bluuebunny/crossref_metadata_2025 huggingface dataset:
3244 The Autonomic Nervous System as a Potential Therapeutic Target in Huntington Disease
Authors: Schultz Jordan L , Harshman Lyndsay , Kamholz John , Nopoulos Peggy
Published: March 2019

OBJECTIVES/SPECIFIC AIMS: This study (1) investigated the presence and severity of autonomic nervous system (ANS) dysfunction in patients with pre-symptomatic Huntington Disease (HD) and (2) determined if pharmacologic manipulation of the ANS could modify the progression of HD. METHODS/STUDY POPULATION: Using a unique data set of children at-risk for HD (the Kids-HD study), markers of autonomic function (resting heart rate [rHR], blood pressure [BP], and core body temperature [CBT]) were compared between pre-symptomatic, gene-expanded children (psGE) and healthy developing children using mixed models analyses controlling for sex, age, and body mass index. Included participants had to be < 18 years old and be at least 10 years from their predicted motor diagnosis of HD. Using the Enroll-HD database, inverse-propensity score weighted, Cox Regression analyses investigated the effects of beta-blockers on the timing of motor diagnosis of presymptomatic, adult patients with HD. RESULTS/ANTICIPATED RESULTS: Compared to healthy controls, the psGE participants had significantly (p<0.05) higher mean rHR, systolic BP percentile, and CBT compared to the healthy controls (elevated by 4.01 bpm 0.19°C, and 5.96 percentile points, respectively, in the psGE group). Participants from Enroll-HD who were using a beta-blocker prior to motor diagnosis (n=65) demonstrated a significantly lower annualized risk of motor diagnosis [HR=0.56, p=0.03], compared to other participants with HD (n=1972). DISCUSSION/SIGNIFICANCE OF IMPACT: Sympathetic nervous system activity is elevated in patients with HD decades prior to their predicted motor diagnosis. Furthermore, modulation of the sympathetic nervous system with beta-blockers significantly lowers the annualized risk of motor diagnosis of HD.
3220 Can you read me now? Clinician variations in managing and responding to secure messages from patients
Authors: Lee Joy Li-Yueh , Weiner Michael , Matthias Marianne
Published: March 2019

OBJECTIVES/SPECIFIC AIMS: To identify areas of variation in primary care clinician responses to secure messaging and to assess the quality of secure messages by clinicians. METHODS/STUDY POPULATION: This mixed-methods study included twenty one primary care clinicians from a Midwestern safety net hospital and Veterans Affairs medical center. Participants were presented with five short clinical vignettes and corresponding secure messages from hypothetical patients and asked to compose responses. Participants were interviewed about their cognitive approach to the responses as well as perspectives on quality of care as related to electronic communications. RESULTS/ANTICIPATED RESULTS: Every participant recalled having patients who misused secure messaging for urgent issues, suggesting the need for more patient education and the possible adverse consequences of overlooked messages. The study also uncovered key differences in several areas, include clinician timeliness, message management, the circumstances in which they would use messaging, and the content of the messages (including patient-centeredness). While participants agreed that messages about clinical issues should not be resolved via secure messaging, there was a lack of consensus regarding emotionally charged messages and messages dealing with medication adjustments. Some participants spoke of the need for more guidance in knowing when best to use secure messaging. “Sometimes,” one physician said, “it feels like we’re just making up [rules for secure messaging].” Although clinician responses were uniformly respectful, the patient-centeredness varied in the use of jargon and social talk, as well as clarity for patients. DISCUSSION/SIGNIFICANCE OF IMPACT: This study revealed variations in provider approaches to secure messaging, and the content of responses. These variations reflect lack of consensus about how care is delivered via secure messaging, and reveal the need for clinician guidance. They also suggest possible negative patient consequences if secure messaging is used ineffectively. The extent to which variations are undesirable remains unknown. Future work will explore the consequences of such variations.
3564 Breaking the Mold: Using a learner & faculty centric approach to increase satisfaction and usability
Authors: Cornelius Katherine , Greenberg-Worisek Alexandra Joelle , Jimison Ryan , Weisbrod Jennifer , Weavers Karen Marie
Published: March 2019

OBJECTIVES/SPECIFIC AIMS: Scholars and faculty in the Clinical and Translational Science (CTS) track of our institution’s biomedical science graduate school reported a lack of satisfaction with our learning management system (LMS); specifically, they reported frustration with the amount of time spent locating learning assignment guidelines, course readings, and submission portals. As a result, we created a new master template to address their concerns. METHODS/STUDY POPULATION: A new template was created within the LMS based on scholar and faculty feedback. Surveys and other tools have been used to determine student and faculty satisfaction as well as measure secondary outcomes of time spent in the online learning space. Some key changes include a redesigned menu and submission portal. RESULTS/ANTICIPATED RESULTS: There was an increase in satisfaction with the new LMS template. Next steps include systematically rolling out the new template, with continued solicitation of feedback from all stakeholders. All courses in the CTS track will be converted to the new template by summer quarter 2020. DISCUSSION/SIGNIFICANCE OF IMPACT: The strengths of this project include the multidisciplinary team-based approach to improving course satisfaction and usability, as well as the use of innovative technologies. Additionally, the analytical capabilities of the LMS will be maximized in the new template, which was a shortcoming of the previously available template.
3563 Clinical research training methods that improve self-efficacy in clinical research domains
Authors: Sebastian Mathew , Robinson Matthew , Dumeny Leanne , Dyson Kyle , McCormack Wayne T. , May William Stratford
Published: March 2019

OBJECTIVES/SPECIFIC AIMS: The study aims to determine the current clinical research training interventions of MD-PhD programs and how effective they are in promoting clinical research self-efficacy. METHODS/STUDY POPULATION: A national survey of MD-PhD trainees was conducted in 2018 to identify clinical research training methods and self-efficacy for clinical research skills. MD-PhD program directors and coordinators from 108 institutions were asked to distribute the survey to their students. Responses were received from 61 institutions (56.5%). Responses were obtained from 647 MD-PhD students in all years of training, representing 17.9% of the 3613 possible participants at the 61 medical schools represented. No compensation was provided for this study. RESULTS/ANTICIPATED RESULTS: The primary methods of clinical research training reported by students included didactics, mentored clinical research, didactics plus mentored clinical research, didactics plus clinical research practicum, and didactics plus mentored clinical research plus clinical research practicum. A quarter of all participants reported having no clinical research training. Clinical research self-efficacy was then correlated with the amount of clinical research training. Students exposed to no clinical research had the lowest self-efficacy in clinical research skills and students experiencing didactics plus mentored clinical research plus clinical research practicum had the highest perceived self-efficacy in clinical research domains. DISCUSSION/SIGNIFICANCE OF IMPACT: This is one of the first studies assessing clinical research training methods for MD-PhD students and assessing their efficacy. We found that of all students questioned, 25% mentioned had not received any type of clinical research training. The remaining students identified 5 research training methods that institutions currently use. This work highlights the importance of clinical research experience students need to improve their self-efficacy, a major influence on research career outcomes.
3368 Mentoring from the ground up: Improving mentoring relationships by empowering mentees
Authors: Hansen Marissa Joanna , Cornelius Katherine , Billings Heather
Published: March 2019

OBJECTIVES/SPECIFIC AIMS: Program Directors and Ph.D. students within the Clinical and Translational Science (CTS) track identified mentorship development as a knowledge gap and educational priority. Most mentors are not provided education in how to be an effective mentor. Similarly, most mentees are not provided education or training on how to optimize a mentoring relationship for their learning and professional development (Ramani, 2006). We adapted mentor training curriculum developed by the University of Wisconsin and facilitated an eight-hour program to better prepare learners to be empowered mentees as well as future mentors. METHODS/STUDY POPULATION: We utilized the Mentoring Competency Assessment (MCA) to measure CTS Ph.D. students’ self-perceptions of eight competencies through a pre and post-intervention survey design (Fleming, etal., 2013). We adapted an evidence-based curriculum (Pfund, etal., 2014) to be delivered to Ph.D. students within an existing structure of educational offerings and incorporated case based discussions, frequent low-stakes formative assessments, and peer-to-peer facilitation to heighten authenticity, relevance and immediacy to the learning experiences. This structured curriculum, intended to increase skills, knowledge, and behaviors to make students more active participants in their mentoring relationships, focuses on one competency area per monthly session and was implemented May-December 2018. Session participation by program alumni allows for contextual demonstration and competency application. RESULTS/ANTICIPATED RESULTS: Preliminary data demonstrates heightened perceived competency in most domains assessed. We found mentors generally rated their mentee’s skills at a higher level than the mentees’ perceived ratings. We also saw significant differences between groups in a few domains e. g. new vs. established relationships, females vs. males, etc. Individual session evaluations are extremely positive, and the students routinely report behavioral changes as a result of these sessions. DISCUSSION/SIGNIFICANCE OF IMPACT: We have demonstrated the successful adaptation and innovative facilitation of a successful mentorship development program for Ph.D. students. We propose that several factors discussed are critical in the success of this type of curriculum. Preliminary conclusion: A structured curriculum in mentoring relationships increases Ph.D. mentee empowerment and readiness to lead future mentoring relationships.
3441 Physician Attitudes Towards the Use of Dietary Interventions in Their Practice: Preliminary Results
Authors: McLeod Megan
Published: March 2019

OBJECTIVES/SPECIFIC AIMS: Diet-related diseases such as obesity, hypertension, diabetes, and irritable bowel syndrome comprise a large portion of primary care visits in the United States. However, primary care physicians seldom prescribe dietary interventions that effectively treat these conditions, and their rate of use has declined in recent years. There are many plausible reasons for this decline, including baseline nutrition education, perceived efficacy of the intervention, time limitations, and compensation. No study has been conducted to assess which of these factors physicians perceive as relevant to their decision to use dietary interventions in their practice. Our study aims to identify key factors that ubiquitously limit physicians’ use of dietary interventions. METHODS/STUDY POPULATION: We created a 30-item survey designed to evaluate physicians’ self-reported use of dietary interventions, relevant knowledge base, comfort employing these interventions, and attitudes regarding the importance of such interventions in their practices. This survey was was distributed to internal medicine, pediatrics, and family medicine residents and physicians at Michigan Medicine and St. Joseph hospitals in Ann Arbor, MI. RESULTS/ANTICIPATED RESULTS: Socio-demographic data, knowledge base and attitudes will be summarized and analyzed using descriptive statistics and simple regression modeling following the administration of the survey. DISCUSSION/SIGNIFICANCE OF IMPACT: We hope that our study may elucidate identify specific avenues of increasing the use of dietary interventions, and thus of improving treatment efficacy for diet-related disorders in the United States.
3308 Training KL2 Scholars to Communicate Science to a General Audience
Authors: Carnes Cynthia Ann , Christman John W. , Wewers Mark Damian , Hobbs Stuart D , Jackson Rebecca
Published: March 2019

OBJECTIVES/SPECIFIC AIMS: Verbal communication is a critical component for professional development and leadership. Yet, many clinical translational scientists lack the skills in communication of their scientific work in a meaningful and exciting manner that conveys the potential impact of their work on human health to the lay public, stakeholders, and to other scientists in different fields. We hypothesized that formal communication training could improve information transfer by trainees that would enhance their career development. METHODS/STUDY POPULATION: We therefore formalized a program for the KL2 scholars at the Ohio State University Center for Clinical and Translational Science that provided training from communications experts to develop a short, concise, and relevant talk about their field of research to general audiences. The program was a hybrid of workshop and individualized training. It culminated in each of the six scholars presenting public talk at the OSU STEM research dissemination and outreach space, the STEAM Factory. The scholars were administered a survey to assess their knowledge of the concepts presented in the training prior to and following the receiving the treatment, as well as their overall assessment of the experience. RESULTS/ANTICIPATED RESULTS: The poster will present the positive results of this evaluation and the impact of the training on the KL2 scholars. DISCUSSION/SIGNIFICANCE OF IMPACT: The poster explain the training as a model that other CTSA KL2 programs could adapt for their trainees.
3133 Building Capacity for Community Engaged Research: Penn State University’s Faculty Fellowship Program
Authors: Wadsworth Martha Ellen , Kraschnewski Jennifer L. , Brelsford Gina M. , Sekhar Deepa L.
Published: March 2019

OBJECTIVES/SPECIFIC AIMS: To build capacity for community engaged, translational research in faculty across the university. METHODS/STUDY POPULATION: Each year, the Community Engagement Research Core (CERC) of the Penn State CTSI invites applications for one to two Community Engagement Faculty Fellowships. Applicant teams are comprised of a junior or mid-level investigator seeking to expand their work into the CEnR arena under the mentorship of a senior investigator with expertise in community engaged scholarship. The fellow must develop a plan for the mentoring year, including a timeline, activities to be undertaken together, knowledge to be acquired, deliverables, and a budget. The funding supports two course releases or the clinical equivalent for the fellow, and a small budget to support the mentor’s research program. Proposals are evaluated using NIH scientific merit criteria. RESULTS/ANTICIPATED RESULTS: We are in our second year of the fellowship program. Two highly qualified fellows are currently working with established community-based mentors. The 2017-2018 fellowship team showcases how an effective mentor-fellow partnership can help move a fellow’s work along the translational spectrum. By working with her mentor, our first fellow’s research has expanded from basic discovery science in a university hospital to development of a neonatal intensive care unit intervention to be employed with parents in the community. The 2018-2019 scholar, who utilized the community engagement research core (CERC) of the PSU CTSI in preparation of a PCORI grant, has since received the PCORI award and is working with her mentor to bring her innovative mental health screenings to the public schools. We are currently evaluating applications for the third year of the program, and please to have engaged applicants from across several Penn State campuses and disciplines. DISCUSSION/SIGNIFICANCE OF IMPACT: The fellowship is enjoying early success in terms of fellow productivity, expanding translational research expertise, and fueling interest across the Penn State campuses in community engagement research. Future work will focus on sustainability planning for this type of program, metrics for tracking success, and plans for integrating fellows into a growing community of engaged scholars at the university.
3583 Impact of Health Literacy and Risk perception on Over-the-Counter Medication Misuse
Authors: Reddy Apoorva , Chui Michelle A.
Published: March 2019

OBJECTIVES/SPECIFIC AIMS: This study aims to describe factors impacting older adult OTC selection and use so they can be targeted with a community pharmacy intervention to improve older adult medication safety. The primary outcome is the characterization of the relationship between health literacy, risk perception, and OTC misuse. These results will directly inform the refinement of the community pharmacy intervention such that it is tailored more precisely to the older adult patient population. METHODS/STUDY POPULATION: This cross-sectional study administers face-to-face surveys to 72 older adults (age 65+) at three locations of a mass-merchandise chain pharmacy. This study is one component of a larger study to develop and implement a community pharmacy intervention to improve OTC safety for older adults. The Protection Motivation Theory (PMT) provides a framework for evaluating the interplay of threat and coping appraisals in the assessment of perceived risk severity and OTC misuse. Health literacy, known to contribute to coping appraisals, is measured with the Newest Vital Sign survey. The TRI-RISK model, originally used to measure risk perception of disease, was adapted and subject to rigorous cognitive interviewing and testing with 8 older adults. This adapted survey is used to measure older adult risk perception of adverse drug events. Walking interviews with older adult participants are conducted in a community pharmacy. In these interviews, participants verbalize their process of selection and use of an OTC to treat a pain, cough/cold, or sleep issue. Additional patient factors such as age, race, gender, education level, and co-morbidities are collected in a survey. Structural equation modeling is used for data analysis. RESULTS/ANTICIPATED RESULTS: It is hypothesized that poor health literacy leads to lower risk perception, which will result in increased instances of potential adverse drug events. Data collection will be complete by Spring 2019 and preliminary results will be presented. DISCUSSION/SIGNIFICANCE OF IMPACT: Few interventions have attempted to decrease misuse of high-risk OTC medications in older adults, and not one has addressed system barriers. Compared to efforts to improve prescription medication safety, efforts to decrease OTC medication misuse in community-dwelling older adults have been practically ignored. This is the first study to characterize and operationalize health literacy and risk perception of adverse drug events in the development of a system-level intervention to address OTC safety for older adults. The population aged 65 and older is expected to increase by 38.5 million from the year 2020 to 2050. Interventions tailored to target the older adult patient population are expected to have greater efficacy in improving older adult medication safety and in alleviating the significant corresponding strain on the US healthcare system.
3464 Readability, Understandability, and Actionability of Inpatient Discharge Instructions: A Health Literacy Perspective
Authors: Glick Alexander , Marquez Kyara , Migotsky Michael , Dreyer Benard , Tomopoulos Suzy , Fierman Arthur , Mendelsohn Alan , Shonna Yin H.
Published: March 2019

OBJECTIVES/SPECIFIC AIMS: Parents often make errors in comprehending and executing their child’s inpatient discharge instructions, putting their child at risk for adverse post-discharge outcomes. Suboptimal provider-caregiver communication has been linked to errors in comprehension and execution of provider instructions, especially for parents with limited health literacy. Few studies have systematically examined features of pediatric inpatient written discharge instructions that may contribute to errors. Our objective was to assess the readability, understandability, and actionability of pediatric inpatient written discharge instructions. METHODS/STUDY POPULATION: This was a cross-sectional analysis of the written discharge instructions (standardized template, content not standardized) provided to parents at an urban public hospital, enrolled as part of a prospective cohort study (n=171) focused on parent ability to comprehend their child’s discharge instructions. Inclusion criteria were: English/Spanish-speaking parents of children ≤12 years old discharged on ≥1 daily medicine. Discharge instructions were assessed for: 1) Readability (Average of 5 formulas [Flesh Reading Ease, Flesch-Kincaid, Gunning Fog, Simple Measure of Gobbledygook, Forcast]), 2) Understandability and actionability (AHRQ Patient Education Materials Assessment Tool [2 independent reviewers; κ>0.8 for both]). RESULTS/ANTICIPATED RESULTS: Mean (SD) reading grade level was 11.4 (0.7); none of the instructions were written at a recommended reading level of 6th to 8th grade or below. Mean (SD) understandability was 37.7 (6.9)%; mean actionability was 41.7 (8.4)%. All 171 sets of instructions used medical terminology without adequate plain language explanations and included information that was not relevant to the child’s diagnosis and associated care (e.g., obesity counseling, smoking cessation given to a child with appendicitis). None of the sets of instructions presented information in a logical sequence (e.g., diet instructions in more than one location) or included any pictographic information or other visual aids to support the text (e.g., diagram of medication dose within a dosing tool). DISCUSSION/SIGNIFICANCE OF IMPACT: Written discharge instructions provided in the pediatric inpatient setting were suboptimal. Use of a systematic approach to improve discharge instructions, using a health literacy perspective, has the potential to improve post-discharge outcomes in children.
3418 Service referral follow up rate among participants of a community engagement initiative in Florida
Authors: Varma Deepthi S , Chaudhari Piyush V , Vaddiparti Krishna , Striley Catherine Woodstock , Cottler Linda B.
Published: March 2019

OBJECTIVES/SPECIFIC AIMS: To examine the rate of medical and social service referral utilization among community members who are enrolled in HealthStreet - a community engagement initiative at University of Florida. METHODS/STUDY POPULATION: HealthStreet utilizes the CHW model to conduct health needs assessment, provide referrals to medical and social services and link them to health research at UF. Across two follow-up schedules, these participants are contacted to assess their rate of referral utilization. RESULTS/ANTICIPATED RESULTS: From October 2011-October 2018, HealthStreet completed 10,829 health needs assessments and provided a total of 15,723 medical and/or social service referrals with an average of 1.48 referrals per person. About a third of people completed first and second follow-up respectively (n=3,461; 32.0% and n=3,477; 32.1%), and another third (n=3,891; 35.9%) completed neither. The total number of follow up attempts was 40,863, with an average of 3.85 attempts per person. The overall service utilization rate was 17.02%. The top barriers to utilization included, could not schedule an appointment (26.3%), busy on the date of appointment (21.9%), transportation (9.4%), and already received the service from elsewhere (4.7%). Others (28.3%) did not identify a specific barrier for non-utilization. DISCUSSION/SIGNIFICANCE OF IMPACT: Findings show that those who need services are still hampered by barriers to care that CHWs and other service providers could help them overcome. Facilitating the appointment and providing transportation would assist over a third of those needing services.
3147 Electroencephalographic suppression from anesthesia and cognitive recovery
Authors: Hickman Leonard Brian , Ching ShiNung , Basner Mathias , Wang Wei , Lin Nan , Kelz Max , Mashour George , Avidan Michael S. , Palanca Ben J. A.
Published: March 2019

OBJECTIVES/SPECIFIC AIMS: (1) Assess if the total duration of EEG suppression during a protocolized exposure to general anesthesia predicts cognitive performance in multiple cognitive domains immediately following emergence from anesthesia. (2) Assess if the total duration of EEG suppression in the same individuals predicts the rate of cognitive recovery in a three-hour period following emergence from anesthesia. METHODS/STUDY POPULATION: This was a non-specified substudy of NCT01911195, a multicenter investigation taking place at the University of Michigan, University of Pennsylvania, and Washington University in St. Louis. 30 healthy volunteers aged 20-40 years were recruited to receive general anesthesia. Participants in the anesthesia arm were anesthetized for three hours at isoflurane levels compatible with surgery (1.3 MAC). Multichannel sensor nets were used for EEG acquisition during the anesthetic exposure. EEG suppression was detected through automated voltage-thresholded classification of 2-second signal epochs, with concordance assessed across sensors. Following return of responsiveness to verbal commands, participants completed up to three hours of serial cognitive tests assessing executive function, reaction time, cognitive throughput, and working memory. Non-linear mixed effects models will be used to estimate the initial cognitive deficit and the rate of cognitive recovery following anesthetic exposure; these measures of cognitive function will be assessed in relation to total duration of suppression during anesthesia. RESULTS/ANTICIPATED RESULTS: Participants displayed wide variability in the total amount of suppression during anesthesia, with a median of 31.2 minutes and range from 0 minutes to 115.2 minutes. Initial analyses suggest that greater duration of burst suppression had a weak relationship with participants’ initial cognitive deficits upon return of responsiveness from anesthesia. Model generation of rate of recovery following anesthetic exposure is pending, but we anticipate this will also have a weak relationship with burst suppression. DISCUSSION/SIGNIFICANCE OF IMPACT: In healthy adults receiving a standardized exposure to anesthesia without surgery, burst suppression appears to be a poor predictor of post-anesthesia cognitive task performance. This suggests that burst suppression may have limited utility as a predictive marker of post-operative cognitive functioning, particularly in young adults without significant illness.
3278 Gendered racism, psychological distress, and the strong Black woman
Authors: Baalbaki Maha
Published: March 2019

OBJECTIVES/SPECIFIC AIMS: Black women experience discrimination that targets their intersecting gender and ethnic identities, termed gendered racism (Essed, 1991). The gendered racism Black women experience has been linked to negative mental health outcomes (Thomas etal., 2008). The ‘strong Black woman’ is a cultural symbol of strength depicting the Black woman as unwavered by hardships, such as gendered racism (Shorter-Gooden & Washington, 1996). However, recent research suggests that belief in the strong Black woman cultural construct is associated with negative mental health outcomes (Watson & Hunter, 2015). The goals of the current study were to (1) replicate previous findings suggesting that experiences with gendered racism is positively correlated with psychological distress, (2) replicate previous findings suggesting that belief in the strong Black woman construct is positively correlated with psychological distress, and (3) explore how experiences with gendered racism and belief in the strong Black woman construct might interact to predict distress. METHODS/STUDY POPULATION: A national sample of 112 Black women completed an online survey via MTurk. Survey measures included the Gendered Racial Microaggressions Scale, Strong Black Woman Cultural Construct Scale, and Psychological Distress Scale. RESULTS/ANTICIPATED RESULTS: Pearson correlation revealed that experiences with gendered racism was positively correlated with psychological distress, r = 0.23, p = .02. Pearson correlation also revealed that belief in the strong Black woman cultural construct was positively correlated with psychological distress, r = 0.39, p < .001. Multiple linear regression revealed an interaction between experiences with gendered racism and belief in the strong Black woman construct (β = -0.18, p = .04) that predicted psychological distress, R2 = .20, F(3,108) = 8.63, p < .01. Namely, for those with high belief in the strong Black woman construct, experiences with gendered racism did not predict distress, β = -0.31, t = -0.29, p = .78. However, for those with low belief in the construct, experiences with gendered racism positively predicted distress, β = -2.57, t = 2.31, p = .02. DISCUSSION/SIGNIFICANCE OF IMPACT: The results underscore the harmful effects of gendered racism and gendered racial stereotypes on Black women’s mental health outcomes. Striving to appear as the strong Black woman is not likely to help Black women overcome daily hardships. In fact, belief in the strong Black woman construct is likely to add extra difficulties.
3126 Association of ancestral genetic admixture and obesity at 12 months of age
Authors: Hazrati Sahel
Published: March 2019

OBJECTIVES/SPECIFIC AIMS: We intended to investigate the relationship between children’s genetic admixture proportions and the incidence of obesity at 12 months of age METHODS/STUDY POPULATION: 821 twelve month old children were included and their genetic admixture was estimated using the ancestry and kinship toolkit (AKT). Weight for Length Percentile (WFLP) at 12 months of age was categorized as <95th percentile and ≥95th percentile. Multiple logistic regression analysis was performed to calculate odds ratios (ORs) with 95% confidence intervals (CIs) for association of admixture proportion including EUR, AMR, AFR, EAS and SAS with WFLP categories adjusting for maternal education, birth weight, frequency of breast feeding and juice consumption RESULTS/ANTICIPATED RESULTS: 821 children were included; WFLP <95th percentile = 671 (81.7%) and WFLP ≥95th percentile = 150 (18.3%). Crude odds ratios showed EUR admixture was protective (OR 0.45 (95% CI 0.27–0.74)) whereas AMR (OR 3.85 (95% CI 1.92 –7.70)) and AFR (OR 5.70 (95% CI 2.19 –14.85)) were positively associated with obesity. After adjusting for confounding variables, only AFR was associated with WFLP≥95th (OR 7.38 (95% CI 2.31 – 23.59)), AMR and EUR were no longer associated with WFLP≥95th DISCUSSION/SIGNIFICANCE OF IMPACT: The AFR admixture proportion remains associated with early childhood obesity after accounting for confounding variables, suggesting the ancestral genetic background may contribute to the differences seen in early childhood obesity
3313 “My research is their business, but I’m not their business”: Patient and Oncologist Perspectives on the Commercialization of Research Data
Authors: Spector-Bagdady Kayte , Krenz Chris , Gornick Michele , Brummel Collin , Kent Madison , Chad Brenner J. , Scott Roberts J. , Shuman Andrew G.
Published: March 2019

OBJECTIVES/SPECIFIC AIMS: Our objective was to assess and compare the attitudes of patients with head and neck cancer and their clinicians regarding the commercialization of genetic research data. We explored whether such opinions changed when profits from such transactions were used to fund 1) cancer research, 2) academic research generally, or 3) if patients were given personalized genetic information in return. METHODS/STUDY POPULATION: This qualitative analysis was nested within a prospective precision oncology genomic sequencing study in an NCI-designated cancer center. We conducted paired, semi-structured interviews with enrolled participants with head & neck cancer and with their doctors (medical oncologists, surgical oncologists, and radiation oncologists). Interviews were recorded, transcribed, and coded for analysis. Codes were developed through an iterative process until saturation was reached, and all transcripts were double-coded (and discrepancies reconciled) to ensure reliability. RESULTS/ANTICIPATED RESULTS: We identified three main themes from the patients and clinicians: (1) Both clinicians and their patients were unclear about how the study protocol and informed consent form authorized patients’ genetic data to be used and commercialized in the future. (2) Patients with cancer were generally more comfortable than their clinician thought they were regarding the ongoing research use of their genetic data and commercialization thereof. (3) There is a strong interest among patients and clinicians in focusing academic medical center profits from commercialization back into the research program from which the data was acquired, rather than being invested into academic research more broadly. DISCUSSION/SIGNIFICANCE OF IMPACT: Given patients’ strong feelings about the commercialization of their data, our results highlight the need for greater transparency—both with patients and with their clinicians—about potential future use of research data. Clinicians appear inclined to be particularly cautious regarding access to and commercialization of patients’ data, however patients generally hope that their data may be used to help future cancer patients. Explicit discussions with patients about specific future uses of profits derived from commercialization of research data can ensure both transparency and participation in future primary and secondary precision health research programs.
3461 A community-based, low calorie dietary intervention for the prevention and remission of type 2 diabetes mellitus
Authors: Qumby Kim , George Colette , Hambleton Ian , Olivier Patrick , Unwin Nigel
Published: March 2019

OBJECTIVES/SPECIFIC AIMS: The aim is to investigate if sustained weight loss due to caloric restriction can be achieved in a community setting, using faith-based organisations (FBOs) as hubs; and if this weight loss can lead to the re-establishment of normal metabolism (using the normalisation of blood sugar levels while off glucose lowering medication as a proxy) in a person with pre-diabetes or T2DM. METHODS/STUDY POPULATION: Members of the FBO with either a diagnosis of T2DM for <6 years or pre-diabetes as defined by the American Diabetes Association (ADA); and a Body Mass index (BMI) of ≥27 kg/m2 are eligible. After counselling, participants will be placed on a 12 week low calorie liquid diet, supplemented by low carbohydrate vegetables, totalling approximately 840 kcal/day. During this time, participants will be monitored weekly at their FBO by trained members of their congregation, with oversight from the study team, for change in weight, fasting blood glucose, waist and hip circumference and blood pressure. This will be followed by a 3 month period during which participants will receive ongoing dietary advice as they transfer to a balanced, reduced calorie, solid diet. Physical measurements will be monitored monthly during this 3 month period. The next 6 months is a period where the participants and the FBO health team move towards ‘independence’. This involves further training of the FBO health team and participants in healthy lifestyle habits; and a commitment by the leadership of the FBO to assume ‘ownership’ for NCD monitoring within their community. Physical measurements will be repeated at the end of one year. RESULTS/ANTICIPATED RESULTS: Based on previous studies, we expect that participants who are compliant to the diet will lose approximately 2.2 kg per week over the 12 week period. This will be associated with rapid (within 1 week) normalisation of fasting blood glucose levels (<7mmol / L). We expect that, due to the accessibility of NCD monitoring and support, that participants to be satisfied with their care and compliant to their regime and that the results of the first 12 weeks will be sustained at the 12 month follow up. We expect that the FBO leadership will assume the responsibility of continuing and NCD programme, not only for the local congregation but for the surrounding community. DISCUSSION/SIGNIFICANCE OF IMPACT: Diabetes remission with a low calorie diet is a viable intervention for T2DM remission however social support is key to an individual’s success. This novel study which proposes institution of a diabetes remission intervention which fits into the participant’s locale and involves peer support, should increase long-term success.
3200 Balancing Cost and Quality of Care in the US and Denmark: Lessons for Nations Transitioning from Volume-Based to Value-Based Care
Authors: Fouladi Negin , Malmmose Margit
Published: March 2019

OBJECTIVES/SPECIFIC AIMS: Promote knowledge translation and evidence-informed decision-making by assessing barriers and facilitators to balancing cost and quality of care within the US state of Maryland and nation of Denmark. METHODS/STUDY POPULATION: Open-ended and semi-structured key-informant interviews were conducted in 2016 and 2017 among high level decision-makers in Maryland (N=21) and the Danish (N=17) healthcare systems, including hospital, local, regional, and cross-organizational administrators and elected officials. The interviews consisted of questions related to: (1) currently practiced and preferred approaches to resource allocation and development and use of quality performance measures, and (2) preferred sources, formats/styles, modes of information, and decision-making strategies based on a shift from volume to quality-driven care. RESULTS/ANTICIPATED RESULTS: Decision-makers in Maryland expressed the need for collaboration in a changing environment, yet increasingly rely on cost and quality outcomes data to drive decisions and note the struggle to identify credible and useful information. Maryland decision-makers also face challenges in regulating utilization and costs without mandated participation of physician practices within the global budget cap model, which is perceived to be a primary driver of healthcare utilization in the hospital sector. Similarly, decision-makers in Denmark conveyed the importance of quantitative data to aid decisions, however, stress collaboration and dialogue as driving factors and important sources of information. Danish decision-makers also express challenges to wide-spread adoption of a quality-driven approach due to unsustained quality assurance regulatory bodies. DISCUSSION/SIGNIFICANCE OF IMPACT: The findings suggest implementation of value-based healthcare is highly driven and influenced by availability of credible data, which may significantly impact development of policies and innovative cost control strategies, and regulatory oversight to promote adoption of quality measures in decision-making. Furthermore, collaboration within and across healthcare organizations remains a key component to health system improvement as it fosters dialogue and sharing of best practices among stakeholders.
3245 Comparison of Health Outcomes in Adolescent and Young Adult (AYA) Oncology Patients Treated at a Pediatric versus Adult Institute
Authors: Moskop Amy , Panepinto Julie , Dobrozsi Sadie
Published: March 2019

OBJECTIVES/SPECIFIC AIMS: Objectives: To examine the differences in health outcomes of adolescents and young adults treated for malignancy at a pediatric cancer center compared to an adult cancer center. To determine the differences in receipt of supportive care for adolescents and young adults with malignancy who are treated at a pediatric cancer center compared to an adult cancer center. METHODS/STUDY POPULATION: Methods: This will be a retrospective cohort study of patients from the ages of 15 to 39 years who are diagnosed with a malignancy common between adult and pediatric facilities within 2013-2017. Data will be abstracted from an existing database at MCW containing patient information at the adult and pediatric centers. Study population: Patients ages 15-39 years of age who are categorized as young adolescent and adult patients (AYAs). Patients are eligible for the cohort if they have a diagnosis that is common between adult and pediatric oncology centers and that is made within the years 2013-2017. These diagnoses will include ALL, AML, Hodgkin Lymphoma, Non-Hodgkin Lymphoma, Germ cell tumors, Osteosarcoma, Ewing Sarcoma, other sarcomas, and CNS tumors. RESULTS/ANTICIPATED RESULTS: There will be a difference in health care utilization, clinical trial enrollment and toxicity of therapy in AYAs with malignancies treated at an adult facility than AYAs treated for similar malignancy at pediatric facility. DISCUSSION/SIGNIFICANCE OF IMPACT: There will be a difference in receipt of supportive care referrals, including psychology, social work, sperm banking, initiation of palliative care, in AYAs treated at a pediatric facility compared to AYAs treated at adult facility.
3429 Inpatient Palliative Care Consultation Improves Readmissions in End-Stage Liver Disease
Authors: Adejumo Adeyinka Charles
Published: March 2019

OBJECTIVES/SPECIFIC AIMS: Inpatient palliative care consultation (PCC) of terminally ill patients has been shown to improve patient’s understanding of their poor prognosis. In heart failure patients, PC improves transfer to hospice (or home with hospice) and decreases readmission rates. In patients with end-stage liver disease (ESLD), factors affecting having PCC has been studied, but the impact of PCC on ESLD readmissions has not been evaluated in a nationwide analysis in the US. In this study, among patients with ESLD, we evaluate the impact of inpatient PCC on 1) 30- and 90-day readmission rates, 2) hospital charges (cost) and length of stay (LOS) during subsequent 30- and 90- day readmission. METHODS/STUDY POPULATION: All ESLD hospitalizations within the first nine months of the National Readmissions Database (2010-2014) were used in this study, to allow up to 3 months to follow up. Frequencies and yearly trends of all-cause 30- and 90-days readmissions, and of PCC referral were computed. A propensity-based greedy-algorithm was used to match (1:1) patients with PCC to those without PCC (no-PCC), to create a pseudorandomized clinical study. Comparing PCC to no-PCC, generalized estimating equations were used to estimate the adjusted odds (AOR) of 30- and 90-day readmissions, and of cost and LOS during subsequent readmissions (SAS 9.4) RESULTS/ANTICIPATED RESULTS: In the United States, from January 1st to September 30th of years 2010-2014, there were 67,271 (approximating 150,396 patients) individual records of ESLD patients who survived index hospitalization. The average annual rate of PCC was 5.4%, which steadily increased from 3.84% to 6.50% over the years (p-trend <0.0001). The average 30- and 90-day readmissions rate were respectively 34.9% and 52.3%, and both remained relatively unchanged over the years (p-trends: 0.1948 & 0.5277). After matching, index PCC was associated with 68% decreased odds for 30 day readmissions (AOR: 0.32[0.28-0.37], p-value < 0.0001). When subsequently readmitted within 30 days, previous PCC resulted in a 17% shorter stay (5.7- vs. 6.9- days, p-value:0.0014) and 30% decreased cost ($47,612 vs. $68,043, p-value:<0.0001). Similarly, index PCC was associated with 74% decreased odds for 90 day readmissions (AOR: 0.26[0.24-0.29], p-value<0.0001). With subsequently readmission within 90 days, previous PCC resulted in a 17% shorter stay (5.7- vs. 6.9- days, p-value:0.0013) and 30% decreased cost ($47,520 vs. $68,016, p-value:<0.0001). DISCUSSION/SIGNIFICANCE OF IMPACT: Patients with ESLD who received PCC had a significantly lower rate of all-cause 30- and 90- day readmissions, and consumed fewer resources (hospital stay and cost) during subsequent readmissions. Although PCC resulted in a less futile use of health care resources, its adoption is still remarkably low among ESLD patients. Studies are needed to understand the barriers to PCC and to increase its use.
3343 Identification of host-microbial interaction networks that mediate intestinal epithelial barrier function in necrotizing enterocolitis
Authors: Hill David R , Cieza Roberto , Yadagiri Veda K. , Tarr Phillip , Spence Jason R. , Young Vincent B.
Published: March 2019

OBJECTIVES/SPECIFIC AIMS: The central goal of this proposal is to characterize the mechanisms that mediate success or failure of immature intestinal barrier in necrotizing enterocilitis. METHODS/STUDY POPULATION: To do this, I will utilize stem cell derived human intestinal organoids (HIOs), an innovative model of the immature intestine, and a cohort of bacterial isolates collected from premature infants who developed NEC to interrogate the cause-effect relationship of these strains on maintenance of the intestinal barrier. I hypothesize that the epithelial response to bacterial colonization is strain-dependent and results in differences in inflammatory signaling that shape epithelial barrier function in the immature intestine. RESULTS/ANTICIPATED RESULTS: Preliminary data shows that colonization of HIOs with different bacteria leads to species-specific changes in barrier function, and some species selectively damage the epithelial barrier while others enhance epithelial barrier function. I have identified key inflammatory signals that serve as central drivers of intestinal barrier function. DISCUSSION/SIGNIFICANCE OF IMPACT: Characterization of this process is expected to substantially advance scientific understanding of early events in NEC pathogenesis and lead to new opportunities for targeted therapeutic intervention to accelerate barrier maturation or prevent hyperinflammatory reactivity in the neonatal intestine. The research proposed in this application represents an entirely novel approach to studying host-microbial interactions in the immature. Conceptually, this novel translational approach will help to define the pivotal role of colonizing bacteria in initiating epithelial inflammation in NEC patients.