Our study aimed to describe the transmission dynamics and genotypic diversity of Mycobacterium tuberculosis in people deprived of liberty (PDL) in four Colombian prisons. Our cohort study included 64 PDL with bacteriologically confirmed pulmonary tuberculosis diagnosed in four Colombian prisons. The 132 isolates were genotyped using 24-mycobacterial interspersed repeated units-variable number tandem repeats (MIRUs-VNTR). A cluster was defined when ≥2 isolates from different PDL had the same genotype. Tuberculosis acquired in prison was considered when ≥2 persons were within the same cluster and had an epidemiological link. We mapped the place of residence before incarceration and within prisons. We assessed overcrowding and ventilation conditions in the prison that had clusters. We found that the most frequent genotypes were LAM (56.8%) and Haarlem (36.4%), and 45.3% of the PDL diagnosed with tuberculosis were clustered. Most PDL diagnosed in prison came from neighborhoods in Medellin with a high TB incidence. M. tuberculosis infection acquired in prison was detected in 19% of PDL, 9.4% had mixed infection, 3.1% reinfection, and 1.6% relapse. Clusters only appeared in one prison, in cell blocks with overcrowding >100%, and inadequate ventilation conditions. Prisons require the implementation of effective respiratory infection control measures to prevent M. tuberculosis transmission.

This cross-sectional ecological study described fruit and vegetable (F&V) intake variability across 144 cities in 8 Latin American countries and by city-level contextual variables. Data sources came from health surveys and census data (Argentina, Brazil, Chile, Colombia, El Salvador, Guatemala, Mexico, and Peru). Self-reported frequency of F&V intake was harmonised across surveys. Daily F&V intake was considered as consumption 7 d of the week. Using a mixed-effects model, we estimated age and sex-standardised city prevalences of daily F&V intake. Through Kruskal–Wallis tests, we compared city F&V daily intake prevalence by tertiles of city variables related to women’s empowerment, socio-economics, and climate zones. The median prevalence for daily F&V intake was 55.7% across all cities (22.1% to 85.4%). Compared to the least favourable tertile of city conditions, F&V daily intake prevalence was higher for cities within the most favourable tertile of per capita GDP (median = 65.7% vs. 53.0%), labour force participation (median = 68.7% vs. 49.4%), women achievement-labour force score (median = 63.9% vs. 45.7%), and gender inequality index (median = 58.6% vs. 48.6%). Also, prevalences were higher for temperate climate zones than arid climate zones (median = 65.9% vs. 50.6%). No patterns were found by city level of educational attainment, city size, or population density. This study provides evidence that the prevalence of daily F&V intake varies across Latin American cities and may be favoured by higher socio-economic development, women’s empowerment, and temperate weather. Interventions to improve F&V intake in Latin America should consider the behaviour disparities related to underlying local social, economic, and climate zone characteristics.

We introduce a versatile high-repetition-rate solid tape target system suitable for relativistic laser-plasma driven secondary sources. We demonstrate the operation and stability monitoring based on a petawatt laser focused at 1 Hz. Experiments were carried out at the VEGA-3 laser system of the Centro de Láseres Pulsados facility where results for different tape materials and thicknesses are presented. Experimental proton spectra were recorded by a Thomson parabola spectrometer and a time-of-flight detector. In addition, non-invasive detectors, such as a target charging monitor and ionization chamber detectors, were tested as metrology for the stability of the source. Degradation of the proton signal at high-repetition-rate operation was observed and it was solved by online optimization of the relative focus position of the target and laser beam parameters. We report the use of the tape target for bursts of 1000 shots at 1 Hz with mean cut-off energies of about 10 MeV in optimized interaction conditions.

The aim of the present work was to evaluate the distribution of the different clones of the parasite prevailing after treatment with benznidazole (BZ) and clomipramine (CLO), in mice infected with Trypanosoma cruzi, Casibla isolate which consists of a mixture of two discrete typing units (DTUs). Albino Swiss mice were infected and treated with high and low concentrations of BZ (100 or 6.25 mg/kg), CLO (5 or 1.25 mg/kg), or the combination of both low doses (BZ6.25 + CLO1.25), during the acute phase of experimental infection. Treatment efficacy was evaluated by comparing parasitaemia, survival and tissular parasite presence. For DTUs genotyping, blood, skeletal and cardiac muscle samples were analysed by multiplex quantitative polymerase chain reaction. The combined treatment had similar outcomes to BZ6.25; BZ100 was the most effective treatment, but it failed to reach parasite clearance and produced greater histological alterations. Non-treated mice and the ones treated with monotherapies showed both DTUs while BZ6.25 + CLO1.25 treated mice showed only TcVI parasites in all the tissues studied. These findings suggest that the treatment may modify the distribution of infecting DTUs in host tissues. Coinfection with T. cruzi clones belonging to different DTUs reveals a complex scenario for the treatment of Chagas disease and search for new therapies.

OBJECTIVES/SPECIFIC AIMS: High on-treatment platelet reactivity (HTPR) with clopidogrel imparts an increased risk for ischemic events in adults with coronary artery disease. Although more potent antiplatelet agents are available, clopidogrel remains the most commonly used P2Y12 inhibitor in Puerto Rico. Platelet reactivity varies with ethnicity and is influenced by both clinical and genetic variables; however, no clopidogrel pharmacogenetic studies with Puerto Rican patients have been reported. Therefore, we sought to identify clinical and genetic determinants of on-treatment platelet reactivity in a cohort of Puerto Rican patients with cardiovascular disease. METHODS/STUDY POPULATION: We performed a retrospective study of 111 Puerto Rican patients on 75 mg/day maintenance dose of clopidogrel. Patients were allocated into 2 groups: Group I, without HTPR; and Group II, with HTPR. Clinical data was obtained from the medical record. Platelet function was measured ex vivo using the VerifyNow® P2Y12 assay and HTPR was defined as P2Y12 reaction units (PRU)≥230. Genotyping of CYP2C19, ABCB1, PON1, PY2R12, B4GALT2, CES1, and PEAR1 was performed using Taqman® Genotyping Assays. RESULTS/ANTICIPATED RESULTS: The mean PRU across the cohort was 203±61 PRU (range, 8–324), and 42 (38%) patients had HTPR. One in four individuals carried at least 1 copy of the CYP2C19*2 variant allele. Hematocrit and PON1 p.Q192R variant were inversely correlated with platelet reactivity (p<0.05). Multiple logistic regression showed that 27% of the total variation in PRU was explained by a history of diabetes mellitus, hematocrit, CYP2C19*2, and PON1 p.Q192R. Body mass index (OR=1.15; CI: 1.03–1.27), diabetes mellitus (OR=3.46; CI: 1.05–11.43), hematocrit (OR=0.75; CI: 0.65–0.87), and CYP2C19*2 (OR=4.44; CI: 1.21–16.20) were the only independent predictors of HTPR. DISCUSSION/SIGNIFICANCE OF IMPACT: In a representative sample of Puerto Rican patients with cardiovascular disease, diabetes mellitus, hematocrit, CYP2C19*2, and PON1 p.Q192R were associated with on-treatment platelet reactivity. These factors may identify a subset of patients at higher risk for adverse events on clopidogrel in the Hispanic population.

OBJECTIVES/SPECIFIC AIMS: This study seeks to test the feasibility and effectiveness of a brief Acceptance and commitment therapy (ACT) treatment for patients with persistent pain in a patient-centered medical home. METHODS/STUDY POPULATION: Participants are recruited via secure messaging, clinic advertisements and clinician referral. Primary care patients age 18 and older with at least 1 pain condition for 12 weeks or more in duration are stratified based on pain severity ratings and randomized into (a) ACT intervention or (b) control group [Enhanced Treatment as Usual (E-TAU)]. Participants in the ACT arm attend 1 individual visit with an integrated behavioral health provider, followed by 3 weekly ACT classes and a booster class 2 months later. E-TAU participants will receive usual care plus patient education handouts informed by cognitive behavioral science. Currently, 17% of our overall goal of 60 patients have completed ACT or enhanced treatment as usual. Average participant age is 49 years old, 70% female, and 70% Hispanic/Latino. Most report multisite pain conditions (e.g., musculoskeletal, fibromyalgia) and 30% are taking opioid medications. Data analysis in this presentation will include early correlational findings from baseline assessments. Upon study completion, we will analyze data using a general linear mixed regression model with repeated measures. RESULTS/ANTICIPATED RESULTS: The overall hypothesis is that brief ACT treatment reduces physical disability in patients with persistent pain when delivered by an integrated behavioral health provider in primary care. By examining a subset of patients on opioid medications, we also anticipate a reduction in opioid misuse behaviors. Additionally, it is anticipated that improvements in patient functioning will be mediated by patient change in pain acceptance and patient engagement in values-consistent behaviors. DISCUSSION/SIGNIFICANCE OF IMPACT: This pilot study will establish preliminary data about the feasibility and effectiveness of addressing persistent pain in a generalizable, “real-world” integrated primary care setting. Data will help support a larger trial in the future. If effective, findings could improve treatment methods and quality of life for patients with persistent pain using a scalable approach.

Population ageing and increasing prevalence of chronic diseases and their consequences, changes in family structure and a decrease in the potential pool of family care, increase the need for formal long-term care for older adults in Mexico, and the need to understand the experiences of informal care-givers and how this impacts their social, family and personal conditions. This study investigates the experience of informal care-givers of dependent older adults using a cross-sectional qualitative study with an ethnographic focus. Thematic analysis was performed. The study comprised 48 semi-structured interviews with care-givers of dependent older adults who are beneficiaries of an in-home medical programme in Mexico City. The average age of care-givers was 54.7 years (standard deviation = 13.1, range = 24–86) and 75 per cent (36) were women. Results show care-giving experiences are diverse and complex, and profoundly affect the care-giver's life in terms of emotional burden, health deterioration and adverse life conditions due to economic deprivation. They also revealed key aspects such as the need to improve communication between care-givers and health-care personnel, the need for training about specific care needs and opportunity costs incurred. This information can serve as a basis for generating support strategies that may be integrated into the in-home programme. It is essential to promote actions that consider the ‘dependent older adult–informal care-giver’ dyad, and that aim to reduce the care-giving burden.

OBJECTIVES/SPECIFIC AIMS: This study seeks to test the feasibility and effectiveness of a brief acceptance and commitment therapy (ACT) treatment for chronic pain patients in a primary care clinic METHODS/STUDY POPULATION: Primary care patients aged 18 years and older with at least 1 pain condition for 12 weeks or more in duration will be recruited. Patients will be randomized into (a) ACT intervention or (b) control group. Participants in the ACT arm will attend 1 individual visit with an integrated behavioral health provider, followed by 3 weekly ACT classes and a booster class 2 months later. Control group will receive enhanced primary care that includes patient education handouts informed by cognitive behavioral science. Data analysis will include 1-way analysis of covariance (ANCOVA), multiple regression with bootstrapping. RESULTS/ANTICIPATED RESULTS: The overall hypothesis is that brief ACT treatment reduces physical disability, improves functioning, and reduces medication misuse in chronic pain patients when delivered by an integrated behavioral health provider in primary care. In addition, it is anticipated that improvements in patient functioning will be mediated by patient change in pain acceptance and patient engagement in value-consistent behaviors. DISCUSSION/SIGNIFICANCE OF IMPACT: This pilot study will establish preliminary data about the effectiveness of addressing chronic pain in a generalizable integrated primary care setting. Data will help support a larger trial in the future. Findings have potential to transform the way chronic pain is currently managed in primary care settings, with results that could decrease disability and improve functioning among patients suffering from chronic pain.

When delegating governing tasks to a coalition partner, the president would like to give a minister ample administrative powers to be able to effectively accomplish the political mission. Due to information asymmetries, the president runs the risk that this discretion might be used to pursue policy outcomes that may harm the president's preferences. This trade-off between delegation and control is key to understanding governance strategies the president chooses to minimize agency risks and coordinate public policies. With Brazil as a case study, this article demonstrates that presidents have strategically made frequent use of junior ministers as watch-dogs of coalition partners, especially when coalition allies are ideologically distant from the president's preferences. Yet neither the portfolio salience nor the president's decision to share powers with coalition partners proportionally seems to interfere in such strategic decisions.

Anthropometric reference data for older adults, particularly for the oldest old, are still limited, especially in developing countries. The aim of the present study was to describe sex- and age-specific distributions of anthropometric measurements and body composition in Mexican older adults. The methods included in the present study were assessment of height, weight, BMI, calf circumference (CC), waist circumference (WC) and hip circumference (HC) as well as knee height in a sample of 8883 Mexican adults aged 60 years and above and the estimation of sex- and age-specific differences in these measures. Results of the study (n 7865, 54 % women) showed that men are taller, have higher BMI, and larger WC than women, whereas women presented higher prevalence of obesity and adiposity. Overall prevalence of underweight was 2·3 % in men and 4·0 % in women, with increasing prevalence with advancing age. Significant differences were found by age group for weight, height, WC, HC, CC, BMI and knee height (P<0·001), but no significant differences in waist–hip circumference were observed. Significant differences between men and women were found in height, weight, circumferences, BMI and knee height (P<0·001). These results, which are consistent with studies of older adults in other countries, can be used for comparison with other Mexican samples including populations living in the USA and other countries with similar developmental and socio-economic conditions. This information can also be used as reference in clinical settings as a tool for detection of individuals at risk of either underweight or overweight and obesity.

The TRISO (tristructural isotropic) coated fuel particle is made of a uranium oxide kernel coated with three layers of pyrolytic carbon and one of silicon carbide. This fuel, originally used in High Temperature Reactors, has been proposed as accident tolerant fuel for Light Water Reactors after the accident in Fukushima. Although this fuel is capable of retaining fission products within the particle up to 1600°C, little is known on the origin of this temperature limit. Therefore, in order to increase the safety of this type of fuel, it is necessary to understand the origin of the degradation of the materials that compose this fuel. We have studied the effect of temperature on the microstructure and diffusion of silver in pyrolytic carbon coatings produced by fluidized bed chemical vapor deposition. Samples were heat treated at 1000°C, 1400°C and 1700°C for 200 hrs. under inert atmosphere. The effect of temperature on the microstructure and silver diffusion behavior were analyzed by Raman spectroscopy, X-Ray diffraction, optical microscopy, SEM and TEM. We observed that the microstructure of PyC changed drastically above 1400°C, showing the increase in anisotropy and the re-orientation of the graphene planes. The diffusion of silver appears to be also correlated with this change in microstructure.