Arterial oxygen saturation in single ventricle patients is dependent on systemic cardiac output. Here, we describe a case of a newborn with single ventricle physiology and an unusual mechanism to explain poor cardiac output and cyanosis. This case highlights the importance of identifying and considering ventricular morphology and ventricular-ventricular interactions to understand clinical challenges.

Observations of radiocarbon (14C) in Earth’s atmosphere and other carbon reservoirs are important to quantify exchanges of CO2 between reservoirs. The amount of 14C is commonly reported in the so-called Delta notation, i.e., Δ14C, the decay- and fractionation-corrected departure of the ratio of 14C to total C from that ratio in an absolute international standard; this Delta notation permits direct comparison of 14C/C ratios in the several reservoirs. However, as Δ14C of atmospheric CO2, Δ14CO2 is based on the ratio of 14CO2 to total atmospheric CO2, its value can and does change not just because of change in the amount of atmospheric14CO2 but also because of change in the amount of total atmospheric CO2, complicating ascription of change in Δ14CO2 to change in one or the other quantity. Here we suggest that presentation of atmospheric 14CO2 amount as mole fraction relative to dry air (moles of 14CO2 per moles of dry air in Earth’s atmosphere), or as moles or molecules of 14CO2 in Earth’s atmosphere, all readily calculated from Δ14CO2 and the amount of atmospheric CO2 (with slight dependence on δ13CO2), complements presentation only as Δ14CO2, and can provide valuable insight into the evolving budget and distribution of atmospheric 14CO2.

OBJECTIVES/GOALS: Our overall objective is to investigate the relationship between radiologic features of meningioma with recently identified histopathological and molecular biomarkers, and to apply a machine learning (ML) approach to further demonstrate their utility in predicting clinical outcomes. METHODS/STUDY POPULATION: We have enrolled a cohort of 84 patients with meningioma diagnosed on the basis of conventional gadolinium-enhanced MRI imaging features since September 2019. Each patient has demographic and clinical data, Ga-68-DOTATATE MRI/PET SUV and dynamic metrics, DCE-MRI perfusion parameters, and histopathologic data. Various tumor subregions will be segmented semi-automatically and later confirmed by experienced neuroradiologist. Histopathologic data will include histologic grade, mitotic rate, Ki67 proliferative index, and presence of WHO established atypical histologic features, immunohistochemical parameters, and established high-grade molecular features. We will use supervised learning techniques to develop algorithms for predicting molecular features from imaging phenotypes. RESULTS/ANTICIPATED RESULTS: Anticipated results - advancements in understanding the molecular biomarkers of meningiomas has uncovered genetic alterations and epigenetic changes that more accurately determine tumor behavior. Currently, the imaging correlates of these molecular biomarkers are unknown, and utilizing radiographic data to predict prognosis and imaging-based classifications of meningiomas have not yet been investigated. Validated imaging correlates of molecular biomarkers not only provide an in-vivo assessment of tumor biology, but can also be integrated with histopathologic features ( radiopathomics models’) for more accurate disease prognostication. We anticipate that our results will identify surrogate imaging features for some of the recently emerged molecular biomarkers of meningioma. DISCUSSION/SIGNIFICANCE: There is a paucity of data on the importance of imaging phenotypes in determining tumor biology. This work has the potential of significant clinical impact by enabling a priori molecular characterization of meningiomas at the time of new diagnosis or recurrence, thereby allowing a personalized medicine approach to treatment planning.

OBJECTIVES/GOALS: Particulate matter (PM) and metabolic syndrome (MetSyn) increase risk of World Trade Center-Lung Injury (WTC-LI). Mediterranean-type diets have also been found to improve lung function. Fire Department of New York 1st-responders with a high PM exposure at WTC and MetSyn may have improved lung function after a Mediterranean dietary intervention. METHODS/STUDY POPULATION: Food Intake REstriction for Health OUtcome Support and Education (FIREHOUSE) randomized clinical trial (RCT) assessed our hypothesis that a low-calorie Mediterranean (LoCalMed) intervention targeting clinically relevant disease modifiers will improve metabolic risk, subclinical indicators of cardiopulmonary disease, quality of life, and lung function in firefighters with WTC-LI. Primary-outcome targeted a LoCalMed loss of BMI(≥1kg/m2). Secondary-outcomes included lung function, quality of life, and cardiovascular health. Male firefighters with WTC-LI and a BMI>27kg/m2 were randomized to: 1. LoCalMed (n=46); or 2. Usual Care (UC; n=43). Clinicaltrials.gov:NCT03581006. RESULTS/ANTICIPATED RESULTS: LoCalMed’s estimated efficacy on BMI reduction crossed the pre-specified significance boundary on interim analysis compared to UC. In addition, improvements were observed in secondary-outcomes of lung health (FEV1 and FVC), inflammation (WBC), vascular disease (DBP), quality of life (SF-36, health perception) and dietary habits (less cholesterol, carbohydrates, fats, and sweets and increased protein) in the LoCalMed arm. DISCUSSION/SIGNIFICANCE: LoCalMed significantly decreased BMI and alleviated adverse health outcomes in our WTC-exposed first responders. A fully powered RCT is required to determine if this approach is efficacious for the treatment of WTC-associated pulmonary disease, as well as LoCalMed’s generalizability to PM associated disease.

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.

Fructose (C6H12O6) is acutely obesogenic and is a risk factor for hypertension, cardiovascular disease, and nonalcoholic fatty liver disease. However, the possible long-lasting effects of early-life fructose consumption have not been studied. We tested for effects of early-life fructose and/or wheel access (voluntary exercise) in a line of selectively bred High Runner (HR) mice and a non-selected Control (C) line. Exposures began at weaning and continued for 3 weeks to sexual maturity, followed by a 23-week "washout" period (equivalent to ∼17 human years). Fructose increased total caloric intake, body mass, and body fat during juvenile exposure, but had no effect on juvenile wheel running and no important lasting effects on adult physical activity or body weight/composition. Interestingly, adult maximal aerobic capacity (VO2max) was reduced in mice that had early-life fructose and wheel access. Consistent with previous studies, early-life exercise promoted adult wheel running. In a 3-way interaction, C mice that had early-life fructose and no wheel access gained body mass in response to 2 weeks of adult wheel access, while all other groups lost mass. Overall, we found some long-lasting positive effects of early-life exercise, but minimal effects of early-life fructose, regardless of the mouse line.

Among 46 infants colonized with vancomycin-resistant Enterococcus faecium during an outbreak in a neonatal intensive care unit, the estimated time until half had achieved clearance was 217 days. All 40 infants who completed follow-up cleared carriage by 1 year. No predictors of prolonged carriage (> 6 months) were identified.

We characterized 57 isolates from a 2-phase clonal outbreak of New Delhi metallo-β-lactamase–producing Eschericha coli, involving 9 Israeli hospitals; all but 1 isolate belonged to sequence-type (ST) 410. Most isolates in the second phase harbored blaKPC-2 in addition to blaNDM-5. Genetic sequencing revealed most dual-carbapenemase–producing isolates to be monophyletically derived from a common ancestor.

Background: Two affiliated teaching hospitals in Chicago, Illinois, participated in an ethnographic study of hospital-based inpatient antimicrobial stewardship programs and interventions between 2017 and 2018. Although antimicrobial stewardship is now a requirement in medical practice, it is not clear how infectious disease physicians perceive and understand antimicrobial stewardship. Over a period of 18 months, we directly observed infectious disease practice to better understand how antimicrobial stewardship is conducted among physicians within the same specialty. Methods: A doctoral candidate medical anthropologist conducted semistructured interviews with infectious disease attending physicians and fellow physicians (N = 18) at 2 affiliated teaching hospitals in Chicago, IL, between July 2017 and March 2018 as part of an ethnographic study involving direct observation of inpatient care. Interview questions focused on 3 key domains: (1) descriptions of antimicrobial use among hospital-based physicians, (2) solicited definitions of antimicrobial stewardship, and (3) experiences practicing as an infectious disease consultant. Physicians who were directly involved with the antimicrobial stewardship program were excluded from this analysis. Transcriptions of the data were analyzed using thematic coding aided by MAXQDA qualitative analysis software. Results: Infectious disease physicians have a robust understanding of antimicrobial stewardship (Table 1). Infectious disease physicians described other hospital-based physicians as regularly overusing and misusing antimicrobials, compared with their practice, which they described as “thoughtful.” Definitions in response to the question “What is antimicrobial stewardship?” centered on guiding the prescribing behavior of others. Infectious disease physicians valued stewardship and were concerned with lack of adherence to antimicrobial prescribing recommendations among other hospital-based physicians, behaviors which infectious disease physicians viewed as perpetuating antibiotic resistance. Finally, infectious disease physicians found serving as antimicrobial stewards during their everyday practice to be challenging based on their role as consultants to the primary service. Conclusions: Our qualitative analysis revealed that infectious disease physicians not regularly involved in antimicrobial stewardship are highly motivated stewards who perceive their hospital-based colleagues to be less effective at appropriately prescribing antimicrobials. As consultants, infectious disease physicians are not autonomous decision makers. However, as antimicrobial stewardship programs search for champions, infectious disease physicians could be better utilized as knowledgeable and motivated individuals who can make the case for stewardship.

Funding: None

Disclosures: None

OBJECTIVES/GOALS: Metabolic syndrome (MetSyn) is a risk for World Trade Center-Lung Injury (WTC-LI; defined as developing FEV1<lower limit of normal [LLN]). Metabolic health is a modifiable disease risk factor. We propose to characterize how time-dependent covariates of MetSyn are longitudinally associated with WTC-LI. METHODS/STUDY POPULATION: WTC-particulate exposed firefighters, consented, with pre-9/11 FEV1 LLN (N = 5,746). Data assessed from last pre-9/11 till August 1, 2017. Longitudinal MetSyn characteristics were assessed using 3 models: i. A linear mixed effect model to assess the effect size of longitudinal MetSyn and its components on longitudinal FEV1% predicted as an outcome; ii. a time-dependent Cox regression to assess the associations of MetSyn to time of onset of WTC-LI; iii. a novel, partially linear single index regression model with repeatedly measured MetSyn to assess their joint effects and delineate their relative contribution on the longitudinal lung function in the WTC-FDNY cohort. RESULTS/ANTICIPATED RESULTS: In Model I, BMI 30 kg/m2 had the largest effect size compared to ever-smoking, with −2.524 (95%CI: −2.708,−2.340) compared to −1.681(−2.325,−1.038) respectively. Having MetSyn, defined as 3/5 risk factors, had an effect size of −2.319(−2.526,−2.112). In Model II, hazards of triglycerides 150mg/dL were highest at 1.497(1.336, 1.677), followed by BMI 30 kg/m2 at 1.406(1.256, 1.575), and HDL<40mg/dL 1.355(1.176-1.561), compared to ever-smoking (1.201, p = 0.002). Having high exposure to PM by being present in the morning of 9/11 was a significant covariate only in Model II investigating HDL<40mg/dL or triglycerides 150mg/dL. Model III The proposed methods will be applied to our cohort study. DISCUSSION/SIGNIFICANCE OF IMPACT: MetSyn is both a predictor and concurrent marker of WTC-LI. The single index model can not only reduce dimensionality of the covariates, but also provides efficient estimates of the joint MetSyn effects, allowing linear or nonlinear effects. Future studies will investigate dietary intervention as a potential disease-modifying factor. CONFLICT OF INTEREST DESCRIPTION: NA, nothing to disclose.

We compared the yield of culturing various body sites to detect carriage of carbapenem-resistant Acinetobacter baumannii (CRAB). Culturing the skin using a premoistened sponge, with overnight enrichment and plating on CHROMagar MDR Acinetobacter, had the highest yield: 92%. Skin is satisfactory as a single site for active surveillance of CRAB.

Recent political contests across Europe and North America have been propelled by a wave of populist, anti-immigrant resentment, and it was widely expected that these populist victories would further fan the flames of xenophobia. This article reports the results of an experiment around the Brexit referendum, designed to test how populist victories shape anti-immigrant attitudes. The study finds that anti-immigrant attitudes actually softened after the Brexit referendum, among both Leave and Remain supporters, and these effects persisted for several months. How could a right-wing, populist victory soften anti-immigrant attitudes? The authors use causal mediation analysis to understand this ‘populist paradox’. Among Leavers, a greater sense of control over immigration channelled the effects of the Brexit outcome onto anti-immigrant attitudes. Individuals' efforts to distance themselves from accusations of xenophobia and racism explains the softening of attitudes towards immigration observed among both Leavers and Remainers.