hours to provide statistical support to clinical and translational researchers at the University of California, Davis Medical Center. We doubled office hours to 2 hours per week and established six 20-minute appointments. Two Ph.D. level statisticians staff office hours. Researchers schedule appointments through Acuity Scheduling, a free on-line resource. Availability of the service is advertised monthly by sending an informational flyer to various university listservs. RESULTS/ANTICIPATED RESULTS: Prior to implementing the program in 2014, we averaged 91 office hour consults per year. Subsequently, consultations jumped to 171 in 2014 and have averaged 150 per year since then. Office hours attract students, residents, staff and faculty from a wide range of disciplines including the Schools of Medicine, Nursing, Veterinary Medicine and basic science departments. Project types span the clinical and translational spectrum covering lab, animal, clinical and population-level studies. Most consults related to data analysis and interpretation (57%) followed by sample size calculations/study design (29%) and response to reviewers (4%), with general statistical advice as the remainder. DISCUSSION/SIGNIFICANCE OF IMPACT: With 6 micro-consults per week, we can meet with many investigators and triage their statistical support needs. This program has proved very popular and was highly rated in a recent user survey, with several investigators noting that the consults facilitated successful publications and proposals.
4178 The feasibility/acceptability of using smartphone technology to assess mental health symptoms among Spanish-speaking outpatients
Authors: Silva Caroline , Ricci Nilsa , Mingoia Alessandra Pérez , Myers Taylor , Van Orden Kimberly , Conwell Yeates
Published: July 2020

OBJECTIVES/GOALS: Geographic and linguistic isolation is associated with negative mental health outcomes, including increased risk for suicide, among ethnic/racial minorities. This study explores the feasibility of using smartphone technology with active and passive sensing to assess mental health symptoms and social behavior among at risk Spanish-speakers. METHODS/STUDY POPULATION: Participants were 13 Spanish-speaking adult outpatients who reported hopelessness/suicide ideation in the last month. Participants completed a baseline interview, 2-weeks of remote ecological momentary assessments (EMA; 4xday) using a smartphone with optional passive sensing (GPS, ambient sound recording), and a final interview. All participants identified as Hispanic (84.6% female, M age = 42.24 years). 53.8% identified as White, with 46.2% reporting race as Other (e.g., Indio, Trigueña). On average, participants had lived in the USA for 6.56 years (SD = 12.63 years). A majority (69.2%) met for Major Depressive Episode Current. At baseline, 53.8% reported passive and 23.1% reported active suicide ideation in the last month. 46.2% of participants reported a previous suicide attempt. RESULTS/ANTICIPATED RESULTS: A majority (84.6%) of participants consented to all passive data collection (GPS tracking and ambient sound recording). One participant dropped out after baseline and did not complete the EMA study portion. Participants completed on average 76.93% EMA survey instances (SD = 18.01%). Baseline depression/anxiety severity were significantly positively associated with symptom severity at 2-week follow-up (p < .01); however, baseline suicide ideation was not associated with ideation at follow-up. Participants did not report significant changes in mood or ideation from baseline to 2-week follow-up. Symptom severity at baseline was not associated with EMA instances completed. Percent of EMA instances completed were also not associated with symptom severity at follow-up, controlling for baseline severity. DISCUSSION/SIGNIFICANCE OF IMPACT: Results support the feasibility of smartphones to assess mental health symptoms and behaviors in real time, real world settings with Spanish-speakers. A majority of patients consented to active and passive remote assessments. Adherence to remote EMA was good and study attrition was minimal. Implications and future directions will be discussed.