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OBJECTIVES/SPECIFIC AIMS: Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) skin and soft tissue infections (SSTIs) are commonly seen in primary care, with recurrence rates that range from 16% to 43%, and present significant challenges to clinicians, patients, and families. This comparative effectiveness research study aims to develop and evaluate a home-based intervention implemented by Community Health Workers (CHWs) or “promotoras” to prevent recurrence of CA-MRSA in patients presenting to primary care with SSTIs and transmission within their households. This presentation will examine associations between wound microbiology, clinical presentation, and housing characteristics, including housing density and household surfaces contamination. METHODS/STUDY POPULATION: In partnership with 3 Community Health Centers and 3 community hospitals in NYC, this study will recruit patients (n=278) with confirmed MRSA SSTIs and their household members. Participants will be randomized to receive either a CHW/Promotora-delivered decolonization-decontamination intervention (based on the REDUCE MRSA trial) or usual care. The highly engaged stakeholder team finalized the intervention protocol, developed and implemented CHW and clinician training, and developed an online health portal application for data management and exchange. RESULTS/ANTICIPATED RESULTS: We have collected 923 isolates from 237 individuals, including 240 wound culture isolates and 683 surveillance culture isolates (nares, axilla, groin). MRSA and MSSA were found in 19% and 21.1% of wound cultures, respectively; 59.5% with MRSA+ wound culture had 1 or more MRSA+ surveillance culture; 67.8% with MSSA+ wound culture had 1 or more MSSA+ surveillance culture. Of those with MRSA or MSSA infections, 70% of subjects were male, with an average age of 37.9 (SD=15.9 y). The most frequent sites of infection were the leg (20%), axilla (18%), buttock (17%), and abdomen/torso (12%). There was no association between the location and type of infection (MRSA/MSSA) (p-value=0.09). The kitchen floor (14.05%) and bedroom floor (14%) were the most common surfaces contaminated with MRSA. These were also the most common surfaces contaminated with MSSA, which was recovered from 10.2% and 9.1% of kitchen floors and bedroom floors, respectively. For individuals with an MRSA or MSSA wound infection, there was an average number of 3.2 (SD=1.6) co-residents per household, and 36.5% of household members were colonized with either MRSA or MSSA. There is no association between household density (number of co-residents) and type of infection (MRSA/MSSA) (Fisher’s p-values=0.171 and 0.371, respectively). In households of participants with MSSA wound infections, the number of colonized sites is positively associated with the level of household MSSA contamination (p=0.027). Further analyses will examine the associations between molecular subtypes, wound location, household surface contamination and household member colonization and infection. DISCUSSION/SIGNIFICANCE OF IMPACT: This study aims to understand the patient-level and environmental-level factors associated with SSTI recurrence, surface contamination and household transmission, and to examine the interactions between bacterial genotypic and clinical/phenotypic factors on decontamination, decolonization, SSTI recurrence and household transmission. This study will evaluate the barriers and facilitators to implementation of home visits by CHWs in underserved populations, and aims to strengthen the evidence base for implementation of strategies to identify and reduce household reservoirs and then control SSTI recurrence and household transmission.


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Reperfusion strategies when non-stemi is misclassified as stemi myocardial infarction Pablo I. Altieri, Alejandro Figueroa, Ismael Valle, Orlando Arce, Brigida Colon, Hector Banchs and Pablo Altieri University of Puerto Rico-Medical Sciences Campus, San Juan, Puerto Rico OBJECTIVES/SPECIFIC AIMS: A retrospective analysis was done at the Cardiovascular Center to evaluate reperfusion strategies, including stemi infarcts and non-stemi classified as stemi in a period of 2 years. METHODS/STUDY POPULATION: Review the records of stemi infarcts in a period of 2 years. RESULTS/ANTICIPATED RESULTS: In total, 101 cases were classified as stemi, but after strict analysis (time wise) 24 cases were non-stemi; 47% had inferior myocardial infarction and 38% an anterior myocardial infarction with a mean age of 65 years. All cases were immediately catheterized. Although the non-stemi, classified originally as stemi did not meet the time limit (<2 h) for cath. The stemi group (77 P.) 58 P. had angioplasty with stent implantation. 19 P. had an EF of 45% and remained that way during follow up. The rest of the P. the EF went up to 50% or more. The non-stemi group (24 P.) had angioplasty with stent implantation. The EF remained around 40% during follow up, which was the EF on admission. Fibrinolysis was given erratically. No changes were seen in the EF on follow up in the fibrinolytic group. DISCUSSION/SIGNIFICANCE OF IMPACT: This shows the importance of classifying the P. well between stemi and non-stemi. The time frame to catheterization should be kept as strict as possible, due to transmural infarcts, and catheterized in <2 hours to avoid deterioration of the left ventricular function and its consequences. This strict classification will save money to the institution when emergency catheterization is avoided in the non-stemi group.

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Patient and household member colonization and environmental contamination with Staphylococcus aureus in a comparative effectiveness study of homebased interventions to reduce CA-MRSA recurrence and household transmission Jonathan N. Tobin, Rhonda G. Kost, Brianna M. D'Orazio, Chamanara Khalida, Jessica Ramachandran, Mina Pastagia, Teresa H. Evering, Maria Pardos de la Gandara, Cameron Coffran, Joel Correa da Rosa, Kimberly Vasquez, Getaw Worku Hassen and Tracie Urba OBJECTIVES/SPECIFIC AIMS: Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) skin and soft tissue infections (SSTIs) are commonly seen in primary care, with recurrence rates that range from 16% to 43%, and present significant challenges to clinicians, patients, and families. This comparative effectiveness research study aims to develop and evaluate a homebased intervention implemented by Community Health Workers (CHWs) or "promotoras" to prevent recurrence of CA-MRSA in patients presenting to primary care with SSTIs and transmission within their households. This presentation will examine associations between wound microbiology, clinical presentation, and housing characteristics, including housing density and household surfaces contamination. METHODS/STUDY POPULATION: In partnership with 3 Community Health Centers and 3 community hospitals in NYC, this study will recruit patients (n = 278) with confirmed MRSA SSTIs and their household members. Participants will be randomized to receive either a CHW/Promotora-delivered decolonizationdecontamination intervention (based on the REDUCE MRSA trial) or usual care. The highly engaged stakeholder team finalized the intervention protocol, developed and implemented CHW and clinician training, and developed an online health portal application for data management and exchange. RESULTS/ANTICIPATED RESULTS: We have collected 923 isolates from 237 individuals, including 240 wound culture isolates and 683 surveillance culture isolates (nares, axilla, groin). MRSA and MSSA were found in 19% and 21.1% of wound cultures, respectively; 59.5% with MRSA + wound culture had 1 or more MRSA + surveillance culture; 67.8% with MSSA + wound culture had 1 or more MSSA + surveillance culture. Of those with MRSA or MSSA infections, 70% of subjects were male, with an average age of 37.9 (SD = 15.9 y). The most frequent sites of infection were the leg (20%), axilla (18%), buttock (17%), and abdomen/torso (12%). There was no association between the location and type of infection (MRSA/MSSA) (p-value = 0.09). The kitchen floor (14.05%) and bedroom floor (14%) were the most common surfaces contaminated with MRSA. These were also the most common surfaces contaminated with MSSA, which was recovered from 10.2% and 9.1% of kitchen floors and bedroom floors, respectively. For individuals with an MRSA or MSSA wound infection, there was an average number of 3.2 (SD = 1.6) co-residents per household, and 36.5% of household members were colonized with either MRSA or MSSA. There is no association between household density (number of co-residents) cambridge.org/jcts and type of infection (MRSA/MSSA) (Fisher's p-values = 0.171 and 0.371, respectively). In households of participants with MSSA wound infections, the number of colonized sites is positively associated with the level of household MSSA contamination (p = 0.027). Further analyses will examine the associations between molecular subtypes, wound location, household surface contamination and household member colonization and infection. DISCUSSION/SIGNIFICANCE OF IMPACT: This study aims to understand the patient-level and environmentallevel factors associated with SSTI recurrence, surface contamination and household transmission, and to examine the interactions between bacterial genotypic and clinical/phenotypic factors on decontamination, decolonization, SSTI recurrence and household transmission. This study will evaluate the barriers and facilitators to implementation of home visits by CHWs in underserved populations, and aims to strengthen the evidence base for implementation of strategies to identify and reduce household reservoirs and then control SSTI recurrence and household transmission.

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Social determinants of health and comorbidity in individuals with type 2 diabetes at HealthStreet, a community engagement initiative Scott Cohen, Jasmine Mack, Catherine Striley and Linda Cottler OBJECTIVES/SPECIFIC AIMS: Research on social determinants of health (SDHs) in type 2 diabetes have largely examined disease etiology rather than severity. To find factors associated with complications, we investigated sociodemographics, healthcare access, and healthcare utilization in individuals with type 2 diabetes with respect to related comorbidity. METHODS/STUDY POPULATION: Community health workers assessed 8494 participants for type 2 diabetes (n = 939; 11%) through HealthStreet, a community-engagement model implemented in North Central Florida. Comorbidities were defined as neuropathy, retinopathy, high cholesterol, hypertension, and kidney failure. We conducted multivariate analyses to test the association of socio-demographic factors and comorbidity status. RESULTS/ANTICIPATED RESULTS: Of 939 members with type 2 diabetes, 164 (17%), 272 (29%), 370 (39%), and 133 (14%) reported having 0, 1, 2, and 3+ comorbidities, respectively. There is a smaller proportion of African-Americans reporting 3+ comorbidities compared with other comorbidity groups (p = 0.003). Those with more comorbidity are less employed (p < 0.0001) and are more likely to have Medicare/Medicaid (p = 0.03) than those without comorbidity. Those with no comorbidity are more likely to be uninsured compared to those with comorbidity (p = 0.0297). Adjusting for age, race, gender, and BMI, those that have at least 1 comorbidity are 1.4 times more likely to be food insecure (p = 0.004) and are 1.9 times more likely to have seen a doctor in the past 12 months (p = 0.002) compared to those without comorbidity. DISCUSSION/SIGNIFICANCE OF IMPACT: Although there is complexity among the relationships between SDHs and diabetic comorbidity, results suggest significant sociodemographic and healthcare-related disparities among individuals living with type 2 diabetes. Members with more comorbidity utilize healthcare, but are more likely to be food insecure among other factors. Those with no comorbidity are least likely to see a physician, which could imply a gap in the care continuum. This analysis gives insight into the importance of efficient diabetes management, focused on disparities in economic stability and healthcare access and utilization.

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National trends in ambulatory Versus emergency department visits for low-income patients with skin and soft tissue infections Brianna M. D'Orazio, Joel Correa da Rosa and Jonathan N. Tobin OBJECTIVES/SPECIFIC AIMS: Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) skin and soft tissue infections (SSTIs) recurrence ranges from 16% to 43% and presents significant challenges to clinicians, patients, and families. The number of emergency department visits for SSTIs increased from 1993 to 2005 from 0.48 to 1.16 ED visits per 100 US residents (95% CI 0.94 to 1.39; p < 0.001); high safety-net status EDs saw a 4-fold increase in visits. The CA-MRSA Project (CAMP2) comparative effectiveness research (CER) study aims to evaluate a home-based intervention implemented by Community Health Workers (CHWs) or "promotoras" to prevent recurrence and transmission of CA-MRSA in primarily low-income, minority patients presenting to primary care with SSTIs. The intervention disseminates and implements methods found effective in the REDUCE MRSA trial. The present analysis was conducted using publically available data set to characterize the national patterns of healthcare utilization for treatment of SSTIs. METHODS/STUDY POPULATION: An analysis was conducted using data downloaded from the CDC National Ambulatory Medical Care Survey (NAMCS) and the CDC National Hospital Ambulatory Medical Care Survey (NHAMCS) from 2012 (most recent data available) to evaluate the addition of Emergency Departments (EDs) as compared to Ambulatory Care as recruitment sources for a clinical trial to reduce CA-MRSA SSTI recurrence and household transmission. "Low-income" population was defined using "Expected Source of Payment" categories "Medicaid" and "Uninsured," and ICD-9-CM dermatologic diagnosis codes for SSTIs and ICD-9-CM Procedure Codes for Incision and Drainage (I&D) were used to define a visit for SSTI treatment. RESULTS/ANTICIPATED RESULTS: In all patients, I&D was performed at a higher rate in EDs as compared with the ambulatory care setting (49.57 vs. 1.44 per 10,000 US residents in Medicaid and Uninsured; 44.48 vs. 5.24 per 10,000 US residents in all other insurance types). Nationally, low-income patients are 4 times more likely to have I&D procedure performed (OR 4.05,, p < 0.0001) and 5 times more likely to be diagnosed with an SSTI (OR 5.10, 95% CI 2.987-8.707, p < 0.001) in the ED setting. DISCUSSION/SIGNIFICANCE OF IMPACT: These results confirm that low income patients seek primary care for SSTIs in both EDs and ambulatory care, such as Federally Qualified Health Centers (FQHCs). This also confirms the trend we have experienced in FQHCs in NYC, many of whom refer patients to the ED for the I&D procedure, and those patients return to the FQHC for follow-up. Thus, the most comprehensive test of using CHWs to disseminate and implement the findings from the REDUCE MRSA trial would engage both EDs and Ambulatory Care/ FQHCs for patient identification and recruitment.

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Investigating markers of early traumatic brain injury (iMet): An interim analysis Tara Rhine, Ting Sa, Nanhua Zhang, Shari Wade and Rachel P. Berger OBJECTIVES/SPECIFIC AIMS: Analyze data from the first 30 children enrolled in a prospective cohort study evaluating the ability of specific serum biomarkers to distinguish children with traumatic brain injuries (TBI) from children with orthopedic injuries (OI). METHODS/STUDY POPULATION: Children ages 0 < 5 years were eligible if they presented to the emergency department within 6 hours of injury. Children were identified as having a TBI if they sustained a head injury and were found to have an acute injury on head CT. Children were identified as having an OI if they sustained a musculoskeletal injury significant enough to necessitate radiography per clinical care. Individual (eg, age) and clinical (eg, radiography findings) factors, as well as serum biomarkers [eg, ubiquitin C-terminal hydrolase L1 (UCH-L1), glial fibrillary acidic protein (GFAP)] were collected at time of enrollment. TBI and OI groups were compared using Wilcoxon rank-sum and Kruskal-Wallis tests. RESULTS/ANTICIPATED RESULTS: This cohort consisted of 13 children with TBI (7 with isolated skull fractures, 1 with intracranial injury, and 5 with both a skull fracture and an intracranial injury) and 17 with OI (12 with fractures). Most patients were male (67%) and White (67%), and this did not differ between groups (p > 0.1). Children with TBI were significantly younger than children with OI, with an average (± standard deviation) age of 15 ±13 and 39 ± 13 months, respectively (p < 0.01). There was not a significant difference in time from injury to biomarker collection between TBI and OI patients at 4.1 ± 1.8 and 5.8 ± 2.6 hours, respectively (p = 0.07). Median (IQR) levels of GFAP were significantly higher (p < 0.01) in children with TBI, relative to children with OI: 220 (67-421) pg/mL Versus 37 (25-74) pg/mL, respectively. Median (IQR) levels of UCH-L1 were also significantly higher (p < 0.01) in the TBI group, relative to children with OI: 444 (377-449) pg/mL Versus 248 (140-417) pg/mL, respectively. In a subanalysis comparing median biomarker levels across three study groups (ie, TBI with an isolated skull fracture, TBI with an intracranial injury, and OI), group differences remained significant for both biomarkers with TBI patients having higher levels, relative to OI patients, of both GFAP (p < 0.01) and UCH-L1 (p = 0.02). DISCUSSION/SIGNIFICANCE OF IMPACT: GFAP and UCH-L1 hold promise to improve the diagnosis of TBI in very young children. Identification of a marker of TBI that can be done in the acute care setting would advance the diagnosis of TBI in very young children, a vulnerable population for whom identification of neurological symptoms can be challenging.