OBJECTIVES/GOALS: During the pandemic, alcohol related deaths increased by 25%. To help understand how we might mitigate this negative outcome, we sought to examine the association of new diagnosis of alcohol use disorder (AUD) with SARS-CoV2 through two years of the pandemic. METHODS/STUDY POPULATION: Using a non-date-shifted TriNetX database, we conducted a retrospective cohort analysis of electronic health records of patients age ≥12 years who had been diagnosed either with COVID-19 (n=1,359,817) or other respiratory infections with no record of COVID-19 (n=2,013,031). Patients were then matched for propensity score risk for AUD, and results were analyzed by three-month intervals from January 2020 through January 2022, in blocks numbered 1-8. Results were expressed as hazard ratios (HR) and 95% confidence intervals (CI) for diagnosis of AUD from two weeks to six months following COVID-19 diagnosis. RESULTS/ANTICIPATED RESULTS: There was significant excess risk compared to control cohorts of AUD following COVID-19 diagnoses made during the first three months of the pandemic (HR (CI)): block 1: 2.41(1.89,3.08); no excess risk was seen for the remainder of 2020 (blocks 2-4) (HR1.01-1.14, NS). The excess risk increased again in 2021 as the delta and omicron variants emerged (HR and 95% CI): block 5 were: 1.26(1.11, 1.43)); block 6: 1.88(1.62-2.18)); block 7: 1.24(1.10,1.41); block 8: 1.12(1.0-1.25). COVID-19 diagnosis was associated with clinically-evident AUD under some pandemic circumstances. DISCUSSION/SIGNIFICANCE: COVID-19 early in the pandemic (block 1) was associated with substantial excess risk for new diagnosis of AUD, with smaller excess risk after COVID-19 during 2021 (blocks 5-7), and no excess risk otherwise. Diagnosis of COVID-19 and pandemic contextual factors are associated with increased risk for AUD.

OBJECTIVES/GOALS: To evaluate the clinical trial designs of stimulant medications approved for the treatment of adult Attention-Deficit/Hyperactivity Disorder (ADHD) and identify discrepancies between safety and efficacy outcome measure criteria. METHODS/STUDY POPULATION: There are 24 stimulants currently approved and marketed for the treatment of adult ADHD: 12 amphetamine (AMP)-based and 12 methylphenidate (MPH)-based formulations. A mixed methods review of clinical trials that have evaluated the safety and efficacy of these drugs will be performed using qualitative and quantitative data, including inclusion and exclusion criteria, primary and secondary outcome measures, manufacturer recommendations, and package inserts, as well as FDA recommendations for industry. After compiling a list of clinical trials for each of the 24 drugs, this information will be analyzed for themes and trends in the assessment of safety and efficacy with particular attention paid to differing criteria between individual drugs and/or the two subclasses of prescription stimulants. RESULTS/ANTICIPATED RESULTS: The FDA has published recommendations for ADHD medication clinical trial design, including suggested outcome measures utilizing validated assessment tools. However, the FDA notes that these assessments may be altered to fit study populations and indicate that other primary and secondary endpoint measures may be acceptable. As such, efficacy assessments for these drugs may vary greatly, and the specific criterion selected for each drug’s study population and outcome measures may suggest more specific indications and usage conditions for optimal efficacy. DISCUSSION/SIGNIFICANCE: Regulatory officials consider AMP- and MPH-based stimulants equivalent therapeutic options for the treatment of ADHD. A study of clinical trial criteria reveals that differing mechanisms have been used to evaluate safety and efficacy. This discrepancy may have implications that affect clinical decision-making and patient experiences.

Non-communicable diseases (NCD) such as CVD and type 2 diabetes mellitus are major contributors to the burden of disease. NCD are largely driven by modifiable lifestyle factors including poor diet and insufficient physical activity, and consequently, prevention is a public health priority. Although diet and physical activity levels can be improved via lifestyle interventions, long-term adherence to such interventions remains low, which limits their effectiveness. Thus, it is critical to identify the underlying mechanisms that challenge uptake and adherence to such interventions. The current commentary discusses an important, but underexplored, psychological driver of poor adherence to lifestyle interventions, namely, future discounting, which describes the tendency to prefer smaller, short-term rewards over larger, long-term rewards. For example, in the nutrition domain, future discounting refers to valuing the immediate reward of excessive intake of energy-dense, nutrient-poor, discretionary foods high in salt, sugar, and saturated fat, and insufficient intake of low-energy, nutrient-dense, whole foods such as vegetables. Prominent theoretical models propose that excessive future discounting is a major contributor to the development of unhealthy lifestyle behaviours. Furthermore, a vast body of evidence suggests that future discounting plays a key role in risk of NCD. Thus, the evidence to date supports the idea that future discounting is an important multi-behaviour target for supporting lifestyle behaviour change; however, this approach has been largely neglected in preventive health efforts. Furthermore, this commentary discusses promising techniques (e.g. Episodic Future Thinking) for disrupting future discounting to promote improved adherence to lifestyle interventions aimed at reducing NCD risk.

The past decade witnessed a wide range of industrial relations reforms in Australia. Employee participation and industrial democracy was espoused by the Labor government (1983–96) as a key element in its workplace reform program. It was also embraced by the trade union movement and, to a lesser extent, by leading employers and their associations. A case study of employee participation in the Ford Motor Company is used to illustrate the process of workplace reform in Australia during this period While Ford Australia provides a positive example of workplace change, it is argued that the promise of employee participation has not generally been fulfilled in Australian industry. Contributing factors identified in the paper include economic recession, the decline of trade union membership and a lack of ‘people’ skills in managerial ranks.

The Recognition Heuristic (Gigerenzer & Goldstein, 1996; Goldstein & Gigerenzer, 2002) makes the counter-intuitive prediction that a decision maker utilizing less information may do as well as, or outperform, an idealized decision maker utilizing more information. We lay a theoretical foundation for the use of single-variable heuristics such as the Recognition Heuristic as an optimal decision strategy within a linear modeling framework. We identify conditions under which over-weighting a single predictor is a mini-max strategy among a class of a priori chosen weights based on decision heuristics with respect to a measure of statistical lack of fit we call “risk”. These strategies, in turn, outperform standard multiple regression as long as the amount of data available is limited. We also show that, under related conditions, weighting only one variable and ignoring all others produces the same risk as ignoring the single variable and weighting all others. This approach has the advantage of generalizing beyond the original environment of the Recognition Heuristic to situations with more than two choice options, binary or continuous representations of recognition, and to other single variable heuristics. We analyze the structure of data used in some prior recognition tasks and find that it matches the sufficient conditions for optimality in our results. Rather than being a poor or adequate substitute for a compensatory model, the Recognition Heuristic closely approximates an optimal strategy when a decision maker has finite data about the world.

The current coronavirus disease (COVID-19) pandemic has placed unprecedented strain on underfunded public health resources in the Southeastern United States. The Memphis, TN, metropolitan region has lacked infrastructure for health data exchange.

This manuscript describes a multidisciplinary initiative to create a community-focused COVID-19 data registry, the Memphis Pandemic Health Informatics System (MEMPHI-SYS). MEMPHI-SYS leverages test result data updated directly from community-based testing sites, as well as a full complement of public health data sets and knowledge-based informatics. It has been guided by relationships with community stakeholders and is managed alongside the largest publicly funded community-based COVID-19 testing response in the Mid-South. MEMPHI-SYS has supported interactive Web-based analytic resources and informs federally funded COVID-19 outreach directed toward neighborhoods most in need of pandemic support.

MEMPHI-SYS provides an instructive case study of how to collaboratively establish the technical scaffolding and human relationships necessary for data-driven, health equity-focused pandemic surveillance, and policy interventions.

The ancient human footprints in valley-bottom sediments in Tularosa Valley, New Mexico, are fascinating and potentially important because they suggest interactions between Pleistocene megafauna as well as great antiquity. The dating of those footprints is crucial in interpretations of when humans first came to North America from Asia, but the ages have larger uncertainties than has been reported. Some of that uncertainty is related to the possibility of a radiocarbon reservoir in the water in which the dated propagules of Ruppia cirrhosa grew. As a test of that possibility, Ruppia specimens collected in 1947 from nearby Malpais Spring returned a radiocarbon age of ca. 7400 cal yr BP. We think it would be appropriate to devise and implement independent means for dating the footprints, thus lowering the uncertainty in the proposed age of the footprints and leading to a better understanding of when humans first arrived in the Americas.

Several Miscanthus species are cultivated in the U.S. Midwest and Northeast, and feral populations can displace the native plant community and potentially negatively affect ecosystem processes. The monetary cost of eradicating feral Miscanthus populations is unknown, but quantifying eradication costs will inform decisions on whether eradication is a feasible goal and should be considered when totaling the economic damage of invasive species. We managed experimental populations of eulaliagrass (Miscanthus sinensis Andersson) and the giant Miscanthus hybrid (Miscanthus × giganteus J.M. Greef & Deuter ex Hodkinson & Renvoize) in three floodplain forest and three old field sites in central Illinois with the goal of eradication. We recorded the time invested in eradication efforts and tracked survival of Miscanthus plants over a 5-yr period, then estimated the costs associated with eradicating these Miscanthus populations. Finally, we used these estimates to predict the total monetary costs of eradicating existing M. sinensis populations reported on EDDMapS. Miscanthus populations in the old field sites were harder to eradicate, resulting in an average of 290% greater estimated eradication costs compared with the floodplain forest sites. However, the cost and time needed to eradicate Miscanthus populations were similar between Miscanthus species. On-site eradication costs ranged from $390 to $3,316 per site (or $1.3 to $11 m−2) in the old field sites, compared with only $85 to $547 (or $0.92 to $1.82 m−2) to eradicate populations within the floodplain forests, with labor comprising the largest share of these costs. Using our M. sinensis eradication cost estimates in Illinois, we predict that the potential costs to eradicate populations reported on EDDMapS would range from $10 to $37 million, with a median predicted cost of $22 million. The monetary costs of eradicating feral Miscanthus populations should be weighed against the benefits of cultivating these species to provide a comprehensive picture of the relative costs and benefits of adding these species to our landscapes.

Background: In spring 2021, the infection prevention and control department at a pediatric academic medical center identified 3 oncology patients with concern for invasive Rhizopus spp infections. An in-depth investigation was conducted, but a common source of the fungus was not identified. In August 2021, an additional oncology patient with concern for invasive Rhizopus spp was identified, resulting in an extended investigation for possible sources of fungus. Methods: A multidisciplinary work group was assembled. The CDC Targeted Environmental Investigation Checklist for Outbreaks of Invasive Infections Caused by Environmental Fungi was used as a framework for conducting the investigation. Stakeholders were engaged throughout the process, including the hematology–oncology service, hospital leadership, environmental services, patient safety and quality, and facilities and engineering. The investigation included hospital incident command system (HICS) activation; visual inspection of patient rooms and common spaces; heating, ventilation, and air conditioning (HVAC) review; environmental sampling (surfaces, linen, and air); chart review; and process mapping. Results: By early October 2021, 2 environmental samples grew isolates (each at 1 CFU/m3) of the same species of Rhizopus as one of the affected patients. One sample was from a patient room, and the other from an outdoor garden space. No source of indoor amplification of Rhizopus was identified. The investigation revealed several opportunities for improvement: annual room maintenance schedules, use of gardens and outdoor spaces by at-risk patients, linen storage, construction and/or infection control risk assessment (ICRA) processes, and appliances used by families (eg, washing machines and refrigerators). Work streams were established to address each of these areas. Conclusions: No definite source was identified for the 4 invasive Rhizopus spp infections. This extensive investigation highlighted multiple opportunities for improvement; the changes implemented may prevent future invasive fungal infections in high-risk pediatric patients.

Funding: None

Disclosures: None

Understanding the relative longevity of different seed lots, perhaps of different species or genotypes, but also following production under different environments or using different cultivation methods, or following different post-harvest treatments, is relevant to anyone concerned with the retention of seed lot viability and vigour during storage. However, different scientists over the years have used different conditions to assess seed lot longevity, as well as different variables as the measure of ‘longevity.’ Here, we give some of the backgrounds to how two standard protocols, with an open and closed system respectively, were derived, and explain why we consider p50, defined as the time during storage when seed lot viability, as measured through a germination test, has declined to 50%, is a suitable longevity trait parameter.