OBJECTIVES/SPECIFIC AIMS: The purpose of this study was to summarize the existing literature on clinical research competencies and determine what competency assessments currently exist. We also wished to assess which competencies should be included in a research competency assessment tool and to evaluate the validity of current competency assessments. We also examined whether these competency assessments can be used for the purposes of formative and summative evaluation. METHODS/STUDY POPULATION: Prior to conducting our search of the literature, we first compiled a list of search terms (e.g., clinical, research, training, competencies) that could be used to locate articles. We then entered these search terms, in various combinations, on several relevant databases. We evaluated abstracts of the articles revealed by this search to determine whether they met three criteria. The first criterion was that the subjects of the article must be clinical investigators or clinical investigators in training. Relevant disciplines included medicine, public health, nursing, pharmacy, dentistry, and other related fields. The second criterion was that articles should focus on research-based (as opposed to clinical) skills. The last criterion was that research-based competencies (or related terms like skills, abilities, mastery, knowledge) must be assessed in some way. If the abstract suggested that the article met all three criteria, the full article was retrieved and analyzed in-depth. To identify articles that eluded literature search, we then examined the reference section of these articles and examined articles that cited these articles. When no additional articles could be located, the search for articles stopped. Once a pool of potentially eligible articles was identified, the articles underwent peer review by several researchers experienced with clinical research and competency-based education and assessment. Articles that were unanimously judged to meet the criteria were included in the systematic review. RESULTS/ANTICIPATED RESULTS: Approximately 75 articles were selected and reviewed for eligibility. After peer review, we found that only a small fraction of these articles met our criteria for inclusion in the systematic literature review. Our preliminary findings suggest that there are few assessments of clinical research competency and that many of these assessments are poorly validated. DISCUSSION/SIGNIFICANCE OF IMPACT: The findings of the present study suggest that the validation methods used thus far are limited and so the validity of many of these assessments is effectively unproven. Future research on assessments of clinical research competency ought to address these limitations by sampling clinical researchers, using more rigorous validation methods, and by confirming hypothesized factor structures in new samples. The use of better-validated instruments may enhance measurement of trainees’ knowledge and skill levels for the purposes of formative and summative assessment.

OBJECTIVES/SPECIFIC AIMS: Research overview: Providing patient-centered care is increasingly a top priority in the U.S. healthcare system.1,2 Hospitals are required to publicly report patient-centered assessments, including results from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) patient satisfaction surveys.3 Furthermore, clinician and hospital reimbursements are partially determined by performance on patient satisfaction measures.3 Consequently, hospitals and clinicians may be incentivized to improve patient satisfaction scores over other important outcomes.4 Paradoxically then, the pursuit of patient-centered care may lead clinicians to fulfill patient requests for unnecessary and potentially harmful treatments.5 Opioid prescribing during hospitalizations may be particularly affected by clinicians’ seeking to optimize patient satisfaction scores.6,7 Satisfaction with pain care is an important predictor of overall patient satisfaction in the HCAHPS surveys,8,9 and clinicians report increased pressure to fulfill patient requests for immediate pain-relief.10,11 Therefore, clinicians may prescribe opioids to avoid receiving lower patient satisfaction scores.12,13 Furthermore, clinicians lack clear guidance on opioid prescribing for some populations, including non-surgical inpatients, who represent almost half of all hospitalizations.14 To reduce clinicians’ incentive to prescribe opioids as a means of achieving patient satisfaction, the Center for Medicare and Medicaid Services (CMS) temporarily removed questions related to patient satisfaction with pain care from the clinician and hospital reimbursement formulas beginning in 2018.15 Importantly, prior research16-20 has not rigorously tested the hypothesis implied by the CMS policy change: that certain opioid prescribing practices in inpatient pain care are associated with higher patient satisfaction. Objectives: The purpose of this study was to evaluate the association between the receipt/dose of opioids during non-surgical hospitalizations and patient satisfaction measured by the HCAHPS survey. METHODS/STUDY POPULATION: Methods/Study Population: We conducted a pooled cross-sectional study of adults (18 and older) with non-surgical hospitalizations within the 11-hospital healthcare system in a Midwestern state from 2011-2016. Data were extracted from electronic health records and linked to HCAHPS patient satisfaction surveys. We estimated the propensity score for receipt of any opioids during hospitalization and separately the receipt of high dose opioids (≥100 morphine milligram equivalent [MME]) based on patient, encounter, and facility characteristics for all hospitalizations with complete data. We used nearest neighbor matching to construct two matched samples to minimize selection bias and confounding by indication. We used a standardized difference threshold of < 0.1 as an indication of the balance between matched groups. Outcomes were compared with a test on the equality of proportions using large-sample statistics. All analysis was performed in STATA 14.0 analytical software. Main outcomes: We analyzed four dependent variables. Two pain-specific patient satisfaction variables were derived from the responses to the following survey questions: 1) “During this hospital stay, how often your pain was well controlled? (pain control)” and 2) “During this hospital stay, how often did the hospital staff do everything they could to help you with your pain? (pain help)”, with 4-point Likert scale responses ranging from “Never” to “Always.” We also used two global satisfaction measures derived from the responses to the following survey questions: 1) “Using any number from 0 to 10, where 0 is the worst hospital possible and 10 is the best hospital possible, what number would you use to rate this hospital during your stay (overall patient satisfaction)?” and 2) “Would you recommend this hospital to your friends and family (willingness to recommend a hospital)? (4-point scale of “Definitely Yes” to “Definitely No”). Because the responses are not normally distributed, and the response options are truncated, we dichotomized each of these questions following previously published approaches8 and CMS methodology3 (e.g. “always” vs. all other responses or “9 or 10 rating” vs. all others). RESULTS/ANTICIPATED RESULTS: Results: Among 17,691 patients who reported that they needed pain medications during hospitalization in their HCAHPS survey, 43.7% (n=7,735) received opioids. Among the matched sample (n=8,848), 55% were female, 90% were white, 9% were black, 74% were emergency admissions, 29% had a circulatory diagnosis, 92% were discharged home, and the average pain score ranged from 0.2 to 7.1 during the hospital stay. Compared to matched patients hospitalized but did not receiving opioids, those who received opioids did not significantly differ in their rating of pain help (75% of patients without opioids rated that they always received help for their pain versus 75% of patients with opioids; p=.78), pain control (55% of patients without opioids reported that their pain was well controlled versus 54% on opioids; p=.93), willingness to recommend the hospital (69% of patients without opioids reported that they would definitely recommend a hospital versus 71% with opioids; p=.16) and overall rating of their care (47% of patients without opioids rated their hospitalization as 10 versus 46% on opioids; p=.22). DISCUSSION/SIGNIFICANCE OF IMPACT: Discussion: We found no evidence that receipt of opioids is associated with patient satisfaction, including at doses. To our knowledge, this is the first study that used propensity score matching to examine the association between inpatient opioid prescribing practices and patient satisfaction. Furthermore, our sample is unique in the inclusion of patients hospitalized for non-surgical indicators over a five year period in the multi-hospital healthcare system in a Midwestern state. Our findings add to the existing literature which has shown contradictory associations between opioid prescribing and patient satisfaction.16-22 Specifically, few studies that looked at surgical inpatients showed a lack of association between patient satisfaction16,18 and opioid prescribing, whereas others showed that receipt of opioids was associated with lower patient satisfaction.17-20 Our findings may imply that satisfaction with pain care may be achieved without administering opioids to non-surgical inpatients. Alternatively, satisfaction with pain care may not be influenced by opioid prescribing for non-surgical inpatients. Future research should further examine the association between opioid prescribing and patient satisfaction among non-surgical inpatients on a national scale to get a better understanding of the relationship between certain pain care practices and patient satisfaction.

OBJECTIVES/SPECIFIC AIMS: Missing data is a common problem in research studies that may lead to inconclusive or inaccurate results. It may even lead to harm secondary to wrong research conclusions. The purpose of this ancillary study is to measure the differences in missing data following implementation of a variety of mechanisms to improve data quality and documentation in a global quality improvement study. Many of the sites involved in the study were in low-income or middle-income countries with minimal research infrastructure. Missing data is defined as “values that are not available that would be meaningful for analysis if they were observed” (The prevention and treatment of missing data, New Engl J Med 367; 14, nejm.org, October 4, 2012). METHODS/STUDY POPULATION: All study sites used REDCap software to enter various data points including hospital and ICU admission and discharge dates as well as whether items on a Checklist relevant to processes of care in the ICU were reviewed. After initial general data collection phase, we categorized data as “must have” and “good to have.” “Must have” variables were defined as data variables that were essential for the study outcomes. “Good to have” variables would not affect the main outcomes of the study if missing. We measured completeness of data using the in-built REDCap data quality check feature. We used several strategies to encourage reduction of missing data. We initially did random data checks but noted that the amount of missing data was substantial and could not be adequately addressed this way. Second, we created excel sheets highlighting missing data for each site and notified sites. This proved onerous to create and made it burdensome for sites to identify easily where data was missing. Third, we built a custom report form in REDCap specifically able to identify which “must have” data points were missing. This could be easily accessed by the principal investigator at each site and made completing the data forms more straightforward. We encouraged all sites to complete their data collection by sending weekly data reports to each site highlighting the patients with missing data. An instructional YouTube tutorial was also created and the link was shared with all sites to demonstrate how to use the custom built report form in REDCap and how to appropriately fill in the missing data. Since this was a global study, we communicated with sites using a variety of locally favored mechanisms including Zoom, FaceTime, WeChat, WhatsApp as well as email. By harnessing the buy-in of local champions our approach was successful. RESULTS/ANTICIPATED RESULTS: The total number of patients recruited for the CERTAIN study is 4843. The rate of all missing variables improved with the efforts described above. Hospital admission dates were missing in 8.4% pre efforts and 4.2% post efforts (p<0.01). ICU admission dates were missing in 5.5% pre and 2.0% post (p<0.01). Documentation of completion of processes of care (including central line review, urinary catheter review, consideration for blood transfusion) improved significantly from pre to post (p<0.01). DISCUSSION/SIGNIFICANCE OF IMPACT: Missing data can be a problem in all types of research studies. This study provides some preliminary evidence for effective approaches that can reduce the problem of missing data when conducting a global study at sites with limited research infrastructure in place. By addressing the concern about missing data, we can be more confident that our results can be accurately analyzed and interpreted, improving the quality of the research.

ABSTRACT IMPACT: This research highlights Adverse Childhood Experiences as a potential risk factor and intervention target contributing to the disproportionate number of individuals with sickle cell disease affected by asthma, a well-established catalyst to the increased morbidity and mortality impacting this high-risk population. OBJECTIVES/GOALS: Adverse Childhood Experiences (ACEs) are strongly associated with asthma. A disproportionate number of individuals with sickle cell disease (SCD) also have asthma. Asthma is strongly associated with increased SCD morbidity and mortality. This study compared the prevalence of asthma among children and adolescents with SCD with and without ACEs. METHODS/STUDY POPULATION: This retrospective cohort study involved 45 children and 30 adolescents with SCD. ACEs were captured using the Center for Youth Wellness Adverse Childhood Experiences Child and Teen Questionnaires, which encompass the original 10 ACEs as well as 7 (child) and 9 (teen) expert-recommended ('expanded') ACEs. ACE exposures were categorized as: Original 0-1 vs. ≥2; Original + Expanded 0-1 vs. ≥2. Asthma prevalence was compared among ≥2 and 0-1 ACE groups using the chi-square (or Fisher’s exact) test. A binary logistic regression was performed to predict the likelihood of asthma while adjusting for characteristics (age, household income and gender) that were statistically different among ACE comparison groups at baseline. RESULTS/ANTICIPATED RESULTS: Among the 45 child participants, 64% had a history of asthma; whereas 50% of teens had a history of asthma. Asthma prevalence was higher among teens with ≥2 vs. 0-1 Original ACEs (89% v. 33%, p=0.014). A history of ≥2 ACEs remained significant (p=0.024) among teens after adjusting for age, household income and gender. There was no significance in asthma prevalence among child ACE comparison groups. DISCUSSION/SIGNIFICANCE OF FINDINGS: Adolescents with ≥2 ACEs had a higher prevalence of asthma compared to subjects with 0-1 ACE. This study, coupled with the cumulative nature of ACEs and the graded-dose response relationship between ACEs and poor health outcomes, highlight the need for larger, longitudinal studies examining the relationship between ACEs, asthma and SCD outcomes.

OBJECTIVES/SPECIFIC AIMS: To use a systematic and iterative process to develop and refine toolkits to support dissemination and implementation (D&I) research. METHODS/STUDY POPULATION: Participants included research staff from the Dissemination and Implementation Research Core (DIRC), a research methods core from the Institute of Clinical and Translational Science at Washington University in St. Louis, other D&I experts from the University, and national experts from the D&I field. This project used education design research methodology and a systematic and iterative process involving several phases. The first phase (preliminary research and initial development) consisted of analysis of the educational problem and its context, and led to the development of toolkit prototypes and plans for their implementation. In the second phase (development and formative evaluation), toolkits were iteratively evaluated with emphasis on content validity and consistency and effectiveness as perceived by the users. Finally, in the summative evaluation, the toolkits were evaluated based on their use as intended. RESULTS/ANTICIPATED RESULTS: Our team identified the target audience as DIRC customers and investigators from disciplines across the University, and found that resources for beginners to D&I were lacking. The team developed 8 toolkits: (1) Introduction to D&I; (2) How to develop D&I Aims; (3) D&I Designs; (4) Implementation Outcomes; (5) Implementation Organizational Measures; (6) Assessing Barriers and Facilitators; (7) D&I Designs; and (8) Guideline research. These prototypes were iteratively revised for content validity and consistency. Finally, each toolkit was evaluated by two national experts in D&I science, and further refined. DISCUSSION/SIGNIFICANCE OF IMPACT: This systematic and cyclical process led to the development of 8 toolkits to support researchers in D&I science, which are now available on the DIRC Web site. This set the stage for development of new toolkits as additional needs are identified.

OBJECTIVES/SPECIFIC AIMS: To mobilize and engage CHWs/promotores as stakeholders, we aim to promote the capacity for CHWs participate in patient centered research (PCOR) by locally implementing a structured research training curriculum for CHWs. Main Questions: How the process of mobilization and engagement would be implemented at local/state level? What would be project challenges, risks and barriers at each and across sites? What modifications would be made to the initial PCOR for CHWs training curriculum and toolkit based on local feedback from collaborators, in both English and Spanish? What would be lessons learned on mobilization, engagement of, and sustainability for CHW training organizations as partners in PCOR? METHODS/STUDY POPULATION: Measures: Monthly calls and quarterly reports from local organizations on activities, deliverables status, modifications, project implementation challenges/barriers and solutions (experienced and potential) to achieve goals of training 10 PCOR CHW Champions and a total of 360 CHWs/promotores trained in PCOR. Input from Note taker reports, Feedback and Evaluation Forms from training attendees at each session. Co-authorship of team members on dissemination activities (submissions for presentations, posters, blogs entries, webinars). Activities/Procedures: Via a highly participatory, consensus-driven decision-making approach, each of the organizations in the target states provide input into refining the toolkit for local use, select the training champions and develop CHW/promotor outreach and recruitment plans, and deliver the PCOR training to CHWs. In addition, the organizations will also set up a local stakeholder CHW/promotores advisory group. Environmental scan and literature review continues on training content areas to complement field experience in implementing the trainings at local sites. Project information tools developed (info sheet for local organizations, informational slide set to be used at calls and statewide seminars, a templates for flyer for training recruitment, agenda, certificates). FL and TN pilot of the translation of the curriculum, addressing problematic concepts and terms, collecting feedback forms eliciting input on terminology variations across Spanish speaking populations and literacy levels. Project Collaborators: Día de la Mujer Latina, a patient advocacy group in Texas with CHW trainings in several states and Puerto Rico Chula Vista Community Collaborative, a community health empowerment organization in Southern California Progresso Community Center, a Latino-focused health coalition based in Tennessee Florida Community Health Worker Coalition, a statewide partnership dedicated to the support and promotion of the CHW profession in Florida. RESULTS/ANTICIPATED RESULTS: Results: Trainings per State - Y1 Jan- October 2018 Totals: 11 PCOR Champions and 252 PCOR-Trained CHWs in CA-TX-TN Y2 Plans (October 2018-September 2019): Will continue to collect CHW trainee demographic data, CHW certification and patient/patient advocate status. Will conduct qualitative and quantitative analysis of all quarterly reports, Note taker, and trainee Feedback and Evaluation forms. Will reach goal of 360 PCOR-trained CHWs in FL, CA, TX and TN. Will continue to submit abstracts on our story on building patient and stakeholder capacity to participate as partners in patient-centered outcomes research, engagement and mobilization, from topic generation through the dissemination of research results. From evaluation analysis of content and process measures, we will discuss sustainability strategies as shared learning collaborative. DISCUSSION/SIGNIFICANCE OF IMPACT: Challenges/Decision Points Y1: On Mobilization and Engagement: Across partners, different levels of readiness/capacities/structures, and access to local resources Process application for request for content and guest instructor approvals to the Texas Department of State Health Services (DSHS) for CHW and CHW Instructor credit Co-branding of informational products (recruitment flyers, agendas, certificates), slides of Welcome section On Content and Curriculum Development: Address different levels of literacy Format (1-day vs spread, in person/online, prescriptive vs open) Clear distinction between service provision and research; paradigm shift of transfer of skills Inserting examples of unethical health research past activities with both African American and Hispanic/Latino populations Reinstating phases of clinical studies basic information Creating a study research design activity in Chapter 1 CHW role as member of research team Adding PCORI-funded project summary fact sheet per state On translations: Diversity of nuances of meaning in vocabulary for concepts On sustainability: Different degrees of organizational and personal involvement Next for newly PCOR-trained CHWs Meaningfully engaging patients and other stakeholders is increasingly recognized as requisite to generate research findings that are trusted, meaningful, and useful to clinicians, patients, and their families. One key engagement strategy used for engaging specific patients/caregivers and patient advocates in underserved communities is leveraging our partnerships with Community Health Workers (CHWs). Moreover, there is a documented need for higher level of training skills to undertake activities such as community health assessments, program evaluations and clinical studies. University of Miami (UM) along FL partners has successfully developed a 7-hr specialized toolkit on patient-centered research for CHWs and trained 148 CHWs/promotores (original plans were for 100) across the six major statewide regions. Evaluation data resulted in 100% of attendees responses’ as excellent and 99% would recommend it to others. Qualitative comments included “even though the training was tailored for research, I feel that it applies to many other aspects of the CHW role” and “I feel more empowered in my role after hearing explicitly the opportunities…for a CHW to be more involved in the research process”. UM has partnered with stakeholders in FL, Texas, southern California and Tennessee to develop a Spanish version of the PCOR for CHWs Training Toolkit (including a slide deck, Facilitator’s Guide and Student Workbook) that can be culturally and linguistically appropriate, to train local CHWs/promotores as PCOR CHW Champions. Attendees will receive lunch and a certificate of participation upon completion of the module. In turn, they agree to train local CHWs in their region. These 7 credit hrs could be used as credits towards state certification requirements, in states with CHW certification programs. This partnership for the mobilization and engagement of CHWs/promotores aims to strengthen their capacity to be involved in PCOR at the local and national level and increase the organizational capacity of CHW representative organizations in their promotion of PCOR. This type of research aims to help patients and those who care for them make better-informed decisions about the healthcare choices they face every day, guided by those who will use that information. In doing so, CHWs/promotores are contributing to PCOR in addressing health disparities and achieving health equity as a more culturally and linguistically diverse healthcare workforce and PCOR research team members.

OBJECTIVES/GOALS: Limited specialty care within safety net health systems reduces availability of follow-up appointments for chronic conditions. We evaluated patient acceptability of a 6 month series of telemedicine group medical visits for chronic migraine at a county hospital-based clinic as a potential method to improve access to specialty care in this setting. METHODS/STUDY POPULATION: We developed and implemented a pilot program of monthly physician-led telemedicine group visits to provide routine follow-up care for adults with chronic migraine. Visits were conducted through the neurology clinic at LAC+USC medical center, a safety net hospital in Los Angeles and included an educational component, peer support, and the opportunity to address individual needs or refill medications. We assessed headache severity (HIT-6) and mood (PHQ-9) through telephone surveys before and 6 months after patients’ first telemedicine group visit and compared timepoints using paired t-tests. Patient acceptability of the group visits was elicited through focus groups and key themes identified using grounded field theory. RESULTS/ANTICIPATED RESULTS: Baseline data was available for 18/20 pilot participants. Patients were predominantly female (89%) with mean age of 46 (SD 8.6). Mean HIT-6 was 65/78 reflecting a very severe impact on daily life, and mean PHQ-9 was 8.7 reflecting mild depressive symptoms. There was no statistically significant change in either HIT-6 (mean difference 2.36, p=0.34) or PHQ-9 (mean difference 2.09, p=0.12) after group participation. Key themes from the focus groups included lack of prior exposure to other people with similar headache burden and logistical barriers to care, such as difficulty contacting a provider or extended clinic wait times. Primary patient-reported benefits included more frequent access to a provider and peer support. DISCUSSION/SIGNIFICANCE: Telemedicine group visits for chronic migraine are feasible in a safety net context and were well-received by patients. However, this pilot study did not show a benefit of telemedicine group visits for headache control or mood symptoms.

OBJECTIVES/SPECIFIC AIMS: (1) To explain and discuss minority health and health disparities and the mechanisms, for example, individual behaviors and lifestyle, genetics and epigenetics, physical and cultural environment, and clinical events and health care, that lead to health disparities. (2) To explore the intersection between health disparity science and clinical and translational science. (3) To present and discuss the NIMHD Framework and how it can be used to guide multilevel research to address minority health and health disparities. (4) To highlight examples of NIMHD-funded novel and innovative research relevant to clinical and translational research from a health disparities perspective. METHODS/STUDY POPULATION: The NIMHD Research Framework will be introduced that is currently being used by NIMHD to address minority health and health disparity research. The Framework looks at targeted populations in relation to biological, behavioral, physical, and sociocultural environmental domains of influence as well as the health care system. These domains have different levels of influence: individual, family/interpersonal, community, and population. Targeted populations include NIH-designated health disparity populations, that include racial/ethnic minorities, socioeconomically disadvantaged populations, underserved rural populations, and sexual and gender minorities. The following research opportunities are among the many opportunities offered by NIMHD: Disparities in Surgical Care and Outcomes Social Epigenomics for Minority Health and Health Disparities Addressing Health Disparities Among Immigrant Populations. RESULTS/ANTICIPATED RESULTS: Select examples of NIMHD supported minority health and health disparities research that intersects with clinical and translational research will be presented. Candidate examples include: Genetic Architecture of Lupus (SLE) in individuals with Asian ancestry; A Novel Racial Disparity Marker for Risk Prediction in Triple Negative Breast Cancer Patients; Self-Applied Wearable Ultrasound Therapy for Osteoarthritis Management in Rural Central NY; Design and Development of a Multifunctional Self-service Health Screening Kiosk. DISCUSSION/SIGNIFICANCE OF IMPACT: Despite notable improvements gained as a result of medical and scientific advances, there continues to be an alarming disproportionate burden of illness and lack of representation in research among minority and other socially disadvantaged and underserved populations. To meet this challenge, NIMHD is committed to supporting a wide range of clinical and translational research aimed at the development of innovative strategies and approaches to reduce and, eventually, eliminate health disparities. NIMHD’s mission, research priorities, and funding opportunities are relevant to the efforts and interests of clinical and translational scientists, especially those interested in the translation of research findings into interventions, products, and tools that may improve minority health and quality of life, increase adherence to medication and treatment regimens, increase access, and improve the delivery of health services.

In 2016, Duke reconfigured its clinical research job descriptions and workforce to be competency-based, modeled around the Joint Taskforce for Clinical Trial Competency framework. To ensure consistency in job classification amongst new hires in the clinical research workforce, Duke subsequently implemented a Title Picker tool. The tool compares the research unit’s description of job responsibility needs against those standardized job descriptions used to map incumbents in 2016. Duke worked with human resources and evaluated the impact on their process as well as on the broader community of staff who hire clinical research professionals. Implementation of the tool has enabled Duke to create consistent job classifications for its workforce and better understand who composes the clinical research professional workforce. This tool has provided valuable workforce metrics, such as attrition, hiring, etc., and strengthened our collaboration with Human Resources.

OBJECTIVES/SPECIFIC AIMS: The goals of this project are to develop, disseminate, and evaluate an online, self-paced training module designed to help mentors better understand and support their mentees’ motivation. The module introduces learners to the CARES mentoring model, which is rooted in Self-Determination Theory (SDT), one of the leading theories of motivation. According to SDT, an optimal mentoring environment provides support for mentees’ psychological needs for Competence, Autonomy, Relatedness, Equity in extrinsic resources, and Structure (CARES). METHODS/STUDY POPULATION: Content for the CARES online module was drawn from a previously developed two-hour mentor training workshop designed for delivery in a face-to-face, small group setting. Content experts developed a slide deck and speaker notes. These materials were edited, adapted into a storyboard, and translated into a 60-minute interactive online module created with e-learning authoring software (Articulate Storyline). An evaluation survey was developed to assess mentors’ perceived skills gains related to course content (e.g., “Encouraging my mentees to think about how well their psychological needs are being met within the work/training environment,” “Recognizing how diversity, equity, and inclusion can be salient issues that impact a mentee’s motivation”) and mentors’ confidence gains in their ability to implement motivation-focused practices into their mentoring relationships (e.g., “Autonomy: Giving my mentees freedom in deciding what goals to pursue and how they to do their work,” “Competence: Working with my mentees to establish appropriate challenges to stretch their abilities”). The module was beta tested in October 2018 by 11 individuals with experience as mentors and in facilitating mentor training. RESULTS/ANTICIPATED RESULTS: The beta testing process produced useful recommendations for improving clarity of content, visual design, and navigation. Users expressed a high level of enthusiasm for the content, which included a combination of practical information and empirical support for the CARES mentoring model. They also appreciated specific functionality in the module, including the presentation of brief case examples of mentoring scenarios that enhance or diminish motivation, opportunities for self-reflection, and a downloadable guide for initiating conversations with mentees about different domains in the CARES model. Evaluation data (quantitative and qualitative) from beta testers (n=11) are being analyzed. A preliminary examination of these findings found that mentors report gains from before to after the training in their self-perceived skills and confidence levels. Moreover, all expressed an intention to makes changes in their mentoring practices as a result of the training. Comments indicated potential value in offering a follow up face-to-face experience in which mentors can hear from others who have successfully implemented the CARES approach and acquire practice in skillfully implementing the CARES conversation guide with their mentees. DISCUSSION/SIGNIFICANCE OF IMPACT: This innovative e-learning module offers a readily accessible and theoretically driven training approach to help mentors recognize the value of supporting their mentees’ motivation, and become more intentional in implementing motivation-focused practices into their mentoring relationships. In future work, the CARES module will be pilot tested with specific cohorts and in different implementation scenarios (as a standalone training, or combined with other programming) and made available to users nationally with support from the University of Minnesota Clinical and Translational Science Institute and the NIH National Research Mentoring Network.

OBJECTIVES/SPECIFIC AIMS: To establish an in vitro quantitative method for the evaluation of polymeric film disintegration that can be applied to predict in vivo behavior. METHODS/STUDY POPULATION: Two clinically advanced vaginal microbicide film products containing tenofovir and dapivirine were used as model films throughout this work. Films were made using the solvent cast manufacturing method in which polymers, excipients, plasticizer, and APIs were either dissolved or dispersed in water, mixed, and cast on a heated substrate. The novel, quantitative method was developed using a TA.XT Plus Texture Analyzer® (Texture Technologies) in combination with a TA-108S5 fixture and the TA-8A: 1/8″ diameter rounded end ball probe. Exponent® was used as the data analysis software. In this method, the film was placed and secured in the fixture, the probe applied a constant force to the film product, and a biologically relevant amount of fluid was applied to the film. The probe was able to penetrate the film upon disintegration resulting in an applied force of zero at that point. A curve of force Versus time was plotted, and disintegration time was defined as the time between fluid addition until the probe force reached zero. Test parameters were optimized in order to reduce error. Visual observation of film disintegration was conducted in the in vivo macaque model using films that included a water-soluble blue dye for film visualization. Colpophotography was also used to confirm film disintegration. In vitro results were compared with in vivo findings. RESULTS/ANTICIPATED RESULTS: The Texture Analyzer disintegration method developed provided quantitative disintegration times and did not rely on user defined endpoints which is common in many visual disintegration tests. The disintegration method was able to distinguish differences between the 2 clinical film products and produced reproducible disintegration times for the tenofovir and dapivirine films. The tenofovir film had a shorter disintegration time (41.28±2.85 s) compared with that of the dapivirine film (88.3 6±9.82 s). This method was also able to distinguish changes made to these 2 clinical film products in terms of volume and formulation alterations. In vitro and in vivo disintegration times differed by orders of magnitude, with in vitro time being measured in seconds and in vivo time being measured in days, for a variety of factors, mainly the application of constant force to the film product. Regardless of these differences, the rank order of film disintegration remained constant for in vitro and in vivo disintegration and an In Vitro In Vivo Correlation (IVIVC) trend could be seen. DISCUSSION/SIGNIFICANCE OF IMPACT: Standardization of preclinical in vitro assessments which minimize user bias are crucial to the field of pharmaceutical film development. As this field continues to develop and more products advance for pharmaceutical application, this method has the potential to become a standard assessment of film functionality. This study represents a first step in the process of developing an IVIVC. More films will need to be tested using both in vitro and visual methods in order to establish and accurate factor to predict in vivo behavior.

OBJECTIVES/GOALS:

• A web interface that allows for easy upload of CSV text data to time-based visualizations

• Implementation of change points analysis to identify and display points where event rates increased or decreased

• customizable plots where the user can change point shapes, color, etc.

• customizable and advanced filtering support

• support for plot comparisons and exports

METHODS/STUDY POPULATION: We used the R/Shiny framework to develop a web application for visualization of time stamped data. The Research and Exploratory Analysis Driven Time-data Visualization (READ-TV) application allows for user-friendly mining for longitudinal patterns in data. READ-TV is built specifically for FD analysis, but is easily adaptable to other clinical use cases, as we allow for the use of general metadata on events and cases.The building of a quantitative framework for event analysis starts with the application of homogeneous Poisson processes, which relate the times of occurrence of events in terms of an underlying rate. To understand the changes in this underlying rate, changepoint analysis is used to model the rate as a function of time using piecewise constant approximations. The changepoint analysis allows us to identify the specific periods of time where the rate of FD is increased relative to a baseline or a desired operating range. RESULTS/ANTICIPATED RESULTS: READ-TV application allows for import of time stamped event data from multiple cases. Event and case metadata are supported to facilitate filtering and mining of interesting subsets of data. Stem plots are used for visualization of selected event timelines in chosen cases. This visualization is accompanied with summary of the number and estimates of rates of occurrence of specific event types (e.g. types of FD). Change-point analysis is implemented using the ‘changepoint‘ R library. These analyses allow the users to quickly understand whether the rates of events (FD) is changing across the case timeline and where exactly these changes are occurring. DISCUSSION/SIGNIFICANCE OF IMPACT: We have demonstrated the READ-TV application to the team of the AHRQ-funded Human Factors and Systems Integration in High Technology Surgery (HF-SIgHTS) study. The ability to visualize and perform quantitative analysis of the study data was received with unanimous positive feedback and enthusiasm. We continue READ-TV development focusing on (1) increased user-friendliness using the HF-SIgHTS as our focus group, (2) increased functionality, and (3) use of more general localization terminology to allow for other applications.

OBJECTIVES/GOALS: Asthma is a significant health concern that affects people of all ages worldwide. EAS demonstrates many of the pathophysiological characteristics of nonatopic human asthma, which has led EAS to be used as naturally occurring model. Previous work from our lab determined that MARCKS (Myristoylated Alanine Rich C Kinase Substrate) protein is an essential regulator of cellular inflammatory functions. In the current study, we hypothesized that MARCKS levels would be increased in BAL cell lysates from horses with EAS, and that inhibition of MARCKS in zymosan-stimulated BAL cells (ex vivo) would diminish respiratory burst. METHODS/STUDY POPULATION: Lysates were prepared from BAL cells isolated from horses with no, mild/moderate and severe EAS. Relative MARCKS protein levels were determined using equine specific MARCKS ELISA (MyBioSource). Cultured BAL cells were pretreated with a MARCKS inhibitor peptide (MANS), control peptide (RNS) or vehicle control and stimulated with zymosan for 5 hours. Reactive oxygen species levels were determined by luminescence to evaluate respiratory burst. Data were analyzed by One-way ANOVA (p<0.05). RESULTS/ANTICIPATED RESULTS: We determined that normalized MARCKS protein expression is significantly increased in BAL cell lysates from horses with mild/moderate or severe EAS, compared to horses with normal BAL cytology. Preliminary findings also suggest that MANS treatment of zymosan-stimulated equine BAL cells ex vivo attenuates levels respiratory burst. DISCUSSION/SIGNIFICANCE OF IMPACT: These findings point to a possible role for MARCKS protein in the pathophysiology of EAS and support MARCKS inhibition as a potential therapeutic strategy.

OBJECTIVES/GOALS: Thiswork is an evidential study that demonstrates the positive impactof integrating Community Health Workers (CHWs) and SocialDeterminants of Health on an important health outcome, notably in decreasing the 30-day unplanned hospital ED readmissions at Sinai Health Systems. METHODS/STUDY POPULATION: Using datafrom the Sinai Urban Health Institute (SUHI), we compare predictingthe readmissions of patients with and without data pertainingto Social Determinants of Health (SDoH). We thoroughly describe the data cleaning and data pre-processing, done in collaboration with experts in community health. We use a fundamental and ubiquitous classifier in Random Forest for its feature characterization capability in order to translate models results into insights and recommendations for the CHW program. RESULTS/ANTICIPATED RESULTS: We show that when patients are simply engaged byCHWs, regardless of the content of those conversations, we canincrease the predictive accuracy of our classifier by 5%. We usethis result to make recommendations for improving patient careand discuss limitations and future work. Importantly our workpoints directly to the human connection between patients andCHWs as an important feature in the readmission rate. DISCUSSION/SIGNIFICANCE: Our work shows that the predictive capabilities of the classifier increases with CHW logs and SDoH survey data, highlighting the benefit of collecting this information. This is the first step in early identification of such patients so that CHWs are focusing on and providing resources to patients who will most benefit from the program.

OBJECTIVES/SPECIFIC AIMS: To access obesity risk perceptions, knowledge and behaviors of Hispanic taxi cab drivers and develop a better understanding of the factors that influence health outcomes in this population. METHODS/STUDY POPULATION: Focus groups were conducted at NYC H+H/Lincoln, where subjects were screened and recruited from taxi bases with the help of the local Federation of Taxi Drivers. This was done by utilizing flyers, messages through taxi-base radios, and referrals from livery cab drivers. Approval from the local Institutional Review Board was obtained. The research investigators, developed a structured focus group procedural protocol of open-ended interview questions related to cardiovascular disease. Participants for the focus groups were older than 18 years old and working as livery cab drivers in NYC for at least 6 months. Three focus groups were held with informed consent obtained from each participant in their primary language before the start of each session. After completion of the focus group, participants received a gift voucher for attending the approximately 1-hour session. Focus groups were moderated by trained research staff members at Lincoln. Three main categories of questions were organized based on perception, knowledge, and behavior. Participants were questioned on topics about obesity, CVD and diabetes knowledge; knowledge about etiology, risk perception, possible prevention and interventions. Responses were recorded using audiotapes and transcribed verbatim. If participants did not elaborate on the initial question, a probing question was asked to clarify. The transcript was translated from Spanish by trained bilingual staff and analyzed using standard qualitative techniques with open code method. Four research investigators read the transcript separately and formulated concepts, which were then categorized and formulated into dominant themes. These themes were then compared and analyzed with a group consensus to ensure representative data. Once recurring themes emerged and the saturation point was reached, the study concluded, after enrolling 25 participants. The Health Believe Model (HBM) was employed to understand and explain the perceptions and behaviors of taxi drivers. HBM is one of the most widely recognized models and is used to understand, predict and modify health behavior. HBM helps to identify perception of risks of unhealthy behavior, barriers for having healthy behavior, actions taken by patients to stay healthy, self-efficacy and commitment to goals [12]. RESULTS/ANTICIPATED RESULTS: Of the 25 Hispanic livery cab drivers, 92% were male. The majority of taxi drivers that participated in the study were immigrants (96%), with a mean age of 53 years (ranged 21–69), and 92%, were spoke Spanish. In total, 52% participants identified themselves as Hispanic, 20% White, 4% Black, and 20% did not identify their race. Mean body mass index (BMI) was 31 (22.8–38.7) kg/m2. In all, 56% were obese and another 40% were overweight. From this sample, 50% had been diagnosed with hypertension and 27% were living with diabetes. In all, 64% had a high school education or higher. Answers provided by the taxi drivers to focus group questions were recorded, reviewed and divided into 8 dominant themes based on concepts that emerged from the focus groups discussions. (a) Focus group study findings: Themes recorded during the focus group discussions, include poor diet, sedentary lifestyle, comorbidities/risk factors, stress, health not being a priority, discipline, education, and intervention. Participants shared their opinions in regards to these themes with minimal differences, making an emphasis on the fact that the nature of their profession was the root cause. Of the themes, the top 3 dominant themes include poor diet, sedentary/lifestyle and comorbidities/risk factors. (1) Diet: The theme “Poor diet” evolved from 151 related concepts that were described by participants. All 25 participants perceived their diet as bad due to eating high-fat meals associated with the cultural food and restaurant chains with lower food prices and ease of car parking. Drivers also reported that they did not have enough time to eat healthy foods based on their long working hours. They say: “comemos muy tarde por que preferimos montar un pasajero” … stating that they preferred to pick up passengers and delay their meals. However, they consider poor diet as the most decisive factor in their increased risk for obesity, diabetes, and hypertension. (2) Life Style: The theme “Sedentary lifestyle” was derived from 147 similar concepts described by participants. They believe that physical inactivity is another leading risk factor for obesity, diabetes, and CVD. The demands of the profession force them to drive more than 10 hours per day. They understand the importance of daily exercise but they admit that at the end of the workday they are too tired to exercise or “stop working” to participate in exercise as this means less money. They also understand that family history of obesity in addition to poor diet increases their risk of obesity, diabetes, and cardiovascular risks. (3) Comorbidity: The theme “Comorbidities” developed from 143 concepts grouped together. Taxi-drivers perceived that obesity complications directly affects many vital organs, such as the kidneys, the heart, and vasculature. Participants perceive obesity as important risk factor for high blood sugar and cholesterol levels. Taxi drivers see an association between their health condition and their work as a taxi driver. However, taxi-drivers reported that they are more concerned about the economic well-being of their families than themselves. Taxi-drivers begin to intervene in their own health only when more serious health conditions related to obesity, diabetes, and hypertension developed. (4) Work Stress: The theme “Stress/other risk factors” was derived from 141 concepts. Taxi-drivers perceive their profession with lack of organization and high-stress levels as one of the leading risk factors contributing to obesity, diabetes, and cardiovascular disease. They also attribute a combination of stressful lifestyle, poor diet, lack of exercise, consumption of alcohol and cigarettes as determining factors in developing negative health outcomes. “One participant says; Tenemos el paquete completo” … we have the entire package. (5) Health as a priority: The theme “Health is not a priority” was derived from 120 concepts based on the cab drivers’ responses. Taxi drivers prioritize their work while their health takes a back seat. They work long shifts as they feel the pressures of financial responsibilities of their family. They admitted lack of intentions to change their behavior and they consider themselves as “hard headed.” Drivers changed their behavior only when serious health conditions develop that require professional medical attention. Taxi drivers explain that the lack of time as being a big factor in pursuing preventative care. (6) Personal Discipline: The theme “Discipline” evolved from 80 concepts derived from the driver’s transcripts. Taxi drivers are aware of their lack of organizational skills in general, especially when it comes to the balance between work and a healthy lifestyle. Taxi drivers recognize that not being disciplined results in the development of their obesity and chronic health conditions. Drivers admit that they do not have a fixed schedule, with no direct supervision, and cannot find the time to go to the doctor or change their behavior. (7) Health Education: The theme “Education” was derived from79 concepts noted from the focus group discussion. Taxi drivers know that their lack of health education is affecting them. With little understanding about the severity of the disease process it is difficult to take proactive measures. They are interested in the development of programs that will educate them about obesity, diabetes and CVD prevention. They want to attend programs that can educate them about prevention of obesity, diabetes, and CVD prevention with strong focus on healthy eating. They understand that this would increase their ability to change their unhealthy behavior. (8) Health interventions: The last major theme “Intervention” was derived out of 71 concepts. When asked about possible interventions that might help them towards healthy behaviors, taxi drivers think that the use of technology as a means of education is very effective. They understand the most direct route to reach them is by cellphone, email, and social media such as Facebook. They also feel that it would be good to use this type of communication to not only to inform them about health issues, but to also educate them directly. (b) Application of Health Behavior Model: We employed the HBM, one of the most utilized and easy to understand health models (18, 20–22) to explain the knowledge, perception, and health behaviors of our study participants. The HBM consist of 6 posits: (1) risk susceptibility, (2) risk severity, (3) benefits of action, and (4) barriers to action, (5) self-efficacy, and (6) cues to action [23]. According to the HBM, people’s beliefs about their risk and their perception of the benefits of taking action to avoid it, influence their readiness to take action [15, 21–22, 24]. Using the HBM, health behavior can be modified positively if the 6 posits are perceived by the person [23]. According to the results of our study, taxi drivers that participated in our study, do not perceive the severity of their risk. Participants admitted that they go to the doctor and start paying attention to their health condition only when they get seriously sick. Another posit of the HBM, understanding benefit of actions, is also not perceived by taxi drivers. Participants understand that they should be involved in physical activity, but do not pursue physical activity. They stated that they are too busy and tired to exercise daily without realizing the benefits of having a healthy life style. Findings from the focus groups also demonstrate that taxi drivers do not possess self-efficacy, as they are not confident that they are able to change their own health behavior. They openly admitted to having poor discipline, lack of organizational skills, and lack of time management skills. But, they expressed their wish to get information about time management, healthy snacks, places where they can get affordable and healthy food, learn more about different physical activities, and places where they can exercise. The sixth posit of the HBM model is the cues for action which should trigger the action to change behavior. Cues such as physical pain or illness in them or family members of cab drivers, trigger a visit to the physician’s office. Cab drivers were open to receiving educational material provided by physicians or health information provided on TV/cellphone about disease prevention. DISCUSSION/SIGNIFICANCE OF IMPACT: Obesity is steadily on the increase in the US population and has become a major public health concern [1–3]. Latinos are at the higher risk of heart diseases such as obesity, hypertension compared to other ethnical groups [3, 13]. There is a higher prevalence of obesity among particular occupational groups with cab drivers having one of the highest obesity prevalence among all professions [5, 7–9, 13]. Obesity risks therefore seem to affect NYC cab drivers who are of Latino background more than others. Surveys conducted in different countries in Asia, Europe, and Africa reported that taxi, truck, and bus show that drivers are at a higher risk of developing obesity, diabetes, and hypertension [5, 8–11]. This study is the first to evaluate the knowledge, perception, and behaviors of NYC Latino taxi cab drivers with respect to obesity. The study uncovers factors and barriers that contribute to their behavior, and identify possible ways that can modify their behavior and decrease their chances of developing obesity. The study results demonstrated that Latino immigrant taxi drivers perceive themselves at a high risk for obesity development. As the result of discussions with focus groups, the eight dominant themes were identified. Participants perceive their risk susceptibility and understand that working as a driver is a sedentary occupation with lack of physical activity significantly contributing to obesity development. Additionally, taxi drivers report that their unhealthy diet is a major factor that contributes to their weight gain. Taxi drivers perceive their poor diet as the result of the food they consume being high in fat content. Due to financial constraints and their cultural diet requirements, they feel limited to unhealthy food options. They acknowledge the risk that poor diet contributes to obesity, high cholesterol, obesity development. Participants also expressed that work stress is another important factor. Busy traffic, lack of organization, financial stress to support their families-push them to work prolonged hours. Participants also admitted that in their leisure time, they use alcohol, smoke cigarettes, and watch TV, instead of going to the gym, because they feel too tired to exercise. Taxi drivers perceive their barriers as a lack of education and knowledge about healthy food choices, places where they can buy healthy affordable snacks, information about physical activities, stress management skills, and organizational skills. Other perceived barriers that prevent them from leading healthy lifestyle include lack of discipline, lack of time for physical activity, economic uncertainty, financial responsibility and the perception that the wellbeing of their families is more important than themselves and their health. HBM is a widely used model that helps to identify perception of risks of unhealthy behavior, barriers to healthy behavior, actions taken by patients to stay healthy, self-efficacy, and commitment to goals. Based on the Glasgow theory, the core of health behavior models is the identification of the barriers and self-efficacy [25]. Our study is unique as it involves using the HBM to explain the basis of taxi cab drivers’ behavior. Results of our research study showed that our participants perceived barriers very well. However, lack of self-efficacy, lack of perceiving benefits of action, lack of cues to action, and lack of understanding the risk of disease severity explain why taxi drivers have greater risk for obesity among occupations, and are not ready to embrace health behavior modification. This qualitative study shows us where the window of opportunity for intervention lies, how we can intervene and modify the health behavior of the at-risk NYC Latino cab driver population. By Glasgow theory, self-efficacy is an important factor in behavior modification models [25]. If the barriers that are perceived by participants as too high, and self-efficacy is low, one can intervene by improving self-efficacy. Bandura has offered ways to increase patients’ self-efficacy by using three strategies: (a) setting small, incremental, and achievable goals; (b) using formalized behavioral contracting to establish goals and specify rewards; and (c) monitoring and reinforcement, including patient self-monitoring by keeping records [20]. We can also improve perception of the benefits of action by providing cues to action namely education during the office visits, by providing reading materials, and the use of modern technology (emails, interactive Web sites, apps, etc.). A study was conducted in South Asia, encouraging taxi drivers to exercise through the use of pedometers [7]. This study provides an example of ways to motivate taxi drivers, improve their self-efficacy, overcome barriers, and provide cues to action. As one of the theories that can explain and help in behavioral modification, the Health Belief model includes the impact of the environment and elements of social learning. Using this model, we were able to differentiate and identify the factors that influence their behavior that need to be addressed by health care workers and public health representatives to improve obesity related risks among inner city taxi cab drivers in NYC.

OBJECTIVES/SPECIFIC AIMS: Our objectives with this project are to engage communities through technology creating a communication channel with affected communities and stakeholders about mosquito-borne illness, vector control and environmental health risk. Furthermore, engaging communities to electronically map ecological risks that impact mosquito-borne illness with the goal of creating a mobile application that will work as an ecological surveillance against mosquito proliferation and potential mosquito population reduction, and finally pilot test and evaluate potential benefits in communities where the application was used. METHODS/STUDY POPULATION: We propose a methodology to perform formative community work that will underscore a distributed, democratized ecological surveillance through an integration of multidimensional health behavior theories that address the challenges of ZIKV in Culebra, a marginalized island community off the coast of the main island of Puerto Rico. Using participatory design, we will develop, test, and evaluate users’ experiences towards mobile applications using qualitative (interviews) and quantitative (survey) methodologies. A mobile application with the capacity of mapping, use of social-media, crowdsourcing, and photo-voice in a dynamic and simple way will allow community members to alert “hot-zone” locations to the stakeholders interested in creating ecological action in their community. This multidimensional concept integrates explanatory and prospective approaches and will generate systematic short-term solutions for mosquito control and long-term solutions providing the necessary tools for community empowerment. RESULTS/ANTICIPATED RESULTS: Our proposed design will facilitate better understanding of the interactions between community members and socio-environmental determinants of mosquito-borne diseases. Furthermore, our proposed project will not only facilitate communication among members of a community, but also it will provide a platform for engagement and empowerment, establishing a change in the preventive paradigm of how communities face the negative impacts of micro-ecologies that surround them. DISCUSSION/SIGNIFICANCE OF IMPACT: Our proposed community collaboratory mHealth tool mZAP! (Zonas, Accion y Proteccion) will address the lack of community participation efforts against mosquito-borne diseases contributed simultaneously by the disengagement and disempowerment of community members. mZAP! will serve as an innovative tool to engage marginalized and communities made vulnerable in Puerto Rico. This approach should be successful as Puerto Rico is one of the most digitally connected countries in Latin America, with high mobile phone usage rates and social media use. Using mZAP!, communities will report and map breeding sites, use social media and crowd sensing, targeting against powerful tools against mosquito ecologies in their own environments. This application could result in an effective way to change the paradigms for public health approaches to use Information Communications Technologies (ICTs) to empower communities.

OBJECTIVES/SPECIFIC AIMS: The purpose of the current study is to determine predictors of linkage-to-care (LTC) outcomes among patients screened for hepatitis C virus (HCV) infection in the emergency department (ED). The study is one of the first to report the impact of factors influencing medical eligibility for HCV treatment. By establishing predictors of linkage outcomes, we hope to characterize patients at highest risk of being lost to follow-up. This information can be used to guide the development of targeted interventions and optimize linkage efforts at institutions with similar programs. METHODS/STUDY POPULATION: In 2013, we implemented an opt-out HCV screening program targeting baby boomers presenting to the ED. The screening program was expanded in 2015, and all patients who presented to the ED (an academic ED with 73,000 annual visits) between 2015 and 2018 were offered an HCV antibody test. Confirmatory RNA tests were ordered for all patients with a positive screening test, and those with confirmed infection were contacted (when possible) by a linkage coordinator, who sought to facilitate linkage to outpatient care. Patients were followed until they had been successfully linked to care or were lost to follow-up; successful linkage was defined as a patient attending a scheduled HCV clinic visit. Linkage outcomes (linked vs. not linked) among confirmed cases were analyzed based on previously described LTC barriers, sociodemographic factors, and factors influencing HCV treatment eligibility. Binary multiple logistic regression was used to model the relationship between predictors and LTC outcomes. RESULTS/ANTICIPATED RESULTS: Between August 2015 and June 2018, 48,947 patients were screened for HCV, yielding 4,026 positive results. HCV infection was confirmed in 1,798 patients, 1,651 of whom were eligible for the current study. By July 2018, 884 eligible patients (53.5%) had been successfully linked to care. Odds of linkage failure were decreased among patients with known linkage barriers including mental health disorders (adjusted odds ratio [aOR], 0.28; 95% confidence interval [CI], 0.21-0.37), active substance abuse (aOR, 0.65; 95% CI, 0.47-0.91), and ‘competing’ medical comorbidities (aOR, 0.31; 95% CI, 0.21-0.47); however, odds of linkage failure were increased in the presence of medical comorbidities leading to ineligibility for HCV treatment (aOR, 21.71; 95% CI, 7.02-67.13). Decreased odds of linkage failure were also found among patients belonging to the baby boomer population (aOR, 0.64; 95% CI, 0.46-0.91) and individuals with HBV co-infection (aOR, 0.36; 95% CI, 0.14-0.94). Finally, odds of linkage failure were increased among patients without health insurance (aOR, 1.952; 95% CI, 1.01-3.79) and with public health insurance (aOR, 2.140; 95% CI, 1.08-4.24). While African-American patients exhibited decreased odds of linkage failure in bivariate analyses, this association was not significant in the multivariate analysis. Variables ultimately found not to be predictive of linkage outcome included race, ethnicity, gender, homelessness, and incarceration. DISCUSSION/SIGNIFICANCE OF IMPACT: In contrast with current trends in the literature, our analysis found that patients with any of three well-described linkage barriers (mental health disorder, active substance abuse, and ‘competing’ comorbidities) exhibited decreased odds of linkage failure. It is possible that knowledge of these barriers by linkage personnel led to increased persistence of efforts for such patients, resulting in improved linkage among patients with these barriers. However, another possibility is that individuals with factors such as a mental health disorder or medical comorbidity were more likely to experience a clinical encounter, during which discussions about HCV treatment could take place. It is also possible that other contributing factors were unaccounted for by our analysis, such as internal programmatic issues, patient education and income levels, marital status, or other ‘destabilizing’ factors that would reduce a patient’s likelihood of being contacted by a linkage coordinator. While patients with general medical comorbidities were less likely to experience linkage failure, patients who were ineligible for HCV treatment due to a medical comorbidity were significantly more likely to experience linkage failure. While this finding is intuitive, it is nonetheless troubling, as we would expect patients with severe medical comorbidities to benefit greatly from health counseling, mental health services, substance abuse treatment, or other resources available through linkage. As a result of this finding, we intend to adapt our approach to medically ineligible patients, emphasizing the availability and potential usefulness of such resources. It is unsurprising that uninsured and publicly insured patients were less likely to be successfully linked to care, as HCV treatment continues to be associated with significant financial costs for such patients. However, it is also possible that confounding factors such as education and income level, which were not included in our analysis, would be more predictive of patients’ ability or willingness to undergo HCV treatment. More research is needed to improve linkage-to-care for patients with HCV. In the near future, we intend to conduct an internal evaluation, as well as a positive deviance analysis of other LTC programs, to determine additional ways to improve linkage outcomes for all patients screened for HCV in the ED.

OBJECTIVES/GOALS: Multivariate regression is used for surgical outcomes analyses; but does not allow for evaluation of all variables. Machine learning could be the perfect alternative to address this issue. Our aim was to evaluate whether machine learning is a feasible alternative to evaluate surgical outcomes. METHODS/STUDY POPULATION: H-CUP National Inpatient Sample database was queried for adult patients with colorectal cancer who underwent colorectal resection, while the NSQIP database was queried for adult patients with rectal cancer who underwent proctectomy. A multivariate regression analysis was performed to assess risk factors associated with 30-day complications following those procedures. Subsequently, machine learning techniques of under-sampling and oversampling were applied to the same datasets for the evaluation of risk factors for the same outcome. These techniques were used to achieve a larger population sample size and to detect statistical significance. Results between the two methodologies were compared. RESULTS/ANTICIPATED RESULTS: Multivariate regression revealed that open approach, gender, race, geographic location, number of comorbidities, and type of insurance was associated with increased 30-day mortality in colorectal resection patients. Conversely, the use of machine learning revealed that preoperative weight loss, preexistent chest heart failure, renal failure or perivascular disease were strongly associated with 30-day mortality. For proctectomy patients, multivariate regression found no association between surgical approach and 30-day mortality. However, machine learning revealed gender, hypertension, and reoperation to be strongly associated with 30-day mortality. DISCUSSION/SIGNIFICANCE OF IMPACT: Machine learning enabled multiple combinations that were not possible to examine in a conventional multivariate regression analysis. Machine learning compared to traditional multivariate regression produced significantly different outcomes, highlighting the need for in depth of these methodologies.