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OBJECTIVES/GOALS: Low and middle income countries (LMICs) face challenges in early detection of breast cancer resulting in high breast cancer mortality. This study serves to identify gaps and opportunities for innovators seeking to address problems in early detection of breast cancer in Uganda and other LMICs. METHODS/STUDY POPULATION: Two methods were used: 1) Three weeks of ethnographic research in Uganda through primary stakeholder interviews and clinical observations. Interviews were conducted with patients, clinicians, NGOs, and key opinion leaders from the Uganda Cancer Institute, Makerere University, and JHPIEGO. Clinical observations were performed to note the workflow and availability of resources across diverse health centers ranging from village health teams in rural settings to the national referral hospital in the urban center. 2) A targeted literature search focused on breast cancer detection in LMICs. Keywords included breast cancer’, screening’, and diagnosis’. Identified challenges were validated through stakeholder interviews and categorized. Potential solutions to each challenge were explored. RESULTS/ANTICIPATED RESULTS: Three broad categories of challenges and suggested innovation targets were identified. 1) Ineffective clinical processes: deskilling and improving training around the process of clinical breast examinations, imaging operation and interpretation, and pathology preparation and interpretation; 2) Accessibility: increasing screening throughput, improving rural community access to breast cancer care, and increasing opportunistic screening; 3) Sensitization: increasing patient and health worker awareness of clinical presentations of breast cancer, reducing cultural barriers, and improving trust in the medical community. DISCUSSION/SIGNIFICANCE: Innovators seeking to solve problems in early breast cancer detection in LMICs should focus on ineffective clinical processes, accessibility, and sensitization. In conjunction with prompt treatment, there is potential to reduce breast cancer mortality rates in line with the Global Breast Initiative.

OBJECTIVES/GOALS: The aim of this study was to evaluate current and new anatomical approaches to treating obstructive sleep apnea (OSA) in patients who fail continuous positive airway pressure (CPAP). Understanding the breadth of devices and procedures increases clinical scope of practice and innovator opportunities. METHODS/STUDY POPULATION: A comprehensive review of literature, FDA approvals, patents, and commercially available technologies was undertaken with regards to anatomical approaches for treating OSA. These include experimental therapies, surgical approaches, and non-surgical ablative procedures. Oral appliances, positive airway pressure devices, and therapeutics were excluded. Key search terms included obstructive sleep apnea,’ anatomy,’ surgery,’ devices,’ experimental therapy,’ innovation,’ technology,’ and translational research.’ Publications were limited to the last five years. Innovations were evaluated for relevance to OSA treatment and then assessed in greater depth based on scientific literature. RESULTS/ANTICIPATED RESULTS: Numbers of preclinical and commercially available innovations pertinent to the anatomical treatment of OSA were reported along with clinically relevant outcome metrics. The greatest number of innovations was found in surgical approaches, including soft-tissue removal, orthognathic surgery, and electrical stimulation. Outcome parameters included safety, efficacy, patient compliance, and mean disease alleviation as a ratio of efficacy to compliance. Innovations were grouped by their intended anatomical targets including retrolingual, palatal, oropharyngeal, epiglottic, nasal, and complete concentric collapse, making special note of gaps in the treatment armamentarium. DISCUSSION/SIGNIFICANCE: In the last decade, sleep surgery has trended toward innovative CPAP alternatives. Nerve stimulation and ablative procedures have grown, but some anatomical presentations have been frequently excluded. These developments present opportunities for innovators to fill persistent gaps in treatment.

OBJECTIVES/GOALS: Adult spinal deformity is commonly treated by spine surgeons. Patient treatment planning and surgical candidacy are dependent on static measurements and inconsistent heuristics which lead to high complication rates and poor outcomes. This study tests the role of supplemental longitudinal and dynamic patient data in improving surgical planning. METHODS/STUDY POPULATION: Ten adult spinal deformity surgeons at Johns Hopkins Hospital were interviewed for 30 minutes by the study team. The script was reviewed by the institutional review board to alleviate any risk of bias. Two patient sets were curated utilizing previously treated, anonymized patient data sets from a non-surveyed practitioner. Each patient set was coupled with relevant radiographic imaging (MRIs, CTs, and plain radiographs) and pertinent clinical information that is collected in a standard clinic visit. Surgeons were presented with a patient and asked to note their specific surgical plan. Subsequently, surgeons were presented with four sets of supplemental dynamic spine data and asked to note their surgical plan for each set. Shaprio-Wilks and Mann-Whitney U tests were used to assess data normality and nonnormality. RESULTS/ANTICIPATED RESULTS: Preliminary data has shown inconsistency in both surgical selection and surgical type amongst physicians when presented with initial clinical findings and radiographic reports for base patient cases. There was minimal consensus among surgeons on the number of levels fused and interbody spacer usage. Early results show that dynamic spine data may be beneficial in creating consistency between surgeons, despite inter-surgeon variability in surgical planning without this data. Posture, pain location, pain severity, and quantified activity throughout the day have been referenced as the most useful dynamic spine data to consider. Amongst all providers, the availability of dynamic spine data resulted in a change in surgical planning. DISCUSSION/SIGNIFICANCE: Recent publications have shown that spine surgery patient candidacy and surgical planning are dependent on heuristics. This has led to inconsistencies amongst surgeon preferences and increases in improper patient selection for procedures. Incorporating longitudinal dynamic data may lead to increased consistency and improved patient outcomes.

OBJECTIVES/GOALS: To demonstrate safety and limit damage to off-target organs, we will be determining dosimetry parameters through experimentation and Monte Carlo simulations with our brachy therapy applicator designed to improve upon current designs to treat a 3-dimensional volume. METHODS/STUDY POPULATION: Low-cost materials were used to manufacture our High Dose Rate (HDR) applicator and a readily available after loading system was used to load our configuration with a radioactive source. The dosimetry of our device was analyzed using commercially available software and external beam therapy films to generate depth dose profiles and superficial dose distribution. Additionally, we attempt to confirm Task Group No. 43 (TG-43) dosimetry parameters using Monte Carlo simulations for our device. These data were compared with currently available applicators used for intraoperative radiotherapy. RESULTS/ANTICIPATED RESULTS: We anticipate that we will be able to validate dosimetry parameters for our device in preparation for clinical use. We aim to show our dose distributions align well with proposed target volumes while considering the composition and shape of our applicator. We hope to demonstrate that, unlike current applicators, our design is more effective at treating a 3-dimensional target volume. DISCUSSION/SIGNIFICANCE: By 2040, pancreatic cancer will be the second-largest cause of cancer-related deaths. Even with current brachytherapy applicators, 30-40% of pancreatic cancer seems to recur near the surgical site after surgery. By preventing local recurrence, we hope to improve patient outcomes.

OBJECTIVES/GOALS: Lymphedema is a chronic, debilitating disease characterized by progressive swelling due to lymphatic dysfunction. Lymphedema affects 5+ million people in the US, commonly as a consequence of cancer treatment. We identified the most relevant needs within lymphedema based on clinical impact, commercial viability, and technological feasibility. METHODS/STUDY POPULATION: A narrative review of lymphedema management was performed through a combination of literature review via English language PubMed, landscape determination for current solutions and primary ethnography. Lymphedema-focused physicians, patients, physical therapists and researchers were interviewed on Needs were identified and clustered based on common themes. These clusters were further refined through an iterative process of systematic scoring and expert evaluation. Clusters were evaluated on their potential for clinical and commercial impact as well as technical feasibility. RESULTS/ANTICIPATED RESULTS: General clusters identified included improved diagnostic modalities, curative treatment, disease knowledge among non-specialized clinicians and increased insurance coverage. 3 primary needs were determined to represent the best opportunities for technological innovation. There is a need for a quantitative method of evaluating lymphedema. This would allow for both improved tracking of progression for patients undergoing conservative management, and for better evaluation of surgical outcomes. Oncologists and surgeons need a method of prophylaxis in order to decrease the rate of lymphedema development following cancer treatment. Physicians need a method for early diagnosis of subclinical lymphedema to enable early intervention through proactive screening rather than reactive management. DISCUSSION/SIGNIFICANCE: Increasingly medical device design has moved towards a “bedside to benchtop” model where technology development is targeted based on critical needs within the clinical environment. Identification of these critical needs will serve as to guide future technological innovation in creating clinically impactful advancements.