ABSTRACT IMPACT: A better understanding of the spectrum of problematic opioid use will lead to more targeted treatments. OBJECTIVES/GOALS: It is unclear how to approach treatment of individuals with problematic opioid use who do not clearly meet criteria for opioid use disorder (OUD). We aim to characterize clinical, demographic, and medication use at time of identification of problematic opioid use across the spectrum as well as identify predictors of poor outcomes. METHODS/STUDY POPULATION: A national sample of Veterans coded as having opioid abuse or dependence were previously categorized as (1) high likelihood of OUD, (2) limited aberrant opioid use, and (3) prescribed opioid use with no evidence of aberrant use based on chart review. We will describe how individuals in these three categories differ demographically and clinically. We will then use a trained binary logistic regression model to predict whether individuals with limited aberrant opioid use more closely resemble category (1) or (3). Cox proportional hazards models will be used to predict all-cause mortality, suicide-related mortality, opioid-overdose related mortality, and hospitalization over a three-year period using the three categories as predictors and adjusting for relevant covariates. RESULTS/ANTICIPATED RESULTS: We anticipate that Veterans with a high likelihood of OUD will be more likely to experience homelessness and have more psychiatric comorbidities (especially PTSD). We hypothesize that Veterans with prescribed opioid use and no evidence of misuse will be significantly older, more likely to have disability, medical comorbidities (ie., chronic pain, cancer), more prescriptions for non-opioid analgesics, and be prescribed higher doses of opioids. Using a trained binary logistic regression model, we predict that Veterans with limited aberrant opioid use will more closely resemble Veterans with a high likelihood of OUD. We expect that all categories of problematic opioid use will have a high risk of mortality, with a high likelihood of OUD associated with the greatest risk of premature death. DISCUSSION/SIGNIFICANCE OF FINDINGS: Identifying and better characterizing individuals with limited aberrant opioid use may be an important opportunity to intervene prior to development of severe OUD. Future research will focus on targeting interventions to this population, which may have specific needs that are separate from classic OUD or simple pain-related opioid dependence.

OBJECTIVES/SPECIFIC AIMS: To identify characteristics of counties with persistently high opioid-overdose rates and low capacity to deliver medications for OUD (MOUD). METHODS/STUDY POPULATION: Setting: County-level opioid-overdose death data, 2013-2016, and 2017 publicly-available treatment provider data for MOUD: buprenorphine-waivered providers, opioid treatment programs (OTPs), and extended-release naltrexone providers. Participants: Populations in 3,142 U.S. counties. 24,851 buprenorphine-waivered providers; 1,517 OTPs; and 5,222 extended-release naltrexone providers. Measurements: The outcome variable, “opioid high-risk county”, was a binary indicator of high (above average) opioid-overdose rates with low (below median) MOUD availability rates. We used spatial logistic regression models to determine correlates of being a high-risk county. RESULTS/ANTICIPATED RESULTS: 46.4% of all counties, and 71.2% of rural counties, lacked a publicly-available MOUD provider in 2017. In adjusted models, rural counties had 53% greater odds of being high-risk than urban counties. Counties in the East South Central, West South Central, and South Atlantic divisions had over twice the odds of being high-risk than counties in the West North Central division. Primary care provider density, greater traversability, and a higher proportion of the population under age 25 were all protective against a county being opioid high-risk. DISCUSSION/SIGNIFICANCE OF IMPACT: Counties with both low MOUD provider availability and high opioid-overdose death rates are significantly more likely to be rural, have less primary care providers per capita, and in the southern regions. Strategies to increase MOUD must account for these factors.

A case-control study was conducted to determine risk factors for hospital-onset Clostridium difficile infection among patients admitted to 2 surgical units. Ertapenem prophylaxis was significantly associated with C. difficile infection risk (odds ratio, 3.13 [95% CI, 1.13–8.68], P=.028) and may offer an antimicrobial stewardship target among surgical patients.

Infect. Control Hosp. Epidemiol. 2015;36(11):1351–1354

A functionalization method for the specific and selective immobilization of the streptavidin (SA) protein on semiconductor nanowires (NWs) was developed. Silicon (Si) and silicon carbide (SiC) NWs were functionalized with 3-aminopropyltriethoxysilane (APTES) and subsequently biotinylated for the conjugation of SA. Existence of a thin native oxide shell on both Si and SiC NWs enabled efficient binding of APTES with the successive attachment of biotin and SA as was confirmed with x-ray photoelectron spectroscopy, high-resolution transmission electron microscopy, and atomic force microscopy. Fluorescence microscopy demonstrated nonspecific, electrostatic binding of the SA and the bovine serum albumin (BSA) proteins to APTES-coated NWs. Inhibition of nonspecific BSA binding and enhancement of selective SA binding were achieved on biotinylated NWs. The biofunctionalized NWs have the potential to be used as biosensing platforms for the specific and selective detection of proteins.

The Palomar Transient Factory (PTF) is a project aimed to discover transients in the Universe, including Type Ia supernovae, core-collapse supernovae, and other exotic and rare transient events. PTF utilizes the Palomar 48-inch Telescope (P48) for discovering the transients, and follow-up mainly by the Palomar 60-inch Telescope (P60, for photometric light and color curves), as well as other telescopes. The discovery rate of PTF is about 7000 candidate transients per year, but currently only about 10% of the candidates are being followed-up and classified. To overcome this shortcoming, a dedicated spectrograph, called the SED Machine, is being designed and built at the California Institute of Technology for the P60 Telescope, aiming to maximize the classification efficiency of transients discovered by PTF. The SED Machine is a low resolution (R ~ 100) IFU spectrograph. It consists of a rainbow camera for spectrophotometric calibration, and a lenslet array plus 3-prism optics system for integrated field spectra. An overview of the science and design of the SED Machine is presented here.

While health warnings are present on cigarette packs around the world, the nature of the warnings varies considerably between countries. In the United States, a small text warning citing the dangers of cigarette smoking is found on the side of all packs. This pilot study sought to determine whether graphic cigarette warning images, like those found in the United Kingdom and Canada, were better at decreasing cravings to smoke than existing text warnings found on cigarette packs in the United States. Twenty-five smokers seeking treatment to quit at a specialty tobacco treatment program were administered the Brief Questionnaire of Smoking Urges (QSU — BRIEF), a validated measure of craving, prior to and following exposure to cigarette pack warning images. The graphic cigarette warning images reduced cravings to smoke (6.20 point decrease) more than neutral images (3.36 point decrease) and current text warnings used in the United States (5.75 point decrease), although this difference was not statistically significant. Based on these pilot data, a larger study could further examine the effectiveness of graphic warning images and whether such warnings hold an advantage over the currently used text warnings.