bluuebunny/crossref_metadata_2025 huggingface dataset:
3303 WHICH ADMISSION FORMULA CRITERIA PREDICT TIMELY COMPLETION OF THE RESEARCH TRAINING PROGRAM FROM THE MEDICAL SCIENCES CAMPUS, UNIVERSITY OF PUERTO RICO?
Authors: San Martin Maria T. , Rios-Motta Ruth , Segarra Barbara , Martinez Karen G. , Marrero Brenda L.
Published: March 2019

OBJECTIVES/SPECIFIC AIMS: This project will present the analysis assessing which of the admission criteria is a useful tool to predict completion of all program requirements METHODS/STUDY POPULATION: All admission criteria from graduates (2003-2016) will be analyzed. Outcomes will be measured according to the scholar’s performance during the two-year of studies and its success in completing on time all program requirements. Descriptive and inferential statistical analyses will be used to determine potential association in each criteria and in the total score. RESULTS/ANTICIPATED RESULTS: We expect that the PPC and total score will be correlated with a higher rate of successful outcomes. DISCUSSION/SIGNIFICANCE OF IMPACT: A systematic admission process should lead to timely program completion.
3512 Identifying Patient-Level Barriers to Non-Muscle Invasive Bladder Cancer Treatment and Surveillance Adherence in Low-Income Latino Patients: A Mixed-Methods Study
Authors: Bhanvadia Sumeet Kaur , Daneshmand Siamak , Stern Mariana , Baezconde-Garbanati Lourdes
Published: March 2019

OBJECTIVES/SPECIFIC AIMS: To evaluate the determinants of non-adherence to guideline treatment and surveillance and unique barriers to care in LIU Latinos with NMIBC that will inform the development of novel patient educational materials and navigation programs that could improve adherence and thus, oncologic outcomes. METHODS/STUDY POPULATION: We will recruit 40 Latino patients with new or existing NMIBC diagnoses who present to the Urology clinic at a large, tertiary public hospital in Los Angeles from November 2018 to March 2019. Quantitative (surveys) and qualitative (semi-structured interviews) data will be collected, analyzed and integrated in order to comprehensively determine patient-level barriers to adherence. RESULTS/ANTICIPATED RESULTS: We expect to identify a unique set of patient-level barriers to adherence to NMIBC care that is unique to this population that center around 1) structural barriers to care, 2) knowledge, attitudes, and beliefs that pertain to education, acculturation, gender and values, and 3) general and disease-specific health literacy. DISCUSSION/SIGNIFICANCE OF IMPACT: The barriers to surveillance and treatment NMIBC care are significant, particularly in LIU and minority patients, which is important as non-adherence to guideline care is linked to poorer cancer outcomes. The data generated herein will inform the development of tools and programs to aid in reducing or eliminating these barriers, but also will inform discussions on the effectiveness of current clinical practices for low-income Latino patients.
3550 Understanding Racial Disparities in Hepatocellular Carcinoma Treatments and Outcomes
Authors: Nephew Lauren Devore , Rawl Susan , Chalasani Naga
Published: March 2019

OBJECTIVES/SPECIFIC AIMS: Black patients with hepatocellular carcinoma (HCC) receive fewer curative therapies and have higher mortality than other groups. Reducing this disparity will require an in-depth understanding of patient comorbidities, tumor characteristics, and social determinants of health. Our objectives are to a) perform a multi-center retrospective cohort study of black and white patients diagnosed with HCC in the Indianapolis area. b) prospectively enroll black and white patients with HCC to collect clinical characteristics as well as data on the social determinants of health. METHODS/STUDY POPULATION: A retrospective chart review of patients with a diagnosis of HCC from 2010-2017 from five area Indianapolis hospitals will be performed. Demographics, comorbidities, liver disease severity, and tumor characteristics will be collected using the Indiana Network for Patient Care database and compared between black and white patients. Concomitantly, a prospective cohort of black and white patients will be enrolled and surveyed to collect data on socioeconomic status and income adequacy, literacy, functional status, substance abuse history, social support, activation, and adherence. The primary outcomes are the receipt of curative therapies for HCC including liver transplantation, resection or ablation. The secondary outcome is mortality. Multivariable logistic regression models will be used to explore disparities seen in the primary and secondary outcomes. RESULTS/ANTICIPATED RESULTS: These preliminary results include Indiana University Hospital (IUH) findings; a multicenter analysis is underway. The IUH cohort included 1,032 (86%) white and 164 (14%) black patients. Black and white patients had similar Model for End-Stage Liver Disease and Child-Pugh scores. There was a trend toward larger tumor size (5.3 cm vs. 4.7 cm; P = 0.05) in black patients; however, Barcelona Clinic Liver Cancer staging and Milan criteria were similar. Black patients were less likely to undergo liver transplantation than white patients—a disparity that was not attenuated (odds ratio [OR], 0.43; 95% confidence interval [CI]: 0.21-0.90) on multivariable analysis. Substance abuse was more frequently cited as the reason black patients within Milan criteria failed to undergo transplantation than white patients. Survival was similar between the two groups. DISCUSSION/SIGNIFICANCE OF IMPACT: Racial differences in patient and tumor characteristics were small in our single center analysis and did not explain the disparity in liver transplantation. This analysis however only reflects 25% of patients diagnosed with HCC in the Indianapolis metropolitan, highlighting the need for a multicenter study. Higher rates of substance abuse in black patients within Milan criteria who failed to undergo transplantation suggest social factors contribute to this disparity and highlight the need for a prospective study that can explore these and other social factors.
3477 Impaired emotion recognition accuracy after right-hemisphere stroke
Authors: OConnell Katherine , Marsh Abigail A. , Greenwald Anna
Published: March 2019

OBJECTIVES/SPECIFIC AIMS: Every year, approximately 800,000 Americans suffer a stroke. Supportive social environments are recognized as an important factor contributing to successful stroke recovery, yet, stroke lesions can affect brain areas important for socioemotional functioning, which could impair a patient’s ability to maintain their social relationships. Specifically, emotion recognition, a fundamental socioemotional skill, is predominantly right-lateralized and may be impacted by right-hemisphere stroke. This research tests for emotion recognition impairments after right-hemisphere stroke and examines whether such deficits are associated with worse reported social support. METHODS/STUDY POPULATION: Twenty right-hemisphere stroke patients (9 female, 11 male) and 23 age-matched healthy control subjects (9 female, 14 male) completed laboratory testing including the Geneva Emotion Recognition Test Short. Subjects additionally completed a measure of self-reported social support using the Older Americans Resources and Services questionnaire. Emotion recognition accuracy was calculated using overall accuracy and valence accuracy (i.e. correctly rating a positive emotion as positive). RESULTS/ANTICIPATED RESULTS: Right-hemisphere stroke patients had lower overall emotion recognition accuracy than controls (patients; M = 37.8%, SD = 18.9%. controls; M = 48.5%, SD = 14.6%, t(41)=2.11, p=.041). Furthermore, patients had significantly lower valence accuracy (patients; M = 84.5%, SD = 10.7%. controls; M = 90.0%, SD = 5.2%, t(41)=2.19, p =.035), indicating that they more often mistook a positive emotion as a negative emotion, and vice-versa. Finally, within the right-hemisphere patient group, overall emotion recognition accuracy was trending to be positively correlated with self-reported social support (rho = 0.397, p =.083), suggesting that poor emotion recognition skills may be associated with worse social outcomes in the real-world. DISCUSSION/SIGNIFICANCE OF IMPACT: Our findings indicate that right-hemisphere stroke is associated with impaired emotion recognition. Future research could investigate whether an emotion recognition training may be beneficial for right-hemisphere stroke patient recovery.
3423 Poorer Outcomes Among Septic Patients with Protein Energy Malnutrition
Authors: Adejumo Adeyinka Charles , Akanbi Olalekan , Pani Lydie
Published: March 2019

OBJECTIVES/SPECIFIC AIMS: Protein Energy Malnutrition (PEM) could compromise the body’s defense systems resulting in sepsis, which further depletes calorie stores. Among hospitalized patients, we investigate 1) the relationship between PEM and sepsis, 2) the impact of PEM on trends in mortality from sepsis, and 3) the influence of PEM on clinical outcomes of sepsis. METHODS/STUDY POPULATION: Using the 2014 Healthcare Cost and Utilization Project - Nationwide Inpatient Sample (NIS) patient’s discharge records, we identified patients with sepsis, PEM, and other clinical conditions with ICD-9-CM codes. After stratifying sepsis into two: uncomplicated (without shock) and complicated (with shock), we estimated the adjusted odds (aOR) of developing sepsis (total, uncomplicated and complicated) with PEM. Then, we selected hospitalizations with sepsis from 2007-2014 years of the HCUP-NIS, and calculated the trend in mortality from sepsis, stratified by PEM status, as an effect modifier. Finally, we matched PEM to no PEM (1:1) using a greedy algorithm-based propensity methodology and estimated the effect of having mortality, complicated sepsis and 10 other clinical outcomes and healthcare utilization (SAS 9.4). RESULTS/ANTICIPATED RESULTS: PEM was associated with higher odds for sepsis (aOR:3.97[3.89-4.05]), and complicated vs. uncomplicated sepsis (1.74[1.67-1.81]). Although mortality in sepsis has been trending down from 2007-2014 (−1.19%/year, p-trend<0.0001), the decrease was less pronounced among those with PEM vs. no-PEM (−0.86%/year vs. −1.29%/year, p-value < 0.0001). After propensity matching, PEM was associated with higher mortality (1.35[1.32-1.37]), cost ($160,724[159,517-161,940] vs. $86,650[85,931-87,375]), length of stay (14.76[14.68-14.84] vs. 8.49[8.45-8.56] days), and worse outcomes in general. DISCUSSION/SIGNIFICANCE OF IMPACT: PEM is a risk factor of sepsis and associated with poorer outcomes among septic patients. A concerted effort involving primary care physicians, nutritionists, nurses in identifying, preventing, and treatment of PEM in the community-dwelling individuals before hospitalization might mitigate against these devastating outcomes.
3527 Quantifying the psychosocial benefits of masculinizing chest reconstruction in transgender men with patient reported outcomes: The GENDER-Q
Authors: Kennedy Adrienne , Alcon Andre , Kim Esther
Published: March 2019

OBJECTIVES/SPECIFIC AIMS: 1. To evaluate the effects of masculinizing chest reconstruction on the quality of life of female-to-male transgender individuals. 2. To develop and validate a quality of life survey for female-to-male transgender individuals undergoing masculinizing chest reconstruction gender-affirming surgery. METHODS/STUDY POPULATION:. We developed and refined the GENDER-Q using focus groups and exploratory interviews with FTM individuals that were recorded, transcribed, and coded. All consenting FTM patients undergoing chest reconstruction at UCSF Parnassus Medical center between 2017-2019 who meet World Professional Association for Transgender Health (WPATH) criteria for gender dysphoria will be enrolled in the study. The GENDER-Q will be co-administered with the WHO Quality of Life-BREF survey pre-operatively, 6 weeks post-operatively, and one year post-operatively through REDCAP, an online survey database. RESULTS/ANTICIPATED RESULTS: Approximately 70 patients will be enrolled in the study. Preliminary results detect statistically significant mean quality of life post-operative improvements in all three sections (Physical Health, Gender Presentation, Psychological Health) of the GENDER-Q at 6-week follow up that is maintained at one-year (p< 0.005). Statistically significant improvements were similarly achieved and maintained with the WHO QOL-BREF survey (p< 0.05). The mean reported improvement from baseline to follow-up appears to be more pronounced in the GENDER-Q survey compared to WHO QOL-BREF. The median time to complete the pre and post-operative surveys was 10 minutes. Calculation of Cronbach’s (0.67-0.81) and the Pearson Correlation Coefficient for each section revealed excellent internal validity. DISCUSSION/SIGNIFICANCE OF IMPACT: There are few studies assessing quality of life outcomes in transgender patients undergoing gender-affirming surgeries. A standardized and validated assessment tool will provide the means for which data can be pooled in large multi-center studies. Providing further evidence to support the positive health outcomes of gender-affirming surgeries can lead to broader access and reduce healthcare disparities among transgender populations.
3571 Expression profile of the ribbon synapse protein Ribeye in the zebrafish
Authors: Frederick Courtney , Zenisek David
Published: March 2019

OBJECTIVES/SPECIFIC AIMS: Although two Ribeye protein isoforms have been identified in zebrafish, information about the identities of their variants is incomplete. This study aims to identify and characterize both of the Ribeye isoforms and their splice variants. METHODS/STUDY POPULATION: Immunohistochemistry was performed on the retina and neuromasts of zebrafish larva and adults.Ribeye expression was analyzed by western blot. Ribeye proteins will be separated, isolated and identified by mass spectrophotometry. RESULTS/ANTICIPATED RESULTS: Immunohistochemistry performed on larval and adult zebrafish retinas revealed the expression of Ribeye A in the inner and outer plexiform layers. Ribeye B was likewise expressed in both plexiform layers in larval zebrafish, but more pronounced expression in the outer plexiform layer in the adult zebrafish retina. Immunohistochemical experiments also demonstrated the co-expression of both Ribeye isoforms in the hair cells of both larval and adult neuromasts. Analysis of Ribeye expression by western blot showed the presence of more than the three previously identified variants. Current experiments are being conducted to characterize the additional Ribeye variants. We expect to identify the residual Ribeye protein as a result of this analysis. DISCUSSION/SIGNIFICANCE OF IMPACT: This study is necessary in order to gain a clear understanding of Ribeye expression in zebrafish tissues. Doing so will enable us to target this protein for gene editing to address outstanding questions about the mechanisms that govern ribbon synapse function. Synapse and synapse-associated proteins are involved in a wide-array of diseases that arise as a result of their dysfunction (e.g. blindness, deafness, bradycardia, autism spectrum disorders, and schizophrenia). Thus, it is important for us to identify the shared and distinct mechanisms that give rise to diseases associated with synaptic dysregulation. Such information could provide the basis for novel therapeutic interventions for synaptic disorders.
3369 Assessment to Action: Engaging network member’s in identifying needs and directions of network improvement
Authors: Estabrooks Paul , Johnson LaKaija , Rohde Jolene , Geary Carol , Zimmerman Lani , Rizzo Matthew , Cramer Mary
Published: March 2019

OBJECTIVES/SPECIFIC AIMS: To complete a needs assessment and action planning process that engaged clinical and translational research network members in identifying needs through survey feedback, characterizing the needs in small group sessions, and developing recommendations for action at the network’s annual scientific meeting. METHODS/STUDY POPULATION: The project included (1) a survey of 357 members across partner institutions from the Great Plains IDeA CTR Network, (2) 6 - 90 minute brainstorming sessions to characterize needs identified through survey assessment, and (3) 6 - 60 minute sessions to develop recommendations for network improvement based on the characterization activity. Approximately 75 members participated in the characterization and recommendation sessions. RESULTS/ANTICIPATED RESULTS: Seven areas of need from the survey were identified based upon the frequency of identification by network members (support to move research across the translational spectrum, database design and management, data access and sharing, data analysis, recruitment and retention of subjects, support for members who have submitted grants but were repeatedly unsuccessful, mentoring). Members indicated which characterization sessions they were interested in attending and based on the enrollment numbers needs related to unsuccessful grant submitters and mentoring were combined as were needs related to database design and data access-sharing. Sessions resulted in 8 inter-related recommendations for network action that included to (1) develop GP-CTR directory/registry of clinicians, researchers, system partners, that can be used to identify people that want to be involved in research partnerships or mentoring, (2) create a GP CTR Navigators Program to will provide support to network members throughout the collaborative research and grant preparation process, (3) identify and disseminate information about assets (funding, databases/registries) that exist amongst network partners that can be leveraged by member, (4) develop a searchable repository of evidence-based interventions for T3/T4 efforts, (5) review GP CTR supported professional development, and technological resource offerings and identify potential gaps, (6) facilitate opportunities for peer support/networking, (7) provide guidance to GP CTR network institutions looking to adopt policies that will support translational research collaboration, and (8) identify potential barriers to GP CTR network engagement (i.e., infrastructure, communication, marketing). DISCUSSION/SIGNIFICANCE OF IMPACT: This process allowed for a wide range of network members to contribute to actionable recommendations for CTR leadership to move into action and improve the scientific network’s ability to conduct clinical and translational research.
3566 Longitudinal analysis of research collaborations and emerging networks
Authors: Dozier Ann Marie , Wayman Elizabeth , Martina Camille Anne , O’Dell Nicole , Rubinstein Eric P. , Fogg Thomas T
Published: March 2019

OBJECTIVES/SPECIFIC AIMS: To longitudinally track emerging research collaborations and assess their development and productivity. METHODS/STUDY POPULATION: In four administrations (2011, 2013, 2015, 2017), all full- and part-time University of Rochester Medical Center faculty received an email invitation to complete a research collaborators survey. Respondents indicated whether they were involved in research, and if involved in research, identified collaborators from a drop-down list of investigators in the institution. Space was provided for write-ins. Full- and part-time status, faculty rank, and departmental affiliation was associated with each investigator. Grant data were obtained from a grant management database maintained by the institution’s Office of Research and Project Administration. Grant data included all submissions (funded and not funded), award number, award effective data, award final expiration date, funding amounts, principal investigator and co-investigators. Using Mathematica SNA software, for each year we identified collaborator dyads (including their characteristics such as inter/intradepartmental; investigator characteristics) and networks (e.g. size, density). RESULTS/ANTICIPATED RESULTS: On average, 1800 (range 1730-2034) full- and part-time faculty received email invitations to complete the survey. An average of 403 respondents (range 385-441) completed the survey each administration. While the response rate seems low, the survey was distributed to every faculty member regardless of their primary appointment. Thus it included a large number of individuals whose role is exclusively clinical. Grant data included 4429 awards received between 2011 and 2018, involving 1395 investigators as principal or co-investigators. Survey respondents naming collaborators ranged from 233 to 280 (average 257) with 1594 to 2265 (average 1988) collaborations named each year. Overall density increased from.0204 in 2011 to.0342 in 2017. Density within the group of female investigators increased from.0219 in 2011 to.0412 in 2017. Within the group of male investigators, density increase from.0226 to.0333 in the same time span. Analysis by rank, changes over time and those with grant funding is underway. DISCUSSION/SIGNIFICANCE OF IMPACT: This methodology captured a consistent number of collaborations over an 8 year period. Analyses reveal network growth over time and of increasing heterogeneity (by gender). Analyzing research networks overtime provides an important metric to assess how research networks evolve and devolve and the characteristics of those that grow or stagnate. Further these analyses can demonstrate the impact of support provided to networks or teams by the CTSI, department or other institutional mechanism.
3222 University of Mississippi Center for Clinical and Translational Science (CCTS): A Catalyst for Clinical and Translational Sciences
Authors: Ross Leigh Ann , Gomez Christian R. , Espinoza Ingrid C. , Adcock Kim G. , Bloodworth Lauren S.
Published: March 2019

OBJECTIVES/SPECIFIC AIMS: To introduce CCTS to the clinical and translational research community. METHODS/STUDY POPULATION: Established in the summer of 2017, the Center for Clinical and Translational Science (CCTS) fosters cooperative clinical and translational sciences between the University of Mississippi School of Pharmacy (UMSOP) and the University of Mississippi Medical Center (UMMC). CCTS facilitates the translation of basic research discoveries into clinically validated therapies to improve the health of populations in Mississippi and beyond. Priority areas of investigation in CCTS include Cardiometabolic disorders, Cancer, Neuroscience, Infectious diseases, Precision Medicine, and Community-Based Research. To accomplish CCTS mission three overarching goals have been defined: I) Develop progressive and sustainable capacity for clinical and translational research in Mississippi; II) Promote interprofessional engagement in clinical and translational science; and III) Foster research collaboration among stakeholders in and outside of Mississippi. RESULTS/ANTICIPATED RESULTS: To carry its CCTS’s mission three research units have been established: 1) The Pre-clinical Research Unit: Develops processes to move basic science discoveries towards translation into research in humans. This unit provides guidance in the development of Investigational New Drug (IND) applications; and identifies and pursues opportunities to develop progressive capacities for in vitro, ex vivo, in vivo, and in silico approaches for evaluating new pharmaceutical and therapeutic agents. 2) The Clinical Research Unit: Transitions projects that have received IND approval into the first phase of clinical trials. It also transitions clinical trials from Phase I to Phase II and to Phase III; develops standard operating procedures (SOPs), personnel training plans, and policies to guide clinical research; works with industry sponsors and governmental funding agencies; and assures compliance with regulatory requirements. 3) Community/population Research Unit: Develops, coordinates, and facilitates research activities and translation between clinical and community/population research stages. To do so, this unit works closely with community partners and Population Health programs on the Oxford and Jackson campuses. DISCUSSION/SIGNIFICANCE OF IMPACT: Since its inception, the CCTS has surpassed 1.5 million dollars in competitive funding. This early success positions the CCTS well to promote research collaboration between UMSOP and UMMC and to progress in becoming a national leader in clinical and translational investigation.
3428 Adopting a learning health system architecture: a scoping review and pre-implementation framework to reduce readmissions within academic hospitals
Authors: Anderson Jami , Reamy Becky , Mugavero Michael
Published: March 2019

OBJECTIVES/SPECIFIC AIMS: Of the six Centers for Medicare and Medicaid Services (CMS) monitored diagnoses targeted for readmissions reductions, reasons for readmissions within academic hospitals are poorly understood and reflect complex interactions between the patient, provider and organizational-level responses to initial hospitalization. Learning health systems (the organizational and orchestrated integration of research into evidence-based practice) can address the complexities of readmissions through an innovative approach to knowledge translation and patient-centered outcomes research. The objective of this review is to define and optimize the architecture of learning health systems to produce a dynamic pre-implementation framework of knowledge translation and patient-centered outcomes research, leveraging two engines (research and learning) within the academic and clinical settings for reducing readmissions. METHODS/STUDY POPULATION: Three databases were utilized for this scoping review (PubMed, Academic Search Premier, and Scopus) focusing on 1.) learning health systems and the methods of defining and building these systems within an academic hospital setting and 2.) the use of learning health systems in reducing readmissions within academic hospitals. Empirical articles and reviews pertaining to the architecture, development, conceptualization, definition, and translation of learning health systems were identified and compiled into a scoping review and proposed framework. RESULTS/ANTICIPATED RESULTS: The scoping review yielded 139 articles; from which 28 articles were retained. No articles were found utilizing learning health systems to address readmissions. Thus, a new architectural framework was developed incorporating common architectural themes from the literature with adaptations to fit the interests of patients, providers, and researchers in reducing readmissions within academic hospitals (Figure 1). DISCUSSION/SIGNIFICANCE OF IMPACT: Given the dearth of information applying learning health systems to readmissions, the proposed architecture for an integrative learning health system can be utilized as a dynamic foundation for adoption and pre-implementation planning for reducing readmissions within academic hospital settings. Additionally, the authors expect this model to be tested and continually refined to address historical and emerging issues for clinically-relevant and clinically-effective approaches to patient-centered practice and research.
3485 Frailty Associated with Increased Rates of Acute Cellular Rejection Within 3 Months After Liver Transplantation
Authors: Fozouni Laila , Lebsack Adrienne , Mohamad Yara , Freise Chris , Stock Peter , Lai Jennifer
Published: March 2019

OBJECTIVES/SPECIFIC AIMS: There is currently a gap in the literature regarding the relationship between acute cellular rejection and frailty in LT patients. We aimed to evaluate the association between frailty and acute cellular rejection in LT patients. METHODS/STUDY POPULATION: Included were LT recipients from 2014-16 at a single center who had a frailty assessment prior to LT using the Liver Frailty index consisting of grip strength, chair stands, and balance. Frailty was defined by a Liver Frailty Index > 4.5. Data on acute cellular rejection at 3 months (primary outcome) and immunosuppression regimens were collected from medical chart review. Univariable and multivariable logistic regression assessed the associations between frailty and acute cellular rejection. RESULTS/ANTICIPATED RESULTS: A total of 241 LT recipients were included. Of these, 37% were female, 55% had Hepatitis C, and the median (IQR) age was 60 (54-65); 46 (19%) were classified as frail. 98% of patients were on a combination of mycophenolate, corticosteroids and tacrolimus on discharge compared to 80% by 3 months. Within the first 3 months post-LT, 7 (15%) of frail patients versus 10 (5%) (p = 0.02) of non-frail patients experienced acute cellular rejection. In univariable logistic regression, frailty was associated with a 3.3 times higher odds of acute cellular rejection at 3 months (95%CI 1.19, 9.26, p = 0.02); age (OR 0.91), Black race (OR 3.2), autoimmune disease (OR 2.3), and diabetes (OR 0.3) were also associated with acute cellular rejection at 3 months with a p-value<0.20. In a multivariate analysis, after adjusting for age, frailty remained significantly associated with rejection (OR 3.06, 95%CI 1.04, 9.01, p = 0.043). There were no significant differences in immunosuppression regimens or rates of mycophenolate dose reduction in the first 3 months between frail and non-frail patients. DISCUSSION/SIGNIFICANCE OF IMPACT: Frailty is associated with an increased rate of acute cellular rejection within 3 months post-LT, despite similar immunosuppression regimens and doses. Future studies should evaluate whether frailty should be considered in the management of immunosuppression in the early post-transplant period.
3334 Insurance Generosity and Inflammatory Bowel Disease: Does Higher Patient Cost-Sharing Result in Suboptimal Medication Habits and Inferior Clinical Outcomes?
Authors: Sceats Lindsay Anne , Kin Cindy , Trickey Amber , Polyakova Maria , Kate Bundorf M.
Published: March 2019

OBJECTIVES/SPECIFIC AIMS: Our primary objectives were to examine the impact of biologic cost sharing on 1) adherence to biologics and 2) persistence on biologics in inflammatory bowel disease (IBD) patients. Our secondary objective was to assess the effect of biologic cost sharing on clinical IBD outcomes, including rates of hospitalization, abdominal surgery, and corticosteroid treatment. METHODS/STUDY POPULATION: This retrospective cohort analysis used a national insurance claims database (Optum Clinformatics DataMart) to assess adult IBD patients enrolled in medium or large private insurance plans from 2007-2016. Patients were followed for one year of continuous enrollment after their index biologic claim. We assessed adherence to biologic medications (medication possession ratio >0.8) dependent on patient cost sharing, as measured by an employer-plan’s average out-of-pocket biologic medication cost. We also examined the effects of patient cost sharing for biologics on need for hospitalization, abdominal surgery, or corticosteroid treatment. We used multivariate logistic regression models adjusting for clinical and demographic characteristics. We estimated the effect of cost sharing on biologic therapy persistence using repeated measures proportional hazard survival models. RESULTS/ANTICIPATED RESULTS: We identified 2,193 adult IBD patients who initiated biologic therapy and met study criteria (Crohn’s disease 66.1% vs. ulcerative colitis 24.9%, mean age 40.8 years, mean Charlson index 0.50). Median [IQR] out-of-pocket cost per 30-day biologic prescription was $62 [$34 - $157]. 66.9% of patients were adherent to biologic therapy. Higher out-of-pocket costs for biologics were associated with increased odds of nonadherence; patients with ulcerative colitis were more price-responsive than patients with Crohn’s disease or indeterminate colitis (Figure 1). However, higher out-of-pocket biologic costs were not associated with increased odds of all-cause or IBD-related hospitalization, IBD-related surgery, or corticosteroid prescriptions for IBD flares. Patients whose out-of-pocket costs were less than $10 per 30-day biologic prescription persisted on biologic therapy for significantly longer than patients who paid >$10 (Figure 2). DISCUSSION/SIGNIFICANCE OF IMPACT: Nonadherence to biologics increases when IBD patients face higher out-of-pocket costs, particularly for ulcerative colitis patients. However, this is not associated with worse clinical outcomes. Patients with cost-sharing<$10 persisted on biologics longer than patients whose cost sharing exceeded $10.
3407 Maternal Daytime Dysfunction Due to Sleepiness and its Relation to Child Psychopathology
Authors: Strong Cameron , Fitzgerald Kate , Premo Julie
Published: March 2019

OBJECTIVES/SPECIFIC AIMS: Anxiety is prevalent in early childhood and, when left untreated, increases children’s risk for chronic anxiety and depression later in life. Maternal risk factors (e.g. income and marital status) have also been shown to heighten their children’s risk for the development of the aforementioned psychopathology. Sleep plays a critical role in behavior regulation, is affected in depression, and is influenced by a wide range of demographic and psychological variables. The purpose of this study was to examine the relationship between maternal sleep and the presence in their children of reported symptoms relating to anxiety, depression, and behavior regulation. METHODS/STUDY POPULATION: Children (n=59, aged: 4-9 years (M = 6.069, SD = 1.006, 59.3% female) and their mothers were sampled from clinic and community settings and were administered questionnaires. Maternal sleep quality was assessed by the Pittsburgh Sleep Quality Index, which captures both numeric and self-reported categories relating to an individual’s perception of their sleep. Child anxiety and depression were assessed via parent-reported Child Behavioral Checklist (CBCL). Maternal depression symptoms were assessed with the Beck Depression Inventory (BDI). Associations between these measures were analyzed by ANOVA with post-hoc analysis and linear regression as appropriate. RESULTS/ANTICIPATED RESULTS: A statistically significant difference was observed in the mean child CBCL scores when children were sub-set into maternal categories of self-reported days of dysfunction due to sleepiness over the past month. Mean child CBCL T-score domains with statistically significant differences were: attention problems (F = 4.935, p = 0.004), depression problems (F = 3.073, p = 0.035), ADHD (F = 4.422, p = 0.007), oppositional defiant (F = 2.865, p = 0.045), and total t-score (F = 3.073, p = 0.035). Maternal mean DBI scores were also statistically significantly different when grouped by days of maternal dysfunction due to sleepiness (F = 9.791, p < 0.001). There was no relation between these CBCL categories and maternal DBI scores. DISCUSSION/SIGNIFICANCE OF IMPACT: Maternal self-reported days of dysfunction due to sleepiness may potentially increase risk for their children to develop further psychopathology independent of mothers’ depression symptomatology. These findings highlight the need for broader assessment clinically of children’s environments with additional focus on maternal function given the potential impact on their children’s functional outcomes.
3047 Patient-Reported Outcomes Measurement Information System (PROMIS®) Global Health Short Form is Responsive to Patient Reported Changes in Systemic Lupus Erythematosus
Authors: Kasturi Shanthini , Szymonifka Jackie , Berman Jessica , Kirou Kyriakos , Levine Alana , Sammaritano Lisa , Mandl Lisa
Published: March 2019

OBJECTIVES/SPECIFIC AIMS: The accurate and efficient serial measurement of patient centered outcomes is a priority in the clinical care of systemic lupus erythematosus (SLE). Patient-Reported Outcomes Measurement Information Systems (PROMIS®) Global Health Short Form (PROMIS10) is a 10-item universal patient reported outcome measure of global physical and mental health with construct validity in SLE. The longitudinal responsiveness (sensitivity to change) of PROMIS10 in SLE patients is unknown. We aimed to evaluate the responsiveness of PROMIS10 in SLE outpatients using patient and physician-derived anchors. METHODS/STUDY POPULATION: Adults meeting SLE classification criteria were recruited from an SLE Center of Excellence. Subjects completed PROMIS10 at two visits a minimum of one month apart. SLE disease activity was measured with a patient global assessment of change, a physician global assessment and the physician-derived SELENA-SLEDAI. Responsiveness over time of PROMIS10 scores was evaluated using known-groups validity. Effect sizes of changes in PROMIS global physical health and global mental health scores from baseline to follow up were compared across groups of patients who differed in their patient global assessment of change, physician global assessment, and SELENA-SLEDAI using Kruskal-Wallis tests. RESULTS/ANTICIPATED RESULTS: A diverse cohort of 228 SLE patients completed baseline surveys (Table 1), with 190 (83%) completing a follow up survey. Using the patient-based anchor, PROMIS10 demonstrated mild to moderate responsiveness to improvement (effect size 0.29) and worsening (effect sizes −0.27 and −0.54) of health status for both global physical health and global mental health (Table 2). Using the physician global assessment and SELENA-SLEDAI as anchors, there were no statistically significant differences in effect sizes across groups. DISCUSSION/SIGNIFICANCE OF IMPACT: PROMIS10 showed responsiveness over time to patient-reported, but not physician-derived changes in lupus health status. These data suggest that PROMIS10 can be used to efficiently measure and monitor important aspects of the patient experience of lupus not captured by physician-derived metrics. Further studies are needed to evaluate the role of PROMIS in optimizing longitudinal disease management in SLE.
3376 Super Bingers: Traits and Patterns Associated with High-Intensity Drinking
Authors: Morris James Keoni , Swan Julia E. , Gowin Josh L. , Schwandt Melanie L. , Diazgranados Nancy , Ramchandani Vijay A.
Published: March 2019

OBJECTIVES/SPECIFIC AIMS: This study attempts to evaluate the drinking patterns and traits of individuals who partake in high intensity drinking, defined as binge drinking at 2 or more times the minimum binge count (4 drinks for females, 5 drinks for males). METHODS/STUDY POPULATION: We analyzed data from non-treatment seeking volunteers enrolled in NIAAA screening protocols. The sample included 706 males and 474 females ranging in age from 18 to 91. Subjects were assigned to one of four groups (Non-Binge, Level 1, Level 2, Level 3) based on the highest binge session reported in their Timeline Followback questionnaire. The criteria for each group were different for males and females based on the current NIAAA definitions of binge drinking. The cutoffs for females were 0-3 drinks for Non-Binge, 4-7 drinks for Level 1, 8-11 drinks for Level 2, and 12+ drinks for Level 3. The male drink cutoffs were 0-4, 5-9, 10-14, and 15+ respectively. We looked at various drinking measures (Timeline Followback, Self-Reported Effects of Alcohol (SRE), Alcohol Use Disorders Identification Test (AUDIT)) and trait measures (UPPS-P Impulsivity Scale, Barratt’s Impulsiveness Scale, Buss Perry Aggression Questionnaire) to identify mean differences between groups. RESULTS/ANTICIPATED RESULTS: There were significant differences in drinking patterns between the groups for both males and females. Number of drinking days, average drinks per drinking day, and number of heavy drinking days all increased as binge level increased. There were also significant differences between groups in males for trait measures. Level 2 and Level 3 bingers scored significantly higher on impulsivity and aggression than the Level 1 and Non-Binge groups. Ongoing analyses are examining differences among binge groups on other measures including SRE and AUDIT. Future analyses will explore potential mechanisms underlying the relationships between trait measures and binge drinking using structural equation modeling. DISCUSSION/SIGNIFICANCE OF IMPACT: This study found significant differences between high-intensity drinkers, or “super bingers”, and lighter binge and non-binge drinkers. Super bingers showed an overall heavier drinking pattern across measures. The elevated aggression, impulsivity, and overall heavy drinking patterns of super bingers suggest a behavioral profile that makes this group in particular at higher risk for developing alcohol use disorder and related problems. These traits and behaviors may also help identify targets for treatment interventions for alcohol use disorder.
3087 US trends in diet and exercise counseling for patients with and without diabetes: The National Ambulatory Medical Care Surveys, 2005-2015
Authors: Shah Megha , Moore Miranda , Narayan Venkat , Ali Mohammed
Published: March 2019

OBJECTIVES/SPECIFIC AIMS: Type 2 diabetes (T2D) is costly and burdensome, but strong evidence exists that lifestyle change and weight loss can improve glycemic control and lower co-morbidities for patients with T2D. We used national data to examine whether the frequency of diet and/or physical activity counseling for patients with T2D in ambulatory settings has been responsive to accumulation of evidence supporting lifestyle change. METHODS/STUDY POPULATION: We used National Ambulatory Medical Care Survey (NAMCS) data over the period 2005-2015 from 31,475 patients with provider-reported T2D. We built multivariate logistic regression models, adjusting for patient, provider, and practice level characteristics (i.e. patient demographics, physician specialty, site of care, and region), to assess changes over time in the provision of diet or exercise counseling during ambulatory care visits, as reported through provider/staff chart review. We also examined whether changes in counseling over time varied by key patient and provider characteristics. We used non-overlapping confidence intervals (CI) to assess for statistical significance. RESULTS/ANTICIPATED RESULTS: Proportions of patients with T2D who received diet or exercise counseling were no different over time: 30% in 2005 [95% CI: 25%-35%] and 25% in 2015 [95% CI: 18%-31%]. Adjusted models show Hispanic patients had higher likelihood of receiving diet or exercise counseling, compared to whites (OR: 1.38 [CI: 1.03-1.85] for diet; OR: 1.37 [CI: 1.01-1.85] for exercise), and younger age was associated with higher likelihood of diet or exercise counselling, compared to those over 75 (age 30-49, OR: 1.47 [CI:1.18-1.82] for diet OR: 1.63 [CI: 1.30-2.03] for exercise). Among provider and practice-level characteristics, metro area and type of provider were associated with higher odds of receiving any diet and/or exercise counseling with visits in a metro area (OR: 1.23 [CI: 1.03-1.48]) and with an advanced practice provider (OR: 1.77 [CI: 0.97-3.22] having higher likelihood of receiving any diet or exercise counseling. DISCUSSION/SIGNIFICANCE OF IMPACT: Up to 30% of Americans with diabetes received any diet or exercise counseling in ambulatory visits, and this remained low over a decade. There were significant differences in counseling across patient, provider, and practice characteristics. Future studies are needed to better understand what interventions might improve counseling in ambulatory settings.
3114 Investigating the therapeutic potential of parthenolide in the treatment of hematopoietic neoplasms in dogs
Authors: Schlein Lisa J , Peterson Aubree , Rose Barbara , Thamm Douglas
Published: March 2019

OBJECTIVES/SPECIFIC AIMS: Determine PTL’s mechanism(s) of action in a panel of canine hematopoietic cell lines; this will enable us to 1) verify that PTL is working as expected and 2) rationally select combination therapeutics. Characterize the in vitro sensitivity of canine hematopoietic cell lines to PTL in combination with other chemotherapeutic agents. Determine immunohistochemical NFκB expression in tissue microarrays of spontaneous canine neoplasms and correlate with outcome-linked data. Characterize the in vivo sensitivity of canine hematopoietic cell lines to PTL using a murine xenograft model. METHODS/STUDY POPULATION: Growth inhibition assays were performed using a panel of canine mast cell, histiocytic sarcoma, lymphoma, and leukemia cell lines, with PTL alone or in combination with redox-perturbing standard-of-care therapeutics. Cell death was assessed using flow cytometry. Immunofluorescence and immunoblotting were used to assess NFκB localization and phosphorylation of NFκB p65 (transcriptional activation), respectively. Intracellular glutathione with and without PTL and combination chemotherapeutics will be assessed spectrophotometrically. Archived spontaneous canine tumors will be evaluated immunohistochemically (IHC) for increased NFκB pathway activation relative to normal control tissues. Nude mice will receive intravenous, intraperitoneal, or subcutaneous injections of canine HS cells and will be treated with PTL or with PTL in combination with standard-of-care chemotherapeutics. RESULTS/ANTICIPATED RESULTS: Results: All immortalized canine cell lines evaluated are sensitive to PTL therapy and undergo dose-dependent apoptosis following exposure to drug. PTL exposure leads to inhibition of NFκB, as evidenced by immunofluorescent nuclear exclusion and decreased p65 phosphorylation. Some chemotherapeutics appear to synergize with PTL in vitro. Anticipated results: We expect to find increased IHC NFκB pathway activation in malignantly transformed tissues relative to controls. We expect standard-of-care therapeutics to synergize with PTL in vivo based on preliminary in vitro data. DISCUSSION/SIGNIFICANCE OF IMPACT: These studies will determine whether PTL therapy may be beneficial in dogs with a variety of hematopoietic neoplasms, either alone or in combination with other therapeutics that are currently in clinical use. Dogs with mast cell or histiocytic neoplasia are an excellent model for rare and deadly human diseases, which may also benefit from PTL therapy.
3104 Characterizing the top 100 articles in benign prostatic hyperplasia literature using bibliometric analysis
Authors: Cruz Alan Paniagua , Ellimoottil Chad , Dauw Casey A. , Skolarus Ted A.
Published: March 2019

OBJECTIVES/SPECIFIC AIMS: The prevalence of BPH, coupled with associated disability ranging from quality of life impairments to hospitalization, has spurred decades of research into its pathophysiology, diagnosis, treatment, and outcomes. For these reasons, we conducted a study to characterize the current landscape of BPH literature, including the most commonly cited articles impacting the field. METHODS/STUDY POPULATION: We used the Web of ScienceTM databases to conduct a bibliometric analysis of the top 100 leading BPH articles. Bibliometric analyses are quantitative approaches examining the impact of academic literature. We used the following search terms: ‘benign prostatic hyperplasia’ and ‘benign prostatic enlargement.’ We identified and characterized the 100 most-cited BPH articles including their citations, journal, author, year, and country through September 2018. RESULTS/ANTICIPATED RESULTS: The top 100 BPH articles were published between 1978 and 2012. The number of citations ranged from 143 to 2,158 across 26 different journals, including 9 urology-specific journals. The Journal of Urology (5-year impact factor: 4.91) was the most published journal with 26 articles, followed by European Urology (5-year impact factor: 15.66) with 16, and Urology (5-year impact factor: 2.39) with 13. The oldest 10 articles in the top 100 mainly focused on BPH etiology/pathogenesis, while the newest 10 articles mainly focused on medical treatment. The 1990’s was the most productive decade accounting for nearly half of the top 100 articles (n=46). Eight authors had two or more first author publications, and 8 institutions had five or more publications in the top 100. Thirteen different countries were represented in the top 100 articles, with the US (n = 64), Italy (n=7), and Germany (n=5) being the most common. The articles were published in the following Web of Science Categories: Urology & Nephrology (n=68), Medicine, General & Internal (n=15), and Endocrinology & Metabolism (n=7). DISCUSSION/SIGNIFICANCE OF IMPACT: This study represents the first bibliometric analysis of the leading 100 BPH articles impacting the academic literature. The literature focus has evolved from BPH pathogenesis/etiology to treatment, and was primarily published in 3 specialty journals. Our findings highlight the most impactful BPH literature, and may be used to guide research and funding priorities for this increasingly common condition.