ABSTRACT IMPACT: The findings from this study will inform the development of an FDA-approved patient-rated outcome measure of drug and alcohol craving that can be used in clinical trials aimed at developing or testing effective treatments for substance use disorder. OBJECTIVES/GOALS: Craving is a potential target of investigative medications to reduce drug use due to the strong link between craving and drug use. We will identify all existing craving measures as the first step for developing an FDA-approved patient-rated outcome measure for use in clinical trials. METHODS/STUDY POPULATION: Following PRISMA guidelines, we will update Rosenberg’s (2009) craving review by conducting a systematic review of all existing published and unpublished measures of craving for alcohol, nicotine, cannabis, opioid, and stimulant use. Electronic database (i.e., Ovid MEDLINE, Embase, PsycINFO, Web of Science, Cochrane), forward, backward, and author searches will be conducted. We will also request unpublished craving measures on major listservs (e.g., Research Society on Alcoholism, the Collaborative Perspectives on Addiction, and the College on Problems of Drug Dependence). All papers included in Rosenberg’s (2009) review through September 2020 will be included. RESULTS/ANTICIPATED RESULTS: The findings from this review will provide a comprehensive summary of the construct of craving and its hypothesized and tested domains. This review will elucidate whether the literature suggests there are components of craving unique to alcohol, nicotine, cannabis, opioid, and/or stimulant use, and whether there are key elements of craving common across the disorders. Therefore, these findings will inform whether a single patient-rated outcome measure of craving can be developed for use across substances or if unique patient-rated outcome measures of craving need to be developed for each substance. DISCUSSION/SIGNIFICANCE OF FINDINGS: While many different measures of craving exist, none have gone through the developmental steps required to qualify as an FDA-approved patient-rated outcome measure on which drug treatment labeling can be based. Completing this systematic review is the first step in this process.

OBJECTIVES/GOALS: Tobacco use remains a significant problem in rural America. Federally Qualified Health Centers (FQHCs) can help reduce the burden of tobacco use in rural areas. Still, we know little about center awareness and implementation of best practices for tobacco control. We assessed the knowledge and existence of tobacco control strategies in rural FQHCs. METHODS/STUDY POPULATION: We electronically surveyed health administrators and providers (n=33) in three rural Louisiana FQHCs between March and April 2021. The assessment measured awareness of the U.S. Public Health Service Clinical Practice Guideline for Treating Tobacco Use, center priority given to smoking cessation programming, the presence of best practices for tobacco control programming such as having a tobacco control champion and team, treatment and smoke-free campus policies, and referral to external cessation services. Descriptive statistics characterize survey respondents and responses. RESULTS/ANTICIPATED RESULTS: The majority of the respondents were female (88.5%), White (53.8%), between 35 and 54 years of age (69.2%), and non-smokers (65.4%). Among all respondents, 69.7% reported awareness of the U.S. Public Health Service Clinical Practice Guideline for Treating Tobacco Use. Less than half (48%) said their health center gave smoking cessation high priority relative to other health priorities. Only a third (36%) reported having a tobacco champion, and a quarter (25%) had a tobacco control team at their facility. Although all centers had a smoke-free campus policy, a quarter (27%) were unaware of the policy. Only a quarter (27%) reported having a written policy for smoking cessation treatment at their center, and a little more than half (56.7%) knew about cessation services to which they could refer tobacco users. DISCUSSION/SIGNIFICANCE: Centers had limited knowledge of the U.S. guideline for tobacco use treatment. Smoking cessation lacked priority, and tobacco control best practices implementation was low. FQHCs serving rural populations can implement guideline-recommend policies and clinical treatments, and future studies should test strategies to increase implementation.

OBJECTIVES/SPECIFIC AIMS: The majority of obese adults do not become obese until adulthood. Although adults spend the equivalent of a 40-hour work week in front of the television (TV), there are mixed data on whether the sedentary behavior of TV viewing is linked with weight gain during adulthood. The purpose of this study was to examine the associations among sedentary behavior, measured as TV viewing and TV in the bedroom, with eating behavior, eating attitudes and cravings, fat gain, and blood pressure in healthy young adults over a 2-year period. METHODS/STUDY POPULATION: The sample included 73 healthy, nonobese adults (56% women, 80% white) who were 26.8±4.5 years of age with a body mass index of 22.9±2.4 kg/m2. Participants completed clinic visits at baseline and 2-years later (Year 2) which assessed weight, height, blood pressure, waist circumference, and total body fat measured by dual energy X-ray absorptiometry. A food frequency questionnaire was used to estimate dietary intake, and the eating inventory was used to assess dietary restraint, disinhibition, and hunger. At baseline, participants self-reported TV habits including number of hours/week of watching TV (including cable, VCR, DVD) and presence of a TV in the bedroom. For the analysis, participants were stratified by quartiles of TV viewing time. T tests were used to examine the association between TV viewing and bedroom TV. Linear regression models were used to examine the association between TV viewing and each anthropometric and body composition measure and change over the 2-year period, as well as with the dietary constructs. Models controlled for age, sex, and baseline body fat. Separate models were used to investigate the associations between bedroom TV and the same dependent variables. RESULTS/ANTICIPATED RESULTS: Participants reported an average of 13.3±10.8 hours/week of TV viewing, with 33.3% reporting a TV in the bedroom. There were no differences in age, sex, or race among the quartiles of TV viewing or between those who did and did not have a bedroom TV. Adults with a bedroom TV did not differ in hours/week of TV viewing compared with those without a bedroom TV. Amount of TV viewing was associated with higher systolic blood pressure at baseline (p=0.05) but with no other anthropometric or body composition indices nor with change in body composition over the 2-year period. Adults with a bedroom TV reported higher craving for sweets at baseline (p=0.03). Amount of TV viewing was related to lower consumption of vegetables (p=0.04) and fruit or fruit juice (p=0.03) at Year 2, but there was no association with total calorie consumption. TV viewing and bedroom TV were not related to dietary restraint, disinhibition, or hunger at either time point. DISCUSSION/SIGNIFICANCE OF IMPACT: Adults who watched more TV consumed fewer fruits and vegetables, and those with a TV in the bedroom reported higher craving for sweets. Though there were no observed relationships between TV habits and body composition change, the associations with cravings and food consumption warrant further exploration. Querying young adults’ TV and media use habits in clinical settings may alert physicians to those at risk of developing poor dietary habits.

OBJECTIVES/SPECIFIC AIMS: This study seeks to evaluate the role of PCOS in insulin resistance and sleep apnea in adolescents. METHODS/STUDY POPULATION: 37 adolescent patients 13-21 with PCOS (27 obese, 11 lean), along with 8 controls ages 18-21 were recruited. Subjects underwent a hyperinsulinemic euglycemic clamp study and a proportion of the PCOS subjects also underwent polysomnography. Baseline parameters were compared and M/I (index of insulin sensitivity), and GIR were compared. RESULTS/ANTICIPATED RESULTS: M/I was only statistically significantly different between obese PCOS subjects vs control (0.056 vs 0.17, p=0.0061). GIR was higher in the obese PCOS group compared to the lean PCOS group (2.48 vs 6.79, p=0.0001). There were no differences in GIR between the lean PCOS subjects and control (6.79 vs 9.08, p=0.30). 21 obese PCOS subjects and 10 lean PCOS underwent polysomnography. None of the lean PCOS subjects had obstructive sleep apnea (OSA). 8 of the obese subjects had OSA. DISCUSSION/SIGNIFICANCE OF IMPACT: More studies are needed to assess insulin sensitivity and sleep apnea in adolescents with lean PCOS. Our study did not find more insulin resistance in adolescents with PCOS compared to lean controls apart from what would be expected from obesity. Of adolescent obese subjects with PCOS, OSA seems quite prevalent and providers should consider screening and referral for these patients.

OBJECTIVES/GOALS: Older patients with HL have worse outcomes than younger patients, which may reflect treatment selection, including fewer chemotherapy cycles. Immortal time bias exists when patients must survival to initiation, and even completion, of treatment. We described treatment length and death to evaluate the extent of immortal time bias. METHODS/STUDY POPULATION: This retrospective cohort study utilized SEER-Medicare data from 1999-2014. Patients diagnosed with incident advanced stage HL at age ≥65 years and enrolled in Medicare Part A and B fee for service were included. Chemotherapy or radiotherapy treatment initiated within 4 months of diagnosis was determined from inpatient, outpatient, and physician/supplier claims. No treatment was defined by lack of treatment claims. Dates from claims were used to define length of treatment; ≥4 months of treatment indicated complete chemotherapy cycles. Date of death was obtained from Medicare data. Analyses were limited to 1 year post-diagnosis. Summary statistics were used to describe treatment length and subsequent death. RESULTS/ANTICIPATED RESULTS: We included 1492 advanced stage HL patients with a mean age of 76 years (SD = 7). 428 (29%) patients had no documented treatment; 397 (27%) were treated <4 months indicating fewer chemotherapy cycles; and 667 (45%) were treated for ≥4 months indicating complete chemotherapy cycles. Among those with no documented treatment, 15% died within 1 month of diagnosis with 78% dying by 1 year post-diagnosis. Among those treated <4 months, 36% died within 1 month of their last treatment claim with 64% dying by 1 year post-diagnosis. Among those treated ≥4 months, 7% died within 1 month of their last treatment claim with 14% dying by 1 year post-diagnosis. DISCUSSION/SIGNIFICANCE OF IMPACT: Few untreated patients died within 1 month of diagnosis. One-third of patients treated <4 months died soon after completion of treatment, while patients treated longer survived longer, suggesting some patients did not survive to complete treatment. To account for this immortal time bias, landmark analysis will be used to assess the relationship between treatment and survival.

OBJECTIVES/SPECIFIC AIMS: Millions of diverse, older adults live with serious and chronic illness for which they will face complex, ongoing medical decisions. Advance care planning (ACP) has been conceptualized as a health behavior that supports adults in understanding and sharing their values, goals, and preferences for future medical care. Depression and anxiety are known barriers to participation in health behaviors. It is unknown whether depression and anxiety are associated with ACP participation or with patients’ values for future medical care. Understanding whether depression and anxiety are associated with ACP would be important to tailor ACP interventions. METHODS/STUDY POPULATION: In total, 908 English-speaking and Spanish-speaking participants ≥55 years of age were recruited from a San Francisco county hospital. We measured depression (Patient Health Questionnaire 8-item scale) and anxiety (Generalized Anxiety Disorder 7-item scale), dichotomized into none-to-mild Versus moderate-to-severe. We measured ACP engagement using a validated survey of Behavior Change Processes (e.g., knowledge, self-efficacy, readiness; 5-point Likert) and Action Measures (e.g., ask, discuss, and document one’s wishes; yes/no). We elicited values concerning life extension categorized as “life is always worth living no matter the health situation” Versus “some health situations would make life not worth living.” To explore associations, we usedχ2, Mann-Whitney tests, linear and logistic regressions. RESULTS/ANTICIPATED RESULTS: Mean participant age was 64 years±6, 80% were non-White, 40% had limited literacy, 45% were Spanish-speaking, and the prevalence of depression and anxiety was 12% and 10%, respectively. Depression and anxiety were not associated with ACP Engagement, p>0.05. However, participants with depression had an increased odds of reporting “some health situations would make life not worth living” than those not depressed, p=0.02. In multivariate linear and logistic regression, controlling for age, gender, literacy, and health status, having depression increased the odds of not valuing life extension OR 2.9 (CI: 1.7–4.9). Anxiety was not associated with values concerning life extension, p>0.05. DISCUSSION/SIGNIFICANCE OF IMPACT: Depression and anxiety were not associated with prior ACP engagement suggesting engaging patients in ACP does not increase these conditions. However, depression was associated with an increased odds of not valuing life extension and, therefore, may influence treatment choices. Longitudinal randomized controlled trials of an ACP intervention are currently underway to investigate these associations further.

OBJECTIVES/GOALS: The aim of this study was to evaluate current and new anatomical approaches to treating obstructive sleep apnea (OSA) in patients who fail continuous positive airway pressure (CPAP). Understanding the breadth of devices and procedures increases clinical scope of practice and innovator opportunities. METHODS/STUDY POPULATION: A comprehensive review of literature, FDA approvals, patents, and commercially available technologies was undertaken with regards to anatomical approaches for treating OSA. These include experimental therapies, surgical approaches, and non-surgical ablative procedures. Oral appliances, positive airway pressure devices, and therapeutics were excluded. Key search terms included obstructive sleep apnea,’ anatomy,’ surgery,’ devices,’ experimental therapy,’ innovation,’ technology,’ and translational research.’ Publications were limited to the last five years. Innovations were evaluated for relevance to OSA treatment and then assessed in greater depth based on scientific literature. RESULTS/ANTICIPATED RESULTS: Numbers of preclinical and commercially available innovations pertinent to the anatomical treatment of OSA were reported along with clinically relevant outcome metrics. The greatest number of innovations was found in surgical approaches, including soft-tissue removal, orthognathic surgery, and electrical stimulation. Outcome parameters included safety, efficacy, patient compliance, and mean disease alleviation as a ratio of efficacy to compliance. Innovations were grouped by their intended anatomical targets including retrolingual, palatal, oropharyngeal, epiglottic, nasal, and complete concentric collapse, making special note of gaps in the treatment armamentarium. DISCUSSION/SIGNIFICANCE: In the last decade, sleep surgery has trended toward innovative CPAP alternatives. Nerve stimulation and ablative procedures have grown, but some anatomical presentations have been frequently excluded. These developments present opportunities for innovators to fill persistent gaps in treatment.

OBJECTIVES/SPECIFIC AIMS: The American Academy of Pediatrics (AAP) recommends that preschool-aged children spend no more than 2 hours/day using digital screens such as TVs. However, there is a proliferation of digital screens in children’s daily lives both at school and at home. The purpose of this study was to examine factors that contribute to children’s screen-time, including their demographic characteristics and whether or not they have screen-time at school. METHODS/STUDY POPULATION: In total, 59 children (3.3±0.4 years of age; 47% female) enrolled in 3 child care centers participated. Center directors reported school screen-time; 1 center was classified as not providing screen-time and 2 centers were classified as providing screen-time. Parents reported child’s age, sex, and maternal education as a proxy for socio-economic status. Parents reported child’s out-of-school screen-time by responding to the question “During the past 30 days, on average how many hours per day did your child sit and watch TV or videos outside of school?” Additional questions queried how many hours per day did the child “use a computer or play computer games,” “play video games,” “use a smartphone,” and “use an iPad or tablet.” Children’s height and weight were collected using standard clinic procedures and body mass index (BMI) was calculated. T tests were used to examine differences in screen-time by age, sex, and school screen-time. General linear models were used to examine the influence of school screen-time (1=no screen-time, 0=between 1 and 60 min/day of screen-time), age, BMI, and maternal education on out-of-school screen-time and time spent with each device. Logistic regression analysis was used to examine likelihood of meeting screen-time recommendations based on the same characteristics. RESULTS/ANTICIPATED RESULTS: Parent-reported total screen-time was 6.3±3.6 hours/day (h/d); specifically, 2.5±1.1 h/d watching TV, 1.5±2.2 h/d using a smartphone, 1.1±0.9 h/d using a tablet, 0.8±1.0 h/d on a computer, and 0.5±0.7 h/d playing video games. Based on total screen-time, 15% of children met AAP recommendations; based on TV viewing only, 52% met AAP recommendations. The 4-year-old children viewed more screen-time overall compared to the 3-year-old children including on TV, computer, and tablet (p<0.05), but there were no sex differences. In fully adjusted linear models, out-of-school screen-time was lower among those who had no screen-time at school (p=0.02) and higher among older children (p<0.01). Computer use was higher among older children (p=0.02). Older children and those with lower maternal education were less likely to meet clinical recommendations based on TV viewing (p<0.05). There were no observed associations with likelihood of meeting clinical recommendations based on total screen-time. BMI was not a significant predictor of screen-time. DISCUSSION/SIGNIFICANCE OF IMPACT: The majority of children exceeded AAP screen-time limits, with screen-time sharply higher among older children, and the associations did not vary by weight status. Children who attended schools that allowed screen-time had higher amounts of out-of-school screen-time. Pediatricians and healthcare providers should query parents on children’s screen-time practices at home and at school and offer strategies to help families meet the clinical recommendations.

OBJECTIVES/GOALS: This project has two linked aims. (1) It seeks to integrate the TSBM into specific practices and processes to advance its integration into translational research and translational science processes. (2) Via this integration, it aims to determine ways to expand the TSBM as a conceptual model. Ultimately, we aim to advance the TSBM framework and use. METHODS/STUDY POPULATION: We developed a process that implemented and integrated the TSBM within three intentionally-distinct processes. First, we expanded the use of the TSBM case study from a focus on research studies to a focus on translational research programs, and specifically workforce development programs. Second, we integrated TSBM domains and indicators into a new Duke CTSA-wide database used to track, monitor, and assess activities and achievements across the CTSA. Third, we embedded TSBM and its indicators into our Pilots projects application and review process as well as ongoing reporting. RESULTS/ANTICIPATED RESULTS: We were able to successfully integrate the TSBM model into the processes indicated in methods, yet this integration identified opportunity to improve the model to enhance its applicability and value. We found the TSBM applies in distinct ways to translational science programs compared to research studies, with added indicators better accommodating TSBM application to programs. To properly integrate TSBM into progress monitoring systems, we found added needs to ensure comprehensibility for a wide array of researchers and program implementers. Across uses, we identified challenge distinguishing between TSBM benefits as demonstrated versus potential and ambiguity in potential as based on time to benefit realization, likelihood of realization, or centrality of a specific project to realization. DISCUSSION/SIGNIFICANCE: Our session contributes significantly to the field of translational research and science through its focus on advancement and implementation of an innovated model in its early stages, including how researchers and translation science entities can incorporate this model into their own work beyond the traditional use of case studies.

OBJECTIVES/SPECIFIC AIMS: Intensive lifestyle change (e.g., the Diabetes Prevention Program) and metformin reduce type 2 diabetes risk among patients with prediabetes. However, real-world uptake remains low. Shared decision-making (SDM) may increase awareness and help patients select and follow through with informed options for diabetes prevention that are aligned with their preferences.The objective was to test the effectiveness of a prediabetes SDM intervention. METHODS/STUDY POPULATION: This was a cluster-randomized controlled trial in 20 primary care clinics within a large regional health system. Participants were overweight/obese adults with prediabetes (BMI>24 kg/m2 and HbA1c 5.7-6.4%) were enrolled from 10 SDM intervention clinics. Propensity score matching was used to identify control patients from 10 usual care clinics.Intervention clinic patients were invited to participate in a face-to-face SDM visit with a pharmacist who used a decision aid (DA) to describe prediabetes and four possible options for diabetes prevention; DPP, DPP +/− metformin, metformin only, or usual care. RESULTS/ANTICIPATED RESULTS: Uptake of DPP and/or metformin was higher among SDM participants (n=351) than controls receiving usual care (n = 1,028; 38% vs. 2%, p<.001). At 12-months follow-up, adjusted weight loss (lbs.) was greater among SDM participants than controls (−5.3 vs. −0.2, p < .001). DISCUSSION/SIGNIFICANCE OF IMPACT: A prediabetes SDM intervention led by pharmacists increased patient engagement in evidence-based options for diabetes prevention and was associated with significantly greater uptake of DPP and/or metformin at 4-months and weight loss at 12-months. Prediabetes SDM may be a promising approach to enhance prevention efforts among patients at increased risk.

ABSTRACT IMPACT: Our research has the potential to impact human health by identifying gender specific neural markers of emotion regulation in alcohol use disorder. OBJECTIVES/GOALS: Emotion dysregulation is known to be mediated by altered functional organization of the limbic system in addiction. This preliminary study sought to identify gender effects in the association between emotion regulation and resting-state functional connectivity (rsFC) of a negative affect network. METHODS/STUDY POPULATION: 55 individuals receiving treatment for alcohol use disorder (˜2 weeks of abstinence) were recruited for this study and included in this analysis (N=55; Age: M=41.78, SD=10.66; 21 females). RsFC within a network involved in the withdrawal/negative affect stage of addiction and Personality Inventory for DSM-5 (PID-5) metrics were collected from all participants. RsFC data were preprocessed using the Human Connectome Project pipelines. Correlations between (a) rsFC within the withdrawal/negative affect network and the (b) scores of the negative affect subscale of the PID-5 instrument were conducted for each gender separately. RESULTS/ANTICIPATED RESULTS: Independent samples t-test showed a statistically significant gender difference in the PID-5 negative affect scores (Males: M=1.02, SD=0.66; Females: M=1.53, SD=0.51); t(55)=-3.002, p=0.004. Only females showed a significant correlation between rsFC within the withdrawal/negative affect network and negative affect scores of the PID-5 (r=0.51, p<0.05). Fisher r-to-z test showed significant gender differences (z=-1.91; p=0.03, 1-tailed) in correlations coefficients representing the relationship between rsFC of the withdrawal/negative affect network and negative affect (PID-5 subscale). DISCUSSION/SIGNIFICANCE OF FINDINGS: Preliminary findings suggest that the relationship between neural networks mediating emotion regulation and negative affect is only found in females. These results provide valuable data to inform personalized chemical dependency treatment that targets emotion regulation specific to females.

OBJECTIVES/SPECIFIC AIMS: There are currently over a million survivors of childhood, adolescent, and young adult cancer in the United States, many of whom were treated with radiation therapy. Chest radiation with fields including the coronary arteries is a risk factor for cardiovascular disease. Of note, survivors are often unaware of this increased cardiovascular disease risk or, if they are aware, do not know how to mitigate the risk. Visual aids and communicating risk in terms of absolute risk reductions are shown to improve patients’ understanding. The Institute of Medicine recommends use of decision aids to optimize patient discussions of benefits and harms of therapies. Our goal is to develop and pilot test a statin therapy risk communication tool for use in high-risk cancer survivors to improve shared decision making and patient knowledge of coronary artery disease risk. METHODS/STUDY POPULATION: Participants were recruited from the adult long-term follow-up clinic at Sloan Kettering Cancer Center into 2 arms, usual care Versus intervention with the statin risk communication tool. The post-visit assessment used Likert-like scales to explore patient perceptions of statin use. The study was not powered for significance as it was a feasibility study; descriptive statistics were run to compare the 2 groups. RESULTS/ANTICIPATED RESULTS: Participants (n=45) had a mean age of 45. In the intervention group, 92% felt the information given was right compared with 73% of the usual care group. In all, 63% of the intervention arm felt the information was helpful, compared with 47% of those in usual care. And 53% of usual care would recommend the method to other patients and for other treatment choices compared to 67% of those in the intervention arm. DISCUSSION/SIGNIFICANCE OF IMPACT: This risk communication tool was assessed for acceptability and found to be more acceptable compared with usual care. In addition, we will gather further information on knowledge enhancement and decisional conflict as well as qualitative data regarding the shared decision making experience. With this information, a future randomized-controlled trial across institutions could provide information on how childhood, adolescent, and young adult survivors approach shared decision making with risk communication tools.

OBJECTIVES/GOALS: The purpose of this report is to describe the role of Periodontal Disease (PD) in Coronary Artery Disease (CAD) in a Hispanic country. METHODS/STUDY POPULATION: Literature and Puerto Rican experience was reviewed and will be discussed. RESULTS/ANTICIPATED RESULTS: PD produces inflammatory disease by bacterial infection in the gingiva. This factor PD activates an inflammatory process affecting the CAD cascade inducing myocites, endothelial cells activation and cytokines. The incidence of gingival disease in the Puerto Rican population (P) is around 50%; of this group 80% will develop periodontal disease. Including this factor and diabetes mellitus Type 2, still the incidence of CAD is 20-30% less than the U.S.A. DISCUSSION/SIGNIFICANCE OF IMPACT : CAD is a systemic disease related to genetic factors and inflammation. PD is related to an inflammatory process, which will activate the CAD process, producing tissue infarcts. The daily use of resolving or liquid Omega 3 in the gingival tissue is useful in the prevention of gingival and periodontal disease. CONFLICT OF INTEREST DESCRIPTION: All authors have no relationship with any industry or financial associations in connection with the submitted abstract.

OBJECTIVES/GOALS: Early clinical case reports have described incidental epileptiform changes during electrophysiological monitoring. The objective of this study was to perform a systematic review of all existing investigations of epileptiform activity during sevoflurane use in pediatric anesthesia. The heterogenous EEG data will be analyzed in a meta analysis METHODS/STUDY POPULATION: A targeted, PICO-based clinical question was crafted and registered a priori on PROSPERO on 3/19/21. Under the guidance of a librarian from the Albert Einstein College of Medicine, a boolean search string was generated to search articles and gray literature for terms such as pediatric, sevoflurane and electroencephalogram in PubMed, OVID, Cochrane, Google Scholar, etc. We utilized the software platform tool COVIDENCE to manage our review. 495 references were imported for initial screening. 56 English-language, full-text studies were included for further review. The final 13 references were included in data extraction and Newcastle-Ottawa bias assessment. The characteristics of the studies and their primary outcomes were collected in tabular form. Strategies for data synthesis were discussed weekly. RESULTS/ANTICIPATED RESULTS: Epileptiform changes reported in the literature during pediatric sevoflurane anesthesia ranged from 0 - 95%. EEG data were acquired using a variety of recording systems with variable number of leads and heterogeneous outcomes reported. The periods of anesthesia monitoring were also heterogeneous. Characteristics of the studies are presented in Table 1. 495 references were imported for screening with 13 final references for data extraction. EEG abnormalities were reported in 204/649 (31.4%) subjects ranging in age from neonate to 18 years; the majority of studies utilized less than 16 channels of (10/13, 76.9%) (Table 1). There was variability in sevoflurane dosing, premedication (e.g., midzolam, hydroxyzine), and periods of anesthesia monitored. DISCUSSION/SIGNIFICANCE: There was heterogeneity noted across reviewed literature including study design, phases of anesthesia, ventilation methods, number of EEG leads recorded and adjuvant anesthetics administered. Nevertheless, this review rigorously classified epileptiform activity during Sevoflurane thereby influencing modern anesthesia.

For decades, the research community called for streamlined Institutional Review Board (IRB) review processes for multisite studies. Department of Health and Human Services and National Institutes of Health (NIH) recognized this need and implemented single IRB (sIRB) of record mandates. However, announcing mandates without sufficient operational guidance and tools is insufficient to foster the desired change. Nearly 4 years into implementation of the NIH’s sIRB mandate, operational challenges remain. Fortunately, NIH supports a web-based sIRB platform, the IRB Reliance Exchange (IREx), to facilitate sIRB communication and documentation. IREx has received continuous NIH funding supporting its evolution since 2011 and is now used by over 5,000 Human Research Protection Program and research personnel, 35 sIRBs, and 415 participating sites to operationalize sIRB review and approval on over 400 studies. IREx supports over 2300 reliance relationships with an average of 7 sites per study. The platform is continually used by sIRBs and relying sites, providing a valuable centralized portal for promoting a harmonized sIRB review process. IREx can promote transparency, standardize practice, minimize workflow variation, and mitigate the need for sIRBs to implement significant technical changes to their local electronic systems. IREx has proven to be nimble and adaptable with practice and policy changes over the past decade, as evidenced by continually increasing platform utilization.

OBJECTIVES/GOALS: The objective is to describe the process for developing two measurement tools to measure confidence (self-efficacy) of the anti-racist advocate in an academic setting. METHODS/STUDY POPULATION: We proposed five spheres encountered by the academic trainees: Academic/Research, Clinical, Policy, Interpersonal, and Intrapersonal. We evaluated a book, by Shereen Daniels, used in anti-racism literature: The Anti-Racist Organization - Dismantling Systemic Racism in the Workplace. Using the proposed metric of RACE framework, Recognize the problem, Analyze the impact, Commit to action, Empower for change, we sought to establish readiness on the spectrum of anti-racism advocacy. We developed a list of anti-racism and anti-bias advocacy skills based on: 1) Informational interviews with anti-racism and anti-bias experts, 2) Scoping literature review and 3) Academic trainees’ and faculty lived experience. RESULTS/ANTICIPATED RESULTS: The first assessment, “5-Spheres”, consists of 10 items that perform, 1) Analysis of readiness on the spectrum of anti-racism advocacy using RACE framework (Figure 1 [https://drive.google.com/file/d/1A3nMArEn7ZSxZSuSgDkYl_row-VOhOXf/view?usp=drive_link]), 2) Assessment of workplace environment. The second assessment, “Skills”, consists of 25 items (Figure 2 [https://drive.google.com/file/d/1GTdfSgn0-mPu-flSUVSN-vIKTxBCkFW3/view?usp=drive_link]) that perform assessment of confidence of specific skills within each of the five spheres using the following scale: 1 – Not confident at all, 2 – Lacking some confidence, 3 – Somewhat confident, 4 – Completely confident DISCUSSION/SIGNIFICANCE: This proposed measurement tool can extend to anti-bias as well as anti-racism. Potential uses of the self-assessment includes: 1) Measurement and 2) Gap-spotting.

OBJECTIVES/GOALS: Severe malarial anemia due to Plasmodium falciparum is often accompanied by thrombocytopenia. Treatment includes transfusion of whole blood, which contains erythrocytes, platelets, and other blood components. The objective of the study was to assess the effect of whole blood transfusion on survival in children with severe falciparum malaria and to examine the potential interaction of thrombocytopenia with malaria mortality and transfusion response. METHODS/STUDY POPULATION: We analyzed a retrospective cohort of 842 hospitalized children in Zambia with severe malarial anemia (703 transfused, 139 not transfused due to stock-out or other reason). Severe malarial anemia was defined as a positive rapid diagnostic test or blood smear in combination with an admission hemoglobin concentration ≤5 g/dL. RESULTS/ANTICIPATED RESULTS: Mortality was 13% (94/703) in the transfused group and 24% (34/139) in the non-transfused group. Kaplan-Meier survival estimates stratified by transfusion status and thrombocytopenia (150,000/μL threshold) showed increased mortality in children with thrombocytopenia who did not undergo transfusion, with no differences in mortality among the other transfused and non-transfused groups (log-rank test P = 0.0001). Effect modification analysis by Cox proportional hazards regression adjusted for age, sex, hemoglobin concentration, blood group type, and eosinophilia showed a significant interaction between platelet count and transfusion status (P = 0.028). Children with thrombocytopenia who were transfused and died had little or no post-transfusion increase in platelets, in contrast to those who survived. Freshness of transfused whole blood, construed from expiration dates, correlated with greater platelet recovery and improved survival. DISCUSSION/SIGNIFICANCE OF IMPACT: The role of platelets in malaria pathophysiology is complex and incompletely understood; prior studies describe preferential binding of platelets to parasitized erythrocytes and direct parasitocidal activity, whereas others detailed deleterious effects in malaria involving the central nervous system vasculature. These findings point to a potential clinical role for platelet-directed transfusion strategies to improve survival in children with severe falciparum malaria, which should be further assessed in randomized interventional studies.