Significant gaps exist in representation of diverse populations in central-line assessment education and tools. We review some of these gaps and provide some real-world guidance on how to assess central line sites in patients of all skin tones.

Amiodarone may be considered for patients with junctional ectopic tachycardia refractory to treatment with sedation, analgesia, cooling, and electrolyte replacements. There are currently no published pediatric data regarding the hemodynamic effects of the newer amiodarone formulation, PM101, devoid of hypotensive agents used in the original amiodarone formulation. We performed a single-center, retrospective, descriptive study from January 2012 to December 2020 in a pediatric ICU. Thirty-three patients were included (22 male and 11 female) between the ages of 1.1 and 1,460 days who developed post-operative junctional ectopic tachycardia or other tachyarrhythmias requiring PM101. Data analysis was performed on hemodynamic parameters (mean arterial pressures and heart rate) and total PM101 (mg/kg) from hour 0 of amiodarone administration to hour 72. Adverse outcomes were defined as Vasoactive-Inotropic Score >20, patients requiring ECMO or CPR, or patient death. There was no statistically significant decrease in mean arterial pressures within the 6 hours of PM101 administration (p > 0.05), but there was a statistically significant therapeutic decrease in heart rate for resolution of tachyarrhythmia (p < 0.05). Patients received up to 25 mg/kg in an 8-hour time for rate control. Average rate control was achieved within 11.91 hours and average rhythm control within 62 hours. There were four adverse events around the time of PM101 administration, with three determined to not be associated with the medication. PM101 is safe and effective in the pediatric cardiac surgical population. Our study demonstrated that PM101 can be used in a more aggressive dosing regimen than previously reported in pediatric literature with the prior formulation.

OBJECTIVES/GOALS: Older adults are included in clinical research infrequently compared to their burden of chronic illness. The goal for this study is to learn from older adults about their lived experiences with research and use this knowledge to develop tools and solutions aimed at increasing their inclusion. METHODS/STUDY POPULATION: This study utilized the 5T Model (developed by Duke CTSA) and Community Engagement Studio (CES) (developed by Vanderbilt CTSA) to connect and engage with community experts (older adults and those who work with older adults) in Oregon. Two CES were completed with 14 community experts and 4 investigators interested in including older adults in their studies. Participants took part in a 2-hour facilitated discussion to gain insight from their perspectives on research. The 5T Model was shared with participants and used to guide the discussion and elicit feedback on the model and identify gaps in resources and training needed for investigators to enhance inclusion of older adults in research. RESULTS/ANTICIPATED RESULTS: Trust, relationships, education, and diversity were themes identified across all of the 5Ts. Participants discussed the need for inclusion and diversity within research, with an emphasis on those at the oldest ages, rural populations, and lower socioeconomic status. Participants acknowledged both investigators and participants require more education, with a great need for improving health literacy for research participants. Participants saw trust and relationships as an integral part of older adult inclusion in research, with the relationship being not only that between investigator and participant, but between them and the communities that support older adults, including family members. DISCUSSION/SIGNIFICANCE: This study highlighted the voices of older adult research participants, allowing for participant-informed findings and solution development. Future directions will focus on developing and refining tools and resources for investigators and expanding to other underrepresented populations.

We propose, following Clark, that generative models also play a central role in the perception and interpretation of linguistic signals. The data explanation approach provides a rationale for the role of prediction in language processing and unifies a number of phenomena, including multiple-cue integration, adaptation effects, and cortical responses to violations of linguistic expectations.

Fourteen ‘treatment resistant’ problem gamblers received 9 weeks of Dialectical Behavior Therapy (DBT) at specialist problem gambling services delivered in Melbourne, Australia. This study is the first to investigate the effectiveness of a brief DBT treatment for problem gambling, with a focus on measuring change in the four DBT process skills (mindfulness, distress tolerance, emotion dysregulation, and negative relationships). Although there were no statistically significant improvements in measures of gambling behaviour, 83% of participants were abstinent or reduced their gambling expenditure pre- to post-treatment. Participants also reported statistically and clinically significant improvements in psychological distress, mindfulness, and distress tolerance. Moreover, there were no increases in alcohol or substance use. These results are discussed in the context of focusing on a single DBT process skill, and the benefits of using group-based approaches.

This study explores the early use of obsidian at the Maya site of Colha in northern Belize and the implications that variations in source distribution have for the site and its regional connections. Energy dispersive x-ray fluorescence (EDXRF) analysis of 104 specimens of obsidian from Preclassic contexts at the site identified El Chayal obsidian as the most common overall followed closely by that from San Martin Jilotepeque. Ixtepeque obsidian, not common in many Preclassic assemblages, was also strongly represented. The results revealed a Middle Preclassic dependence on San Martin obsidian gradually diminishing through the Preclassic to the Classic period, when San Martin all but disappears from the site. A corresponding increase in El Chayal obsidian use through time at Colha coincides with the rise of Kaminaljuyu in the Guatemalan highlands. Analysis of the obsidian by context indicated that El Chayal obsidian dominated in architectural and ritual deposits while Ixtepeque obsidian was the most common in workshops. San Martin accounted for a slightly greater percentage than El Chayal obsidian in middens, with Ixtepeque materials notably less common. The data indicate that Colha was connected to a broad distribution network from the Middle Preclassic onward, and that obsidian source variability was greater during the Preclassic than the subsequent Classic period.

The results of trace-element analysis of 200 prismatic blades from Colha, Belize, are reported. Questions concerning possible elite control and restriction of obsidian distribution, and the relative decline and increase of the El Chayal and Ixtepeque sources in varying functional contexts within lower- and upper-status areas are the primary focus of the study. Contrary to expectations, a high percentage (51%) of obsidian was assigned to the Ixtepeque source, 48% was assigned to El Chayal, and only two samples (1%) were assigned to Rio Pixcaya. The use of obsidian from the Ixtepeque source declines through time from Tepeu 2 through Tepeu 3 from 72% to 43%, and Ixtepeque obsidian appears to have had a largely ceremonial use by the Terminal Classic period. It appears that as Ixtepeque obsidian became less available at the site, it fell more into the hands of the elite. This trend runs counter to our expectations of an apparent lack of elite control of Ixtepeque obsidian in the Postclassic. The Colha data suggest that a slightly different process may have governed the distribution of Ixtepeque obsidian in the Late/Terminal Classic than during the Postclassic period. It is not clear, however, whether this trend extends to regional differences in control or is simply a local idiosyncratic phenomenon at Colha.

This paper examines choice-making in work and community access programs by people perceived to have a severe intellectual disability. The results indicate that the quality and quantity of choice-making are restricted in these settings. The impact of factors such as type of work setting, gender, perceived attractiveness and level of ability are investigated. The implications of this study for research, personnel preparation and workplace interactions are explored.