Objectives/Goals: The Mayo Clinic Comprehensive Cancer Center’s Community Outreach and Engagement program and the Center for Clinical and Translational Science’s Community Engagement Research program developed a shared service to foster and catalyze community engagement in research. We describe the development, operations, and management of this shared service. Methods/Study Population: Community Outreach and Engagement in Research Services (COERS) is a shared service for all 19 Mayo Clinic sites across five US states. COERS is supported by 31 staff, located across all Mayo Clinic sites. The staff offers consultative services assisting investigators in engaging communities to increase robust participation in research and develop trusting research relationships with over 200 collaborative community partners. Consultative services include facilitating research through resource connections; development of community partner engagement plans; development of community outreach and engagement strategies; development of community-based recruitment and retention strategies; assigning Community Scientists to study teams; and facilitating Community Engagement Studios. Results/Anticipated Results: Since 2021, COERS has engaged over 100,000 community members across all Mayo Clinic sites in outreach, health education, and research awareness activities with the goals of addressing disease burden in communities; improving trust and participation in research; and engaging communities as collaborators and advisors in research design. There have been over 250 consultations with investigators. COERS developed a Community Research Registry to enhance participation in research with over 2000 participants enrolled. Forty Community Scientists were trained, and 20 were matched to study teams. Over 75 Community Engagement Studios were conducted with a total of 180 community experts. COERS provided $260K to 12 community organizations to develop evidence-based interventions to improve community health. Discussion/Significance of Impact: COERS creates a platform that expands Mayo Clinic’s capacity to foster trust, engagement, and translate discoveries into meaningful community health outcomes. This approach has strengthened the relevance and impact of Mayo Clinic research and laid a foundation for continued progress in improving health outcomes through community-engaged science

OBJECTIVES/GOALS: Socioeconomic status (SES) affects risk of disease and access to therapies. The expanded access (EA) pathway allows for the clinical use of investigational products for patients who have serious illness but no Food and Drug Administration (FDA)-approved therapeutic options. The SES of patients who receive EA is unknown. METHODS/STUDY POPULATION: We reviewed the patients who were approved for treatment through a single-patient EA pathway between 2018 and 2023. Using Michigan Medicine (MM) DataDirect software linked to the MM electronic medical record system, we linked the EA pathway patients to neighborhood data from the National Neighborhood Data Archive (NaNDA) to compare neighborhood related markers of affluence among EA patients and others treated at MM. We used descriptive statistics to compare variables between EA pathway patients and residents of the state of Michigan or the local county surrounding MM (Washtenaw County), using US Census tract data to provide context for these findings. RESULTS/ANTICIPATED RESULTS: MM patients who received EA treatments were more likely to come from neighborhoods that showed markers of high SES compared to residents of the state of Michigan but not Washtenaw County. This includes the proportion of persons living in poverty (12.5% EA / 13.4% Michigan / 12.4% Washtenaw) and education in the form of a bachelor’s degree or higher (32.2% / 30.6% / 57.2%). This varied by the disease being treated. Oncology patients were more likely to be from areas with less poverty and more education (12.4% / 76.8%) than the EA average. EA patients being treated for infectious diseases were from areas with more poverty and less education (13.5% / 26.7%). DISCUSSION/SIGNIFICANCE: Patients treated at Michigan Medicine using treatments obtained through the EA pathway came from areas that were, on average, more affluent than residents of the state of Michigan as a whole. This finding warrants more research to ensure equitable access to these therapies for patients in disadvantaged neighborhoods.

OBJECTIVES/GOALS: Insertable devices (IDs) for obstetric fistula (OF) management are feasible, acceptable, but not accessible; implementation determinants in low and middle-income countries (LMICs) are unknown. Thus, the purpose of this study was to understand pre-adoption facilitators and barriers among global stakeholders for a therapeutic ID for OF in LMICs. METHODS/STUDY POPULATION: Stakeholders, including researchers (n = 11), clinicians (n = 4), government officials (n = 2), and administrators (n = 4), were purposefully identified from various sectors involved in understanding and addressing the needs of women with OF: clinical care, academia, international health, civil society, and government. Twenty-one individuals were interviewed about their perceptions of IDs for OF self-management and their implementation. Interviews were audio-recorded and transcribed. The Consolidated Framework for Implementation Research (CFIR) guided data collection and analysis. Thematic analyses were carried out within Nvivo v.12. RESULTS/ANTICIPATED RESULTS: Determinants of implementation of an ID for OF self-management (by CFIR domain) include: (1) intervention characteristics—relative advantage and cost; (2) individual characteristics—knowledge and beliefs about the innovation; (3) inner setting-- organizational culture, implementation climate, tension for change, and compatibility; (4) outer setting-- patient needs and resources and external policy and incentives; (5) process—opinion leaders and collaboration. Facilitators include: tension for change for low-cost, accessible IDs; relative advantage over existing tools; development of partnerships; and identification of implementation champions. Barriers include: need for educational strategies to encourage clinical provider acceptability; lack of evidence of the optimal beneficiary. DISCUSSION/SIGNIFICANCE OF IMPACT: Tools for therapeutic OF self-management could be integrated into comprehensive OF programming. Employing the CFIR as an overarching typology allows for comparison across contexts and settings where OF care occurs and may be useful for clinicians, researchers, and policy-makers interested in implementing IDs for OF self-management in LMICs. CONFLICT OF INTEREST DESCRIPTION: I am working with colleagues at the non-profit Restore Health on developing an insertable cup for therapeutic self-management of obstetric fistula in LMICs

OBJECTIVES/SPECIFIC AIMS: Anxiety is prevalent in early childhood and, when left untreated, increases children’s risk for chronic anxiety and depression later in life. Maternal risk factors (e.g. income and marital status) have also been shown to heighten their children’s risk for the development of the aforementioned psychopathology. Sleep plays a critical role in behavior regulation, is affected in depression, and is influenced by a wide range of demographic and psychological variables. The purpose of this study was to examine the relationship between maternal sleep and the presence in their children of reported symptoms relating to anxiety, depression, and behavior regulation. METHODS/STUDY POPULATION: Children (n=59, aged: 4-9 years (M = 6.069, SD = 1.006, 59.3% female) and their mothers were sampled from clinic and community settings and were administered questionnaires. Maternal sleep quality was assessed by the Pittsburgh Sleep Quality Index, which captures both numeric and self-reported categories relating to an individual’s perception of their sleep. Child anxiety and depression were assessed via parent-reported Child Behavioral Checklist (CBCL). Maternal depression symptoms were assessed with the Beck Depression Inventory (BDI). Associations between these measures were analyzed by ANOVA with post-hoc analysis and linear regression as appropriate. RESULTS/ANTICIPATED RESULTS: A statistically significant difference was observed in the mean child CBCL scores when children were sub-set into maternal categories of self-reported days of dysfunction due to sleepiness over the past month. Mean child CBCL T-score domains with statistically significant differences were: attention problems (F = 4.935, p = 0.004), depression problems (F = 3.073, p = 0.035), ADHD (F = 4.422, p = 0.007), oppositional defiant (F = 2.865, p = 0.045), and total t-score (F = 3.073, p = 0.035). Maternal mean DBI scores were also statistically significantly different when grouped by days of maternal dysfunction due to sleepiness (F = 9.791, p < 0.001). There was no relation between these CBCL categories and maternal DBI scores. DISCUSSION/SIGNIFICANCE OF IMPACT: Maternal self-reported days of dysfunction due to sleepiness may potentially increase risk for their children to develop further psychopathology independent of mothers’ depression symptomatology. These findings highlight the need for broader assessment clinically of children’s environments with additional focus on maternal function given the potential impact on their children’s functional outcomes.

The shift in learning environments due to the COVID-19 pandemic necessitates a closer look at course design, faculty approaches to teaching, and student interaction, all of which may predict learner achievement and satisfaction. Transitioning to an online environment requires the reinvention, reimagining, and applying of “e-flavors” of general learning theory. With this shift to online learning comes the opportunity for misunderstandings and “myths” to occur, which may stand in the way of faculty embracing online learning and fully realizing its potential. This article seeks to address several myths and misconceptions that have arisen in higher education during the rapid shift to online teaching and learning. While not comprehensive, these myths represent a snapshot of common challenges. These are we can transfer our in-person course design to online; adult learners do not need an empathetic approach; and online teaching and learning is socially isolating. Through an appreciative inquiry framework, we present each myth in the context of relevant literature and invite faculty with varied online teaching experience to share their own case studies that illustrate how they have “busted” these myths with the goal to identify existing examples of locally effective practices for the express purpose of replication that leads to positive change.

Multicenter clinical trials are essential for evaluating interventions but often face significant challenges in study design, site coordination, participant recruitment, and regulatory compliance. To address these issues, the National Institutes of Health’s National Center for Advancing Translational Sciences established the Trial Innovation Network (TIN). The TIN offers a scientific consultation process, providing access to clinical trial and disease experts who provide input and recommendations throughout the trial’s duration, at no cost to investigators. This approach aims to improve trial design, accelerate implementation, foster interdisciplinary teamwork, and spur innovations that enhance multicenter trial quality and efficiency. The TIN leverages resources of the Clinical and Translational Science Awards (CTSA) program, complementing local capabilities at the investigator’s institution. The Initial Consultation process focuses on the study’s scientific premise, design, site development, recruitment and retention strategies, funding feasibility, and other support areas. As of 6/1/2024, the TIN has provided 431 Initial Consultations to increase efficiency and accelerate trial implementation by delivering customized support and tailored recommendations. Across a range of clinical trials, the TIN has developed standardized, streamlined, and adaptable processes. We describe these processes, provide operational metrics, and include a set of lessons learned for consideration by other trial support and innovation networks.

Accelerating COVID-19 Therapeutic Interventions and Vaccines (ACTIV) was an extraordinary example of a public-private partnership (PPP) that brought together over thirty organizations and hundreds of individuals to address one of the most pressing global health needs in recent decades. In particular, ACTIV provided a key avenue for testing numerous therapeutics for their potential benefit in treating the SARS-CoV-2 virus or the resulting symptoms of acute COVID-19 infection. Given the speed and scale at which ACTIV designed and implemented master protocols across global networks that it was simultaneously working to create, the PPP can provide valuable lessons for best practices and avoiding pitfalls the next time the world is faced with a global pandemic of a novel pathogen. This report provides a general overview of the ACTIV partnership to set the stage and context for the subsequent articles in this issue that will relay these lessons learned.

Learning Health Systems (LHSs) enable data-driven improvement in clinical care. However, research processes that generate this evidence remain fragmented, limiting systematic learning across study portfolios and contributing to persistent translational inefficiencies. We introduce the Learning Research System (LRS) as a sociotechnical extension of the LHS that leverages LHS infrastructure to render research operations measurable, reusable, and governable across studies, positioning research as an object of continuous learning. Using targeted literature synthesis and supplementary searches, we traced the emergence of the LRS from foundational LHS scholarship and developed five core capabilities as proposed maturity indicators: cross-study measurement, reuse of cohorts and analytic assets, portfolio-level governance, feedback-enabled workflow optimization, and integration of research outputs into clinical and operational improvement. We illustrate the distinction between LHS and LRS roles across the NCATS Translational Science Spectrum. Finally, we applied the capabilities to a formative case at the University of Nebraska Medical Center through an institutional environmental scan, mapping them as indicators of emerging LRS maturity from an existing LHS. The LRS provides a framework for evaluating research-process learning, reducing fragmentation across translational stages, and addressing selected translational discontinuities, such as early-stage “valley of death” barriers between discovery and human studies.

Objectives/Goals: Our team has developed a 24-well donor-derived skeletal muscle microphysiological system (MPS) to study signaling pathways associated with a variety of muscle diseases. 3D muscle will be utilized to evaluate pharmacologic interventions for these muscle conditions to improve both muscle mass and function. Methods/Study Population: In this study, muscle MPS were formed from healthy young female and male subjects. 3D muscle underwent a 21-day differentiation with an electrical stimulation (e-stim) regimen twice daily beginning on Day 14. Functional assessments in permeabilized fibers of both sexes included isometric and isotonic calcium-induced contractions, allowing for the characterization of force-pCa (-log[Ca2+]), force-velocity and force-power relationships. Samples from Day 17 and Day 21 will be assessed for pro-growth protein signaling via western blotting and a subset of samples will be analyzed by histology and microscopy for fiber type and size. Finally, culture media pre- and post-terminal e-stim on Day 21 will be collected for extracellular vesicle (EV) isolation and EVs will be assessed by standard proteomics analysis. Results/Anticipated Results: Permeabilized fibers from both sexes reproduced the well-established sigmoidal force-pCa and the curvilinear force-velocity and force-power relationships reported in native striated muscle. Maximum specific force and force-pCa relationship were not different between sexes. Isotonic contractile measurements revealed that these male and female fibers also exhibit similar force-velocity and force-power relationships. We anticipate that 3D muscles from day 17 compared to day 21 will exhibit higher levels of pro-growth protein signaling due to e-stim application and no differences in fiber type or size between sexes. Additionally, we expect that EV quantity will depend upon 3D muscle maturity and presence of e-stim. Discussion/Significance of Impact: This study demonstrates the similarities of functional characteristics and exercise (or e-stim) adaptation between native human skeletal muscle and 3D bioengineered skeletal muscle. Ultimately, this data further validates the muscle MPS system to study muscle diseases and to enhance the translation of therapeutics to clinical settings.

Objectives/Goals: Hospital mergers have proliferated in the USA, yet a comprehensive understanding of how mergers affect nurses’ well-being and their ability to provide safe, high-quality care is lacking. We examined the associations among hospital mergers, nursing, nurse well-being, and patient safety and quality of care to guide policy or hospital interventions. Methods/Study Population: Following the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for scoping reviews reporting guidelines, we conducted a scoping review by systematically searching 10 databases comprised of both business and healthcare literature up to January 2025. Eligible studies met the following inclusion criteria: (1) US-based sample, (2) specify a hospital merger and one nursing-related criteria, (3) use empirical data, (4) peer-reviewed, and (5) in English. Conference abstracts, protocols, interventions, non-empirical studies, theses or dissertations, quality improvement, and systematic review articles were excluded. Two reviewers independently screened articles and extracted data to focus on empirical research that examined hospital mergers and nursing. Results/Anticipated Results: Our search yielded 1,772 articles; 10 met our inclusion criteria and were included in the analysis: 5 quantitative, 3 qualitative, and 2 multi-methods. Only three studies analyzed data from 2003 or later. Although the data were sparse and older, we found that hospital mergers introduced organizational changes among the nursing workforce – nurse staffing, leadership, and operations. Nurse-sensitive patient safety and quality of care outcomes may not improve post-merger. Qualitatively, nurses described poor communication, a perceived lack of trust in leadership, a loss of identity and unity, decreased morale, increased fear or uncertainty, and issues with equal and/or respectful treatment. The identified study methods were unable to draw strong causal and/or detailed conclusions, and few variables were examined. Discussion/Significance of Impact: This review highlights potential links between US hospital mergers and nursing, nurse well-being, and patient safety and quality of care and emphasizes the lack of robust, up-to-date studies to guide policymakers and hospital administrators in making informed decisions – potentially leading to negative consequences.

Objectives/Goals: Private equity (PE) investment in Medicare Home Health Care (HH) is rising, raising concerns that PE’s profit focus may reduce spending on staff, training, and care quality. Objective: Examine the growth and regional trends of PE involvement in HH across the USA. Methods/Study Population: Background: PE investment in Medicare Home Health Care (HH) is becoming increasingly common, and HH is among the top healthcare sectors attracting interest from PE investors. This is potentially concerning given that PE’s focus on maximizing short-term returns may come at the expense of investments in staffing, training, and other agency operations that enhance care quality. Methods: We linked an investor targeted dataset (LevinPro HC), typically used by investment banks to track mergers and acquisitions, with Medicare administrative data on HH agencies. We then tracked PE deals to HH agencies and mapped deals to HH agency states. Results/Anticipated Results: Results: By combining the LevinPro HC and Medicare Provider of services data sources, we created a novel dataset of PE transactions in HH from 2006 through 2024. We found that there were 796 HH agencies (532 unique) acquired in 117 PE deals. Overall, HH acquisition by PE has been increasing over time with the majority of deals taking place between 2016 and 2022. Deals ranged in size from 1 to 115 HH agencies. Texas led the nation in PE activity in the HH sector with over 50% more deals than California, the state with the next higher number of acquisitions. Discussion/Significance of Impact: This study is the first to document the growth of PE involvement in HH across the USA by linking HH PE industry data with CMS data. Using these linked data will be essential for examining complex patterns of ownership and affiliation that were previously difficult to capture and that influence HH care delivery, competition, and regulatory oversight.

OBJECTIVES/GOALS: This study seeks to comprehensively evaluate the extent to which participants in clinical trials (CT) for Atopic Dermatitis (AD) accurately mirror the demographics and characteristics of the broader AD-affected populations. We will achieve this objective by analyzing data from AD CTs spanning the years 2011 to 2022. METHODS/STUDY POPULATION: We examined completed trials for 10 FDA approved treatments for AD, utilizing data sourced fromclinicaltrials.gov [http://clinicaltrials.gov]. In light of the increased number of AD clinical trials over the past decade, we tailored our search parameters to encampass all trials related to approved treatments from 2011-2022. To assess the characteristics of the participant population in these trials, information including inclusion and exclusion criteria, age, location, sex, and disease severity were collected for each trial. Furthermore, race and ethnicity data were also extracted and analyzed. Additionally, comparisons were drawn between trials completed before and after April 2017, when the FDA began requiring that researchers publish race and ethnicity data toclinicaltrials.gov [http://clinicaltrials.gov]. RESULTS/ANTICIPATED RESULTS: Across 67 CTs examined, 45% of trials were restricted to adult patients, 28% were restricted to pediatric patients, and 27% included both. 77% of CTs occurred in urban settings and 23% occurred in rural settings according to the The Economic Research Service definition. 36% of CTs included mild-to-moderate AD patients, and 64% of CTs included moderate-to-severe AD patients. Race distribution of CTs revealed 67% White, 14% Black/African American, 16% Asian, and 3% others. 13% of participants identified as Hispanic or Latino. With further analysis, we will determine whether there is a difference in ethnic distribution between trials completed before and after April 2017, when the FDA started requiring race/ethnicity data to be submitted. DISCUSSION/SIGNIFICANCE: The findings highlight a significant concern in AD CTs: the insufficient representation of Black and Asian populations. The findings emphasize the need for a more inclusive selection process that accurately reflects the diversity of patients. Failing to do so could undermine the assessment of treatment effectiveness in such populations.

OBJECTIVES/GOALS: To compare the herbal medicine (HM) programs of the U.S. to those of different countries–including the European Union, South Korea, China, and India–and to examine each regulatory body’s process for obtaining market approval for HM drugs. METHODS/STUDY POPULATION: The European Union, South Korea, China, and India’s respective HM regulatory programs were examined and compared to the U.S. FDA’s HM process. These specific regulatory bodies were chosen based on the country’s long history with HM and/or the robustness of their existing HM review processes. International HM programs were researched using official government websites and journals published by independent, external research institutions that were accessed via USC’s library services. Data regarding the efficacy of HM policies such as HM IND approval rates, number of marketed HM drugs, and establishment of unique HM sectors will be collected. RESULTS/ANTICIPATED RESULTS: Investigational New Drug (INDs) applications regarding HM from each country will be categorized and displayed according to their approval status in order to provide insight on a HM program’s efficiency. Results also included a table displaying common challenges for approval for HM drugs across federal regulatory bodies. If applicable, effective solutions implemented to address some of these obstacles that proved to be effective will also be displayed in the form of a table. DISCUSSION/SIGNIFICANCE: Tables displaying the collective flaws of international HM programs and the resulting regulatory solutions can provide clearer guidance for companies seeking to submit HM INDs and for the U.S. FDA seeking to develop improved HM regulations.

Objectives/Goals: Obesity has been classified as a global epidemic and origin of numerous health issues. The central hypothesis of this study is that psychological measures, DNA methylation, and gene transcription will predict obesity-related outcomes after lifestyle interventions, and such interventions may alter DNA methylation profiles. Methods/Study Population: This study consisted of a randomized-controlled trial examining the effects of lifestyle +/- stress reduction interventions in 285 highly stressed parents with obesity, followed for 2 years. Full participants received nutrition and activity counseling, and were randomized to either a stress reduction intervention or a contact control. Those who otherwise qualified for the study but unable to fully participate were included in a no intervention control group. The intervention consisted of 12 weeks of nutrition and activity counseling +/- 2-hour weekly stress reduction interventions using MBSR and CBT-based strategies. DNA methylation was assessed using Illumina EPIC arrays. Results/Anticipated Results: Using linear mixed models (LMMs), this study will first examine the hypothesis that baseline psychological measures and pre-existing methylation sites associated with obesity and glycemic control (e.g., ABCG1, ATP10A, TXNIP, SREBF1, RNF39, and SOCS3) predict changes in BMI, HOMA-IR, and HgbA1C post-intervention and at 1 and 2 year follow-ups. Using sites that demonstrate statistical significance, we will develop a polymethylation risk score predictor of change in BMI. Next, we will examine the hypothesis that interventions which reduce obesity may also lead to improvements in epigenetic aging using LMMs to determine if changes in BMI or HOMA-IR predict changes in epigenetic age acceleration over the course of the study. Discussion/Significance of Impact: This work examines whether psychological factors and/or epigenetic markers may be used in patient stratification at initiation of treatment, enabling improved treatment selection, fewer years of obesity and decreased risk of comorbidities. This proposal also asks whether lifestyle interventions impact the aging process itself.

OBJECTIVES/GOALS: In 2017, new guidelines recommended multi-step algorithms for CDI diagnosis, and clinical centers rapidly implemented changes despite limited pediatric data. We assessed a multi-step algorithm using NAAT followed by EIA for ability to differentiate symptomatic CDI from colonization in children. METHODS/STUDY POPULATION: We prospectively enrolled pediatric patients with cancer, cystic fibrosis, or inflammatory bowel disease who were not being tested or treated for CDI and obtained a stool sample for NAAT. If positive by NAAT (colonized), EIA was performed. Children with symptomatic CDI who tested positive by NAAT via the clinical laboratory were also enrolled and EIA performed on residual stool. A functional cell cytotoxicity neutralization assay (CCNA) was performed in addition. RESULTS/ANTICIPATED RESULTS: Of the 138 asymptomatic children enrolled, 24 (17%) were colonized. An additional 37 children with symptomatic CDI were enrolled. Neither EIA positivity (41% versus 21%, P = 0.11) or CCNA positivity (49% versus 46%, P = 0.84) were significantly different between symptomatic versus colonized children. When both EIA and CCNA were positive, children were more commonly symptomatic than colonized (33% versus 13%, P = 0.04). DISCUSSION/SIGNIFICANCE OF IMPACT: A multi-step testing algorithm with NAAT and EIA failed to differentiate symptomatic CDI from colonization in our pediatric cohort. As multi-step algorithms are moved into clinical care, pediatric providers will need to be aware of the continued limitations in diagnostic testing.

OBJECTIVES/SPECIFIC AIMS: The study aims to measure the associations between nonclinical factors and the likelihood of electing contralateral prophylactic mastectomy [(CPM) i.e. bilateral mastectomy for unilateral cancer] among women with breast cancer, with a focus on the roles of race, relationship status, and geographic location. The outcome of interest is a dichotomized surgery type variable (i.e. CPM versus other surgery). METHODS/STUDY POPULATION:. The Surveillance, Epidemiology, and End Results registry was queried to identify female breast cancer patients diagnosed at stage IA through IIIC from 2010 through 2015 and received surgery as part of their primary treatment (n=174,776). A multilevel logistic regression was used to model likelihood of CPM versus less aggressive surgical treatment (i.e. breast conserving surgery or unilateral mastectomy). Fixed-effects included age at diagnosis, race, relationship status, insurance type, county-level median income, county-level population density, stage at diagnosis (low-stage, IA-IIB; advanced-stage, IIIA-IIIC), an interaction term between race and stage at diagnosis, and breast tumor subtype. County of residence was used as a random-effect. RESULTS/ANTICIPATED RESULTS: Among women with low-stage cancer, compared to the reference class of white women, black women had 0.57 times lower odds of CPM (p<0.0001), Hispanic women had 0.69 times lower odds of CPM (p<0.0001), and Asian women had 0.60 times lower odds of CPM (p<0.0001). Among women with advanced-stage cancer, compared to white women, black women had 0.42 times lower odds of CPM (p<0.0001), Hispanic women had 0.51 times lower odds of CPM (p<0.0001), and Asian women had 0.45 times lower odds of CPM (p<0.0001). Compared to the reference class of single, never-married women, divorced/separated women had 1.25 times greater odds of CPM (p<0.0001), widowed women had 1.11 times greater odds of CPM (p=0.009), and married/partnered women had 1.18 times greater odds of CPM (p<0.0001). County-level variation from the random-effect (MOR, 1.49; p<0.001) had a greater influence on CPM election than fixed-effects for insurance class, breast tumor subtype, county median income, county population density, and year of surgery. DISCUSSION/SIGNIFICANCE OF IMPACT: The nonclinical factors associated with variation in breast cancer surgical decision-making suggest patients and providers both may benefit from further education about surgical treatment options. Providers may also benefit from educational materials that highlight treatment selection disparities within specific contexts, such as surgery for primary unilateral breast cancer. To more narrowly tailor future policy interventions, an additional mixed-methods exploration is recommended to clarify how relationship status and location serve as mechanisms for breast cancer decision-making.

OBJECTIVES/GOALS: Transportation may be a barrier for individuals with Autism Spectrum Disorder (ASD). More individuals with ASD utilize public transportation compared to typically developing (TD) individuals. This study seeks to elucidate the transportation needs of individuals with ASD in the Southeast. METHODS/STUDY POPULATION: Sixty-one licensed drivers with a diagnosis of ASD (n = 21), Attention-Deficit/Hyperactivity Disorder (ADHD; n = 19), or no diagnosis (TD; n = 21) were recruited and were matched across diagnosis groups by age (16-30 years old), gender, and IQ. Participants completed an adapted version of the Barriers to Care Scale and a survey assessing transportation preferences and quality of life. Means and frequencies were obtained. Chi-square analyses were conducted to estimate associations between diagnosis and transportation preferences. RESULTS/ANTICIPATED RESULTS: Nearly all of the sample had access to a car (98.4%). Yet, only 71.4% of drivers ASD preferred to use their own car compared to 89.5% and 90.5% of the ADHD and TD groups respectively. The use of public transportation (6.6%) and ride-hailing services (18%) for general transportation needs was very low across the groups. There was a significant association between group type and the reliance on others for transportation (χ2(2,61) = 9.9, p < .01). Only 21.1% of those with ADHD relying on others for transportation needs, compared to 61.9% of TD and 66.7% of individuals with ASD. 23.8% of ASD drivers, 10.5% of ADHD drivers, and 9.5% of TD drivers believe transportation proved as an obstacle. DISCUSSION/SIGNIFICANCE OF IMPACT: The proportion of ASD drivers who believed transportation to be a barrier appeared slightly higher than other groups. Public transportation use may be low due to lower accessibility to such services in the Southeast. The travel patterns of individuals with ASD and ADHD merits further exploration.

OBJECTIVES/SPECIFIC AIMS: Examine data from PNID patients to evaluation the strength of associations between pre-operative and post-operative levels of pain, quality of life, and emotional reactions to pain to determine if one or more can serve as better predictors of surgical success than pain. METHODS/STUDY POPULATION: In our preliminary study, we gathered data from a pre-existing database of 464 PNID patients that contains self-reported visual analog scale scores (VAS) of pain intensity, QoL, and depression. We measured these variables at three time points: pre-operatively, post-operatively, and at the final visit. We used the Wilcoxon signed rank test to determine if each of these three variables differed significantly between the pre-operative visit and the post-operative visit period and from the pre-operative visit to the final visit. RESULTS/ANTICIPATED RESULTS: Median time from the pre-operative visit to surgery was 9 weeks; median time from surgery to the post-operative visit was 4 weeks; and median time from the post-operative visit to the final visit was 23.5 weeks. There was a clinically meaningful difference in pain scores between the pre-operative and post-operative visits (median difference 1.15; 95% CI 0.75-1.55). In the period between the post-operative visit and the final visit there was also a decrease in pain (0.90; 95% CI 0.55-1.30). The magnitude of change in median difference of 1.85 (95% CI 1.50-2.20) between the pre-operative visit and the final visit was larger than the change in median difference of 0.90 (95% CI 0.55-1.30) between the post-operative visit and the final visit. The pre-operative visit median QoL score was higher than the median score at the post-operative visit (1.65; 95% CI 1.25-2.10). The smallest median difference in QoL of occurred between the post-operative and the final visit (1.10; 95% CI 0.60-1.45). As seen with the pain scores, the magnitude of change in median difference of 2.50 (95% CI 2.20-2.85) for QoL was greatest between the pre-operative and the final visit. Depression scores showed the least amount of change amongst all the variables, between the pre-operative and the post-operative visit (1.00; 95% CI (0.70-1.40), and similarly between the post-operative visit and the final visit (0.15; 95% CI (0-.40). The median differences between the pre-operative and final visit were greatest in QoL (2.50; 95% CI 2.20-2.85), followed by pain scores (1.85; 95% CI 1.50-2.20), and finally, depression (1.05; 95% CI 0.70-1.40). DISCUSSION/SIGNIFICANCE OF IMPACT: Our results show that all three variables measured improve with surgery and continue to improve over the post-operative course to the final visit. This suggest that the relationships between pain, QoL, and depression should be further investigated. We are hopeful that elucidating how these variables interact in the PNID patient population, will encourage peripheral nerve surgeons to use these parameters in conjunction with pain intensity to measure outcomes. A follow-up study expanding on these results and including measures of anger and frustration in a larger sample is underway.