BackgroundThere are established regional and racial/ethnic disparities in lower limb amputation due to diabetes; risk is higher in people of African American and Hispanic origin, particularly those in South Texas. The studies exposing these disparities in the Lower Rio Grande Valley are not current and are limited in number.MethodsWe collected data from 2011 to 2016 from the United States Census Bureau, Texas Department of State Health Services (DSHS), and Robert Wood Johnson Foundation (RWJF) databases. Demographic information related to gender, race, and Hispanic ethnicity was extracted from the Census Bureau, counts of minor and major amputations from DSHS, and socioeconomic data such as percent of unemployed, uninsured, and college education attainment from RWJF. Using multivariate Poisson regression, current rates of lower limb amputation secondary to diabetes in the Rio Grande Valley were analyzed, and the role of Hispanic ethnicity in county-level amputation rates was explored.ResultsThe Valley population living with diabetes had a significantly increased risk (1.334; CI 1.291, 1.378) of diabetes-related lower limb amputation compared to the rest of Texas when adjusting for the year. Similarly, Hispanic ethnicity was associated with an increased risk of amputation by a factor of 2.172 (CI 2.097, 2.248) compared to non-Hispanic ethnicity. However, when adjusting for Hispanic ethnicity, residing in the Valley is a protective factor for amputation, decreasing risk by a factor of 0.827 (CI 0.795, 0.86) compared to the rest of Texas.ConclusionWhile Hispanic ethnicity is associated with an increased individual risk of diabetes-related lower limb amputation in the Rio Grande Valley, residence in the Valley is simultaneously a protective factor from amputation.

Objectives To evaluate the relationship between contextual social determinants of health and successful community discharge after postacute rehabilitation care. Design This was a cross-sectional, secondary analysis of data from the Agency for Healthcare Research and Quality Social Determinants of Health (AHRQ SDOH) data set for 2018 with data about the social and economic characteristics of communities from the American Community Survey and other administrative data sets at the ZCTA-level. We identified community risks through a principal factor analysis with varimax rotation identifying and scoring factors with an eigenvalue of >1. We regressed rate of successful community discharge on the retained factors. Significance was set at 0.001. Setting AHRQ ZCTA-level data aggregated to Rehabilitation Service Areas (RSAs), which are postacute care utilization areas for rehabilitation services for the US. Participants This study used area-level data aggregated from Medicare claims to 1711 RSAs. Interventions Not applicable. Main Outcome Measures Percent successful community discharge after postacute care rehabilitation for each RSA based on Centers for Medicare and Medicaid Services quality measure specifications, with adjustment for individual clinical risk factors. Results Principal factor analysis identified 16 factors representing diverse community characteristics. Thirteen factors were significantly associated with and accounted for 85.34% of the variation in successful community discharge for RSAs. Economic disadvantage was strongly and positively associated with a higher rate of successful community discharge (B=0.44, P<.0001). Immigrant enclaves (B=−0.38, P<.0001), high-rent areas (B=−0.37, P<.0001), and ex-urban long-distance commuter suburbs (B=−0.33, P<.0001) are all sites with significantly lower successful community discharge. Model R-squared for these 4 factors alone was 0.58. Conclusions Community social and economic characteristics are significantly associated with successful community discharge after postacute care rehabilitation. These findings suggest nonclinical targets that policymakers, researchers, and administrators can leverage to understand and improve postacute care outcomes.Supported by the Agency for Healthcare Research and Quality (AHRQ) R01-R01-HS029891. Disclosures none.

"Limb salvage " efforts, such as performing minor amputations before infections spread proximally from the foot to decrease major lower extremity amputation, are an important part of healthcare today. It is unclear whether these efforts are preventing the number of major amputations and improving patients ' quality of life and the costeffectiveness of the U.S. healthcare system. Rates of non-traumatic lower extremity amputation (NLEA) among patients with diabetes decreased in the early 2000s but rebounded in the 2010s. We analyzed the proportion of major amputations and differences in amputation rates between age groups in Texas. Patient data was extracted from the Texas Hospital Discharge Data Public Use Data File. Population estimates were obtained from the Texas Population Estimates Program from 2011 to 2015 and from intercensal estimates provided by the U.S. Census Bureau from 2006 to 2010. Raw numbers of minor, major, and all NLEA surgeries and the ratio of major amputations to total amputations per year were reported for each age group. Poisson regression and Joinpoint analyses were performed to capture these changes in trends. Rates of amputations increased, with signi ficant decreasing relative prevalence of major amputations. Patients aged 45 to 64 with diabetes are likely driving these increases. Rates of lower extremity amputation in patients with diabetes increased from 2009 to 2015. This holds for all and minor amputations. In contrast, the ratio of major to all amputations decreased from 2010. Utilization of major and minor amputation differs between age groups, remaining stable in the youngest subjects, with minor amputation rates increasing in those aged 45 to 64. (c) 2024 by the American College of Foot and Ankle Surgeons. All rights reserved.

Date Presented 04/21/2023 Social determinants of health across rehabilitation service areas are related to successful community discharge. Using the Agency for Healthcare Research and Quality Beta Dataset, 23 measures were identified, representing economic, social, physical, educational, and health care contexts. Primary Author and Speaker: Timothy Reistetter Contributing Authors: Alex Bokov, Susanne Schmidt, Mei-Ling A. Lin, Julianna Dean, Chih-Ying Li, Allen Haas, John Prochaska

Despite the favorable health impacts of preventive services use, young adults remain at a higher risk of not using these services compared with older adults. This study seeks to identify barriers to receiving recommended preventive services among Asian young adults compared to other racial/ethnic young adults. Using 2016-2018 National Health Interview Survey data, this study examined barriers to recommended preventive services among non-Hispanic (NH) Asian young adults aged 18-39 years compared with other racial/ethnic groups in the United States (Total = 25,430; NH Asians = 6.3%). General prevention included fasting blood sugar, cholesterol, blood pressure, and Human Immunodeficiency Virus checkups. We documented information on vaccinations for influenza, pneumonia, tetanus, hepatitis A/B, and female-specific preventive care measures. NH Asian young adults reported blood pressure checkups less often than NH Whites (72.88% vs. 79.92%, p < 0.001). NH Asian young adults were also less likely to report HIV testing than all other racial/ethnic groups (p < 0.001). After controlling for covariates, NH Whites (odds ratio [OR] = 2.00, 95% confidence interval [CI] = 1.60, 2.50), NH Blacks (OR = 1.55, 95% CI = 1.18, 2.02), and other races (OR = 2.40, 95% CI = 1.60, 3.58) were more likely to receive any preventive services than NH Asians. Among those receiving any preventive services, there were no differences between NH Asians and all other racial/ethnic groups in whether they reported receiving relatively more preventive services. Our findings demonstrate that the rates of certain recommended preventive services use were lower among NH Asian young adults. Targeted public health strategies are needed to increase the use of preventive healthcare for racial/ethnic minority young adults.

Background Geographic areas have been developed for many healthcare sectors including acute and primary care. These areas aid in understanding health care supply, use, and outcomes. However, little attention has been given to developing similar geographic tools for understanding rehabilitation in post-acute care. The purpose of this study was to develop and characterize post-acute care Rehabilitation Service Areas (RSAs) in the United States (US) that reflect rehabilitation use by Medicare beneficiaries. Methods A patient origin study was conducted to cluster beneficiary ZIP (Zone Improvement Plan) code tabulation areas (ZCTAs) with providers who service those areas using Ward’s clustering method. We used US national Medicare claims data for 2013 to 2015 for beneficiaries discharged from an acute care hospital to an inpatient rehabilitation facility (IRF), skilled nursing facility (SNF), long-term care hospital (LTCH), or home health agency (HHA). Medicare is a US health insurance program primarily for older adults. The study population included patient records across all diagnostic groups. We used IRF, SNF, LTCH and HHA services to create the RSAs. We used 2013 and 2014 data ( n = 2,730,366) to develop the RSAs and 2015 data ( n = 1,118,936) to evaluate stability. We described the RSAs by provider type availability, population, and traveling patterns among beneficiaries. Results The method resulted in 1,711 discrete RSAs. 38.7% of these RSAs had IRFs, 16.1% had LTCHs, and 99.7% had SNFs. The number of RSAs varied across states; some had fewer than 10 while others had greater than 70. Overall, 21.9% of beneficiaries traveled from the RSA where they resided to another RSA for care. Conclusions Rehabilitation Service Areas are a new tool for the measurement and understanding of post-acute care utilization, resources, quality, and outcomes. These areas provide policy makers, researchers, and administrators with small-area boundaries to assess access, supply, demand, and understanding of financing to improve practice and policy for post-acute care in the US.

Fair inclusion of research subjects is necessary to ensure that post-acute sequelae COVID-19 (PASC) research results benefit all members of society. Scientists should conduct research on a broad sample of individuals who represent clinically relevant factors influencing a disease. Without demographic diversity and sociological and environmental variability, research outputs are less likely to apply to different populations and would thus increase health disparities. The goal of this narrative literature review and ethical analysis is to apply fair selection criteria to PASC research studies. We briefly highlight the importance of fair subject selection in translational research and then identify features of PASC, as well as PASC research, that hinder fair inclusion of research participants. We will demonstrate that determining an adequate and representative sample is not simply a matter of ensuring greater diversity; rather, fairness requires a broader evaluation of risks, burdens, and benefits specific to underrepresented populations. We provide recommendations to ensure fair subject selection in PASC research and promote translation toward positive health outcomes for all individuals, including the most vulnerable.

OBJECTIVES/GOALS: The 2020-2021 Galveston County Youth Risk Survey continues past efforts to characterize behavioral risks for local youth, identify disproportionate risks among groups, and provide the data needed for action and intervention to improve the health and safety of our youth in Galveston, Texas. METHODS/STUDY POPULATION: While the survey is based on the CDC Youth Risk Behavior Surveillance System (YRBSS), there was community need for an expanded survey and thus a workgroup was formed to create the Galveston Youth Risk Survey, including members from UTMBs Institute for Translational Sciences, a number of other UTMB departments and Centers, the Research, Education, and Community Health (REACH) Coalition, several school districts, Teen Health Clinic, and a variety of other community health organizations with vested interest. The survey was administered in November 2020 via ScanTron and REDCap to two local high schools with populations greater than 2,000. CDC guidelines for administration of the YRBSS were followed. RESULTS/ANTICIPATED RESULTS: A total of 2,428 students completed the survey from GISD and DISD. The survey provided insight into the following categories, with mental health emerging as a pressing issue, specifically stress and depression, particularly among females. All results are reported in several contexts, including comparisons by gender, grade, and ethnicity, a comparison to state and national statistics when available, as well as risk trends from previous surveys. Demographics Safety, including driving, violence, and bullying Mental Health: stress, depression, suicidal ideation, and ACEs Human Trafficking Substance Use, including smoking, alcohol, marijuana, and other drug use Sexual Behaviors, including contraceptive use Body Weight and Body Image Health Conditions Home Life: Support and Security DISCUSSION/SIGNIFICANCE: The report has been presented to the school districts, immediate stakeholders, REACH membership, and the general public. Several presentations have been given to groups to report the findings. Workgroups will now be formed to address the needs of our students, as well as a possible follow-up survey to look at data specific to COVID-19 and mental health.

Abstract Background Breast cancer survivors have a unique risk for negative health outcomes. Engaging in routine physical activity (PA) can reduce these risks. However, PA levels are low among this population. Narrative visualization (NV) is a technique that uses drawings, photographs, and text to contextualize data, which may increase integrated regulation, or motivation related to personal values and identity. A PA intervention targeting breast cancer survivors using an NV strategy may improve PA behavior. The purpose of this study was to determine whether scrapbooking activities could successfully be used as an NV strategy for older (55+) breast cancer survivors. Methods Breast cancer survivors were given workbooks, wearable electronic activity monitors, instant cameras, and art supplies including a variety of stickers (e.g., emojis, affirmations). Participants were instructed to use these materials for 7 days. The workbook pages prompted participants to re-draw their daily activity graphs from the wearable’s mobile app, then annotate them with text, photographs, stickers, etc. to reflect what the data meant to them. Hybrid thematic analysis was used to analyze the photographs, drawings, and written content to identify emergent themes. Content analysis was also used to investigate use of stickers and photographs. Results Of the 20 consented women (mean age 67 ± 5 years, 45% non-Hispanic white), 3 participants were lost to follow-up or unable to complete the procedures. The NV procedures were successfully utilized by the remaining 17 participants, who collectively used 945 stickers over 7 days, most of which were emojis. Emojis were both positively and negatively valanced. Participants took a mean of 9 photos over 7 days and completed workbook questions regarding current PA and PA goals. Themes within the photos included family, specific locations, everyday objects, religion, and friends. Themes within the written portions of the workbook included family, chores and obligations, health, personal reflection, hobbies, and shopping. Conclusions The materials provided allowed breast cancer survivors to successfully use NV techniques to reflect on their PA data and behavior. These techniques show promise for promoting integrated regulation in activity monitoring interventions. Trial registration This study was funded by the National Cancer Institute ( R21CA218543 ) beginning July 1, 2018.

Research Objectives Explore national geographic differences in unplanned readmission after accounting for patient-level admission factors and area-level post-acute care availability for individuals receiving home health services following stroke or lower-extremity joint replacement (JR). Design Retrospective cross-sectional analysis of Centers for Medicare & Medicaid Services (CMS) home health claims records and the Outcome and Assessment Information Set (OASIS). Using Rural-Urban Continuum Codes (RUCC) we classified all US counties into metro, metro-adjacent rural, and non-metro-adjacent rural areas and examined the availability of other post-acute care (PAC) provider types (long-term care hospitals, skilled nursing (SNF), and inpatient rehabilitation facilities) in each. We conducted multilevel logistic regressions to show the association between county classification and the odds of an unplanned readmission. Setting We examined acute care discharges to home health agencies. Participants The population included 100% Medicare records from 2013–2015 fee-for-service beneficiaries >65 years. The cohort included 21,395 stroke records and 160,287 JR records. Interventions N/A. Main Outcome Measures Odds of an unplanned readmission for individuals who received home health services following stroke or JR. Results Overall, 11.0% of stroke and 3.4% of JR had an unplanned readmission. For those >65 with JR, unplanned readmissions increased as age (range 2.6–5.4%) and length of stay (2.9–13%) increased. PAC availability other than home health varied across county groups. For metro counties, >50% were SNF-only; only 20% had all PAC provider types, whereas 80% of metro-adjacent rural counties were SNF-only with < 2% with all PAC provider types. Compared to metro areas, residing in a rural area was protective of readmission for those with stroke (metro-adjacent rural OR=0.887 (95CI 0.751–1.047), metro non-adjacent rural OR=0.789 (0.634–0.982). There was no significant effect of rural area on JR unplanned readmission. Conclusions Residing in rural counties is protective against unplanned readmission following home health services for stroke care. Further research should characterize social and contextual factors in rural areas that contribute to community-dwelling individuals' health. Author(s) Disclosures This work was supported by the Agency for Healthcare Research and Quality (AHRQ) R01-HS024711. Authors declare no conflicts.

OBJECTIVES/GOALS: Diabetes is related to risk for heart disease, stroke, high blood pressure, and COVID-19. It is exacerbated by built/social environment issues, e.g., food insecurity, access to healthy foods and health care, and other poverty-related factors. Our goal is to assess the efficacy of an integrated care model for patients with poorly controlled diabetes. METHODS/STUDY POPULATION: We utilize an integrated, team-based approach to diabetes treatment. In a traditional care model, too little focus is on social determinants and their impacts on health and well-being. Our project involves enrollment of patients with diabetes in an intervention whereby their medical care is integrated with intensive diabetes education and provision of social and other health services, including diet and nutrition, exercise, provision of foods and nutritional supplements, and other support services as needed to achieve optimal health and to reduce morbidity and unnecessary hospitalization and emergency room visits. Subjects are underserved patients treated through our non-profit community clinic partners. We track metrics including individual outcomes, organizational outcomes, and collective impact. RESULTS/ANTICIPATED RESULTS: We anticipate that patients enrolled in this study will demonstrate significant improvements in diabetes control and management. Clinical improvements will include better glycemic control, improved hypertension and dyslipidemia management, reduced complications, and increased preventive measures including foot, eye and oral health exams and monitoring of microalbuminuria. Overall, we anticipate decreased frequency of hospitalizations and readmissions as well as decreased frequency of emergency care visits for treatment of diabetes-related issues. We expect patients to experience enhanced self-efficacy, increased physical activity, and improved quality of life. Their outcomes will be compared to controls receiving the standard medical regimen, matched on age, race, gender, and time of onset. DISCUSSION/SIGNIFICANCE: These activities will improve understanding of factors influencing diabetes outcomes at individual and upstream levels. It will inform food distribution and models of care for improved patient outcomes, including social determinants of health and will establish new protocols for community-based provision of health care to our most vulnerable.

Abstract Older adults’ exposure to poverty, poor health, and negative life events over their lifetime creates cumulative adversity, increasing their risk of depressive symptoms. We hypothesize that those with disadvantaged sociodemographic characteristics like household poverty, chronic health conditions, and negative lifecourse exposures will be more likely to report a high number of depressive symptoms in old age. Three sequential multivariable logistic regression models were estimated using Wave 3 (2012) of the Mexican Health and Aging Study (MHAS). The final sample included 5,610 respondents aged 50 and older, of which 34.3% reported depression measured by a modified 9-item CES-D scale. The sample was mostly female (63.3%) with a mean age of 69. Present-day conditions were measured by quality of the home, consumer durables, chronic health conditions, and health insurance. Early-life conditions were measured by the respondent’s mother’s education and exposure to poverty and illness during childhood. In 2012, older Mexican adults living in homes built with poor construction materials or homes that lack access to water and sanitation (OR=1.24) were more likely to experience high depressive symptoms. In addition, those living in homes without consumer durable goods (OR=1.23) were at increased risk. Older Mexican adults who experienced poverty (OR=1.16) or illness during childhood (OR=1.21) were more likely to report a high number of depressive symptoms in old age. In conclusion, we find evidence of a “long-arm” of childhood, whereas older Mexican adults’ exposure to poverty and illness in childhood increases their likelihood of poor mental health outcomes, regardless of their present-day conditions.

Fasciola hepatica is a neglected parasitic infection with significant human health and livestock industry impact. The Andean Altiplano harbors an estimated 50% of the Fasciola's world infection burden. There is scarce data regarding the spatial associations between different Fasciola hosts. In this project, we aimed to determine the geospatial relationships between Fasciola eggs passed in feces of different livestock species and the risk of infection among each household as a unit. We used data from a cross-sectional study evaluating children and livestock feces for Fasciola infection around households in three districts of Anta province, in the Cusco region of Peru. Each sample was geographically tagged and evaluated for fascioliasis using microscopy methods. A total of 2070 households were included, the median age was 9.1 years (6.7-11.8), 49.5% were female, and 7.2% of the households had at least one infected child. A total of 2420 livestock feces samples were evaluated. The infection rate in livestock samples was 30.9%. The highest infection rate was found in sheep with 40.8%, followed by cattle (33.8%), and swine (26.4%). The median distance between a household with an infected child to a positive animal sample was 44.6 meters (IQR 14.7-112.8) and the distance between a household with no infected children to a positive animal sample was 62.2 meters (IQR 18.3-158.6) (p = 0.025). The multivariable logistic regression adjusted by presence of poor sanitation, unsafe water consumption, altitude, and presence of multiple infected children per household demonstrated an association between household infection and any cattle feces at a 50 meters radius (Uninfected: OR 1.42 (95%CI 1.07-1.89), p = 0.017. Infected: OR 1.89 (95%CI 1.31-2.73), p = 0.001), positive cattle feces at a 100 meters radius (OR 1.35 (95% CI 1.08-1.69), p = 0.008), and negative cattle feces at a 200 meters radius (OR 1.08 (95% CI 1.01-1.15), p = 0.022). We identified potential hot and cold spots for fascioliasis in the Anta province. An association between environmental contamination with feces from different livestock species and infected children in rural households was found in our study. Local health authorities may apply this strategy to estimate the risk of infection in human populations and apply targeted interventions.

Research Objectives Evaluate: 1) variation in successful community discharge across Rehabilitation Service Areas (RSAs) nationally, and 2) the relationship between social determinants of health (SDH) variables/indices and successful community discharge across RSAs. Design Retrospective cross-sectional analysis of Centers for Medicare & Medicaid Services (CMS) and AHRQ SDH dataset. We performed maximum likelihood factor analysis with varimax rotation and principled mean analysis to identify how many factors to extract from the AHRQ-SDH dataset and calculated a rehabilitation-specific SDH measure (SDH-R) based on these factors and variables. Next, we calculated the Social Deprivation Index (SDI) and the SDH-R for a random sample of 800 RSAs and examined the association between SDI and SDH-R and successful community discharge. Setting We examined discharges following post-acute care from long-term care hospitals, home health agencies, and skilled nursing and inpatient rehabilitation facilities. Participants The population included 2013–2015 Medicare records from fee-for-service beneficiaries >65 years. The cohort included 2,287,210 records across all diagnostic groups. Interventions N/A. Main Outcome Measures Successful community discharge across the 1711 RSAs nationally using CMS quality measure specifications. Results The national average for successful community discharge across RSAs was 55.1%. The pattern of successful community discharge indicates the majority of RSAs(1239, 72.4%) perform at the national average for successful community discharge with 253 RSAs (14.8%) significantly below and 219(12.8%) significantly above the national average. Factor analysis with AHRQ-SDH variables identified five factors with eigenvalues >1.0. The resultant model explained 23.1% of the variation in successful community discharge. The SDH-R model performed significantly better than the SDI (RMSE:SDH-R=0.88 vs SDI=0.99). Conclusions Successful community discharge varied across RSAs nationally. We identified SDH variables related to successful community discharge following rehabilitation. More research is needed to understand how SDH impacts community discharge across high- and low-performing RSAs and explore disparities and equity issues related to successful community discharge following post-acute care rehabilitation. Author(s) Disclosures This work was supported by the Agency for Healthcare Research and Quality (AHRQ) R01-HS024711 (TR,JP,AH,YK,KE), T32-HS026133 (YK,JD). All authors declare no conflicts.

ABSTRACT IMPACT: Using network analysis and a systems science lens, UTMB’s Institute for Translational Sciences is able to quantify the evolution of REACH (its Community-Campus Partnership) as measured by the creation of new partnerships among member entities, promoting the translation and sharing of ideas and resources, and formalization of relationships among members. OBJECTIVES/GOALS: o Present how network analysis and systems science can inform evaluation of community-campus partnerships o Describe results from our experience with evaluating the REACH coalition o Summarize lessons-learned and likely improvements we are considering for our methodology METHODS/STUDY POPULATION: In 2016, we administered a network survey to core members of the Research, Education, and Community Health (REACH) coalition. The survey captured attributes about each organization, including size, populations served, etc. The survey also captured data on the relationships among these organizations, including joint meeting attendance, joint event planning, shared tangible resources, shared information, and formal legal agreements between organizations. These data were analyzed using network analysis methods. The survey was again repeated in 2018, and comparisons were made to evaluate how the network structure had evolved from 2016 to 2018. RESULTS/ANTICIPATED RESULTS: Joint meeting attendance was high in both 2016 and 2018; however, there was evidence of increased sharing of information and tangible resources in 2018. We also observed an increase in joint event planning among partnering agencies. Most strikingly, we observed that the number of formalized agreements (in the form of Memoranda of Understanding or more formalized contracts) between agencies more than doubled between 2016 and 2018. By measuring the evolution of our network of partners, we are able to document the evolution of a community-campus partnership over time. DISCUSSION/SIGNIFICANCE OF FINDINGS: Over the course of 2 years, the coalition signaled an increase in deeper collaborations beyond simply meeting together. The use of network analysis demonstrated utility and provided another dimension for evaluating the development of teams, partnerships, and coalitions.

Objective The aims of the study were to demonstrate a method for developing rehabilitation service areas and to compare service areas based on postacute care rehabilitation admissions to service areas based on acute care hospital admissions. Design We conducted a secondary analysis of 2013-2014 Medicare records for older patients in Texas (N = 469,172). Our analysis included admission records for inpatient rehabilitation facilities, skilled nursing facilities, long-term care hospitals, and home health agencies. We used Ward's algorithm to cluster patient ZIP Code Tabulation Areas based on which facilities patients were admitted to for rehabilitation. For comparison, we set the number of rehabilitation clusters to 22 to allow for comparison to the 22 hospital referral regions in Texas. Two methods were used to evaluate rehabilitation service areas: intraclass correlation coefficient and variance in the number of rehabilitation beds across areas. Results Rehabilitation service areas had a higher intraclass correlation coefficient (0.081 vs. 0.076) and variance in beds (27.8 vs. 21.4). Our findings suggest that service areas based on rehabilitation admissions capture has more variation than those based on acute hospital admissions. Conclusions This study suggests that the use of rehabilitation service areas would lead to more accurate assessments of rehabilitation geographic variations and their use in understanding rehabilitation outcomes.

Global cooperation is an integral component of global health research and practice. One Retinoblastoma World (1RBW) is a cooperative network of global treatment centers that care for children affected by retinoblastoma. The study aimed to determine the number, scope and nature of collaborations within 1RBW, and uncover how they are perceived to contribute towards improving retinoblastoma outcomes. A cross-sectional, mixed-methods egocentric network analysis was conducted. Treatment centers (n = 170) were invited to complete an electronic survey to identify collaborative activities between their institution (ego), and respective partners (alters). Network maps were generated to visualize connectivity. Key informants (n = 18) participated in semi-structured interviews to add details about the reported collaborations. Interviews were analysed through inductive thematic analysis. Surveys were completed by 56/170 (33%) of 1RBW treatment centers. Collectively, they identified 112 unique alters (80 treatment centers; 32 other organizations) for a total network size of 168 nodes. Most collaborations involved patient referrals, consultations and twinning/capacity building. Interviews identified four main themes: conceptualization of partnership; primary motivation for collaborations; common challenges to collaboration; and benefits to partnership. There is extensive global collaboration to reduce global retinoblastoma mortality, but there is room to expand connectivity through active efforts to include actors located at network peripheries.

ABSTRACT IMPACT: Throughout the COVID-19 pandemic, the UTMB Institute for Translational Sciences has sought to answer our communities’ needs for research, for knowledge of research, and involvement in research, while recognizing that meaningful engagement involves understanding all emergent needs and responding to maximize the health and well-being of those we serve. OBJECTIVES/GOALS: ITS community programs responsive to COVID-19 include: ο Ongoing communication with community and business stakeholders ο Social media and public health campaigns promoting safe practices, research updates, and testing information ο Community initiatives to increase testing among vulnerable populations METHODS/STUDY POPULATION: Like sister hubs across the US, the UTMB ITS has brought available resources to bear on addressing COVID-19 through research, medical response, and public health outreach. Community engagement activities have included facilitating communication, particularly by rapidly translating information for multiple audiences and wherever possible and appropriate, providing opportunities for the patient’s voice to inform and guide development of research. We realized the community’s need for trustworthy and reliable information about COVID-19 early in the pandemic. Key partnerships with community members and organizations were critical in enabling us all to be most responsive in meeting these needs. RESULTS/ANTICIPATED RESULTS: ITS community outreach included developing infographics, media notices, and educational materials related to prevention and testing as well as appropriate use of PPE. These efforts resulted in an article in a regional newspaper, which was disseminated widely through social media networks. ITS faculty also engaged doctoral and MPH trainees to support the Health District’s contact tracing effort. We held several events on mental health impacts as well as discussions related to health disparities. Both activities shaped plans for community-based interventions and research. The ITS also hosted a virtual workshop to facilitate discussion around key research questions related to the pandemic. DISCUSSION/SIGNIFICANCE OF FINDINGS: Throughout the pandemic, the ITS has maintained contact with stakeholders. Our roles have been to communicate, disseminate, translate, provide resources, and build bridges. We also listen, share, and provide opportunities for patients and communities to engage in all phases of the research spectrum.