ABSTRACT IMPACT: Our work will provide valuable information about the associations between physical symptoms and PTSD in patients from a Spanish-speaking, evidence-based clinic. OBJECTIVES/GOALS: In this reserach study, we want to describe physical symptoms of patients with a preliminary PTSD diagnosis. We also want to explain associations between physical symptoms, and the presence, or absence of PTSD, and to evaluate findings in terms of prevention services, referrals, and alternatives for augmenting treatment-adherence. METHODS/STUDY POPULATION: This was a descriptive, secondary database analysis of the Center for the Study of Fear and Anxiety (by its Spanish acronym, CETMA). The database included information of the initial evaluation between 2012 and 2019. We aimed to describe sociodemographic and medical variables, and evaluate associations, in terms of the presence or absence of PTSD. RESULTS/ANTICIPATED RESULTS: Patients with PTSD were mostly women, single, with a completed bachelor’s degree. The majority had at least one neurological, or musculoskeletal condition. Respiratory conditions were the least represented. We found significant associations between musculoskeletal, neurological, and ear/nose/throat conditions, in terms of PTSD diagnosis. DISCUSSION/SIGNIFICANCE OF FINDINGS: Puerto Rico recently experienced two hurricanes, several earthquakes, and the pandemic. Findings provide data about the interface between mental and physical symptoms of patients with PTSD. We recommend a randomized population study with mental and physical variables, for understanding possible effects of cumulative stress in Puerto Ricans.

ABSTRACT IMPACT: The existing literature describing immune-related adverse events (irAE) has predominantly focused on clinical trial populations, which may not be representative of the broader population receiving immune checkpoint inhibitors (ICI), so we sought to perform a comprehensive evaluation of irAE in a real-world population of cancer patients being treated with ICI. OBJECTIVES/GOALS: With a cohort of patients with malignancy treated with ICI, we characterized incidence, severity, timecourse of ir-AE. We sought to inform providers who prescribe ICI to recognize the clinical burden of irAE in an effort to more effectively communicate the benefits and risks of ICI with patients. METHODS/STUDY POPULATION: After obtaining approval from the institutional review board, we used a pharmacy database to identify adult cancer patients treated with an ICI between January 2014 and October 2018. We used electronic medical records to obtain baseline variables. Each patient was followed at each clinic visit for 12 months for development of a physician-reported irAE.

For irAE, site and grade were recorded as documented by the provider. At diagnosis and each follow-up visit, we collected: 1) adjustments to ICI, immunosuppression, and hormone therapy.

Continuous variables were summarized using mean and standard deviation (SD) or median and interquartile range (IQR). Categorical variables were summarized using frequencies and percentages. Time to development and resolution of irAE were calculated using Kaplan-Meier curves. RESULTS/ANTICIPATED RESULTS: Among 131 patients, two-thirds were men, and 60% were Caucasian with a mean age was 65 years. Nearly 40% had an Eastern Cooperative Oncology Group performance score of 2 or higher. A small proportion (3.1%) had an autoimmune disorder. Nearly half had lung cancer (49.6%), and several had received radiation (33.6%). Over 70% were former or current smokers. In total, 57 patients (43.5%) developed an irAE, resultng in a total of 95 irAE, at a median of 208 days (126 days, not reached). The most common irAE included dermatitis, thyroiditis, pneumonitis, and hepatitis. Of 95 irAE, half were grade 1, 30% were grade 2, and nearly 20% were grade 3 or higher. Median time to resolution was 85 days (56-183 days). DISCUSSION/SIGNIFICANCE OF FINDINGS: This study demonstrates that irAE are clinically impactful in this relatively unfit, medically complex population, which may be a more accurate reflection of patients receiving ICI in everyday practice. This study showcases that this population is susceptible to irAE, although this needs to be examined in larger, prospective trials.

ABSTRACT IMPACT: Quantification of neonatal THC exposure will allow for better insight into how THC exposure correlates with neurodevelopmental outcomes. OBJECTIVES/GOALS: Tetrahydrocannabinol (THC) use has become increasingly prevalent in recent years, including among pregnant women. However, few, if any, clinical studies have quantified precise in utero exposure levels of THC during pregnancy. Our study aims to fill this gap by using analytical methods to quantify THC in mother and baby following prenatal THC use. METHODS/STUDY POPULATION: Pregnant women were asked to give a self-report of all cannabis and cannabinoid use during pregnancy, including dose, frequency, and route of consumption. Upon arrival at the labor and delivery unit, maternal blood samples were collected. Immediately following birth and 24 hours after birth, umbilical cord and neonatal blood samples were collected, respectively. All blood samples were analyzed using tandem liquid chromatography-mass spectrometry (LC-MS) for the presence of THC, tetrahydrocannabinol carboxylic acid (THC-COOH), and hydroxy-tetrahydrocannabinol (THC-OH). Maternal THC and metabolite levels were compared to both cord and neonate samples. RESULTS/ANTICIPATED RESULTS: To date, we have collected 3 mother-infant sample dyads and 4 mother-infant control samples. We anticipate collecting a total of 20 mother-infant samples from each group. We will quantify levels of THC and its metabolites in maternal samples and compare these to cord and infant samples. We expect that THC/metabolite levels will vary as a function of dose and frequency of consumption. We also expect that THC/metabolites will be higher in umbilical cord blood relative to neonatal blood. DISCUSSION/SIGNIFICANCE OF FINDINGS: This study is among the first to directly measure exposure in the neonate following prenatal cannabis use. Quantification of THC/metabolite concentrations will be supplemented with developmental evaluations of infants at 6 and 12 months of age in order to gain better insight into how THC exposure correlates with neurodevelopmental outcomes.

ABSTRACT IMPACT: Identifying racial disparities in septic shock mortality, a common and lethal condition, can inform future research and policy efforts aimed at understanding the drivers these disparities and addressing the underlying factors in order to reduce disparities and improve health. OBJECTIVES/GOALS: Septic shock is a major public health problem with significant mortality. Existing data indicate racial disparities in sepsis incidence, but evidence is limited on differences in septic shock outcomes. Our objective was to determine the association between race and septic shock mortality in a statewide cohort while controlling for clinical factors. METHODS/STUDY POPULATION: This was a retrospective analysis of septic shock patients in the One Florida Data Trust between 2012-18. Data was collected regarding age, sex, race, insurance status, and selected comorbid conditions [liver disease, hypertension, chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), end-stage renal disease (ESRD), and human immunodeficiency virus infection (HIV)]. To account for severity of illness, we assigned Sequential Organ Failure Assessment scores for components based on laboratory values (labSOFA), and collected data on mechanical ventilation use and initial lactate.

The primary outcome was 90-day mortality. The Least Absolute Shrinkage and Selection Operator (LASSO) method was used for variable selection for the multivariable regression model. RESULTS/ANTICIPATED RESULTS: There were 13,932 septic shock patients with a mean (SD) age of 61(16) years. Of these, 68% identified as white, 28% as black, 2.1% as Hispanic, and 2.0% as other races. 90-day mortality was 32% (n=4,437) and 59% required mechanical ventilation. Significant independent predictors of mortality in the regression model were age (OR 1.04; p<0.01), black race (1.72; p<0.01), lactate (1.10; p<0.01), mechanical ventilation (3.62; p<0.01), labSOFA (1.18; p<0.01), history of liver disease (1.75; p<0.01), hypertension (0.70; p<0.01), COPD (0.87; p<0.01), CHF (1.18; p<0.01), HIV (1.30; p=0.05), and the interaction between age and black race. Black patients had 1.72 times the odds of mortality compared to white patients. For every one-year decrease in age, black patients had a 1% increased odds of mortality (OR 1.01; p < 0.01). DISCUSSION/SIGNIFICANCE OF FINDINGS: Black patients have increased odds of dying from septic shock compared to white patients after controlling for age, selected comorbid conditions, and markers of illness severity. Future work is needed to move beyond demonstrating septic shock disparities and towards understanding the underlying factors.

ABSTRACT IMPACT: This work will estimate current EPT implementation in Minnesota and provide cost-effectiveness analyses of different implementation scenarios to inform STI treatment policy. OBJECTIVES/GOALS: This research aims to 1) assess current implementation of Expedited Partner Therapy (EPT) as treatment for C. Trachomatis (chlamydia) and N. Gonorrhoeae (gonorrhea) among healthcare providers in Minnesota and to 2) simulate the current burden of chlamydia and gonorrhea infections to test the cost-effectiveness of increasing EPT implementation. METHODS/STUDY POPULATION: We will conduct key informant interviews (KII) and an online survey of health providers across the continuum of care for chlamydia and gonorrhea treatment. Based on experience in prior studies, the KII sample size is expected to be about 15 informants. KIIs will be carried out among providers who submitted EPT protocols to the Minnesota Department of Health to understand how EPT is currently being implemented. KII results will inform the online survey of health providers, which will estimate how many providers across the state provide EPT. We will distribute the survey through Minnesota health provider networks to achieve a sample of at least 500 health providers. The KII and survey results will inform model structure and parameter values for a compartmental cost-effectiveness model of EPT. RESULTS/ANTICIPATED RESULTS: Initial results from KII pilots suggest that EPT is primarily provided through a paper script for the sexual partner of a patient who tests positive for CT or NG by the treating provider. Less commonly, a patient’s partner who is already a patient in the health system may receive notification and treatment through the provider. While EPT is legal in Minnesota, concerns about medical liability for adverse reactions and difficulty obtaining paper scripts in electronic workflows are barriers to implementation. The statewide survey will include questions to estimate the likelihood of EPT provision among providers when these concerns are addressed. These figures will be integrated into the cost-effectiveness model to simulate outcomes and costs across different EPT implementation scenarios. DISCUSSION/SIGNIFICANCE OF FINDINGS: The statewide survey will define cost-effectiveness model parameters, including the proportion of providers in the state who currently provide EPT or would be willing to provide EPT under different scenarios. Study findings will be shared with health provider networks and health departments to inform STI treatment procedures and state EPT policies.

ABSTRACT IMPACT: Our work may be able to impact the examination and clinical decision making of a clinician to identify and target movement impairments to treat people with low back pain. OBJECTIVES/GOALS: Test if the magnitude of spinal control impairments is different in two clinical tests of lower limb movement in people with and without low back pain (LBP). The impairment is defined as the time difference between the start of limb to lumbopelvic motion. Also, test if the magnitude of impairments across tests is associated with LBP intensity and function. METHODS/STUDY POPULATION: 18 controls and 21 people with LBP (51.6% F, 34.5 ±11.5 yrs) participated in a cross-sectional, laboratory-based study. Subjects completed the modified Oswestry Disability Questionnaire (LBP-related functional limitation measure; 0-100%) and the Numeric Pain Rating Scale (LBP intensity; average pain prior 7 days; 0-10) self-report surveys and clinical tests of hip medial and lateral rotation performed in prone. A three-dimensional motion capture system was used to capture angular lumbopelvic and hip motion across time. A 2x2 mixed model ANOVA will be used to examine the effects of group, hip rotation test, and group x hip rotation test. Separate bivariate correlations will be used to quantify the association of magnitude of the impairment to (1) average LBP intensity and (2) LBP-related functional limitation. RESULTS/ANTICIPATED RESULTS: We hypothesize that, compared to healthy controls, people with LBP will display a greater magnitude of impairment across the hip medial and lateral rotation tests. In addition, we hypothesize that the magnitude of the difference in impairment between people with LBP vs controls will be larger during the hip lateral rotation test compared to the hip medial rotation test. Finally, we hypothesize that in people with LBP the magnitude of the impairments across tests will be associated with LBP intensity and LBP-related functional limitation. DISCUSSION/SIGNIFICANCE OF FINDINGS: If our hypotheses are supported, the hip rotation tests would further be recognized as a key part of a clinician’s examination and an important target for treatment of LBP.

ABSTRACT IMPACT: Effective robotic pedaling therapy would allow stroke survivors a precision, customized, and adaptable therapy to help recover lower extremity function. OBJECTIVES/GOALS: It has been observed that people post-stroke can pedal each limb individually but not simultaneously when the bicycle is split-crank. This implies that lower extremity movement difficulties are affected more by interlimb rather than unilateral coordination deficits. This work seeks to further develop a robotic split-crank pedaling therapy device. METHODS/STUDY POPULATION: This work uses a robotic split-crank pedaling device to facilitate rehabilitation of interlimb coordination, measured by continuous relative phase (CRP) and paretic neuromuscular output. The effects of three control schemes were tested: assist, resist, and assist+resist. Each limb was strapped to a pedal which was connected to a motor. The participants were asked to pedal forward while keeping the pedals antiphase. The robot aided or resisted according to the activated control scheme. Control schemes were tested on two stroke participants. The control schemes respond proportionally to phasing deviation from 180 degrees. The assist scheme assisted the lagging limb while the resist scheme resisted the leading limb. The assist+resist did both control actions. RESULTS/ANTICIPATED RESULTS: For the assist scheme, CRP improved for participant 1 (P1) and declined for participant 2 (P2). P1 increased paretic velocity while P2 decreased. Rectus Femoris (RF) and Biceps Femoris (BF) activity of both limbs lowered for P1. RF and BF activity of both limbs remained about the same but shifted for P2. For the resist scheme, CRP improved for P1 and declined for P2. P1 increased paretic velocity while P2 decreased. P1 increased BF activity of both limbs while RF activity remained constant. P2 increased paretic BF activity and non-paretic RF activity. For the assist+resist scheme, CRP improved for both participants. Both participants increased paretic velocity. P1 increased paretic BF activity and decreased RF activity. P2 better modulated paretic BF and RF. DISCUSSION/SIGNIFICANCE OF FINDINGS: All control schemes augmented performance, however the assist+resist scheme showed the most promise in terms of CRP and muscle activity. More participants are needed to determine true effects of each control scheme. The control scheme selected will be the foundation for further improvements such as adaptive control and extrinsic feedback.

ABSTRACT IMPACT: This study is providing a telehealth intervention for the first time in patients with sickle cell disease with the goal of improving cognitive functioning and preparing adolescents for successful transition of care to adult healthcare providers. OBJECTIVES/GOALS: There is a high prevalence of cognitive impairment in adolescents with sickle cell disease (SCD). The purpose of this study is to test the efficacy of an individualized cognitive remediation program designed to promote not just cognitive function, but also adaptive and self-management skills necessary for successful transition to independence. METHODS/STUDY POPULATION: 12 participants with SCD (5 males, ages 10-16) participated in an individualized program, Cognitive-Remediation of Executive and Adaptive Deficits in Youth [C-READY], consisting of three main components: individual goal-based therapy, parent training sessions, and home skill practice. C-READY sessions occur one-on-one with a trained therapist for 8 sessions conducted over 4 weeks. Weekly parent training sessions are also conducted as part of the C-READY program. All of these sessions occurred via telehealth video-calling between the therapist and the adolescent/parent. Participants were evaluated before and after the C-READY program using neuropsychological assessment measures and transition readiness questionnaires. Parents also completed ratings on telehealth delivery, content, and timing. RESULTS/ANTICIPATED RESULTS: Repeated measures ANOVA indicated significant improvement in transition readiness behaviors as rated by parents, including improved independence in medication management (p = 0.029) and in talking with their healthcare providers (p = 0.019). Significant improvement was also demonstrated on a neuropsychological measure related to executive function skills, specifically inhibition and switching (p = 0.012). Results from telehealth surveys (rated on a 5-point Likert scale) indicated overall satisfaction with services (4.2/5), including visual (4/5) and voice quality (4.3/5) of telehealth equipment. Ratings also indicated feeling that their privacy was respected (4/5) and that their interactions with their therapist were appropriate and sensitive (4.5/5). DISCUSSION/SIGNIFICANCE OF FINDINGS: These results provide support for interventions that focus on cognitive skills to improve behaviors necessary for successful transition of care in youth with SCD. Results are also promising for delivery via telehealth in order to address barriers related to access to care. Future results will continue to be reported, as this study is currently ongoing.

ABSTRACT IMPACT: Building a patient cohort to support clinical-translational research in chronic hepatitis B OBJECTIVES/GOALS: The overall objective of my KL2 project is to delineate the effect of HIV coinfection, and CHB disease stage and hepatitis B (HBV) viremia on the ability of toll-like receptor 8 agonism to restore HBV-specific immune cell function. This abstract describes the characteristics of the cohort from which research blood samples for my KL2 are collected. METHODS/STUDY POPULATION: HOPE is a prospective cohort study enrolling people with CHB including HIV/CHB coinfection, and resolved CHB. Participants are enrolled at primary care clinics in Maryland, Washington D.C., and Virginia. Standard-of-care antiviral treatment with tenofovir alafenamide (TAF) is prescribed through the study if indicated. Patients receiving TAF from the study are either starting treatment, or switching to TAF from another antiviral medication. If receiving TAF, participants are seen every 3-6 months for medication refills, clinical and research blood draws, and adverse event evaluations. Liver fibrosis is measured by FibroScan and a minority undergo liver biopsy. RESULTS/ANTICIPATED RESULTS: So far, 204 people have been enrolled, 177 with CHB (23 HIV/CHB coinfection), and 22 with resolved HBV infection. To date, 45 patients who were viremic at baseline and initiated on TAF have been enrolled. CHB predominantly affects Asian and African immigrants in the U.S, and the majority (77%) of HOPE participants are immigrants from these countries. The majority are male (70%), mean age 51 years (SD ±14). So far, 86 people with CHB monoinfection have been prescribed TAF on-study. Thirty-five percent of these had significant (>F2) liver fibrosis at baseline and half had elevated ALT (mean 47.5, SD ±55 IU/ml). Forty-three percent switched to TAF from another oral antiviral. Most switched due to lack of coverage by health insurance. DISCUSSION/SIGNIFICANCE OF FINDINGS: HOPE is a CHB cohort dedicated to collecting research samples and providing antiviral treatment. It is the foundation for the CHB translational research program at the University of Maryland School of Medicine. The availability of paired viremic and virally suppressed, HIV/CHB, and resolved HBV research samples are strengths of HOPE.

ABSTRACT IMPACT: Because diabetes disproportionately affects residents in the Deep South, identifying factors increasing the risk of hospital readmissions unique to this population can translate to tailored interventions and strategies to improve transitions of care and patients’ health outcomes. OBJECTIVES/GOALS: Patients with diabetes (PWD) are susceptible to hospital readmissions due to inadequate transitions of care (TOC). To better understand how to improve TOC, the objective of the study is to identify factors associated with readmissions among PWD in Alabama disproportionally affected by diabetes. METHODS/STUDY POPULATION: This retrospective cohort study utilizes electronic health record data from an urban health system in Alabama. The study population includes adults (≥18 years old) diagnosed with diabetes who were hospitalized between 2016 and 2020. Women who are pregnant during hospitalization or diagnosed with gestational diabetes are excluded. Patient’s index hospitalization is identified with a 3-month washout period preceding admission. The primary outcome is all-cause 30-day readmission. Characteristics are compared between patients with and without readmissions. Factors significantly associated with readmissions are identified with multiple logistic regression, adjusted for potential confounders. RESULTS/ANTICIPATED RESULTS: The sample size is expected to be around 30,000 individual PWD. Anticipated results include estimation of the all-cause 30-day readmission rate experienced by the PWD in Alabama. It is expected that various factors will be associated with either higher or lower odds of readmission, interpreted via odds ratios and 95% confidence intervals. Factors investigated are driven by previously identified risk factors of readmission from the literature, including but not limited to sociodemographic variables, lab values (A1C, glucose, serum albumin, serum sodium, etc.), vital signs (blood pressure), comorbidities, medications, length of stay, insurance coverage, geographic location, and social history. DISCUSSION/SIGNIFICANCE OF FINDINGS: Findings will establish evidence-based knowledge about TOC for PWD in the Deep South, specifically Alabama. Identifying factors associated with readmissions among PWD in Alabama will inform TOC intervention studies tailored to populations in the Deep South to effectively mitigate readmissions.

ABSTRACT IMPACT: This study has implications for understanding early developmental mechanisms of ADHD and for guidelines regarding safe use of acetaminophen during pregnancy. OBJECTIVES/GOALS: Prenatal acetaminophen exposure has been associated with childhood attention-deficit hyperactivity disorder (ADHD), but the underlying mechanism is unknown. This prospective birth cohort study aims to identify linkages between specific metabolites in umbilical cord plasma and the association of prenatal acetaminophen exposure and ADHD. METHODS/STUDY POPULATION: The sample was a subset of the Boston Birth Cohort that included 583 mother-newborn dyads followed at Boston Medical Center from 1998 to 2018. Metabolites were measured from cord plasma collected at birth. Based on existing literature, the analyses focused on candidate metabolites involved in neuroendocrine, inflammation, and oxidative stress pathways. The outcome was physician-diagnosed ADHD between the ages of 3 and 16 years. Exploratory analyses and multiple logistic regressions were used to examine the association of these candidate metabolites with both unmetabolized cord plasma acetaminophen levels and with incident risk of ADHD, adjusting for covariates of maternal and child characteristics. RESULTS/ANTICIPATED RESULTS: Of the 583 children, 257 had ADHD and 326 had neurotypical development. Two promising results have been found thus far. 5-methoxytryptophol (5-MTX), a neuroendocrine molecule which also has antioxidant and immunomodulatory properties, was inversely associated with acetaminophen and ADHD risk. For children below the median cord 5-MTX level, the odds of ADHD were 3.29 (95% CI [1.56, 7.16], p=0.002) for the third tertile of acetaminophen compared to the first tertile. This association attenuated among those above the median 5-MTX level: 2.23 (95% CI [0.98, 5.21], p=0.059), suggesting a protective effect. Tryptophan, an essential amino acid and precursor of serotonin, was positively associated with acetaminophen and ADHD. Next steps include mediation analysis with tryptophan and analyses for other metabolites. DISCUSSION/SIGNIFICANCE OF FINDINGS: This study identifies cord plasma metabolites as possible modifiers or mediators linking prenatal acetaminophen exposure and childhood ADHD, which may offer insight into a mechanistic pathway. The study findings have implications for FDA, clinical, and public health guidelines regarding safe use of acetaminophen during pregnancy.

ABSTRACT IMPACT: Understanding dietary patterns and nutrient intakes of the aging population may help address concerns and dietary guidelines regarding their nutritional needs. OBJECTIVES/GOALS: The objective of this study is to test the hypothesis that a healthy dietary pattern in the oldest old (aged 80 years and older) is related to greater compliance with dietary recommendations and better nutrient intake profiles. METHODS/STUDY POPULATION: We conducted a cross-sectional study of 122 participants aged 82 to 97 years old from the Geisinger Rural Aging Study (GRAS) cohort in rural Pennsylvania (n = 56 men and 66 women). The main outcome measures of the investigation were the daily nutrient intakes and food group intakes evaluated from the average of three 24-hour dietary recalls. The dietary patterns were determined by cluster analysis from 28 food groups. Diet quality and adherence to the Dietary Guidelines for Americans was assessed by the Healthy Eating Index (HEI)-2015 and the Dietary Screening Tool (DST). Recommended intakes were determined by the Recommended Dietary Allowances (RDAs) or Adequate Intakes (AIs). RESULTS/ANTICIPATED RESULTS: Less than 50% of participants met the dietary recommended intakes for vitamins D, E, K, B6, dietary fiber, zinc, potassium, and calcium. The more-nutrient-dense cluster was characterized by higher intakes of fruits and vegetables. The less-nutrient-dense cluster was characterized by higher intakes of foods including desserts and sweets. After adjusting for age, sex, and energy intake, participants in the more-nutrient-dense dietary pattern had a higher intake of vitamins A, D, K, C, fiber, and potassium (p < 0.05 for all). After adjusting for age and sex, participants in the more-nutrient-dense pattern had better diet quality assessed by the (HEI)-2015 (p < 0.001) and DST (p = 0.006). DISCUSSION/SIGNIFICANCE OF FINDINGS: Among the oldest old, many participants were found to have nutrient intakes lower than the recommended levels for fundamental nutrients suggesting that dietary guidance in addition to a dietary pattern more aligned with dietary guidelines may be beneficial for supporting healthy aging.

ABSTRACT IMPACT: This research study will provide evidence for public policy, systemic changes, and other interventions to address the adverse impacts of prolonged stress exposure experienced by young Black men. OBJECTIVES/GOALS: Previous studies have demonstrated a strong association between allostatic load (i.e., stress-induced cumulative biological risk) and mortality in the Black American population. The aim of this study is to examine the association between allostatic load and mortality in Black men and to determine if the relation varies by age. METHODS/STUDY POPULATION: Data from the third National Health and Nutritional Examination Survey (NHANES III, 1988-1994), linked to the 2015 National Death Index Public Release File, will be used for Black male adults 18 years or older. Allostatic load score includes nine biomarkers: albumin, C-reactive protein, total cholesterol, high-density lipoprotein, hemoglobin A1C, waist-to-hip ratio, systolic blood pressure, diastolic blood pressure, and pulse rate. The number of variables for which the participant’s scores fall in the quartile of highest clinical risk are added together to create a summary score. Cox proportional-hazard analyses is employed to estimate the associations between allostatic load and all-cause mortality for the total sample and stratified by age, adjusting for selected characteristics. RESULTS/ANTICIPATED RESULTS: We hypothesize that the association of allostatic load with mortality will be greater among younger, compared to older, Black men. Young Black men (ages 25-44) are at particular risk of adverse impacts of chronic stress and allostatic load, due to their experience of chronic discrimination, systemic racism, racial battle fatigue, and mundane, extreme, environmental stress. Furthermore, the allostatic load-mortality association may be attenuated for older Black men due to a survival effect. DISCUSSION/SIGNIFICANCE OF FINDINGS: If the association between allostatic load score and mortality is stronger in young Black men, it would provide evidence for early identification of a group with high risk of premature mortality, and for public policy, systemic changes, and other interventions to address the adverse impacts of prolonged stress exposure experienced by young Black men.

ABSTRACT IMPACT: Within three EDs in a regional health system in Connecticut, African American race, male gender, non-Hispanic ethnicity, lack of private insurance, and homelessness were associated with significant odds of being physically restrained during a visit. OBJECTIVES/GOALS: Agitated patient encounters in the Emergency Department (ED) are on the rise, and physical restraints are used to protect staff and prevent self-harm. However, these are associated with safety risks and potential stigmatization of vulnerable individuals. We aim to determine factors that are associated with odds of being restrained in the ED. METHODS/STUDY POPULATION: We conducted a retrospective cohort analysis of all patients (≥18 yo) placed in restraints during an ED visit to three hospitals within a large tertiary health system from Jan 2013-Aug 2018. We undertook descriptive analysis of the data and created a generalized linear mixed model with a binary logistic identity link to model restraint use and determine odds ratios for various clinically significant demographic factors. These include gender, race, ethnicity, insurance status, alcohol use, illicit drug use, and homelessness. Our model accounted for patients nested across the three EDs and also accounted for multiple patient visits. RESULTS/ANTICIPATED RESULTS: In 726,417 total ED visits, 7,090 (1%) had associated restraint orders. Restrained patients had an average age of 45, with 64% male, 54% Caucasian and 29% African American. 17% had private insurance, 36% endorsed illicit substances, 51.4% endorsed alcohol use and 2.3% were homeless. African Americans had statistically significant odds of being restrained compared to Caucasians with adjusted odds ratio (AOR) of 1.14 (1.08,1.21). Females (AOR 0.75 [0.71, 0.79] had lower odds of being restrained compared to males while patients with Medicaid (AOR 1.57 [1.46, 1.68]) and Medicare (AOR 1.70 [1.57, 1.85]) had increased odds compared to the privately insured. Illicit substance use (AOR 1.55 [1.46, 1.64]), alcohol use (AOR 1.13 [1.07, 1.20] and homelessness (AOR 1.35 [1.14, 1.16]) had increased odds of restraint use. DISCUSSION/SIGNIFICANCE OF FINDINGS: We showed statistically significant effects of patient demographics on odds of restraint use in the ED. The increased odds based on race, insurance status, and substance use highlight the potential effects of implicit bias on the decision to physically restrain patients and underscores the importance of objective assessments of these patients.

ABSTRACT IMPACT: Olfactory dysfunction is a defining symptom of COVID-19 infection. As the number of total, confirmed COVID-19 cases approaches 7 million in the United States, it is estimated that there will be up to 500,000 new cases of chronically diminished smell. We offer a promising treatment. OBJECTIVES/GOALS: The primary aim is to explore the main effects and interaction of bimodal visual-olfactory training and patient-preferred scents on olfactory training in patients with post-COVID-19 hyposmia or anosmia. METHODS/STUDY POPULATION: The study will utilize a 2x2 factorial design. The two effects we will explore are unimodal versus bimodal training and conventional versus patient-preferred odors. All 4 arms will undergo 12 weeks of olfactory training. Participants will be assessed pre and post-intervention. Measurements of olfactory function include the objective smell identification test and subjective measures including the Clinical Global Impression Scale and Olfactory Dysfunction Outcomes Rating. Individuals eligible for the study include men and women between 18 and 70 years of age with olfactory dysfunction of at least 3 months duration initially diagnosed within 2 weeks of a COVID-19 infection. Of note, we will enroll nationally. RESULTS/ANTICIPATED RESULTS: We anticipate that the bimodal, patient-preferred scents training group will have the greatest improvement in smell scores, number of responders, and patient-reported sense of smell and health-related quality of life due to an additive interaction between the bimodal visual-olfactory and patient-preferred interventions. DISCUSSION/SIGNIFICANCE OF FINDINGS: The pathophysiology of COVID-19 olfactory dysfunction is mediated through damage to the peripheral and central olfactory pathways. This suggests that interventions most likely to be efficacious target both pathways, as olfactory training does.

ABSTRACT IMPACT: Despite its importance in systemic diseases such as diabetes, the eye is notably difficult to examine for non-specialists; this study introduces a fully automated approach for eye disease screening, coupling a deep learning algorithm with a robotically-aligned optical coherence tomography system to improve eye care in non-ophthalmology settings. OBJECTIVES/GOALS: This study aims to develop and test a deep learning (DL) method to classify images acquired from a robotically-aligned optical coherence tomography (OCT) system as normal vs. abnormal. The long-term goal of our study is to integrate artificial intelligence and robotic eye imaging to fully automate eye disease screening in diverse clinical settings. METHODS/STUDY POPULATION: Between August and October 2020, patients seen at the Duke Eye Center and healthy volunteers (age ≥18) were imaged with a custom, robotically-aligned OCT (RAOCT) system following routine eye exam. Using transfer learning, we adapted a preexisting convolutional neural network to train a DL algorithm to classify OCT images as normal vs. abnormal. The model was trained and validated on two publicly available OCT datasets and two of our own RAOCT volumes. For external testing, the top-performing model based on validation was applied to a representative averaged B-scan from each of the remaining RAOCT volumes. The model’s performance was evaluated against a reference standard of clinical diagnoses by retina specialists. Saliency maps were created to visualize the areas contributing most to the model predictions. RESULTS/ANTICIPATED RESULTS: The training and validation datasets included 87,697 OCT images, of which 59,743 were abnormal. The top-performing DL model had a training accuracy of 96% and a validation accuracy of 99%. For external testing, 43 eyes of 27 subjects were imaged with the robotically-aligned OCT system. Compared to clinical diagnoses, the model correctly labeled 18 out of 22 normal averaged B-scans and 18 out of 21 abnormal averaged B-scans. Overall, in the testing set, the model had an AUC for the detection of pathology of 0.92, an accuracy of 84%, a sensitivity of 86%, and a specificity of 82%. For the correctly predicted scans, saliency maps identified the areas contributing most to the DL algorithm’s predictions, which matched the regions of greatest clinical importance. DISCUSSION/SIGNIFICANCE OF FINDINGS: This is the first study to develop and apply a DL model to images acquired from a self-aligning OCT system, demonstrating the potential of integrating DL and robotic eye imaging to automate eye disease screening. We are working to translate this technology for use in emergency departments and primary care, where it will have the greatest impact.

ABSTRACT IMPACT: Grouping patients with potentially high intensity specialty care needs based on their propensity for healthcare continuity patterns can inform the development of personalized care coordination and care navigation interventions OBJECTIVES/GOALS: To examine variation in healthcare continuity patterns across primary care, mental health care, and specialty care for a patient population with chronic gastrointestinal conditions and a high risk for healthcare utilization. METHODS/STUDY POPULATION: We analyzed data for Veterans Affairs patients with chronic gastrointestinal disease (cirrhosis, inflammatory bowel disease, chronic pancreatitis) whose 1-year hospitalization risk was ≥90th percentile in 2014, and who had a minimum of 4 office visits. To assess continuity, we examined frequency of office visits, number of outpatient providers, and two established continuity of care measures (the usual provider of care index and the Bice-Boxerman continuity of care index) over 12 months. We used latent class analysis to categorize patients into classes based on overall, primary care (PCP)-specific, gastroenterology (GI)-specific, and mental health specific-healthcare continuity patterns. RESULTS/ANTICIPATED RESULTS: The 26,751 Veterans in the analytic cohort had a mean of 13.3 (sd 8.63) office visits and 7.2 (sd 3.83) providers per patient. Patients were classified into five phenotypes: (1) moderate overall use and continuity; (2) low overall continuity of care; (3) high GI- and PCP-specific continuity of care; (4) low overall continuity of care with some mental health use; and (5) high utilization with substantial mental health use. In the subsequent year, 11,259 (42.1%) patients had a hospitalization and 16,167 (60.4%) had an emergency department visit. These groups varied in their sociodemographic and clinical characteristics, and in their risk for hospitalization and emergency department use. DISCUSSION/SIGNIFICANCE OF FINDINGS: Latent class analysis revealed five distinct primary and specialty care utilization patterns. Grouping patients with high intensity specialty care needs based on their propensity for healthcare continuity patterns can inform the development of personalized care navigation interventions.

ABSTRACT IMPACT: Our study suggests that maternal e-cigarette use may reduce fetal growth and pose harm to newborns. OBJECTIVES/GOALS: Women are motivated to quit smoking during pregnancy. Many view electronic cigarettes (e-cigarettes) as a safer and healthier alternative to traditional tobacco smoke. We aim to determine the effect of third-trimester e-cigarette use on the risk of infant related outcomes. METHODS/STUDY POPULATION: We conducted a cross-sectional survey study using Pregnancy Risk Assessment Monitoring System (PRAMS). Women who gave live singleton births in 2016-2018 and at states that met response rate threshold criteria were included. Women were classified as never smokers, sole e-cigarette smokers, sole traditional cigarette smokers, and dual-users. Logistic regression was conducted to determine the association between third-trimester cigarette use and preterm birth (<37 weeks), low birth weight (<2,500 grams), and small for gestational age births (SGA, weight lower than the tenth percentile of the population). Analyses were weighted to account for the survey design and non-response. RESULTS/ANTICIPATED RESULTS: 94,539 women (weighted population of 4,765,290) were included. Compared with never smokers, third-trimester sole e-cigarette use increased the odds of preterm birth (Adjusted odds ratio [AOR]: 1.61, 95% confidence interval [CI]: 1.05, 2.48), low birthweight (AOR: 1.49, 95%CI: 1.06, 2.09), and SGA (AOR: 1.19, 95%CI: 0.71, 2.00), sole traditional cigarette use increased the odds of preterm birth (AOR: 1.36, 95%CI: 1.21, 1.52), low birthweight (AOR: 1.90, 95%CI: 1.72, 2.10), and SGA (AOR: 2.28, 95%CI: 2.05, 2.53); and dual use increased the odds of preterm birth (AOR: 1.17, 95%CI: 0.82, 1.67), low birthweight (AOR: 2.16, 95%CI: 1.58, 2.96), and SGA (AOR: 2.67, 95%CI: 1.97, 3.64). DISCUSSION/SIGNIFICANCE OF FINDINGS: E-cigarette use, by itself or in combination with traditional cigarettes, increases the risk of preterm birth, low birthweight, and SGA. Our study suggests that maternal e-cigarette use may reduce fetal growth and pose harm to newborns.

ABSTRACT IMPACT: Demonstrate applicability of an underutilized method for showing variation that enables public health agencies to respond to the COVID-19 pandemic OBJECTIVES/GOALS: Enacting sensible public policies in the coronavirus disease 2019 (COVID-19) pandemic requires real-time data that civic and public health leaders can easily interpret and act on. This collaboration between a CTSA and a local health department sought a novel use of control charts to provide timely and interpretable data. METHODS/STUDY POPULATION: Healthcare and other industries use control charts to understand the behavior of processes and systems so they can intervene on them. The CTSA science team developed statistical process control charts at the neighborhood level to help illustrate their value for decision-making as the pandemic progresses. This method included accounting for congregate populations (skilled nursing facilities, correctional facilities) to produce data for the general public. RESULTS/ANTICIPATED RESULTS: Patterns in COVID-19 vary over time by neighborhood. Juxtaposing control charts with social characteristics of local areas in a dashboard format provides granularity for decision-makers and data for engaging communities in changing behavior. Annotating time series charts in real time connects events and local knowledge with observed data, which can help authorities and people to learn and act based on variations displayed by the control charts about disease outbreaks and cases. School districts are among those that could benefit from control charts with information about the school community and how COVID-19 spread is occurring. DISCUSSION/SIGNIFICANCE OF FINDINGS: Control charts have rarely been used in public health despite their ease of use and interpretability. This study demonstrates a novel approach to providing timely, accurate data that can support real-time decision-making of government and public health as well as school districts, businesses, and others.

ABSTRACT IMPACT: To improve care and services for patients with chronic disease, health systems are focusing on evaluating social determinants of health of populations at risk; this information is currently not available in electronic health records (EHR) but we show that it could be accessed by linking area deprivation index to EHR. OBJECTIVES/GOALS: To inform care delivery and policy, health care systems are studying ways of improving social determinants of health (SDoH) in patients with chronic disease such as diabetes (DM). Our goal was to better characterize the SDoH of a cohort of DM patients by using the area deprivation index (ADI). METHODS/STUDY POPULATION: Our study population included DM patients seen in primary care practices in 2013-2017. We integrated ADI levels to data extracted from electronic health records (EHR). ADI ranks neighborhoods by socioeconomic status calculated from income, education, employment and housing quality. ADI has 10 levels that we grouped into 5 categories of 2 levels. Addresses were geocoded using ArcMap to obtain census block groups information. We used multivariable logistic regression to calculate odds ratios (OR) and 95% confidence intervals [], with diabetic complications as a binary dependent variable, ADI levels as the exposure, and demographics, smoking status and number of comorbidities as confounders. RESULTS/ANTICIPATED RESULTS: Our study population included 8,558 patients: 56% were female, 61% white, 31% black, 28% were on Medicare, 66% on commercial insurance, median age was 55 years, 57% never smoked, 10% had no comorbidities, 42% had 3 or more comorbidities, and 37% developed diabetic-related complications. After evaluating collinearity and adjusting for confounders, our multivariable analysis showed that worsening ADI was associated with higher likelihood of complications. Compared to ADI level 1&2 (least disadvantaged), the ORs for patients residing in neighborhoods with ADI levels 3&4, 5&6, 7&8, 9&10 (most disadvantaged) were respectively 1.01 [0.88-1.16), 1.20 [1.04-1.39], 1.15 [0.99-1.33], 1.30 [1.11-1.52]. DISCUSSION/SIGNIFICANCE OF FINDINGS: Neighborhood ADI could provide precious information to health care providers when associated to the EHR. We found that neighborhoods with ADI level 9&10, which is not collected in the EHR, was significantly associated with a higher burden of disease. ADI could serve as a proxy for evaluating SDoH.