OBJECTIVES/GOALS: To evaluate the association of maternal delivery history with a brachial plexus birth injury (BPBI) risk in subsequent deliveries, and to estimate the effect of subsequent delivery method on BPBI risk. METHODS/STUDY POPULATION: We conducted a retrospective cohort study of all livebirth deliveries occurring in California-licensed hospitals from 1996-2012. The primary outcome was recurrent BPBI in a subsequent pregnancy. The exposure was prior delivery history (parity, shoulder dystocia in a previous delivery, or previously delivering an infant with BPBI). Multiple logistic regression was used to model adjusted associations of prior delivery history with BPBI in a subsequent pregnancy. The adjusted risk (AR) and adjusted risk difference (ARD) for BPBI between vaginal and cesarean delivery in subsequent pregnancies were determined, stratified by prior delivery history, and the number of cesarean deliveries needed to prevent one BPBI was determined. RESULTS/ANTICIPATED RESULTS: Of 6,286,324 infants delivered by 4,104,825 individuals, 7,762 (0.12%) were diagnosed with a BPBI. Higher parity was associated with a 5.7% decrease in BPBI risk with each subsequent delivery (aOR 0.94, 95%CI 0.92, 0.97). Previous shoulder dystocia or BPBI were associated with 5-fold (aOR=5.39, 95%CI 4.10, 7.08) and 17-fold increases (aOR=17.22, 95%CI 13.31, 22.27) in BPBI risk, respectively. Among individuals with a history of delivering an infant with a BPBI , cesarean delivery was associated with a 73.0% decrease in BPBI risk (aOR=0.27, 95%CI 0.13, 0.55), compared with an 87.9% decrease in BPBI risk (aOR=0.12, 95%CI 0.10, 0.15) in individuals without this history. Among individuals with a previous history of BPBI, 48.1 cesarean deliveries are needed to prevent one BPBI. DISCUSSION/SIGNIFICANCE: Parity, previous shoulder dystocia, and previously delivering a BPBI infant are associated with future BPBI risk. These factors are identifiable prenatally and can inform discussions with pregnant individuals regarding BPBI risk and planned mode of delivery.

Objectives/Goals: The emergency department (ED) is a critical locus of care for mechanically ventilated patients. Emergency physician (EP) perceptions and decision-making on sedation for these patients have not been studied. We seek to characterize EP decision-making on sedatives. Methods/Study Population: This is a preliminary report of a single-center survey study. We surveyed senior residents and attending EP scaring for patients enrolled in an ongoing prospective cohort study of ED sedation. Surveys were delivered electronically. Respondents were asked to provide demographics, impressions effectiveness of the sedative infusions they administered, occurrence of related adverse events (AE), and ranking of factors influencing their decision-making. Respondents were also asked if they considered using other sedative infusions (propofol [PRO], fentanyl [FENT], dexmedetomidine [DEX], ketamine [KET], and midazolam [MDZ]), and why they chose not to use them. The use of bolus-dose sedatives was not assessed. Results/Anticipated Results: From October 2024 through September 2025, 174 surveys were sent and 127 completed (73%). PRO was most commonly used (94%), followed by FENT (51%) and DEX (14%). Effectiveness was highest for PRO (84% “somewhat” or “very” effective; FENT 75%, DEX 72%). The leading AE was hypotension (PRO 32%, DEX 17%). Effectiveness was the most important decision-making factor, familiarity the least. DEX, FENT, KET, and MDZ were considered but not used in about 25% of cases. Emerging themes from free-text comments included perception of under-sedation as an AE and influence of medication accessibility. Discussion/Significance of Impact: EPs perceive PRO as effective but associated with frequent AE, usually hypotension. Perceived effectiveness drives sedative selection. Our findings will inform the design of interventions to optimize ED sedation.

ABSTRACT IMPACT: Evaluate the impact that the Kidney Allocation System has had on racial and ethnic disparities in pediatric deceased donor kidney transplant recipients. OBJECTIVES/GOALS: Racial and ethnic minority pediatric transplant candidates have known disparities in access to kidney transplantation. The Kidney Allocation System (KAS), implemented in 2014, was designed in part to alleviate some of these disparities thereby making transplant more equitable. We investigated the effect of KAS on reported disparities. METHODS/STUDY POPULATION: We utilized Scientific Registry of Transplant Recipients (SRTR) data to determine differences in new waitlist registrants, deceased donor (DDKT) and living donor kidney transplants (LDKT), HLA mismatch, and allograft survival among pediatric patients of different racial and ethnic backgrounds. RESULTS/ANTICIPATED RESULTS: Black pediatric patients represented 21.3% of new waitlist registrants pre-KAS and 18.9% post-KAS. Waitlist time increased for pediatric patients of all races post-KAS with the highest increase (131 days) in Asian patients (p < 0.01). The racial distribution of DDKT pre- and post-KAS was unchanged (White 38.4% vs 38.3%, Black 24.5% vs 22.5%, Hispanic 30.6% vs 31.1%, Asian 3.7% vs 4.4%, p = 0.12). The 3-yr graft failure rate is disproportionately worse in Black children compared to other races pre- and post-KAS (White 6.8% vs 5.3%, Black 14% vs 8.7%, Hispanic 8% vs 4.5%, Asian 6.6% vs 6.7%, Other 6.5% vs 2.9%) although there is a trend towards better graft survival in the post-KAS era. Graft survival worsened in Asian children in the post-KAS era (HR 2.34,95% CI 1.05 - 5.25, p=0.038). DISCUSSION/SIGNIFICANCE OF FINDINGS: Racial and ethnic disparities in pediatric ESRD patients have not been ameliorated by KAS. Children of color have longer waitlist time and are more likely to have graft failure. Alarmingly, allograft failure rate increased in Asian patients post-KAS, which merits further evaluation.

ABSTRACT IMPACT: Advanced spatial analysis techniques are used to target a community education intervention for Immigrant and African American women to increase breast cancer screening. OBJECTIVES/GOALS: We are addressing breast cancer screening disparities through the development of the COmmuNity kNowlEdge to aCtion Toolkit (CONNECT). CONNECT implements a mixed-methods approach using GIScience, community education, and social media to mitigate the impact of breast cancer screening disparities for Immigrant African and African American women. METHODS/STUDY POPULATION: We used advanced spatial analysis techniques, Spatially Adaptive Filters (SAF) to reveal mammography screening rates below the state level. SAF create screening maps of This new information allows lay health educators to identify and engage their communities in the Breast Cancer Champions program. We transformed and curated existing cancer educational material into culturally relevant educational training for lay health educators. Lay health educators participate in educational trainings and receive stipends for conducting formal and informal breast cancer education and screening events. RESULTS/ANTICIPATED RESULTS: We have identified four principles for designing culturally relevant education materials.

1. 1. Visual representation of the community in materials

2. 2. Positive Framing

3. 3. Statistics and graphs should be minimal

4. 4. Appropriate reading level and minimizing jargon

Due to COVID-19, our breast cancer champions are engaging with their community in socially responsible ways (i.e., engaging through social media, developing and placing community education flyers, community radio spots). Our social media campaign, which began in October has already attracted over 1000 followers. DISCUSSION/SIGNIFICANCE OF FINDINGS: Despite the disruption of COVID-19, our project continues reduce breast cancer screening disparities. We have developed and created culturally appropriate materials and are currently training Champions. By incorporating an online presence into our community outreach, we are increasing the ways we connect with our community.

OBJECTIVES/GOALS: This study aims to assess the outcomes of a new virtual multidisciplinary immune-related toxicity (IR-tox) team implemented at Johns Hopkins Hospital. In particular, to understand if the IR-tox team’s input reduced the number of inpatient hospitalizations for irAEs for referred patients. METHODS/STUDY POPULATION: Since August 2017, nearly 250 patient referrals to the IR-tox team have been created and stored in an electronic database. Through retrospective chart review, hospitalization and irAE management data will be collected for these patients to assess whether rates for suspected irAEs have decreased. These rates will be compared against historical controls. We will assess the features of hospitalized patients, their immunotherapy regimens, and management to identify high-risk groups who may require early intervention. Additionally, we aim to understand what patient features are associated with IR-Tox team referral and subsequent hospitalization. RESULTS/ANTICIPATED RESULTS: The IR-tox team provided a new multidisciplinary channel to help physicians diagnose and manage complex irAEs. The goal of the team was the reduce the number of irAE-related hospitalizations as, historically, 85% of high-grade irAEs have required hospitalization. A clinically meaningful reduction is defined as lowering the hospitalization rate to 75%. Planned analyses includes calculating the hospitalization rate, using descriptive statistics to summarize patient features, multivariate analyses to understand features associated with both IR-Tox team referral and hospitalization, and computing the relative risk reduction to assess the efficacy of subspecialist referral implementation. DISCUSSION/SIGNIFICANCE OF IMPACT: IrAEs are challenging to diagnose and treat. They contribute to a notable proportion of hospitalizations in those treated with immunotherapy. With expanding use of immunotherapy, widespread implementations of IR-Tox teams may help reduce hospitalizations and costs associated with care for irAEs.

OBJECTIVES/SPECIFIC AIMS: Focus groups are being conducted to describe and identify barriers and/or facilitators to Hispanic males’ health literacy, culture, and language related to cervical cancer prevention practices METHODS/STUDY POPULATION: A purposive convenience sample was recruited to participate in focus group sessions with English or Spanish speaking Hispanic males 21 years of age and older. Groups were segmented by age (21–29, 30–39, 40–49, and 50–65), and language (English or Spanish). Focus group discussions (n=8) were led by a bilingual/bicultural female researcher using a discussion guide that followed Zarcadoolas et al. (2005) health literacy model 6 as related to their partners’ cervical cancer screening and prevention practices. All sessions were audio-recorded and transcribed verbatim. Participants completed standardized questioners regarding demographic data and their health literacy. Qualitative content analysis was used for analyzing focus group interviews. RESULTS/ANTICIPATED RESULTS: Preliminary qualitative analysis shows the struggle Hispanic males’ face accepting cervical cancer screening for their female partners. One participant reported that it was “a clash of cultures.” A “clash of cultures” was described as a constant struggle and acceptance between science, personal knowledge, and Hispanic cultural taboos. DISCUSSION/SIGNIFICANCE OF IMPACT: Hispanic male’s health literacy, communication, language preferences, and cervical cancer risks, will further enhance the knowledge needed to design intervention measures for cancer prevention among Hispanics. Understanding the factors that contribute to the unequal burden of cervical cancer incidence and mortality among Hispanic women in South Texas is critical to prevent cervical cancer among this population.

OBJECTIVES/GOALS: The objectives of this presentation are to discuss 1) the implementation of Consent to Contact at an Academic Medical Center; 2) the access to lists of potential participants by study teams; and 3) the challenges and adjustments made to the initial conceptualized process. METHODS/STUDY POPULATION: Participant recruitment is critical to the success of all research studies. It is particularly challenging when investigators do not have a patient population from which to recruit. Thus, the University of Miami launched the CTC initiative in 2016 to facilitate study recruitment. Study investigators can request access to a registry of participants who agreed to be contacted and meet the initial study eligibility criteria. A multidisciplinary Operational Committee provides oversight and regulates access to the CTC registry. RESULTS/ANTICIPATED RESULTS: The registry has over 110K patients who have agreed to be contacted for eligible research studies. The demographic distribution of the patients in the registry mirrors the diversity of the UHealth population. As of January 2018, when the registry became available to the research community, 25 study teams from different departments, including the All of Us Research Program, have requested potential participant lists. The process of requesting access to patient lists is adapted to studies’ needs, with particular reference to sensitive populations, such as HIV/AIDS, substance abuse, etc. Results on utilization and satisfaction of the CTC initiative are being collected and will be presented. DISCUSSION/SIGNIFICANCE OF IMPACT: The CTC initiative allows UHealth patients to opt-in to the registry for research studies. The Operational Committee continues to monitor the successful consent of patients to participate in individual research studies and improving the request process.

OBJECTIVES/GOALS: Childhood survivors of ALL are at considerable risk for late effects which are exacerbated by excess weight. The proposed study involves the adaption and evaluation of the first empirically supported intervention for childhood survivors of ALL that is consistent with all national recommendations for the treatment of childhood obesity. METHODS/STUDY POPULATION: The proposed intervention will be adapted from family-based behavioral weight loss treatment (FBT) a multicomponent intervention which targets diet, activity, behavioral skills, parenting, and social facilitation among children and their parents. The Framework for Reporting Adaptations and Modifications-Enhanced structure (FRAME), a dissemination and implementation framework, will guide the adaptation, allowing for the incorporation of feedback previously gathered from key stakeholders. A single-arm, non-randomized trial of the adapted intervention will then be conducted to evaluate its acceptability, feasibility, and preliminary indications of efficacy including measures of relative weight change and associated health-related behaviors among 40 childhood ALL survivors and their families. RESULTS/ANTICIPATED RESULTS: Self-reported feedback from families at the end of treatment (EoT) is anticipated to demonstrate that this intervention will be regarded as both acceptable and feasible. Other measures of feasibility will include attendance and retention rates, which are expected to reflect to those of previous FBT trials (92% and 85%, respectively). Preliminary indications of the efficacy of the adapted intervention will be investigated through the comparison of a series of measurements taken at both baseline and EoT. Changes in relative weight will be assessed and are expected to meet a previously established range of clinically meaningful reduction in child percent overweight of 9 units or more. Improvements in dietary intake, physical activity, and health related quality of life are also anticipated. DISCUSSION/SIGNIFICANCE: Knowledge gained from the implementation of the first evidence-based intervention adapted for childhood survivors of ALL will be critical to the justification of a larger-scale, randomized controlled trial and holds promise to effectively modify the risk for chronic disease among a vulnerable population.

Objectives/Goals: Dissemination and implementation scientists often conflate or confuse pragmatic trials and effectiveness-implementation trial designs. This study evaluates the barriers and facilitators affecting these scientists’ collaborative work to design, plan for, and conduct these different kinds of trials. Methods/Study Population: This is a sequential mixed-methods study. For the quantitative evaluation secondary data collection and surveys of roughly 200 investigators constituting an Implementation Science Network were carried out to identify research needs and impacts associated with the Translational Science Benefits Model. Surveys were prepopulated with respondents’ grant awards and prompts to define the study designs being used. Interviews of respondents are being conducted to identify barriers and challenges they faced in conducting different implementation trials and to develop case studies of their resultant research agendas. A peer-reviewed interview protocol designed for Clinical and Translational Research Institutes to conduct case studies of translational research is being used for this qualitative evaluation. Results/Anticipated Results: The 182 ISN members submitted 1590 research proposals since 2020, 52% of which were funded. ISN members responding to surveys (N = 30) self-identified many of these studies as being Hybrid 3 (29%), Hybrid 1 (17%), or Pragmatic trials (7%), although the largest proportion included studies classified “other” (33%), and some could not be classified (12%). Surveys of ISN members also indicated that many want to conduct pragmatic trials (36%) or hybrid trials (8%) but need more opportunities to collaborate (19%). Twelve (40%) ISN members agreed to be interviewed and another 11 (37%) indicated that they would do so in fall 2024 if available. Initial findings suggest that regular interactions with colleagues helped investigators new to the field understand how varied study designs could advance their implementation science. Discussion/Significance of Impact: These findings will show how U-M implementation scientists collaborate to conduct implementation trials. If the kinds of barriers faced by investigators differs by trial type, research supports and initiatives can be tailored to better support all implementation scientists in the CTSA Consortium.

OBJECTIVES/GOALS: African-Americans are at increased risk for nutrition disparities; home cooking is a strategy to optimize dietary quality. to develop a cooking intervention, a mixed-methods community-based participatory, acceptability study was conducted to understand cooking behaviors, options for intervention content, and implementation factors. METHODS/STUDY POPULATION: Self-identified African-American adults were recruited from a larger community-based study within Washington, D.C. Five moderated virtual focus groups with four participants in each group were conducted in March and April of 2021. A semi-structured moderator’s guide focused on cooking, meal habits, food choices, and the proposed cooking intervention was utilized. Qualitative data collected were verbatim transcriptions and notes from research team members. Thematic analysis was conducted using an iterative process among research team members. Participant validation interviews were conducted following the research team analysis. Electronic self-administered surveys were used to measure demographic, food environment, cooking behavior, health behavior, and psychosocial variables. RESULTS/ANTICIPATED RESULTS: Study participants (n=20 females, mean age 60.1 years) lived in low-food resource neighborhoods but reported high food security (n=14). Barriers to the intervention included traveling distances to other neighborhoods for produce, poor quality of vegetables and fruit within neighborhood stores, lack of trustworthiness from neighborhood store experiences, perception of decreased cooking skills, and competing priorities related to time and weekday schedules. Motivators included health promotion for self, family, community, and enjoyment from cooking. Virtual or in-person sessions were suggested. Intervention options included costs of recipe ingredients, using recipes with ingredient flexibility, nutrition information, and provisioning of or compensation for ingredients used in virtual classes. DISCUSSION/SIGNIFICANCE: Use of virtual focus groups for a participant-based design of a cooking intervention among African American adults living in low-food access neighborhoods provided acceptability results that were food and home environments contextual and provided barriers and motivators to participation and implementation of behavior from the intervention.

OBJECTIVES/SPECIFIC AIMS: To explore associations among bio-psychosocial factors predictive of overall physical and mental health status as assessed using the SF-12 Health Survey. METHODS/STUDY POPULATION: Community-dwelling, male and female elders with peripheral arterial disease (PAD) were administered an assessment battery to identify factors associated with self-assessed physical and mental health status using the SF-12 Health Survey. The battery included an assessment of pain, depressive symptoms, perceived social support, perceived psychological stress, physical function, as well as selected demographic variables. RESULTS/ANTICIPATED RESULTS: Preliminary linear regression analyses have identified several factors predictive of physical and mental health status including depressive symptoms, pain, perceived stress, and physical function. A more in-depth examination using path analysis is anticipated to reveal important mediational associations, wherein physical function is a strong mediator between bio-psychosocial factors and overall physical and mental health status. DISCUSSION/SIGNIFICANCE OF IMPACT: Aging is often associated with a reduction in physical and mental well-being, frequently exacerbated by the development and progression of chronic disease. PAD is a common chronic condition that places significant burden on the older patient and their family. Identifying and developing a more in-depth understanding of the factors that impact health status in PAD is an important and timely objective. We anticipate that our findings will inform development of more targeted and effective intervention strategies we can employ to improve the quality of life among elders struggling to manage PAD.

OBJECTIVES/GOALS: The present work aims to use baseline data to identify demographic, clinical, and psychosocial factors associated with patients who receive analgesic benefit from temporary neurostimulation. METHODS/STUDY POPULATION: This study presents baseline data from our descriptive, prospective, longitudinal study. Consecutive patients who present to the University of Arkansas for Medical Sciences Interventional Pain Management Clinic for implantation of a neurostimulation device, have met clinical criteria for implantation of a neuromodulation device, and are able to speak and understand English are invited to participate. Prior to the placement of the temporary stimulator, each patient completes demographic and symptom-related questionnaires. Clinical characteristics are obtained through medical record review. RESULTS/ANTICIPATED RESULTS: We anticipate enrolling 50 participants in order to have 30 patients that report analgesic benefit from temporary neurostimulation. Variability in demographics, clinical characteristics, and psychosocial factors will be reported between patients who receive and those who do not receive analgesia following temporary neurostimulation. Gender differences will also be reported. DISCUSSION/SIGNIFICANCE: Despite the use of varying outcome measures, studies to date have not incorporated validated patient reported outcomes or controlled for key demographic and clinical characteristics. Our analysis evaluates clinical and psychosocial variables associated with successful temporary neurostimulation.

Objectives/Goals: The CTSA at the University of Michigan, MICHR, has conducted a sequential mixed-methods needs assessment of a network of over 250 dissemination and implementation scientists working at the university. The purpose of this evaluation is to identify the research training needs of this network and to inform efforts to improve the networks’ productivity. Methods/Study Population: An IRB-approved sequential mixed-methods needs assessment of a network of over 250 dissemination and implementation scientists was conducted. First, surveys were sent to all members of the network using Qualtrics. This survey was designed to measure the challenges and facilitators encountered by members of this network, using response categories aligned with the Translational Science Benefits Model (Luke et al., 2018) to facilitate the identification of programmatic improvement goals. The survey also asked questions regarding network members’ training preferences, and their current plans to design specific types of implementation science clinical trials (Fortney et al., 2024). Survey respondents also indicated their availability for subsequent interviews to explore their career and training paths. Results/Anticipated Results: Surveys were sent out to over 250 individual members of the Implementation Science Network supported by MICHR. This network includes 249 U-M employees representing 44 departments or units, 7 individuals from Veterans Affairs and 16 from other Institutions, and of these 32 individuals (11%). Despite this low response rate, the results clearly indicated that accessing D&I training/educational resources, or learning about relevant measures, metrics and testable strategies was a major barrier to 71% of network members, with 61% particularly interested in training on developing and testing strategies. Most respondents (54%) reported that having more financial resources was a facilitator of their work and 62% volunteered to be interviewed about their careers. Interviews are being conducted and analyzed. Discussion/Significance of Impact: The results of this evaluation suggest dissemination and implementation scientists need more formal training programs, specifically ones focused on the selection of implementation strategies for testing in pragmatic and hybrid clinical trials. This work provides a rigorous and reproduceable methods for CTSAs to conduct needs assessments.

OBJECTIVES/GOALS: Patients on chronic opioids face gaps in transitions of care in the time following surgery, increasing the risk for adverse events, specifically high-risk opioid prescribing. The objective of this study is to determine how rates of high-risk prescribing differ between patients with public and private insurance. METHODS/STUDY POPULATION: A retrospective cohort study of 1,435 adult patients with preoperative chronic opioid use on Medicaid or commercial insurance who underwent surgery between November 2017 and February 2021. Patients were identified using the Michigan Surgical Quality Collaborative (MSQC) database, a collection of perioperative data from 70 hospitals across the state of Michigan. Data from the MSQC were merged with Michigan’s prescription drug monitoring program to provide additional information on pre- and postoperative opioid prescribing. Multivariable logistic regression was used to assess high-risk prescribing by the presence of a preoperative usual prescriber and insurance type. RESULTS/ANTICIPATED RESULTS: Overall, 22.7% of patients on private insurance and 23.6% of patients on Medicaid fulfilled criteria for new, postoperative high-risk prescribing. Among criteria for high-risk prescribing, multiple prescribers was the most significant contributor (private insurance: 17.4%, Medicaid: 18.9%). Patients on Medicaid insurance did not have increased odds of new postoperative high-risk prescribing (OR = 1.067, 95% CI: 0.813-1.402). While fewer patients on Medicaid had a preoperative usual prescriber (86.9% and 90.9% respectively, p = 0.015), there was no significant difference between the two insurance types in baseline rates of high-risk prescribing prior to surgery (private insurance: 43.4%, Medicaid: 46.0%, p = 0.352). DISCUSSION/SIGNIFICANCE: While we do not observe disparities in high-risk prescribing between insurance types, rates of high-risk prescribing postoperatively are high across payer types. Further studies to determine the factors driving rates of high-risk opioid prescribing among patients with chronic opioid use are needed to identify areas for future intervention.