OBJECTIVES/GOALS: To date, no reviews have been published combining the topics of pre-operative mental illness and postoperative atrial fibrillation (POAF). For adult cardiac surgical procedures, therefore, this scoping review provides an overview of the published evidence for this novel topic. METHODS/STUDY POPULATION: A combination of MESH terms and text words were used to capture all papers analyzing any risk factors for atrial fibrillation development after any cardiovascular surgery, and thus, 4,203 search results were initially identified. Papers were manually screened for relevance, resulting in 69 articles that analyzed risk factors associated with POAF. As a separate analytical step, all included publications were used to identify additional citations and Web of Science PubMed identification number-based (i.e., PMID) specific backwards citation searches were performed to ensure comprehensive coverage. For each of the three articles analyzed, moreover, these PMIDs were further evaluated using individual google scholar searches to assure no other relevant literature was inadvertently found. RESULTS/ANTICIPATED RESULTS: For the 69 relevant articles found with multivariable risk models predicting new onset POAF during this scoping review, a wide variety of patient risk factors were reported. The statistically significant predictors reported for new POAF included age (57 papers), hypertension (22 papers), tobacco use (15 papers), LVEF-related characteristics (14 papers), COPD (13 papers), and patient gender (13 papers). All other factors were found to be significant 10 times or fewer; importantly, no multivariable models evaluated mental illness-related factors as predictors of new onset POAF. Only 3 articles even considered the potential influence of mental illnesses. DISCUSSION/SIGNIFICANCE: Mentally ill patients have been documented to have increased incidence of cardiovascular disease and adverse cardiac outcomes, however, very few articles evaluated mental illness associations with POAF. This comprehensive review has demonstrated the urgent need for new research focused on mental illness impacts.

Implementation assessment plans are crucial for clinical trials to achieve their full potential. Without a proactive plan to implement trial results, it can take decades for one-fifth of effective interventions to be adopted into routine care settings. The Veterans Health Administration Office of Research and Development is undergoing a systematic transformation to embed implementation planning in research protocols through the Cooperative Studies Program, its flagship clinical research program. This manuscript has two objectives: 1) to introduce an Implementation Planning Assessment (IPA) Tool that any clinical trialist may use to facilitate post-trial implementation of interventions found to be effective and 2) to provide a case study demonstrating the IPA Tool’s use. The IPA Tool encourages study designers to initially consider rigorous data collection to maximize acceptability of the intervention by end-users. It also helps identify and prepare potential interested parties at local and national leadership levels to ensure, upon trial completion, interventions can be integrated into programs, technologies, and policies in a sustainable way. The IPA Tool can alleviate some of the overwhelming nature of implementation science by providing a practical guide based on implementation science principles for researchers desiring to scale up and spread effective, clinical trial-tested interventions to benefit patients.

OBJECTIVES/GOALS: We have created the first-ever database for all patients who have acute peripheral nerve injuries. Our goal is to use this data to construct two clinical scoring systems to facilitate triaging by emergency room physicians by 1.) identifying patients who would likely benefit from a nerve surgery, and 2.) identify patients who are less likely to follow up. METHODS/STUDY POPULATION: Based on 2,606 consult emails from the Washington University in St. Louiss Division of Plastic and Reconstructive Surgery, from 2013 to 2019, we have identified more than 600 patient cases in which patients presented after an injury with any kind of nerve deficit. We have defined nerve deficits as any abnormality on motor or sensory exam of the extremities, excluding those younger than 18 years old and those with other disease processes that may affect function of the peripheral nervous system. Data for these patients was collected from electronic medical records and include handedness, nerve injured, operative details, area deprivation index decile, mechanism of injury, insurance and employment status, and whether injuries were a result of work or violence. RESULTS/ANTICIPATED RESULTS: Our plan is to provide the first descriptive statistics for such a population, as well as multiple regression analysis for our two endpoints, loss to follow up and need for surgery. Following regression analysis, we also look to perform cluster analysis to further study co-occurring clinical and social features that affect our endpoints. We are excitedly awaiting to perform the analysis after the final data has been collected. DISCUSSION/SIGNIFICANCE: Nerve injury is a common symptom of penetrating injuries. Many of the socioeconomic factors associated with increased risk for violent injury are also risk factors for decreased rates of follow up. This problem is particularly worrisome given that nerve repair surgery is only viable as an option to return function within the first year after injury.

Clinical and Translational Science Award (CTSA) hub websites are a critical communication gateway to assist the clinical and translational science community and promote CTSA hub offerings. The objective of this funded pilot project was to create a website and online database for the CTSA consortium that allows users to conduct structured searches among the 50 + CTSA hub websites. The result is CTSA Search Solutions, an online, searchable database that includes access to 50 + CTSA hub websites with 80+ structured search term options and over 800 links collected, organized, and published. Hubs can be searched by name and filtered by a specific CTSA topic, state, region, or even number of years funded to make detailed comparisons with the data identified. The home page for each hub can be accessed directly from the search page. The CTSA Search Solutions online database will allow for a wide breadth of CTSA personnel (core leads, researchers, administrators, communicators, and evaluators) to find consolidated information to learn about specific CTSA hub program highlights, as well as conduct research into program hub outputs and best practices across the nationwide CTSA consortium.

OBJECTIVES/GOALS: At least 15 stroke thrombectomies per proceduralist per year are required for Thrombectomy-Capable and Comprehensive Stroke Centers. We sought to estimate the potential impact of these minimum volume thresholds on geographic access to stroke thrombectomy (ST). METHODS/STUDY POPULATION: Using the Florida State Inpatient Database, we will identify patients discharged with acute ischemic stroke from 2015-2019 and all non-federal facilities that performed ?1 ST procedure per year. We will then calculate the proportion of stroke patients who live within 20, 65, 115, 165 and 200 miles (correlating with estimated ground transport times of 1, 2, 3, 4 and 5 hours, respectively) of centers that perform ST using ArcGIS software and evaluate the impact of varying the threshold ST volume required by each facility on this proportion. We will then perform multiple two proportion z-tests to compare proportions of patients within driving distance over time. RESULTS/ANTICIPATED RESULTS: We hypothesize that over time, and particularly after the pivotal trials of ST were published in 2015, that the number of facilities that perform ST have increased over time, which would increase the geographic access to ST. We also hypothesize that since the Joint Commission set the minimum procedural volume for proceduralists at Thrombectomy-Capable and Comprehensive Stroke Center to 15 per year, this would work to increase regionalization and could work to decrease geographic access to ST. However, we hope to elucidate the net impact of the interplay between these two opposing factors on regionalization of care over time which is currently unclear. DISCUSSION/SIGNIFICANCE: Current ST volume thresholds have focused on technical proficiency but may impact regionalization of care and geographic access to ST. Since access to ST is time-sensitive, a data-driven approach and better coordination on a regional level may be necessary to ensure timely access to ST.

OBJECTIVES/GOALS: Lack of a vehicle and the distant location of supermarkets influence the ease with which people can shop for healthy foods. The aim of this qualitative study is to understand how transportation impacts food access and food purchases of Baltimore residents who do not own an automobile. METHODS/STUDY POPULATION: The Lyft Grocery Access Program was piloted in Baltimore, MD from November 2019 through September 2020. Eligible households resided in Healthy Food Priority Areas, formerly known as food deserts, in south and west Baltimore and also did not own a vehicle. Enrolled households were offered discounted Lyft rides to select supermarkets. Participants for the present study will be purposively recruited via email and phone using contact information that was provided by enrolled households during the pilot program. Each in-depth interview will be conducted via Zoom and recorded, transcribed and analyzed for themes by two trained coders. Data collection and analysis will occur simultaneously. Data collection will cease once data saturation is reached and themes will be derived from the data. RESULTS/ANTICIPATED RESULTS: This study is in progress. Anticipated themes may relate to the food environment, transportation and food access. DISCUSSION/SIGNIFICANCE: Access to healthy foods is an important determinant of health, and how food access is impacted by broader aspects of daily living such as transportation will add to the food access literature. Findings may provide new insights that can help inform food policy and transportation planning in urban communities.

OBJECTIVES/GOALS: Well-appearing febrile infants are a model for exploring communication, bias, and health disparities in the pediatric emergency department (ED). Using mixed methods, we will perform an in-depth analysis of disparities and shared decision making, a potentially modifiable driver of inequities. METHODS/STUDY POPULATION: We will conduct a multicenter cross-sectional chart review study of well-appearing febrile infants 29-60 days old treated in the ED and apply multivariable logistic regression to assess the association between 1) race/ethnicity and 2) limited English proficiency with the primary outcome, discharge to home without lumbar puncture and without antibiotics (standard of care). We will concurrently perform an interpretive study using purposive sampling to conduct interviews with: 1) minority parents of febrile infants and 2) ED physicians. By capturing dyadic data, we will triangulate perspectives to elucidate disparities and bias that can emerge in the shared decision making process. RESULTS/ANTICIPATED RESULTS: Forty member institutions of the Pediatric Emergency Medicine Collaborative Research Committee are participating, providing a projected cohort of 3000 infants. In the 6 months since site recruitment, 235 eligible infants have been entered into the dataset (43% minority race/ethnicity, 6% language other than English), 61% of whom received the primary outcome. Chart review has the benefits of 1) ensuring exclusion of ill infants, 2) providing data on interpreter use that is unavailable in administrative datasets, and 3) allowing an analysis of shared decision making. These findings will inform an interpretive study of parent and provider experiences of bias in shared decision making. DISCUSSION/SIGNIFICANCE: We demonstrate the feasibility of a large-scale manual chart review to analyze disparities within a shared decision making context. Partnered with qualitative scholarship, this research will support the development of communication interventions to mitigate implicit bias in the clinical encounter.

The University of Pittsburgh (Pitt) Clinical and Translational Science Institute (CTSI) and the nonprofit Bidwell Training Center co-developed a new program for translational workforce diversification and development to foster diversity and inclusion in clinical research. The STricklAnd Research Training (START) program provides students in the Medical Assistant program at Bidwell a career path in clinical research. We created a 12-hour didactic package that covers responsible conduct of human subjects research and good clinical practice as an add-on to existing vocational curriculums. Students have the option of completing a clinical research-related externship at Pitt, which includes mentoring, shadowing, and protocol-specific training on a study team whose intention is to hire them as a clinical research assistant. Those who accept a position at Pitt receive continued mentorship, education, and professional development through Pitt CTSI. In the first three cohorts, two of which had access to research externships at Pitt, 92% of students successfully completed the instruction in clinical research. We plan to expand START to new venues to train and hire local community members from diverse backgrounds who can bring their lived experience to research programs.

OBJECTIVES/GOALS: HelpBeatCOVID19.org, a novel self-reporting symptom tracking surveillance system, is based at the University of Alabama, Birmingham. Helpbeatcovid19.org captures social determinants of health (SDOH) data. This presentation will report research in progress to understand the utility of self-reported data with communicable disease outbreaks. METHODS/STUDY POPULATION: Individuals voluntarily completed an online questionnaire at HelpBeatCOVID19.org which captured SDOH data and other disease surveillance variables including zip code, gender, age group, race, ethnicity, symptoms, underlying conditions, type of home (e.g., single-family, mobile home, etc.), and household COVID-19 diagnosis status. The data are stored on HIPAA-compliant servers. De-identified self-reported data were culled from the HelpBeatCOVID19 database, cleaned, sorted, and analyzed by zip code. Using STATA/SE 16.1, we employed regression analysis to determine if there might be any statistically significant associations that could be made based on zip codes, especially where there are health disparities in historically African American neighborhoods in Jefferson County. RESULTS/ANTICIPATED RESULTS: To date, 102,308 people have reported their symptoms in HelpBeatCOVID19. Of those, 77,903 are from Alabama. More than half of the people who completed HelpBeatCOVID19.org reported zero symptoms. However, 19.3% of Alabamians reported having underlying health conditions. Midfield, AL, a predominantly African-American neighborhood (81.1%), has 74.1% of people reporting underlying conditions where the median household income is $38,750. By comparison, Vestavia Hills, AL, a more affluent neighborhood with an 88.8% White population and median household income being $109,485, had more people participating in HelpBeatCOVID19 (3,920), yet a smaller percentage (15.2%) with underlying health conditions. Final results will be reported during the ACTS Conference. DISCUSSION/SIGNIFICANCE: Our analysis of the data reveals that in Jefferson County, AL, a greater number of people in affluent communities participated in the study. Whereas state-wide, a greater percentage of individuals indicated that they had zero symptoms. Identifying self-reported underlying conditions that impact persons with COVID-19 symptoms will be significant.

OBJECTIVES/GOALS: This study examined patterns in helpline call data as the COVID-19 pandemic evolved including the impact of stay-at-home orders, relaxing of restrictive orders, and stages of vaccine uptake, as well as differences in call volume by Chicago neighborhood health indicators. METHODS/STUDY POPULATION: From November 1, 2018 to June 30, 2021, 56 NAMI-Chicago workers accepted 26,173 helpline calls from 9,374 individuals from 438 zip codes across northeastern Illinois with the majority of calls from high poverty Chicago communities. Descriptive and time series analyses examined patterns in call volume related to the onset of the COVID-19 pandemic, Illinois Stay-at-Home Order, and Illinois reopening and vaccine uptake plan relative to comparable times the prior year. Health indicators from the Chicago Health Atlas (https://chicagohealthatlas.org/) were examined to determine patterns related to NAMI call volume and various health indicators at the zip code level. RESULTS/ANTICIPATED RESULTS: Time series analysis indicated the greatest number of calls occurred in 2020; specifically, there was a 212% increase in call volume and 331% increase in repeat callers (three or more calls per caller) during the first and second phase (March 20th to May 28th) of Illinois Stay-at-Home Order from 2019 to 2020. Analysis of the callers primary need indicated NAMI provided resources and referrals to people with unmet basic needs such as housing, food, and access to healthcare during the height of COVID-19 Pandemic in 2020. A series of ANOVAs indicated that individuals from Chicago zip codes with high levels of uninsured rates, poverty rates, households using SNAP benefits, and economic diversity called NAMI significantly more than those with low levels of these health indicators. DISCUSSION/SIGNIFICANCE: Helplines are a much-needed model to assess needs and implement services during public health crises, particularly in communities experiencing economic hardship and stress. Implications for behavioral health service needs both during and following the pandemic will be discussed.

OBJECTIVES/GOALS: To test whether implementing DASH-aligned meals in a congregate meal program, combined with Self-Measured Blood Pressure (SMBP) monitoring, lowers systolic blood pressure in community-living seniors at two senior centers. Secondary Aims included cognitive and behavioral change, and attention to client preferences. METHODS/STUDY POPULATION: The Carter Burden Network (CBN) provides services and congregate meals to older adults in NYC, many with low income, and unmet health needs. Eligible participants at two CBN sites, aged 60 or older and consuming >4 congregate meals/week, were recruited. After baseline assessments, participants received DASH-aligned meals onsite, education on nutrition and BP management, and personal devices and support for self-measured blood pressure (SMBP) monitoring. Primary outcome data (BP measured by health professional) was collected at Month 1, with secondary assessments at Months 3 and 6. Staff downloaded SMBP data regularly. Study surveys tracked cognitive and behavioral changes. Qualitative feedback from a project Advisory Committee, participants and study partners was collected throughout implementation. RESULTS/ANTICIPATED RESULTS: 97 Participants enrolled (49% White, 32% Black, 19% Other races; mean age 73). At Baseline, 67% were overweight/obese; 80% were hypertensive (32% Stage I; 48% Stage 2). Primary outcome: Mean change in systolic BP at Month 1 compared to Baseline, was -4.41 mmHg (n= 61; p=0.07). By multiple regression analysis, change in BP at Month 1 was associated with BMI, age, and baseline blood pressure (p= .02, .04, .00, respectively). SMBP: Mean change in systolic SMBP by End-of-Study was -6.9 mmHg (p=.003). 56% participants completed SMBP through Month 1 and 30% to End-of-Study. Mean frequency of > 1 SMBP measure/day was 3 days/week. Women (n= 22, 88%) and Black participants (n= 15, 60%) were more likely to continue taking their home blood pressure measurements to End-of-Study (p=.002, p=.037, respectively). DISCUSSION/SIGNIFICANCE: This study provides the first data to support the potential of DASH as part of an effective community-implemented program for seniors and demonstrates the feasibility of implementing a multi-component intervention using existing congregate meal programs at senior centers that can reach minority and low-income communities.

OBJECTIVES/GOALS: Over 30% of patients with rheumatoid arthritis (RA) exhibit fibromyalgianess, a symptom cluster associated with increased pain sensitivity. Up to half of RA patients use oral glucocorticoids (GCs) long-term despite their known, dose-dependent toxicity. We examined the association between fibromyalgianess and oral GC persistence in RA patients. METHODS/STUDY POPULATION: We used data from the Central Pain in Rheumatoid Arthritis (CPIRA) cohort to follow participants with active RA on oral prednisone who initiated a new disease-modifying anti-rheumatic drug. We measured fibromyalgianess using the Fibromyalgia Survey Questionnaire (FSQ), previously shown to correlate with key fibromyalgia features often superimposed upon RA. We stratified fibromyalgianess severity as follows: FSQ<8 low, 8-10 moderate, >10 high/very high. We defined GC persistence as GC use at 3 month followup visit. We assessed the association between baseline fibromyalgianess (exposure) and GC persistence at followup (outcome) using multiple logistic regression, adjusted for demographics, RA duration, serostatus, and inflammatory activity measured by swollen joint count and C reactive protein. RESULTS/ANTICIPATED RESULTS: Of 97 participants on prednisone at baseline, 65% were taking prednisone at follow-up. Fifty-seven percent of participants with low baseline fibromyalgianess had persistent GC use, compared to 84% with high or very high fibromyalgianess. After adjustment as outlined above, participants with high/very high baseline fibromyalgianess remained more likely to be on prednisone at follow-up, relative to those with low fibromyalgianess (OR 4.99 [95% CI 1.20 – 20.73]). DISCUSSION/SIGNIFICANCE: In this cohort of patients with active RA, high fibromyalgianess is associated with persistent GC use, independent of inflammatory activity. This finding suggests non-inflammatory pain related to fibromyalgianess may be misclassified as inflammatory pain related to RA disease activity.

OBJECTIVES/GOALS: The A2CPS was funded by the National Institutes of Health (NIH) Common Fund to identify biomarkers and their collective biosignatures (combination of several biomarkers) that predict susceptibility or resilience to the development of chronic pain. METHODS/STUDY POPULATION: The A2CPS includes 2-Multisite Clinical Centers (10 recruitment sites and 6 data collection sites), 1-Clinical Coordinating Center, 1-Data Integration and Resource Center, 3-Omics Data Generation Centers, and representation from the NIH. The A2CPS will recruit a large cohort from 2 different surgical interventions, total knee arthroplasty (n?1800) and thoracotomy (n?1800). This observational study will collect candidate and exploratory biomarkers across the following domains: clinical pain, fatigue, function, sleep, psychosocial, genomics, proteomics, metabolomics, lipidomics, pain sensitivity, and brain imaging. Data will be collected before and up to 3 months after surgery to determine factors that predict chronic pain at 6 months. RESULTS/ANTICIPATED RESULTS: Recruitment started in 2021 following standard operating procedures and is ongoing at both Multisite Clinical Centers. The A2CPS will provide an example of collaborative, multidisciplinary efforts in establishing a data repository consisting of biopsychosocial markers that will be available to the research community to test novel hypotheses. This presentation will describe the conceptual design, study aims, biomarker selection, protocol standardization and study implementation for the A2CPS. An update on study progress and data completeness will be presented. Final results will be reported after study completion which is anticipated by 2024. DISCUSSION/SIGNIFICANCE: Identifying biomarkers and biosignatures that predict high- versus low-risk for the transition to chronic pain will inform future clinical trials, identify novel therapeutic targets, and advance personalized pain treatment strategies; ultimately transforming the prevention and treatment of chronic postsurgical pain.