Objectives/Goals: To explore the caregivers’ lived experiences related to facilitators of and barriers to effective primary care or neurology follow-up for children discharged from the pediatric emergency department (PED) with headaches. Methods/Study Population: We used the descriptive phenomenology qualitative study design to ascertain caregivers’ lived experiences with making follow-up appointments after their child’s PED visit. We conducted semi-structured interviews with caregivers of children with headaches from 4 large urban PEDs over HIPAA-compliant Zoom conferencing platform. A facilitator/co-facilitator team (JH and SL) guided all interviews, and the audio of which was transcribed using the TRINT software. Conventional content analysis was performed by two coders (JH and AS) to generate new themes, and coding disputes were resolved by team members using Atlas TI (version 24). Results/Anticipated Results: We interviewed a total of 11 caregivers (9 mothers, 1 grandmother, and 1 father). Among interviewees, 45% identified as White non-Hispanic, 45% Hispanic, 9% as African-American, and 37% were publicly insured. Participants described similar experiences in obtaining follow-up care that included long waits to obtain neurology appointments. Participants also described opportunities to overcome wait times that included offering alternative healthcare provider types as well as telehealth options. Last, participants described desired action while awaiting neurology appointments such as obtaining testing and setting treatment plans. Discussion/Significance of Impact: Caregivers perceived time to appointment as too long and identified practical solutions to ease frustrations while waiting. Future research should explore sharing caregiver experiences with primary care providers, PED physicians, and neurologists while developing plans to implement caregiver-informed interventions.

Ice shelves play a critical role in modulating dynamic loss of ice from the grounded portion of the Antarctic Ice Sheet and its contribution to sea-level rise. Measurements of ice-shelf motion provide insights into processes modifying buttressing. Here we investigate the effect of seasonal variability of basal melting on ice flow of Ross Ice Shelf. Velocities were measured from November 2015 to December 2016 at 12 GPS stations deployed from the ice front to 430 km upstream. The flow-parallel velocity anomaly at each station, relative to the annual mean, was small during early austral summer (November–January), negative during February–April, and positive during austral winter (May–September). The maximum velocity anomaly reached several metres per year at most stations. We used a 2-D ice-sheet model of the RIS and its grounded tributaries to explore the seasonal response of the ice sheet to time-varying basal melt rates. We find that melt-rate response to changes in summer upper-ocean heating near the ice front will affect the future flow of RIS and its tributary glaciers. However, modelled seasonal flow variations from increased summer basal melting near the ice front are much smaller than observed, suggesting that other as-yet-unidentified seasonal processes are currently dominant.

“Real knowledge,” as I use the term, is the most highly prized form of true belief sought by an epistemic agent. This paper argues that defeasible infinitism provides a good way to characterize real knowledge and it shows how real knowledge can arise from fallible justification. Then, I argue that there are two ways of interpreting Ernest Sosa's account of real knowledge as belief that is aptly formed and capable of being fully defended. On the one hand, if beliefs are aptly formed only if they have a specific causal etiology, namely that they are efficiently caused fully or partially by virtuous characteristics of the epistemic agent, then Sosa's account falls prey to what I call the problem of the Hazard of Empirical Disconfirmation (HED). The HED problem applies to all forms of causal accounts of real knowledge and is simply that as we gain more empirical knowledge about the causal origins of our true beliefs that are the most highly prized we will discover that they do not always (or even hardly ever) satisfy the required efficient causal constraints. Bluntly put, having sufficiently good reasons for our beliefs might not require that the beliefs have the requisite efficient causal etiology. On the other hand, there is a way of interpreting Sosa's views that does not include an efficient causal prerequisite. That interpretation makes Sosa's account of real knowledge almost identical to defeasible infinitism but expressed in an alternate vocabulary. Such a view is not subject to the HED problem and it can solve the deep problem in epistemology, namely how to get epistemically certain (as opposed to psychologically certain) knowledge from fallible justification.

The tracer-to-infant deuterium dilution method for the measurement of milk intake was evaluated in twenty breast-fed and twenty formula-fed infants. The isotope method was compared with conventional direct-weighing techniques. Human milk intake was assessed by 5 d test-weighing. Intakes of formula, supplemental foods, and water were determined by pre- and post-weighing of feeding bottles. An oral dose of 200 mg 2H2O/kg body-weight was given to each infant, and urine was sampled daily for 14 d. 2H enrichment of the urine was measured by gas-isotope-ratio mass spectrometry. Milk intakes estimated from the deuterium dilution method were consistently higher than those from direct-weighing; the mean difference between methods was 106 (sd 47) g/d or 14% for the breast-fed group and 70 (sd 155) g/d or 8 % for the formula-fed group. Estimates of intake for some infants varied substantially between the two methods of measurement. When the estimated values of human milk intake were corrected for environmental water influx and insensible water loss during breast-feeding, the relative bias decreased to 5%. Correction of the estimated values of formula intake for environmental water influx decreased the relative bias to 1–2%. The acceptability of the deuterium dilution method to determine milk intake depends on the goals and the tolerance for error in group and individual intake estimates of a given study

1. Body fat, fat-free mass and total body water of ten lactating women were estimated from deuterium-dilution spaces and from skinfold thickness measurements. Deuterium-dilution spaces were calculated from the 6 h (equilibration) and zero-time (extrapolation) deuterium enrichments in saliva, urine, human milk and breath water vapour samples.

2. The deuterium spaces obtained by equilibration were statistically larger than those obtained by extrapolation. Isotope dilution spaces derived from deuterium enrichments in saliva, breath water vapour and human milk did not differ with the exception of the 6 h equilibration value of milk, which was greater than that estimated from saliva. Deuterium-dilution spaces estimated from urine were consistently smaller than those derived from the other biological fluids.

3. No significant differences in body fat, fat-free mass and total body water were observed between anthropometric measurements and deuterium-dilution methods, except for extrapolated values derived from deuterium enrichments in urine.