ABSTRACT IMPACT: This study is designed to address a critical gap in our understanding of how aging patients and caregivers recognize and respond to clinically important changes in heart failure symptoms during vulnerable transitions. OBJECTIVES/GOALS: Research on family involvement in heart failure (HF) symptom response is limited. Our objective is to examine HF symptom monitoring processes in couples after HF hospitalization, and quantify how coupled symptom assessments predict symptom response, patient clinical events, care strain, and dyad health during the high-risk post-discharge period. METHODS/STUDY POPULATION: This is an ongoing T2 translational study that employs an intensive longitudinal design. Adults aged ≥65 years hospitalized for HF and their caregiving spouse/partner are enrolled. The target n is 48 dyads. Over 5 weeks of follow-up, dyads complete daily diaries assessing patient HF symptoms. Clinical biomarkers of HF severity (NTproBNP, ST2) are also collected. Primary study endpoints are dyads’ HF symptom response behaviors and caregiver strain; secondary endpoints are dyads’ health status and patient clinical events. Dyadic dynamics of symptom assessment will first be characterized using dyadic autoregressive time series models. Subsequently, we will extract cross-partner effect parameters from the time series models and test whether dyadic effects predict the trajectories of each of our endpoints. RESULTS/ANTICIPATED RESULTS: This study is currently underway. In line with our study hypotheses, we anticipate that couples who assess patient symptoms similarly (dyadic agreement), and whose symptom assessments accurately reflect clinical severity, will be more likely to respond to symptoms appropriately with lower stress to the caregiving partner, and have better trajectories of health (self-reported and clinical). Characterizing dyadic symptom dynamics will provide important insight into the day-to-day process of symptom recognition in couples. Further, quantifying dyadic symptom dynamics in relation to our endpoints will provide information on the clinical value of dyadic symptom agreement, and whether it might be a target for future interventions to support better symptom response and health outcomes for both dyad members. DISCUSSION/SIGNIFICANCE OF FINDINGS: This project innovates on existing paradigms by applying family-level theory and techniques to better understand and support interventions for couples during post-discharge HF transitions - a vulnerable period for older adults that has traditionally been studied almost exclusively at the patient-level, with marginal success.

The present work has been done within the IAEA Environmental Modelling for Radiation Safety Programme. EMRAS-II aims to improve the capabilities in the field of environmental radiation dose assessment by means of acquisition of improved data for model testing, comparison, reaching consensus on modelling philosophies, approaches and parameter values, development of improved methods and exchange of information.

We consider the one-dimensional operator,

on 0<x<∞ with . The coefficients p, V1 and V2 are assumed to be real, locally Lebesgue integrable functions; c1 and c2 are positive numbers. The operator L acts in the Hilbert space H of all equivalence classes of complex vector-value functions such that . L has domain D(L) consisting of ally∈H such that y is locally absolutely continuous and Ly∈H; thus in the language of differential operators L is a maximal operator. Associated with L is the minimal operator L0 defined as the closure of where is the restriction of L to the functions with compact support in (0,∞).

Post-operative pain and delayed oral intake are common reasons for failure of discharge in day-case tonsillectomy. A double blind prospective randomized study was devised to investigate the effectiveness of topical bupivacaine in reducing post-operative pain in paediatric day-case tonsillectomy. Ninety-nine patients aged between three and 16 years were recruited into the study. One group received bupivacaine soaked swabs tightly packed in their tonsillar fossae while the control group received saline-soaked swabs. The bupivacaine group was found to drink (p < 0.001) and eat (p = 0.006) earlier than the control group. The pain scores at one (p < 0.001), three (p < 0.001) and six (p < 0.001) hours post-operatively were also found to be lower in the bupivacaine group than the control group. We conclude that topical bupivacaine has a role in facilitating recovery in day-case tonsillectomy in children.

In the quest for hearing preservation in patients with acoustic schwannomas it is essential that surgeons do not lose sight of the concept of ‘useful’ hearing. There is an important difference between hearing preservation which pleases the surgeon and that which will be appreciated by the patient.

Tumour size, pure tone audiogram average differences between ears and speech discrimination scores have been recorded in a series of 114 patients with unilateral acoustic schwannomas. Criteria for useful hearing are presented in terms of pure tone audiogram average difference and speech discrimination scores.

There were 11 patients (10 per cent) with a speech discrimination score of 50 per cent or more, a pure tone audiogram average difference of 30 dB or better and a tumour size of no more than 2 cm. Only one patient (0.9 per cent) had a speech discrimination score of 50 per cent or more, a pure tone audiogram average difference of 20 dB or better and a tumour size of no more than 1 cm.

It is concluded that hearing preservation techniques may be applicable to between 1 and 10 per cent of patients with unilateral acoustic schwannomas.

Two cases of cervicocephalic arterial dissection of the intrapetrous carotid artery are described. One patient presented with intolerable objective pulsatile tinnitus, the other with a cerebral infarction. Both were successfully treated with anticoagulants. The significance of minor degrees of trauma and of neck extension in the aetiology of these apparently spontaneous lesions is discussed.

The Later Bronze Age site at Black Patch consisted of hut platforms and enclosures set in a system of rectangular fields. The settlement area is overlooked by round barrows. Area and sample excavations of the settlement revealed circular huts and activity areas within a C-14 date range of 1070 ± 70 bc–830 ± 80 bc. Extensive economic data in the form of seeds, animal bones, foreign stones and artefacts were recovered. These formed the basis of an economic resource-area analysis undertaken around Black Patch and other contemporary occupation sites on the South Downs. From this an economic activity model is proposed.

Liouville type transformations are given for symmetric linear ordinary and partial differential operators of second order. Explicit formulas are given for the coefficients of the transformed operators. As a corollary to the general theory we obtain an “Atkinson form” for certain first order vector partial differential operators. This leads to a generalization of the concept of “g-unitary” transformations. Applications to oscillation and spectral theories are included.

1. Introduction. Let P(x) be an m × m matrix-valued function that is continuous, real, symmetric, and positive definite for all x in an interval J , which will be further specified. Let w(x) be a positive and continuous weight function and define the formally self adjoint operator l by

where y(x) is assumed to be an m-dimensional vector-valued function. The operator l generates a minimal closed symmetric operator L 0 in the Hilbert space ℒm2 (J; w) of all complex, m-dimensional vector-valued functions y on J satisfying

with inner product

where . All selfadjoint extensions of L 0 have the same essential spectrum ([5] or [19]). As a consequence, the discreteness of the spectrum S(L) of one selfadjoint extension L will imply that the spectrum of every selfadjoint extension is entirely discrete.

A weighted, formally self-adjoint ordinary differential operator l of order 2n is considered, and conditions are given on the coefficients of l which ensure that all self-adjoint operators associated with l have a spectrum which is discrete and bounded below. Both finite and infinite singularities are considered. The results are obtained by the establishment of certain conditions which imply that l is non-oscillatory.

Let l be the differential operator of order 2n defined by

where the coefficients are real continuous functions and pn > 0. The formally self-adjoint operator l determines a minimal closed symmetric linear operator L0 in the Hilbert space L2 (0, ∞) with domain dense in L2 (0, ∞) ((4), § 17). The operator L0 has a self-adjoint extension L which is not unique, but all such L have the same continuous spectrum ((4), § 19·4). We are concerned here with conditions on the pi which will imply that the spectrum of such an L is bounded below and discrete.