OBJECTIVES/GOALS: Physical therapy (PT) is key for treating functional decline that inpatients experience but is a constrained resource in hospital settings. The Activity Measure Post-Acute Care (AM-PAC) score is a mobility measurement tool that has been used to define misallocation of PT. We aim to optimize PT referrals using AM-PAC-based clinical decision support . METHODS/STUDY POPULATION: We conducted a prospective study of patients admitted to University of Chicago Medical Center. AM-PAC scores were assessed by nursing staff every 12 hours. Clinical decision support was designed using validated AM-PAC cutoffs (> 18, a predictor of discharge to home). The tool was embedded in hospital medicine note templates, requiring providers to indicate PT referral status based on current AM-PAC scores. The primary outcome, unskilled consult , was defined as PT referral for patients with AM-PAC > 18. Data were collected for one year prior to implementation and one year after implementation for intervention (hospital medicine) and control (general internal medicine) services. Difference in differences analysis was used to assess the association between the intervention and unskilled consults. RESULTS/ANTICIPATED RESULTS: Between October 2018 and March 2021, 18,241 admissions were eligible for the study. Compared to preintervention, there was a lower rate of referral to PT for patients with high AM-PAC mobility scores in the post-intervention period [18.5% vs 16.6%; X2(1) = 7.02; p < 0.01]. In the postintervention time period, the control group experienced a 2.6% increase in unskilled consults while the intervention group experienced a 2.3% decrease, a difference in differences of 4.9% (95% CI -0.07–-0.03 for difference in differences) controlling for age sex, race, LOS, and change in mobility. Compared to preintervention, there was no statistically significant difference in mean change in mobility score post-intervention for either group. DISCUSSION/SIGNIFICANCE: Our results suggest that clinical decision support can decrease unskilled PT consults. Many functionally independent patients can mobilize with nursing or other mobilization staff. Hospitals should consider mobility score-based decision support to prioritize PT for impaired and at-risk patients.

Across South Africa, Lesotho, and Eswatini, long-term citizen science atlas data have suggested concerning declines in the population of Black Stork Ciconia nigra. Unlike the Asian and European populations, the southern African Black Stork population is described as resident and is listed as “Vulnerable” in South Africa, Lesotho, and Eswatini. Here we report on surveys of historical nesting locations across northern South Africa, finding evidence for nest site abandonment and limited evidence of recent breeding. We undertook detailed species distribution modelling within a maximum entropy framework, using occurrence records from the BirdLasser mobile app. We cross-validated the models against information in the Southern African Bird Atlas Project (SABAP2) database, highlighting Lesotho as an important potential breeding area. Additionally, we used SABAP2 to assess population trends by investigating interannual patterns in reporting rate. Comparing current reporting rates with those from SABAP1 (1987–1992), we found that there has been a dramatic decrease. We noted that a large proportion of the population occurs outside the breeding range during the breeding season, suggesting a considerable non-breeding population, especially in the extensive wildlife refuge of the Kruger National Park. The slow declines observed might be indicative of a population which is not losing many adults but is failing to recruit significant numbers of juveniles due to limited breeding. Using densities derived from transect surveys, we used predictive models to derive estimates of breeding range carrying capacity and a population estimate, which suggested declines to numbers around 600 for this subregion. Minimising disturbance at breeding sites of this cliff-nesting species and improving water quality at key population strongholds are pathways to improving the status of the species in the subregion.

Increasing the availability of lower energy food options is a promising public health approach. However, it is unclear the extent to which availability interventions may result in consumers later ‘compensating’ for reductions in energy intake caused by selecting lower energy food options and to what extent these effects may differ based on socio-economic position (SEP). Our objective was to examine the impact of increasing availability of lower energy meal options on immediate meal energy intake and subsequent energy intake in participants of higher v. lower SEP. In a within-subjects design, seventy-seven UK adults ordered meals from a supermarket ready meal menu with standard (30 %) and increased (70 %) availability of lower energy options. The meals were delivered to be consumed at home, with meal intake measured using the Digital Photography of Foods Method. Post-meal compensation was measured using food diaries to determine self-reported energy intake after the meal and the next day. Participants consumed significantly less energy (196 kcal (820 kJ), 95 % CI 138, 252) from the menu with increased availability of lower energy options v. the standard availability menu (P < 0·001). There was no statistically significant evidence that this reduction in energy intake was substantially compensated for (33 % compensated, P = 0·57). The effects of increasing availability of lower energy food items were similar in participants from lower and higher SEP. Increasing the availability of lower energy food options is likely to be an effective and equitable approach to reducing energy intake which may contribute to improving diet and population health.

Portion sizes of many foods have increased over time. However, the size of effect that reducing food portion sizes has on daily energy intake and body weight is less clear. We used a systematic review methodology to identify eligible articles that used an experimental design to manipulate portion size served to human participants and measured energy intake for a minimum of 1 d. Searches were conducted in September 2020 and again in October 2021. Fourteen eligible studies contributing eighty-five effects were included in the primary meta-analysis. There was a moderate-to-large reduction in daily energy intake when comparing smaller v. larger portions (Standardised Mean Difference (SMD) = –0·709 (95 % CI: –0·956, –0·461), approximately 235 kcal (983·24 kJ)). Larger reductions to portion size resulted in larger decreases in daily energy intake. There was evidence of a curvilinear relationship between portion size and daily energy intake; reductions to daily energy intake were markedly smaller when reducing portion size from very large portions. In a subset of studies that measured body weight (four studies contributing five comparisons), being served smaller v. larger portions was associated with less weight gain (0·58 kg). Reducing food portion sizes may be an effective population-level strategy to prevent weight gain.

From 2014 to 2020, we compiled radiocarbon ages from the lower 48 states, creating a database of more than 100,000 archaeological, geological, and paleontological ages that will be freely available to researchers through the Canadian Archaeological Radiocarbon Database. Here, we discuss the process used to compile ages, general characteristics of the database, and lessons learned from this exercise in “big data” compilation.

Perinatal light exposure predisposes towards health and behaviour in adulthood. Season of birth is associated with psychiatric, allergic, cardiovascular and metabolic problems. It has been proposed that early-life environmental light disrupts the development of biological rhythms which, in turn, influence later-life health. However, the mechanisms linking perinatal seasonal light to later-life biological rhythm and health in humans are unknown. In this study, we investigated the association between season of birth and epigenome-wide DNA methylation of two postmortem human brain regions (16 hypothalamus, 14 temporal cortex). We did not find statistically significant differences at the whole epigenome level, either because we lacked statistical power or that no association exists. However, when we examined 24 CpG sites that had the highest significance or differential methylation, we identified regions which may be associated with circadian rhythm entrainment, cholinergic neurotransmission and neural development. Amongst methylation of the core clock genes, we identified that hypothalamus Neuronal PAS Domain Protein 2 (NPAS2) gene has hypermethylated regions in long photoperiod-born individuals. In addition, we found nominal associations between season of birth and genes linked to chronotype and narcolepsy. Season of birth-related brain DNA methylation profile was different than a previously reported blood methylation profile, suggesting a tissue-specific mechanism of perinatal light programming. Overall, we are the first to analyse the relationship between season of birth and human brain DNA methylation. Further studies with larger sample sizes are required to confirm an imprinting effect of perinatal light on the circadian clock.

A profound characteristic of field cancerization is alterations in chromatin packing. This study aimed to quantify these alterations using electron microscopy image analysis of buccal mucosa cells of laryngeal, esophageal, and lung cancer patients. Analysis was done on normal-appearing mucosa, believed to be within the cancerization field, and not tumor itself. Large-scale electron microscopy (nanotomy) images were acquired of cancer patients and controls. Within the nuclei, the chromatin packing of euchromatin and heterochromatin was characterized. Furthermore, the chromatin organization was quantified through chromatin packing density scaling. A significant difference was found between the cancer and control groups in the chromatin packing density scaling parameter for length scales below the optical diffraction limit (200 nm) in both the euchromatin (p = 0.002) and the heterochromatin (p = 0.006). The chromatin packing scaling analysis also indicated that the chromatin organization of cancer patients deviated significantly from the control group. They might allow for novel strategies for cancer risk stratification and diagnosis with high sensitivity. This could aid clinicians in personalizing screening strategies for high-risk patients and follow-up strategies for treated cancer patients.

Can multicellular life be distinguished from single cellular life on an exoplanet? We hypothesize that abundant upright photosynthetic multicellular life (trees) will cast shadows at high sun angles that will distinguish them from single cellular life and test this using Earth as an exoplanet. We first test the concept using unmanned aerial vehicles at a replica moon-landing site near Flagstaff, Arizona and show trees have both a distinctive reflectance signature (red edge) and geometric signature (shadows at high sun angles) that can distinguish them from replica moon craters. Next, we calculate reflectance signatures for Earth at several phase angles with POLDER (Polarization and Directionality of Earth's reflectance) satellite directional reflectance measurements and then reduce Earth to a single pixel. We compare Earth to other planetary bodies (Mars, the Moon, Venus and Uranus) and hypothesize that Earth's directional reflectance will be between strongly backscattering rocky bodies with no weathering (like Mars and the Moon) and cloudy bodies with more isotropic scattering (like Venus and Uranus). Our modelling results put Earth in line with strongly backscattering Mars, while our empirical results put Earth in line with more isotropic scattering Venus. We identify potential weaknesses in both the modelled and empirical results and suggest additional steps to determine whether this technique could distinguish upright multicellular life on exoplanets.

This paper follows up from a previous study on this topic and outlines the second part of a wider, two-part study on the information seeking behaviour (ISB) of law students. Exploratory work was outlined in a previous publication17 and there we found that although mobile technologies offered benefits to law students seeking information for their academic studies, there was concern from law librarians that the use of electronic resources via both non-mobile and mobile interfaces resulted in a loss of skills required for information retrieval due to the increasing capabilities of electronic resources’ search interfaces. To gain more insight into how law students were using mobile information resources, and better understand the advantages and disadvantages of such, we extended our study to a wider cohort and employed more research techniques including a focus group. This final phase of our study was conducted between 2015 to 2017. Here our cohort included another set of law librarians (13) and a further 54 law students. We expanded our research tools to include 2 thematic questionnaires and a focus group exercise. Our findings discovered that law librarians were concerned with the intangibility of digital formats. Law students remained indifferent to this aspect and valued the speed, multi-tasking and near-ubiquitous accessibility attributes that electronic format use via mobile technologies provided. These learnings and more, with conclusions, are reported in the course of this paper written by Zaki Abbas, Andrew MacFarlane and Lyn Robinson.