Substance use disorder (SUD) is a public health crisis in the United States associated with significant economic costs including healthcare, criminal justice, productivity, and mortality and morbidity costs. In this paper, we present a tool for a customizable economic analysis that can be utilized by different recovery program owners and operators within the SUD continuum of care that considers these program’s operating and capital costs, location, size, and success rate. The goal of this tool is to provide owners and operators with an accessible tool that can estimate their individual program’s economic costs, benefits, and return on investment. In applications of the tool, we find that there are significant benefits associated with SUD recovery-oriented services, even with more conservative modeling of recovery benefits. Specifically, we find that a representative recovery housing program in Florida yields a net benefit of $143 million over 20 years with an associated return on investment of $22.19 per dollar invested. Further, we find that the net benefits of different recovery-oriented modalities including a recovery house, a recovery campus, and a residential inpatient program are positive, with returns on investment varying from nearly $22 per dollar invested to $1 per dollar.

Autistic children and young people (CYP) experience mental health difficulties but face many barriers to accessing and benefiting from mental health care. There is a need to explore strategies in mental health care for autistic CYP to guide clinical practice and future research and support their mental health needs. Our aim was to identify strategies used to improve mental health care for autistic CYP and examine evidence on their acceptability, feasibility, and effectiveness. A systematic review and meta-analysis were carried out. All study designs reporting acceptability/feasibility outcomes and empirical quantitative studies reporting effectiveness outcomes for strategies tested within mental health care were eligible. We conducted a narrative synthesis and separate meta-analyses by informant (self, parent, and clinician). Fifty-seven papers were included, with most investigating cognitive behavioral therapy (CBT)-based interventions for anxiety and several exploring service-level strategies, such as autism screening tools, clinician training, and adaptations regarding organization of services. Most papers described caregiver involvement in therapy and reported adaptations to communication and intervention content; a few reported environmental adjustments. In the meta-analyses, parent- and clinician-reported outcomes, but not self-reported outcomes, showed with moderate certainty that CBT for anxiety was an effective treatment compared to any comparison condition in reducing anxiety symptoms in autistic individuals. The certainty of evidence for effectiveness, synthesized narratively, ranged from low to moderate. Evidence for feasibility and acceptability tended to be positive. Many identified strategies are simple, reasonable adjustments that can be implemented in services to enhance mental health care for autistic individuals. Notable research gaps persist, however.

OBJECTIVES/GOALS: Distinguishing indolent from aggressive prostate cancer and early identification of men at risk of developing aggressive, metastatic disease is of great importance. We aim to explore the relationship between N-glycan and collagen composition in prostate tumor tissue and the long-term outcome of the disease. METHODS/STUDY POPULATION: Matrix assisted laser desorption/ionization mass spectrometry can be utilized to characterize N-glycan profiles in formalin fixed paraffin embedded tissues. Collagen may also be characterized using ECM-targeted collagenase MALDI imaging. These approaches were used to analyze prostatectomy samples with different clinical outcomes. Tissue microarrays containing tissues from 75 non-progressors (no evidence of disease; NED) and 50 metastatic cases (MET) were examined. From a combined list of 90 N-glycans and 500 collagenase peptides, the average AUC intensity value for each glycan and collagen peptide was extracted and assessed as a predictor of metastatic progression. Ancestral informative markers were analyzed and polygenic hazard risk scores were generated for samples as well. RESULTS/ANTICIPATED RESULTS: Three N-glycans and three collagen peptides were found to discriminate between NED and MET cases with statistical significance. The best performing N-glycan was Hex6HexNAc6Fuc1 with an AUC of 0.77 (p<0.001). While the best performing collagen peptide was COL1A2 with an AUC of C 0.77 (p<0.001). DISCUSSION/SIGNIFICANCE: Both a collagen peptide and N-glycan were discovered as promising biomarkers to predict metastasis. Future validation studies are needed to confirm biomarker potential and to determine if the addition of these biomarkers can strengthen current genomic classifier’s ability to predict metastatic prostate cancer.

Boduch-Grabka and Lev-Ari (2021) showed that so-called “native” British-English speakers judged statements produced by Polish-accented English speakers as less likely to be true than statements produced by “native” speakers and that prior exposure to Polish-accented English speech modulates this effect. Given the real-world consequences of this study, as well as our commitment to assessing and mitigating linguistic biases, we conducted a close replication, extending the work by collecting additional information about participants’ explicit biases towards Polish migrants in the UK. We did not reproduce the original pattern of results, observing no effect of speaker accent or exposure on comprehension or veracity. In addition, the measure of explicit bias did not predict differential veracity ratings for Polish- and British-accented speech. Although the current pattern of results differs from that of the original study, our finding that neither comprehension nor veracity were impacted by accent or exposure condition is not inconsistent with the Boduch-Grabka and Lev-Ari (2021) processing difficulty account of the accent-based veracity judgment effect. We explore possible explanations for the lack of replication and future directions for this work.

OBJECTIVES/GOALS: We examined how individual characteristics and characteristics of the socioeconomic and built environment were associated with care coordination’s effect on cardiovascular disease (CVD) risks to identify geographic areas that may benefit from supplementary clinic-community linkages. METHODS/STUDY POPULATION: We analyzed data with geocoded residential addresses and data from electronic health records for 9946 adults from a Centers for Medicare & Medicaid Services funded innovation project from 7/1/2013 to 3/30/2015. Variables included patient-level demographics, Elixhauser comorbidity index, total time with a nurse care manager, and neighborhood factors such as poverty indicators, walkability, and social capital index. Outcomes were change in CVD risk factors, hemoglobin A1C, blood pressure (BP), and low-density lipoprotein (LDL). Generalized linear models were used to assess the effect of nurse care management program on outcomes after controlling for confounding factors. RESULTS/ANTICIPATED RESULTS: We report preliminary models that include patient demographics (age, sex, race), health care utilization, nurse care manager contact time, Elixhauser comorbidity index, neighborhood education status, percent of population below 200% federal poverty level, median home value, walkability score of the residential address, and social capital index. After adjusting for all mentioned variables, in adults with HbA1C more than 7.5% at baseline, females had worsening HbA1C by 0.53% over the study period. Additionally, LDL values in females worsened over the study period by 4.8 mg/dL after adjusting for all variables. No clinically significant changes were noted for BP. DISCUSSION/SIGNIFICANCE OF IMPACT: Women’s HbA1C and LDL worsened despite nurse care management and may benefit from additional community-based interventions or interventionists. In future analyses, we anticipate that CVD risk will worsen for patients with higher fast food proximity and with greater geographic distance from their PCP.

Extra-care housing (ECH) has been hailed as a potential solution to some of the problems associated with traditional forms of social care, since it allows older people to live independently, while also having access to care and support if required. However, little longitudinal research has focused on the experiences of residents living in ECH, particularly in recent years. This paper reports on a longitudinal study of four ECH schemes in the United Kingdom. Older residents living in ECH were interviewed four times over a two-year period to examine how changes in their care needs were encountered and negotiated by care workers, managers and residents themselves. This paper focuses on how residents managed their own changing care needs within the context of ECH. Drawing upon theories of the third and fourth age, the paper makes two arguments. First, that transitions across the boundary between the third and fourth age are not always straightforward or irreversible and, moreover, can sometimes be resisted, planned-for and managed by older people. Second, that operational practices within ECH schemes can function to facilitate or impede residents’ attempts to manage this boundary.

Coastal ecosystems have been degraded by human activity over centuries, with loss of memory about past states resulting in shifted baselines. More recently conservation efforts have resulted in localized recoveries of species and ecosystems. Given the dynamism of ecosystem degradation and recovery, understanding how communities perceive long-term and recent changes is important for developing and implementing conservation measures. We interviewed stakeholders on three Caribbean islands and identified a shifted baseline with respect to the extent and degree of long-term declines in marine animal populations; stakeholders with more experience identified more species as depleted and key species as less abundant than those with less experience. Notably, the average respondent with < 15 years of experience listed no species as depleted despite clear evidence of declines. We also identified a phenomenon we call the policy placebo effect, in which interviewees perceived some animal populations as recently recovering following passage of new conservation legislation but in the absence of evidence for actual recovery. Although shifted baselines have a negative effect on conservation as they can lower recovery goals, the outcomes of a policy placebo effect are unclear. If the public prematurely perceives recovery, motivation for continued conservation could decline. Alternatively, perception of rapid success could lead communities to set more ambitious conservation goals.

The Numeniini is a tribe of 13 wader species (Scolopacidae, Charadriiformes) of which seven are Near Threatened or globally threatened, including two Critically Endangered. To help inform conservation management and policy responses, we present the results of an expert assessment of the threats that members of this taxonomic group face across migratory flyways. Most threats are increasing in intensity, particularly in non-breeding areas, where habitat loss resulting from residential and commercial development, aquaculture, mining, transport, disturbance, problematic invasive species, pollution and climate change were regarded as having the greatest detrimental impact. Fewer threats (mining, disturbance, problematic native species and climate change) were identified as widely affecting breeding areas. Numeniini populations face the greatest number of non-breeding threats in the East Asian-Australasian Flyway, especially those associated with coastal reclamation; related threats were also identified across the Central and Atlantic Americas, and East Atlantic flyways. Threats on the breeding grounds were greatest in Central and Atlantic Americas, East Atlantic and West Asian flyways. Three priority actions were associated with monitoring and research: to monitor breeding population trends (which for species breeding in remote areas may best be achieved through surveys at key non-breeding sites), to deploy tracking technologies to identify migratory connectivity, and to monitor land-cover change across breeding and non-breeding areas. Two priority actions were focused on conservation and policy responses: to identify and effectively protect key non-breeding sites across all flyways (particularly in the East Asian- Australasian Flyway), and to implement successful conservation interventions at a sufficient scale across human-dominated landscapes for species’ recovery to be achieved. If implemented urgently, these measures in combination have the potential to alter the current population declines of many Numeniini species and provide a template for the conservation of other groups of threatened species.

Giant ragweed has been increasing as a major weed of row crops in the last 30 yr, but quantitative data regarding its pattern and mechanisms of spread in crop fields are lacking. To address this gap, we conducted a Web-based survey of certified crop advisors in the U.S. Corn Belt and Ontario, Canada. Participants were asked questions regarding giant ragweed and crop production practices for the county of their choice. Responses were mapped and correlation analyses were conducted among the responses to determine factors associated with giant ragweed populations. Respondents rated giant ragweed as the most or one of the most difficult weeds to manage in 45% of 421 U.S. counties responding, and 57% of responding counties reported giant ragweed populations with herbicide resistance to acetolactate synthase inhibitors, glyphosate, or both herbicides. Results suggest that giant ragweed is increasing in crop fields outward from the east-central U.S. Corn Belt in most directions. Crop production practices associated with giant ragweed populations included minimum tillage, continuous soybean, and multiple-application herbicide programs; ecological factors included giant ragweed presence in noncrop edge habitats, early and prolonged emergence, and presence of the seed-burying common earthworm in crop fields. Managing giant ragweed in noncrop areas could reduce giant ragweed migration from noncrop habitats into crop fields and slow its spread. Where giant ragweed is already established in crop fields, including a more diverse combination of crop species, tillage practices, and herbicide sites of action will be critical to reduce populations, disrupt emergence patterns, and select against herbicide-resistant giant ragweed genotypes. Incorporation of a cereal grain into the crop rotation may help suppress early giant ragweed emergence and provide chemical or mechanical control options for late-emerging giant ragweed.

Estimating population sizes in the heavily traded grey parrots of West and Central Africa would provide insights into conservation status and sustainability of harvests. Ideally, density estimates would be derived from a standardized method such as distance sampling, but survey efforts are hampered by the extensive ranges, patchy distribution, variable abundance, cryptic habits and high mobility of the parrots as well as by logistical difficulties and limited resources. We carried out line transect distance sampling alongside a simpler encounter rate method at 10 sites across five West and Central African countries. Density estimates were variable across sites, from 0–0.5 individuals km−2 in Côte d'Ivoire and central Democratic Republic of the Congo to c. 30 km−2 in Cameroon and > 70 km−2 on the island of Príncipe. Most significantly, we identified the relationship between densities estimated from distance sampling and simple encounter rates, which has important applications in monitoring grey parrots: (1) to convert records of parrot groups encountered in a day's activities by anti-poaching patrols within protected areas into indicative density estimates, (2) to confirm low density in areas where parrots are so rare that distance sampling is not feasible, and (3) to provide a link between anecdotal records and local density estimates. Encounter rates of less than one parrot group per day of walking are a reality in most forests within the species’ ranges. Densities in these areas are expected to be one individual km−2 or lower, and local harvest should be disallowed on this basis.

With “Unfinished Migrations,” Patterson and Kelley have provided an indispensable overview of the recent resurgence of African diaspora scholarship. Describing this “rebirth” in light of contemporary concerns with globalization and transnationalism, they usefully update the work of scholars such as St. Clair Drake, Joseph Harris, and George Shepperson, who over the past thirty-five years have provided similar catalogues and calls.

Rather than contest any particular element of their overview, I will focus briefly on what I consider to be some crucial issues of epistemological strategy raised by their salutary attempt to conceptualize a “theoretical framework… that treats the African diaspora as a unit of analysis.” The first is that we need to consider in more detail the genealogy of the term diaspora itself. Patterson and Kelley are correct to note that “attempts to identify and make sense of the African diaspora are almost as old as the diaspora itself,” but surely it is also significant that the term diaspora has been appropriated so recently in black intellectual discourse. Writers and activists including Equiano, Blyden, Delany, Du Bois, and Nardal proposed varying visions of internationalism over the past two centuries, but only in the past three decades have black intellectuals turned to an explicit discourse of an “African diaspora.” It seems to me that we need to be able to explain why this term arises, as Patterson and Kelley point out, only in the late 1950s and early 1960s.

Rectal colonization with multidrug-resistant Enterobacteriaceae was found in 23 of 94 consecutively enrolled international patients hospitalized at Mayo Clinic, Rochester, Minnesota. No carbapenemase producers were detected. Twenty-one isolates were extended-spectrum β-lactamase-producing Escherichia coli. Colonization was associated with gastrointestinal disease and central venous catheter placement within the antecedent year.