OBJECTIVES/GOALS: Heart failure (HF) is a clinical condition that notably affects the lives of patients in rural areas. The partnering of a rural satellite hospital with an urban academic medical center may provide geographically underrepresented populations with HF an opportunity to access controlled clinical trials (CCTs). METHODS/STUDY POPULATION: We report our experience in screening, consenting and enrolling subjects at the VCU Health Community Memorial Hospital (VCU-CMH) in rural South Hill, Virginia, that is part of the larger VCU Health network, with the lead institution being VCU Health Medical College of Virginia Hospitals (VCU-MCV), Richmond, VA. Subjects were enrolled in a clinical trial sponsored by the National Institutes of Health (ClinicalTrials.gov: NCT03797001) and assigned to treatment with an anti-inflammatory drug for HF or placebo. We used the electronic health record and remote guidance and oversight from the VCU-MCV resources using a closed-loop communication network to work with local resources at the facility to perform screening, consenting and enrollment. RESULTS/ANTICIPATED RESULTS: One hundred subjects with recently decompensated HF were screened between January 2019 and August 2021, of these 61 are enrolled to date: 52 (85 %) at VCU-MCV and 9 (15%) at VCU-CMH. Of the subjects enrolled at VCU-CMH, 33% were female, 77% Black, with a mean age of 5210 years. DISCUSSION/SIGNIFICANCE: The use of a combination of virtual/remote monitoring and guidance of local resources in this trial provides an opportunity for decentralization and access of CCTs for potential novel treatment of HF to underrepresented individuals from rural areas.

Carbon-rich Asymptotic Giant Branch (AGB) stars are major sources of gas and dust in the interstellar medium. During the brief (∼1000 yr) period in the evolution from AGB to the Planetary Nebula (PN) stage, the molecular composition evolves from mainly diatomic and small polyatomic species to more complex molecules. Using the Submillimeter Array (SMA), we have carried out a spectral line survey of CRL 618, covering a frequency range of 281.9 to 359.4 GHz. More than 1000 lines were detected in the ∼60 GHz range, most of them assigned to HC3N and c-C3H2, and their isotopologues. About 200 lines are unassigned. Lines of CO, HCO+, and CS show the fast outflow wings, while the majority of line emission arises from a compact region of ∼1” diameter. We have analyzed the lines of HC3N, c-C3H2, CH3CN, and their isotopologues with rotation temperature diagrams.

We report a multi-wavelength study of a recent major flare (~ 80,000 Jy at VLSR ~ -98.1 km s−1) of the 22-GHz water maser in W49A. In February 2014, we started monthly monitoring with the Effelsberg 100-m radio telescope. In May 2014, we carried out the nearly simultaneous observations of the 22-GHz transition with selected submillimeter water transitions using the IRAM 30-m telescope (at 183 GHz) and the Atacama Pathfinder Experiment (APEX) 12-m telescope (from 321 to 475 GHz). We have also performed interferometric observations using the NRAO Very Long Baseline Array (VLBA) at 22 GHz and the Submillimeter Array (SMA) at 321 and 325 GHz. One remarkable result is the detection of very high velocity emission features in several transitions. Our data also represent its first detection of the 475-GHz water transition in a star-forming region. Studying these multiple masing transitions in conjunction with theoretical modeling of their excitation not only places strong constraints on the physical conditions of the masing gas but also allows us to study their association with the embedded massive stellar cluster in W49A.

VLBI multi-epoch water maser observations are a powerful tool to study the gas very close to the central engine responsible for the phenomena associated with the early evolution of massive protostars. In this paper we present a summary of the main observational results obtained toward the massive star-forming regions of Cepheus A and W75N. These observations revealed unexpected phenomena in the earliest stages of evolution of massive objects (e.g., non-collimated “short-lived” pulsed ejections in different massive protostars), and provided new insights in the study of the dynamic scenario of the formation of high-mass stars (e.g., simultaneous presence of a jet and wide-angle outflow in the massive object Cep A HW2, similar to what is observed in low-mass protostars). In addition, with these observations it has been possible to identify new, previously unseen centers of high-mass star formation through outflow activity.

Using the Submillimeter Array (SMA) we have imaged for the first time the 321.226 GHz, 1029 − 936 ortho-H2O maser emission. This is also the first detection of this line in the Cepheus A high-mass star-forming region. The 22.235 GHz, 616 – 523 water masers were also observed with the Very Large Array 43 days following the SMA observations. Three of the nine detected submillimeter maser spots are associated with the centimeter masers spatially as well as kinematically, while there are 36 22 GHz maser spots without corresponding submillimeter masers. In the HW2 source, both the 321 GHz and 22 GHz masers occur within the region of ~1″ which includes the disk-jet system, but the position angles of the roughly linear structures traced by the masers indicate that the 321 GHz masers are along the jet while the 22 GHz masers are perpendicular to it. We interpret the submillimeter masers in Cepheus A to be tracing significantly hotter regions (600~2000 K) than the centimeter masers.

We present Very Long Baseline Array (VLBA) proper motion observations of water masers toward two young stellar objects (YSOs) of the W75N(B) high-mass star forming region. These observations (Torrelles et al. 2003) show two objects having a similar spectral type (early-B stars), separated in the sky by 0$0^''$7 (corresponding to 1400 AU at the source distance), sharing the same molecular gas environment, but presenting a strikingly different outflow ejection geometry. One of these YSOs, W75N(B)-VLA 1, has a jet-like outflow at 2000 AU scale, with the water masers moving at velocities of ${\simeq}$20 km s$^{-1}$ along the major axis of the thermal radio continuum jet, while the other YSO has a water maser shell outflow of 160 AU radius expanding at ${\simeq}$30 km s$^{-1}$ in multiple directions with respect to the central compact radio continuum source W75N(B)-VLA 2. Given the small dynamical time obtained for the water maser shell (${\simeq}$13 yr), we propose that in the very early stages of the star-formation process there may exist short lived, possibly repetitive, events associated with very poorly collimated outflows. All these results suggest that outflow collimation is not only a consequence of ambient conditions, but something intrinsic to the evolution of the individual stars, opening the important question of how and when these non-collimated wind ejection events occur in the evolution of YSOs. Although we argue in this paper that W75N(B)-VLA 2 could be in an earlier stage of evolution than W75N(B)-VLA 1, we think that observations at (sub)millimeter wavelengths with angular resolutions of ${\simeq}0^''1$ can provide the key for determining the relative stage of evolution of these two remarkable YSOs.

The Internet has become a very important source of health information. We wanted to determine otolaryngology patients’ access to, and use of, the Internet as a medical information resource, to identify factors that make patients more likely to use it, and to determine how useful they find this information.

A questionnaire survey was completed by patients while waiting for their consultation in the out-patient department of the Royal National Throat Nose and Ear Hospital in London. Five hundred and thirty-five questionnaires were completed. Sixty-four per cent (344/535) reported having access to the Web. Of the 344 with access, 62 (18 per cent) had searched the Web for medical information prior to their consultation. Higher education (p <0.001) and age between 18 and 40 years (p = 0.001) correlated significantly with higher Internet use. Ninety-five per cent planned to use the Internet again.

Approximately one out of five otolaryngology out-patients with Internet access reported having obtained medical information from the Web before their consultation. The majority found it helpful to some degree and were planning to use it again. As clinicians we should be aware ofthis use and the onus should be on ourselves to review these sites in order to guide our patients to sources of reliable and helpful medical information on the Internet.

The objective of this study was to evaluate the safety, efficacy and acceptability to patients of day-case septorhinoplasty. Twenty-nine patients undergoing elective septorhinoplasty in a dedicated teaching hospital day-case unit were asked to complete day surgery questionnaires (DSQ) at six weeks post-operatively. Details of surgery performed, demographic data, readmission rates and complications were collected prospectively. No major complications were recorded. One patient had to be admitted for overnight observation following post-operative bleeding. The DSQ showed that the great majority of patients were satisfied from the day-case setting (satisfaction score 81). This preliminary study showed that day surgery septorhinoplasty was acceptable to the patient and was associated with a very low readmission rate. We believe that in carefully selected young healthy patients it is an acceptable alternative to an in-patient procedure.

Tissue engineering is the development of biological substitutes for the repair and regeneration of damaged tissues. We explain the principles of this emerging field of biotechology. The present and potential applications of tissue engineering technologies in ENT surgery are then reviewed.

We have carried out and recently reported VLBA multi-epoch water maser observations toward Cepheus A with an angular and velocity resolution of 0.5 mas and 0.2 km s−1, respectively. Some of the masers detected previously with the VLA (observations made with angular and velocity resolutions of 80 mas and 1.3 km s−1, respectively) are resolved now into linear/arcuate coherent “microstructures”. These structures, while smaller than the VLA beam, are 6-200 times the size of the VLBA synthesized beam. The morphology and the observed proper motions found in these structures imply three different centers of star formation activity in a region of ⋍ 0.3 radius (⋍ 200 AU). The most remarkable result from these observations is the discovery of an arc of water masers which is perfectly fitted by a circle to one part in a thousand. This arc is expanding and suggests a spherical “puff” of ejected material ejected 33 years ago from a protostar located 600 mas south of the radio jet HW2. This spherical ejection represents a very strong challenge for theoretical studies of star formation.