OBJECTIVES/SPECIFIC AIMS: (1) To propose an iterative decision-making model of care planning for CSHCN. (2) To identify targets warranting measurement in future studies of SDM in care planning for CSHCN. METHODS/STUDY POPULATION: Conceptual model developed by a multidisciplinary team iteratively considering the complex relationships among diverse factors affecting care planning for CSHCN, informed by clinical and implementation science experience and a scoping literature review of medical and cognitive sciences literature addressing interpersonal decision-making, communication, negotiation, and trust among children, their parents, and their clinicians. RESULTS/ANTICIPATED RESULTS: Decision-making interventions in pediatrics tend to focus narrowly on single acute decisions, providing minimal guidance for decisions related to chronic disease management over time. Few models account for the role of the child in the decision-making process, despite their ongoing development. Therefore, we propose a model of shared decision-making in the context of managing chronic illness in children that recognizes all actors and can support both the design of clinical care and research. This model—The SDM Learning Loop Model—highlights the dynamic iterative nature of exchanges between and among the clinical team and the parent-child dyad and recognizes the child as the center of each decision-making cycle. The model accounts for key practice, family, experiential, and emotional contexts influencing the decision-making encounter. In this model, change in child health status and developmental capacity resulting from a given cycle’s care plan will directly influence the relationship between clinician and parent-child dyad (eg, mutual trust, attunement) and impact each party’s engagement in the next round of decision-making. The relationship between experience and outcome stimulates learning. DISCUSSION/SIGNIFICANCE OF IMPACT: Our proposed SDM Learning Loop Model suggests that increasing the shared nature of decision making is not only likely to optimize care planning, but creates “buy-in” that can both reinforce the impact of positive outcomes, and moderate the negative impact on relationships when the outcome is other than desired. We hypothesize that this model can guide care planning and shape research to the benefit of both clinical outcomes and clinician-family relationships. Future work should focus on the development and validation of measures to account for the experiential and emotional contexts in which such decisions are made, and the outcomes of care in this population.

OBJECTIVES/SPECIFIC AIMS: Women with GDM have a 7-fold higher risk of developing T2DM, and rates of GDM are higher among racial and ethnic minorities and women of lower socio-economic status. There are no data on postpartum diabetes screening after the first postpartum year or among women receiving care in FQHCs. We aim to address this gap in the literature by (1) defining the rates of follow-up screening for T2DM at 6–12 weeks and 1–3 years postpartum and (2) characterizing patient, provider, and healthcare system attributes that are associated with lack of follow-up screening for T2DM in a population of low-income women with GDM. METHODS/STUDY POPULATION: This is a retrospective cohort study of women with GDM during pregnancy receiving care in Missouri FQHCs from 2010 to 2015. Electronic health records (EHR) data from 26 FQHCs is housed in a central repository through the Missouri Primary Care Association (MPCA). This includes patient demographic, lab, and medication information as well as encounter level patient and provider data for the prenatal and postpartum period. EHR data does not include accurate delivery information, however. Pregnancies during the study time frame were identified using CPT and ICD9/10 codes. Deidentified data on individuals with a pregnancy was utilized to identify a subpopulation of “GDM candidates,” using a broad definition of glucose abnormalities as follows: ICD-9/ICD-10 codes for diabetes, medications and testing supplies used for diabetes, infant birth weight ≥4000 g or 8 lb or 13 oz, or abnormal glucose labs [defined as fasting glucose≥95, gestational glucose screen≥130, 1 h test≥130 (or ≥180 if 2 h test and 3 h test recorded on same day), 2 h test≥155, 3 h test≥140, A1C≥6, any glucose≥130, or any positive urine glucose]. This subpopulation was then linked to Medicaid administrative claims data [housed at the University of Missouri Office of Social and Economic Development Analysis (OSEDA)], providing detailed information on delivery, to further characterize patients with GDM in the time frame and provide all dates necessary to classify pregnancy and postpartum periods. RESULTS/ANTICIPATED RESULTS: From the de-identified pregnancy data set including 45,810 individuals, we identified 8008 “GDM candidates.” EHR data were linked to Medicaid claims data for these individuals from 2010 to 2015. Utilizing the enhanced data set, we are defining a pregnancy for each individual by the delivery date in the Medicaid record and an algorithm using lab and ultrasound record dates to define gestational age at delivery. This will result in a pregnancy level data set linked with individual encrypted identifiers with each record representing 1 pregnancy and postpartum period. GDM in pregnancy will be defined as having a baby with birth weight≥4000 g or 8 lb or 13 oz, ICD-9 or ICD-10 code for GDM during pregnancy or at delivery, or an oral glucose tolerance test (oGTT) 12–16 weeks before delivery with 2 or more abnormal results by Carpenter and Coustan criteria. We anticipate that our final GDM data set will include 2000–3000 individuals. We will then calculate the percentage of individuals receiving recommended screening tests at 6–12 weeks (fasting glucose or 2 h oGTT) and 1–3 years postpartum (fasting glucose, 2 h oGTT, HbA1C). We will use multivariable regression techniques to identify risk factors for lack of screening. We will be able to incorporate predictors not previously evaluated including distance from home to health center, access to public transport, specialty and training of the patient’s providers, pregnancy weight gain, postpartum appointment time of day, and number of various types of office visits. DISCUSSION/SIGNIFICANCE OF IMPACT: The creation of a linked data set of pregnancies complicated by GDM in women receiving care in FQHCs in Missouri is the first step toward better characterizing follow-up diabetes screening rates in this population and understanding patient, provider, and healthcare system variables that affect postpartum screening. The ultimate goal is to translate evidence-based patient-centered sustainable interventions into practice for low-income women with a history of GDM and improve population outcomes with the ability to track progress prospectively over time.

Acknowledgements: The authors thank Susan Wilson (MPCA), Jill Lucht, and Bhawani Mishra (OSEDA).

OBJECTIVES/SPECIFIC AIMS: “Loss to follow up” is a common phenomenon and challenge in clinical medicine. Missed appointments are a well-documented source of waste in the health care system, and can lead to strained patient-physician relationships and inferior quality of care. Meningiomas are relatively common, benign tumors that arise from the dural coverings of the brain. Although complete surgical resection is considered curative, surgically excised meningiomas have a well-documented propensity to recur, necessitating continued imaging surveillance of postresection patients. A recent retrospective study at our institute demonstrated that 20% of postresection patients fail to return for follow up within a year of their surgery. Although social determinants of health have been associated with failure to follow up in this population, there has been no research identifying patient-reported barriers that result in loss to follow up in this patient population. The purpose of this study is to identify specific barriers that prevent patients from returning for surveillance. METHODS/STUDY POPULATION: We used an IRB approved, prospective brain tumor clinical database to identify patients who underwent surgical resection of intracranial meningioma at our institution between 2001 and 2013. “Loss to follow up” was defined as failure to attend follow-up appointments with neurosurgery, radiation oncology, or neuro-oncology within a year of the most recent assigned follow-up interval, as recorded in the electronic medical record. Structured interviews were conducted with patients who met study criteria and specific barriers to follow-up were elicited, transcribed, and coded. In 2 cases, a primary caregiver participated in all or portions of the interview with the patient. A general assessment of patient knowledge about meningioma and a screening for basic health literacy were also conducted. RESULTS/ANTICIPATED RESULTS: There were 80 patients in the brain tumor clinical database met chart review criteria for inclusion in the study. A total of 9 structured interviews were conducted; 1 interview was excluded from analysis for failure to meet study criteria. In total, 24 unique obstacles to follow up were recorded. These were stratified and grouped into 4 broad categories: 2 of 8 (25%) patients identified environmental factors, including distance to appointment and challenges with insurance coverage as barriers to follow up; 2 patients (25%) identified psychosocial factors, including poor communication with and distrust of their neurosurgeon as barriers to follow up; 2 (25%) patients identified health factors, including poor health and old age, as barriers to follow up; 6 patients identified healthcare systems factors as barriers to follow up, with 6 patients (75%) reporting seeing a non-specialist for follow up after surgery and 4 patients (50%) reporting not being told by their neurosurgeon that they would need continued follow up. Of those patients seen by non-specialists, only 1 reported any recent brain imaging by those providers. All patients had limited to no prior knowledge of meningiomas before their diagnosis. Four (50%) patients reported satisfaction with the level education about meningiomas they received from their physician. Of these patients, 3 (75%) correctly reported that meningiomas may recur following surgery. Of the patients who did not report satisfaction with physician counseling, 3 (75%) did not realize that meningiomas can recur. DISCUSSION/SIGNIFICANCE OF IMPACT: Healthcare system factors, including uncoordinated transition of postoperative care to non-neurosurgeons and uncertain postoperative surveillance schedules, represent that most common patient-identified barriers to follow up after meningioma resection. Improving transition of care from specialists to non-specialists, including designation of appropriate imaging surveillance schedules, as well as improving communication between specialists and patients about the need for continued follow up, represent clear points for intervention that could improve care for this patient population. In addition, consistent and clear counseling about meningioma and its disease course may reduce loss to follow up following meningioma resection. It is important to note, however, that the small sample size represents a significant limitation of the study.

OBJECTIVES/SPECIFIC AIMS: Evidence-based guideline-concordant care leads to better outcomes in patients with early stage breast cancer, including survival. However, previous studies of guideline compliance have been limited by small study sample sizes, localized geography, unknown causal factors, and lack of diverse population. We use a national database to assess socio-economic, clinical, and facility factors that impact treatment compliance with evidence-based guidelines from the American Society of Clinical Oncology (ASCO) and the National Comprehensive Cancer Network (NCCN). METHODS/STUDY POPULATION: This is a retrospective cohort study of the National Cancer Data Base Participant User File Breast 2014, which captures ~70%–80% of all newly diagnosed cancer cases in the United States. Female patients who were diagnosed with early stage breast adenocarcinoma (T0, T1, T1A, T1B, 2, 2A, or T2N1) from 2004 to 2014 were eligible for this study. RESULTS/ANTICIPATED RESULTS: A total of 807,314 patients were included in this study. Evidence-based guidelines examined with associated compliance rates include surgery completion (79.3% overall compliance), breast conserving surgery Versus mastectomy (88.05% vs. 11.95%, respectively), radiation after breast conserving surgery (77.5% overall compliance), HER2 testing (88.6% overall compliance), estrogen/progesterone receptor (ER/PR) testing (96.3% overall compliance), hormone treatment for positive ER/PR breast cancer (80.2% overall compliance), and sentinel lymph node biopsy completion (67.5% overall compliance). Univariate association between these guidelines and covariates such as facility type, facility location, age, race, insurance status, median income quartiles, achievement of high school degree, urban Versus rural, Charlson-Deyo score, year of diagnosis, and overall survival were assessed. Logistic regression analysis will be used to determine multivariate relationships between these characteristics and the probability that a patient will be compliant to guideline regimen. DISCUSSION/SIGNIFICANCE OF IMPACT: The results of this study will help identify socio-economic, clinical, and facility factors that influence guideline-concordant care and subsequent critical outcomes for patients with early stage breast cancer. Lack of guideline concordant care for specific stages of cancer or treatment modalities will point to a need for tailored interventions to enhance compliance. A prediction model will help identify the most important predictors of noncompliance in breast cancer treatment so noncompliance can be prevented in at-risk populations.

OBJECTIVES/SPECIFIC AIMS: In this pilot study, we are testing a new approach for detecting neuroinflammation in individuals who have sustained a traumatic brain injury (TBI). We hypothesize that many long-term adverse consequences of TBI are driven by abnormal inflammatory processes in the brain that occur secondary to the original neural injury. This inflammation can spread well beyond the damaged tissue and cause profound fatigue, widespread pain, cognitive impairment, and depressed mood. METHODS/STUDY POPULATION: Using a technique based on magnetic resonance spectroscopy, we can obtain precise and accurate temperature measurements throughout the human brain, which may serve as a proxy for neuroinflammation. In this study, we examine 20 men who have sustained a moderate-to-severe TBI and 10 age-matched healthy men without history of TBI. Temperature is assessed on a voxel-by-voxel basis throughout the entire brain. Cognitive ability is measured with the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Information on pain, fatigue, and mood is collected through questionnaire. RESULTS/ANTICIPATED RESULTS: We anticipate that (1) average whole-brain temperature will be significantly higher in the TBI group than the healthy control group; (2) severity of (a) pain, (b) fatigue, and (c) mood symptoms will be correlated with brain temperature; and (3) severity of cognitive impairment will be correlated with brain temperature. DISCUSSION/SIGNIFICANCE OF IMPACT: If the hypotheses are confirmed, this tool will fill a need for objective tests of TBI pathology that can be used to improve diagnostic and treatment decisions and predict long-term functioning. This test would be the first completely noninvasive tool for detecting neuroinflammation, and will allow for safe and inexpensive longitudinal testing. Ultimately, we hope this noninvasive scanning technique will accurately track neuroinflammation in TBI, leading to more targeted and effective treatments.

OBJECTIVES/SPECIFIC AIMS: To explore associations among bio-psychosocial factors predictive of overall physical and mental health status as assessed using the SF-12 Health Survey. METHODS/STUDY POPULATION: Community-dwelling, male and female elders with peripheral arterial disease (PAD) were administered an assessment battery to identify factors associated with self-assessed physical and mental health status using the SF-12 Health Survey. The battery included an assessment of pain, depressive symptoms, perceived social support, perceived psychological stress, physical function, as well as selected demographic variables. RESULTS/ANTICIPATED RESULTS: Preliminary linear regression analyses have identified several factors predictive of physical and mental health status including depressive symptoms, pain, perceived stress, and physical function. A more in-depth examination using path analysis is anticipated to reveal important mediational associations, wherein physical function is a strong mediator between bio-psychosocial factors and overall physical and mental health status. DISCUSSION/SIGNIFICANCE OF IMPACT: Aging is often associated with a reduction in physical and mental well-being, frequently exacerbated by the development and progression of chronic disease. PAD is a common chronic condition that places significant burden on the older patient and their family. Identifying and developing a more in-depth understanding of the factors that impact health status in PAD is an important and timely objective. We anticipate that our findings will inform development of more targeted and effective intervention strategies we can employ to improve the quality of life among elders struggling to manage PAD.

OBJECTIVES/SPECIFIC AIMS: Focus groups are being conducted to describe and identify barriers and/or facilitators to Hispanic males’ health literacy, culture, and language related to cervical cancer prevention practices METHODS/STUDY POPULATION: A purposive convenience sample was recruited to participate in focus group sessions with English or Spanish speaking Hispanic males 21 years of age and older. Groups were segmented by age (21–29, 30–39, 40–49, and 50–65), and language (English or Spanish). Focus group discussions (n=8) were led by a bilingual/bicultural female researcher using a discussion guide that followed Zarcadoolas et al. (2005) health literacy model 6 as related to their partners’ cervical cancer screening and prevention practices. All sessions were audio-recorded and transcribed verbatim. Participants completed standardized questioners regarding demographic data and their health literacy. Qualitative content analysis was used for analyzing focus group interviews. RESULTS/ANTICIPATED RESULTS: Preliminary qualitative analysis shows the struggle Hispanic males’ face accepting cervical cancer screening for their female partners. One participant reported that it was “a clash of cultures.” A “clash of cultures” was described as a constant struggle and acceptance between science, personal knowledge, and Hispanic cultural taboos. DISCUSSION/SIGNIFICANCE OF IMPACT: Hispanic male’s health literacy, communication, language preferences, and cervical cancer risks, will further enhance the knowledge needed to design intervention measures for cancer prevention among Hispanics. Understanding the factors that contribute to the unequal burden of cervical cancer incidence and mortality among Hispanic women in South Texas is critical to prevent cervical cancer among this population.

OBJECTIVES/SPECIFIC AIMS: (1) To assess the prevalence of mental health symptomatology (depressive symptoms, anxiety symptoms, PTSD symptoms, and problematic alcohol use) and psychosocial risk factors for mental health disorders (low social support, immigration stress, acculturation, and marital/partner discord), and their association with immigration status, health care access and contextual risk factors in Spanish-speaking parents of young children (ages 0–5) who attended a well-child visit. (2) To explore acceptability of screening for and discussing parental distress in the pediatric primary care setting, and parental acceptability of a group well-visit format to address both psychosocial risk factors and mental health symptoms in this population. METHODS/STUDY POPULATION: Latino immigrant parents (n=100) of children ages 0–5 attending well-child visits at Johns Hopkins Bayview Children’s Medical Practice were surveyed between October 2015 and February 2016. The verbally administered survey included the Woman Abuse Screening Tool (WAST), AUDIT-C, Primary Care Post-Traumatic Stress Disorder (PC-PTSD) Screener, California Health Interview Survey (CHIS), National Latino and Asian American Study (NLAAS), Appraisal Support Subscale from Interpersonal Support Evaluation List (ISEL), Personal Health Questionnaire Depression Scale (PHQ-8), and Generalized Anxiety Disorder Scale (GAD-2). These questionnaires have been used in large regional or national surveys and most have been validated with US Latino populations. Positive screens were defined as PHQ-8>5 (mild depression or greater), GAD-2>3, AUDIT-C>3 for women and >4 for men, and PC-PTSD>3. Descriptive information and comparisons were obtained by χ2 and Student t-test. Study protocol will allow review of childrens’ pediatric records (n=100). From this sample, parents were separately recruited to participate in in-depth interviews (n=11 of 20 planned have been completed) further exploring both sources of parental distress, acceptability of screening for parental mental health symptoms in the primary care pediatric setting, and acceptability of a potential group-based well-visit model in the pediatric setting. RESULTS/ANTICIPATED RESULTS: Survey participants were 93.0% women, and predominantly<35 years of age. The vast majority (94.0%) were undocumented, recently arrived (<15 years ago) and reported poor or very poor English proficiency (75.0%). Most (84.7%) reported living with a partner or spouse (84.7%), and 58% reported partner relationship strain. In all, 71% reported poor social support. The prevalence of “screen positive” mental health symptoms was highest for depression (55%) and PTSD (35%), followed by anxiety (29%) and alcohol risk use (25%). Having depression was significantly higher (68.4%) (p<0.02) in participants with less education (<6 grade). Partner relationship strain was associated with a higher prevalence of depressive symptoms (59.3%) (p<0.03). Immigration stress (feeling guilty for leaving family and friends) was also significantly associated with depressive symptoms (58.1%) and PTSD (43.5%) (p<0.03). More than half of the participants (60.0%) with depression were not covered by any health insurance and 56.3% of those with depression reported not having been seen by a health care provider in the past 12 months. A high prevalence of symptoms was found in those with poor appraised social support: alcohol risk use (76.0%), depression (69.1%), anxiety (69.0%), and PTSD (68.6%). Among participants, those aged<30 years old and those with more children reported poorer appraised social support. Data from child medical records (including BMI, presence of feeding problems, referrals for social work, or mental health services) has been extracted but not yet linked to parent survey or interview results. Preliminary review of In Depth Interviews suggests that the most common reported source of stress among participants was related to finances, followed by documentation/legal status difficulties, access to childcare, and limited English proficiency. Some mothers also mentioned interpersonal violence and lack of access to healthcare as stressors. All mothers expressed an interest in a pediatric primary care based parent focused the majority of which indicated that a group based intervention would be acceptable, some mothers indicated they preferred a one-to-one intervention if mental health were to be discussed. Mothers seem preferential to social worker-led interventions compared with pediatrician-led, but most mothers were indifferent. Finally, mothers expressed low support from the Latino community in Baltimore. DISCUSSION/SIGNIFICANCE OF IMPACT: Results from this study suggest that this population of parents is experiencing a relatively high rate of mental health symptoms, low perceived social support, and limited access to their own source of care. This suggests that an intervention delivered within a primary care pediatric setting would have the potential to reach parents who might not otherwise interact with their own providers, and that there are an array of problems that could be targeted. Intervening with parents of young children has the potential to affect multiple child outcomes. A group intervention may target poor social support, though this format is not universally preferred. Next steps for this project include assessing the acceptability of and preference for various content components (ie, depression, parenting stress, legal issues) and linking parent data with child data (including developmental screening results, weight, feeding problems, and behavior problems).

OBJECTIVES/SPECIFIC AIMS: Community engagement is a commonly used term, but is complex in both meaning and application. In order to help academic institutions and administrators develop infrastructure to promote and support community engagement and to help investigators work productively with communities, this analysis discusses the major components of community engagement in research on both the institutional and individual project levels as well as the interplay between them. METHODS/STUDY POPULATION: A literature synthesis conducted by a community engagement in research committee at 1 CTSA institution that examined the myriad factors related to effective community engagement in research identified across multiple disciplines was used to distill the major factors identified, assesses the interplay of the identified factors, and produce a conceptual model to help administrators and investigators apply best practices in engaging communities in clinical and translational research. RESULTS/ANTICIPATED RESULTS: This work takes a concept—community engagement in research—that is often stated and discussed, but is highly complex and challenging to implement—and identifies and discusses the multiple, interrelated factors germane to it. The model illustrates that while community engagement in research is implemented in the context of individual projects, a deep and continual interplay between individual projects and the goals, capacity, and policies of research institutions is needed for rigorous, ethical, and effective community engagement. DISCUSSION/SIGNIFICANCE OF IMPACT: Results are presented through a conceptual framework which displays the major components needed for rigorous, ethical, and effective community engagement in clinical and translational research. In addition, the conceptual framework presented will provide assistance to those developing approaches to measure and evaluate institutional readiness for community engagement in research as well as the effectiveness of individual community engagement efforts.

OBJECTIVES/SPECIFIC AIMS: Alabama (AL) experienced a 145% increase in its Latino population between 2000 and 2010; making it the state with the second fastest growing Latino population in the United States (US) during that time. Adolescent Latinas in the US and in AL are disproportionately affected by sexual health disparities as evidenced by the disproportionate burden of HIV, STIs and early pregnancy compared with their non-Hispanic, White counterparts. Empirical data with adult Latinas in the southeast suggest significant barriers to sexual healthcare access. However, to our knowledge, no other researchers have examined barriers and facilitators to sexual healthcare access for this subpopulation. Therefore, the purpose of this study is to examine adolescent Latinas’ sexual healthcare needs through in-depth qualitative interviews. These qualitative interviews (phase 1 of a 3-phase study) will inform the development of community-driven, theory-based, culturally-relevant, multi-level intervention strategies to reduce sexual health disparities and increase sexual healthcare access for this group. Community-based participatory research (CBPR), which ensures equitable participation of stakeholder groups through partnerships, and the socioecological model of health, which conceptualizes the individual as nested within a set of social structures, provide the philosophical and theoretical frameworks for the work. METHODS/STUDY POPULATION: Between January and March of 2017, we will conduct 30 qualitative interviews with eligible adolescents who: self-identify as Latina, are between 15 and 19 years old, have been in the US for over 5 years, and live west AL. We will use venue-based, purposeful convenience sampling to recruit participants. We will manage and analyze the data with the qualitative software NVivo 10. We will use a multi-step, consensus-based process to code and analyze the interviews in the language in which they were conducted (ie, Spanish or English). We will maintain detailed audit trails during the analysis process and seek an inter-rater reliability of 0.85. RESULTS/ANTICIPATED RESULTS: We expect to identify barriers and facilitators to sexual healthcare services at distinct levels of the socioecological model of health. Study results and implications for practice in clinical settings will be discussed in detail. DISCUSSION/SIGNIFICANCE OF IMPACT: The proposed research is significant because (1) the state of AL experienced a dramatic increase in its Latino/a population over the last 15 years and adolescent Latinas in AL are disproportionately affected by sexual health disparities; (2) to our knowledge, this will be the first study to examine the multi-level factors associated with sexual healthcare access for adolescent Latinas in the South and inform intervention strategies to promote sexual healthcare access in this population; (3) the work will be conducted under the philosophical lens of CBPR such that community members will be involved in every step of the research process, resulting in culturally relevant intervention strategies.

OBJECTIVES/SPECIFIC AIMS: The aim of this study was to determining how interruptions affect the triage process. METHODS/STUDY POPULATION: Prospective, observational study, where 118 triage interviews were observed. RESULTS/ANTICIPATED RESULTS: In total, 57% of triage interviews were interrupted. The most common interruption was by other nurses; however, 7% of the interruptions were by the triage nurse themselves. When an interruption occurred during the triage process, 67% of the time the triage nurse would stop the triage assessment and attend to the interrupter. In the interrupted interviews, 17% of the entire triage time was dedicated to addressing interruptions. Some interruptions (ie, additionally staff entering to conduct ECG) had a positive impact by expediting care during the triage process; where other interruptions delayed patient care. DISCUSSION/SIGNIFICANCE OF IMPACT: Interruptions increased the total triage time and contributed to patient treatment delays, as well as led to errors in nursing assessment. Understanding the classifications of triage interruptions and the impact on patient outcomes will allow researchers to develop interventions to mitigate the impact of these interruptions.

OBJECTIVES/SPECIFIC AIMS: To create a composite index, referred to as the Pediatric Hydrocephalus Severity Index (PHSI), to classify the severity of disease at baseline and predict outcomes among children treated for hydrocephalus. METHODS/STUDY POPULATION: The Hydrocephalus Outcome Questionnaire will be administered in person or online to the parents of 150 patients between the ages of 5 and 18 years who are followed at the Neurosurgery Clinic at St. Louis Children’s Hospital for hydrocephalus. Patients must have been diagnosed and treated for hydrocephalus at least 6 months prior to the survey date. Potential participants are excluded if their health status changed during the 4 weeks prior to survey date, as determined by the child’s parents. Potential risk factors (see anticipated results) will be identified on retrospective medical record review. We will create a clinical prediction rule, called the PHSI, to stratify patients on likelihood of experiencing a poor long-term outcome after surgical treatment. Participants will be classified as “good” or “poor” outcome based on thresholds set for questionnaire results. We will use a combination of bivariate analysis and clinical reasoning to restrict the number of factors for further analysis, and multivariate logistic regression to build a predictive model for poor outcome. Creation of the PHSI will involve assigning integer values to adjusted odds ratios for significant risk factors at a 95% confidence level. RESULTS/ANTICIPATED RESULTS: Risk factors that we anticipate will be predictive of long-term clinical outcome include signs and symptoms at onset (bulging fontanel, splayed sutures, papilledema, up-gaze palsy, headache, vomiting, lethargy), head circumference above the 97th percentile, frontal-occipital horn ratio greater than 0.4, etiology of meningitis or neonatal intraventricular hemorrhage, central nervous system comorbidities (seizures, Chiari malformation, scoliosis, periventricular leukomalacia), preoperative infection or sepsis, and frequent shunt revisions or infections. We hypothesize that a PHSI will be a valuable tool for stratifying patients in future research studies, as well as aiding prognosis in clinical situations. DISCUSSION/SIGNIFICANCE OF IMPACT: A validated composite PHSI would be a major advance in clinical hydrocephalus research and practice. A PHSI would allow investigators to stratify patients based on initial presentation for clinical research studies, which may in turn lead to the establishment of more standardized treatment guidelines. It would also facilitate studies investigating differential utilization of healthcare resources based on disease severity. Clinically, a PHSI would better equip physicians to counsel parents on what to expect for their child or future healthcare resource requirements.

OBJECTIVES/SPECIFIC AIMS: Low-income, urban adolescents experience high rates of interpersonal and community violence and consequently post-traumatic stress disorder (PTSD). Memory theory purports that the development of PTSD can be explained by dysfunctional trauma cognitions, high sensory and poor articulation of trauma memories, and poor emotional regulation. The purpose of this paper are as follows: (1) to describe trauma experiences and PTSD symptoms of a high-risk sample of low-income urban youth and (2) to explore if post-traumatic cognitions, trauma memory quality, or emotional regulation means differ in participants screening positive for PTSD as compared with those that did not screen positive. METHODS/STUDY POPULATION: A preliminary sample of low-income, urban adolescents (ages 16–21) at risk for homelessness took a web-based, self-report survey responding to questions related to their experiences of trauma and mental health (n=48). PTSD was measured with the PTSD Checklist for DSM-5 criteria (PCL_5). A cut-off of 33 was used as a positive screen for PTSD. Post-traumatic cognitions was measured with the post-traumatic cognition inventory (pcti) with higher scores representing greater dysfunctions and negative cognitions. Trauma memory was measured with the Trauma Memory Quality Questionnaire (TMQQ) with higher scores representing more sensory-based and poorly verbalized memories. Emotional regulation was measured using the Difficulties in Emotional Regulation Scale (DERS) with higher scores representing greater difficulties with emotional regulation. All 3 variables conceptually represented theoretical constructs of the development of PTSD. Initial data from the baseline survey was used conducted a 1-way ANOVA to compare the difference in post-traumatic cognition, quality of trauma memory, and emotional regulation in those that screened positive for PTSD as compared with their peers. RESULTS/ANTICIPATED RESULTS: The majority of this population (80%) experienced at least 1 traumatic life event. This sample experienced an average of 10.5 lifetime traumas (SD=10.6). Of those experiencing trauma about 20% (n=8) reported a positive PTSD screen (PCL-5). There were significant group differences among those screening positive for PTSD and their peers in the following variables: (1) pcti (F1,24=10.43, p<0.004), (2) TMQQ (F1,29=11.02, p<0.002), and (3) DERS (F1,36=19.68, p=0.000). The majority of this population (80%) experienced at least one traumatic life event. This sample experienced an average of 10.5 lifetime traumas (SD=10.6). Of those experiencing trauma about 20% (N=8) reported a positive PTSD screen (PCL-5). There were significant group differences among those screening positive for PTSD and their peers in the following variables: 1) pcti [F(1,24) = 10.43, p<.004], 2) TMQQ [F(1,29) =11.02, p<.002], [F(1,36) =19.68, p=.000]. DISCUSSION/SIGNIFICANCE OF IMPACT: This sample reported high rates of trauma and PTSD. Constructs representing memory theory (cognition dysfunction, quality of memory, and emotional regulation) all significantly differed among participants with PTSD compared with their peers. Consequently, it may be useful for trauma interventions to target the maladaptive post-traumatic cognitions, quality of traumatic memories, and emotional regulation in this population. These results will inform work that aims to explore if a trauma intervention, based on the memory theory can improve PTSD symptoms. Anticipated data collection completion in March 2017 (n=120).

OBJECTIVES/SPECIFIC AIMS: More than 2 out of 3 adults in the United States are overweight or obese. Obesity disproportionately affects minority populations. There is limited data on obesity and CVD risks among inner-city minority cab drivers in New York City (NYC). The goal is to study perceptions, knowledge and health behaviors of Hispanic livery cab drivers of NYC that contributes to obesity. METHODS/STUDY POPULATION: We conducted an observational study of focus groups related to perception, knowledge, or behavior among Latino livery cab drivers of NYC. Direct transcription of the taped recordings into concepts were grouped into themes and common themes were categorized. The sample size of the focus groups was based on the saturation point where common themes emerged. RESULTS/ANTICIPATED RESULTS: In total, 25 Latino livery cab drivers were enrolled. Of those, 24 were men. Mean age is 53 years (21–69); body mass index (BMI) is 31 (22.8–38.7) kg/m2; 50% had hypertension and 27% had diabetes. Eight dominant themes emerged. Cab drivers were aware of their increased risk for CVD which most of them attributed to work stress, sedentary lifestyle, and poor eating habits “on-the-go”. In particular, they mentioned a tendency of having “Pipa,” a Spanish term denoting increased abdominal girth, which they equated to early death. Family and social support was an important facilitator in changing unhealthy behaviors. DISCUSSION/SIGNIFICANCE OF IMPACT: Our study shows that minority cab drivers are generally obese or overweight and aware of their personal risk factors for CVD including central obesity. Social and family support may be key to improving their lifestyle. An evidenced-based health model that includes family education and decision support will be tested in our next study phase to understand if it can improve body weight.

OBJECTIVES/SPECIFIC AIMS: As part of a larger effort to create a longitudinal record of care for patients with chronic kidney disease (CKD) in Delaware, we assessed transitions of care from pediatric to adult care. This study examined the length of time between last pediatric contact and first contact in the adult system in order to determine characteristics associated with delayed transition to adult care. METHODS/STUDY POPULATION: Patients who receive pediatric care at the Nemours/Alfred I. duPont Hospital for Children (Nemours) are transitioned to adult care between the ages of 18 and 21. Our study population consists of all patients seen in the Nephrology unit at Nemours for CKD, hypertension (HTN), or diabetes who turned 21 years old between 2007 and 2013. Records of office visits from Nemours, Christiana Care Health System (CCHS), and Nephrology Associates, P.A. (NAPA) were transformed into the OMOP common data model and merged. Patients who had at least 1 record in the Nemours EHR of pediatric care before age 21 and had at least 1 record in the CCHS or NAPA adult EHRs were considered transitioned. To identify characteristics associated with delayed transition to adult care, we compared gender, race, ethnicity, age, comorbidities, and level of kidney function at the last pediatric visit between patients whose transition gap was less than 1 year and patients whose gap was 1 year or more. Kidney function was estimated by calculating glomerular filtration rate (GFR). Nemours estimates GFR in children using the revised Schwartz equation, which is based on serum creatinine and height. To calculate adult GFR, we used the CKD-Epi equation, which is based on serum creatinine, age, sex, and race and is widely used to derive adult GFR. As kidney function declines, GFR decreases. We used Fisher exact test to compare categorical variables and t-test to compare age and GFR. RESULTS/ANTICIPATED RESULTS: We found only 109 (25%) patients who had records in our adult offices out of the 440 Nemours patients in our data set. Of the 109 transitioned patients, 54 had office visits at CCHS, 37 at NAPA, and 18 at both locations. Examining the office visits of the 109 transitioned patients, 34 (31%) had an overlap in visits defined as an office visit at CCHS or NAPA before the last office visit at Nemours, and 75 (69%) did not have an overlap. The median gap between last pediatric and first adult office visit for the 75 patients without an overlap was 615 days (range 8–3495 d). Only 6 (6%) of the 109 transitioned patients had overlapping GFR measurements from pediatric to adult care, and all of the adult GFR calculations (CKD-Epi) were greater than the pediatric GFR calculations (Schwartz). The difference between child and adult GFR ranged from 8.2 to 87.1 mL/minute per 1.72 m2. DISCUSSION/SIGNIFICANCE OF IMPACT: During the transition from pediatric care to adult care, many young adults with CKD experience declines in health outcomes and comorbidities such as diabetes and HTN complicate self-management. Lack of overlap between pediatric and adult care office visits indicates a delay in executing this transition. In our population of 109 transitioned patients, 69% did not have an overlap in care, and 50% of those without overlap had a gap of more than 615 days (1 y, 8 mo). Our analysis suggests that young adults who are younger at last pediatric office visit are more likely to delay transitioning to adult care. Transitioning from the nurturing environment of pediatric care to adult care is a complex process and could be challenging for young adults with CKD. Transition clinics may be necessary to improve the coordination of care and help these young adults keep their physician appointments.

OBJECTIVES/SPECIFIC AIMS: Compared to others, African-Americans (AA) have a higher prevalence of hypertension. Although, hypertension control has been well studied in clinical settings, a significant number of AA patients have uncontrolled hypertension. We conducted a qualitative study on CVD risk perceptions, knowledge, and behaviors among hypertensive AA in the South Bronx, NY. METHODS/STUDY POPULATION: Hypertensive AA participants, 18 years and older were recruited at a community-based hospital clinic. Focus groups with open-ended questions on CVD knowledge, perception, and behaviors was conducted. Responses were transcribed and transcript was analyzed using open code method. Concepts were formulated, which were then categorized into dominant themes. The sample size was based on the saturation point related to emerging common themes. RESULTS/ANTICIPATED RESULTS: There were 21 patients participated in 3 focus group sessions. The median age was 59 years; BMI median of 31.5 kg/m2; 76% were female. In total, 57% had controlled BP and 67% were diagnosed with diabetes mellitus; 8 themes emerged of which unhealthy diet was dominant. Participants acknowledged eating fried foods and meat seasoned with salt contributed to their hypertension. Their food choices were based on family tradition and economical cost more than nutritional value. DISCUSSION/SIGNIFICANCE OF IMPACT: This study reveals that inner city hypertensive AA patients have misperceptions, gaps in knowledge, and barriers to healthy behaviors. We propose to partner with them using shared decision making to raise awareness, knowledge and change in behaviors to prevent CVD in community settings.

OBJECTIVES/SPECIFIC AIMS: This presentation will highlight the framework and domains of the monitoring and evaluation (M&E) System Checklist created in response to the need for practical guidelines and intended to improve the quality, efficiency, and consistency of monitoring and evaluation of the clinical and translational work. The recently published NCATS Strategic Plan (2016; p. 18) presents the following objectives and guidelines that implicitly suggest the need for sound M&E: “Objective 4-1: Continually assess and optimize internal business practices” and “Objective 4-2: Ensure all scientific programs and operational activities are conducted in a rigorous, robust and data-driven manner.” Given the complexity of clinical and translational work and associated monitoring/evaluation processes and the dearth of practical tools in the CTR evaluation area, the need for such a checklist is clear. A “checklist” (a detailed list of items/steps required, things to be done, or points to be considered) is a type of informational job aid used to improve performance, reduce failure, deal with complexity, and ensure consistency and completeness in carrying out work. Checklists are popular in many fields—due to their brevity, concreteness, order, implicit (and sometimes explicit) mandate to do things right, and expectation for a checklist’s being grounded in good practices and/or strong theory. A notable example is the famed WHO Surgical Safety Checklist (2008). The proposed M&E Checklist has been developed based on the author’s extensive experience in internal evaluation, checklist development and use, and working with the Clinical and Translational Sciences Awards (CTSAs)—as the UMN CTSI M&E Director, ACTS Evaluation SIG Chair, and a Co-Lead of the Evaluators Working Group within the NCATS CTSA Common Metrics Initiative. Although there is no “golden” algorithm that will totally suit every organization, the M&E checklist provides useful guidelines for building M&E. The Checklist presents the key concepts and important issues in M&E development and implementation. It also incorporates a synthesis of 3 grounded frameworks: King and Volkov’s Framework for Building Evaluation Capacity (2005), Simister’s Framework for Developing M&E Systems for Complex Organizations (2009), and the award-winning CDC Framework for Program Evaluation in Public Health (1999). For the purposes of the proposed Checklist, an M&E system (or framework/approach) is understood as “a series of policies, practices and processes that enable the systematic and effective collection, analysis and use of monitoring and evaluation information” (Simister, 2009; p. 1). A well-designed M&E system ensures a consistent approach to the collection, analysis, and use of information, while allowing considerable scope for different parts of an organization to develop and apply their own solutions in response to their particular situations. The M&E Checklist structured around 3 key domains (adapted from the Volkov and King ECB Checklist, 2007): (1) M&E/organizational context: taking advantage of the internal and external organizational context, administrative culture, and decision-making processes. (2) M&E structures: creating structures—mechanisms within the organization—that enable the M&E development and use. (3) M&E resources: making M&E resources available and used. For each domain, the Checklist has a number of associated categories and activities. Specifically, the checklist adopts and adapts the following useful steps from Simister’s approach: “Define the scope and purpose,” “Perform a situational analysis,” “Consult with relevant stakeholders,” “Identify the key levels and focus areas,” and “Integrate the M&E system horizontally and vertically,” as well as the CDC Framework’s steps “Engage stakeholders,” “Focus the M&E Design,” and “Ensure use and share lessons learned.”With slight modification, the organizations can also utilize the Checklist as a rubric/assessment tool to gauge the status of their M&E capacity. METHODS/STUDY POPULATION: A case study of methodological/implementation tool development. There are no human subjects in this study, thus, Study Population is not applicable to this study. This study is not subject to IRB review. RESULTS/ANTICIPATED RESULTS: The proposed checklist approach shows sound promise to not only impact individual programs and their M&E systems but to also enhance internal evaluation capacity, critical thinking, learning, strategic management, and improvement within clinical and translational science organizations. DISCUSSION/SIGNIFICANCE OF IMPACT: The ultimate goal and impact of the proposed checklist is to help ensure that organizations and their M&E teams consistently follow a few critical steps and thereby maximize the quality, efficiency, and consistency of monitoring and evaluation of the clinical and translational work. The checklist’s impact is significant in that it fills the current gap in the practice, literature, and methodology and provides practical guidance for CTR (and other) organizations and programs striving to improve the quantity and quality of evaluation.

References

Centers for Disease Control and Prevention (CDC). Framework for program evaluation in public health. MMWR 1999; 48 (no. RR-11).

King JA, Volkov B. A framework for building evaluation capacity based on the experiences of three organizations. CURA Reporter 2005; 35(3): 10–16.

National Center for Advancing Translational Sciences. NCATS Strategic Plan [Internet], 2016. NIH. (https://ncats.nih.gov/strategicplan)

Simister N. Developing M&E systems for complex organisations: a methodology. INTRAC, 2009.

Volkov B, King J. A checklist for building organizational evaluation capacity [Internt], 2007 (https://www.wmich.edu/sites/default/files/attachments/u350/2014/organiziationevalcapacity.pdf)

World Alliance for Patient Safety. WHO surgical safety checklist and implementation manual [Internet], 2008 (http://www.who.int/patientsafety/safesurgery/ss_checklist/en/)

BACKGROUND: Of the ~50 million cases of epilepsy worldwide, an estimated 80% originate from cortical areas implicated in language. Although the precise language loci can vary significantly across individuals, electrical stimulation mapping for eloquent areas has become standard of care in resective surgery for frontotemporal epilepsies. Although considerable work has been done to establish the minimum necessary resection distance from these sites to preserve language, no previous work has shown how these representations are affected by proximal resections. METHODS: Between 1967 and 2005, 22 patients [seizure onset (y): 11.5 (0.2–33); age at initial resection (y): 27.7 (10–39); time between operations (y): 8.4 (1–20.3); sex: 14 females; hemisphere: 21 left] underwent repeated perisylvian resective epilepsy surgeries of the language-dominant hemisphere. Each set of operations comprised intraoperative language mapping and cortical photographs. Using this data, a Bayesian hierarchical model was used to estimate the variability of language localization pre-resection Versus post-resection. RESULTS: The statistical model shows the posterior median difference in cortical location of language sites preresection Versus postresection is 0.6 cm, with a posterior 95% CI of 0.4 cm, 0.9 cm. CONCLUSION: This work suggests permanence in cortical language centers following resection of infringing cortex, while providing a reasonable statistical method to impute unobserved sites during the mappings, and confirming the validity of using proximity sites defined by shortest distance in the current literature.

OBJECTIVES/SPECIFIC AIMS: The goal of this study is to use patient-centered qualitative techniques to determine what strategies caregivers use to cope with the stress of a child having recently (ie, within the past month) undergone surgical removal of a brain tumor. Results will eventually be evaluated and compared with results of quantitative measures of psychosocial risk and distress as well as demographic and medical characteristics. METHODS/STUDY POPULATION: All caregivers of patients with a newly diagnosed brain tumor requiring neurosurgery admitted to Children’s of Alabama (with English or Spanish-speaking parents) are eligible for enrollment. Participants are enrolled during their child’s initial hospitalization for surgical removal of a brain tumor. Approximately 1 month after hospital discharge, during a routine follow-up clinic visit, caregivers participate in a semistructured interview with a research assistant. Interview questions are used to obtain information about parent and family coping by asking first broadly about stress management over the previous month and then specifically about individual coping strategies. Semistructured interviews are audio recorded, transcribed, and coded for common themes. Interviews are coded by using specific words or phrases to describe various domains of the experience from the caregiver’s perspective. Each participant is given a study ID and study IDs are logged with each code word or phrase endorsed during the interview. RESULTS/ANTICIPATED RESULTS: To date, 22 caregivers have been enrolled and 15 have completed interviews. The most common coping mechanisms fall into the domains of active, avoidance, emotion-focused, and spiritual coping. Active coping consists of information seeking (eg, taking notes, internet research, asking questions), openly communicating emotions, celebrating small victories (eg, focusing on a good scan or test result, thinking that the diagnosis or treatment could have been worse), planning (eg, focusing on 1 d at a time), and maintaining normalcy (eg, maintaining extracurricular activities, returning to school if possible, continuing to see family and friends). Avoidance coping consists of evading discussions about emotions, withdrawal from family members, denial (eg, keeping a cancer diagnosis from the child), and avoiding seeing people or participating in activities. Emotion-focused coping consists of crying, laughing, and staying strong in front of the patient. In general, those who self-identify as coping poorly tend to be those who utilized more avoidance-focused coping strategies. Further, caregivers tended to identify active coping strategies (eg, taking notes, focusing on 1 appointment or treatment at a time) as the most helpful. DISCUSSION/SIGNIFICANCE OF IMPACT: It will be helpful for providers to more deeply understand the experience of caregivers whose children have recently undergone brain tumor resection and the strategies used to cope with the stress of the first month postsurgery. This information can be used to create standardized interventions for use during posthospitalization clinic visits. For example, if families continue to endorse that active coping mechanisms are the most helpful, providers can assist caregivers in developing these strategies (eg, uniformly provide notebooks and encourage caregivers to keep track of questions and appointment information, pair caregivers who are struggling with others who use more active coping strategies). Those utilizing more avoidance coping strategies may need more coaching and recommendations. A brief assessment could potentially be developed for caregivers dealing with this diagnosis, in order to quickly assess coping strategies and provide appropriate recommendations. Future analyses will determine whether initial coping strategies and adjustment are predicted by child age or medical information.

OBJECTIVES/SPECIFIC AIMS: A retrospective analysis was done at the Cardiovascular Center to evaluate reperfusion strategies, including stemi infarcts and non-stemi classified as stemi in a period of 2 years. METHODS/STUDY POPULATION: Review the records of stemi infarcts in a period of 2 years. RESULTS/ANTICIPATED RESULTS: In total, 101 cases were classified as stemi, but after strict analysis (time wise) 24 cases were non-stemi; 47% had inferior myocardial infarction and 38% an anterior myocardial infarction with a mean age of 65 years. All cases were immediately catheterized. Although the non-stemi, classified originally as stemi did not meet the time limit (<2 h) for cath. The stemi group (77 P.) 58 P. had angioplasty with stent implantation. 19 P. had an EF of 45% and remained that way during follow up. The rest of the P. the EF went up to 50% or more. The non-stemi group (24 P.) had angioplasty with stent implantation. The EF remained around 40% during follow up, which was the EF on admission. Fibrinolysis was given erratically. No changes were seen in the EF on follow up in the fibrinolytic group. DISCUSSION/SIGNIFICANCE OF IMPACT: This shows the importance of classifying the P. well between stemi and non-stemi. The time frame to catheterization should be kept as strict as possible, due to transmural infarcts, and catheterized in <2 hours to avoid deterioration of the left ventricular function and its consequences. This strict classification will save money to the institution when emergency catheterization is avoided in the non-stemi group.