The Ming dynasty’s survival depended on locating and employing men with the ability to direct military forces, and contemporary observers were deeply concerned with the nexus of command, troop morale, and dynastic fighting capacity. This essay focuses on the years following the Tumu Crisis of 1449, a time when dynastic authorities were particularly alive to issues of military ability, and it draws on the perspectives of two men, the Minister of War, Yu Qian 于謙 (1398–1457), and another more junior official, Ye Sheng 葉盛 (1420–72). The essay offers a snapshot of how military ability was defined, cultivated, assessed, and rewarded. Further, it suggests that, read carefully, the writings of Ye Sheng and Yu Qian not only offer insight into the views of elite civil officials but also shed light, however faint and wavering, on military labor and working conditions for those who fought and commanded for a living.

Over the past decade, several multi-institutional research consortia have formed within the North American pediatric surgical community. In this article, we describe our experience with the creation and implementation of the Eastern Pediatric Surgery Network, a large and comprehensive research consortium designed to produce a wide array of high-quality clinical studies within our subspecialty. In 2020, a vision statement and rules of governance were established at thirteen academic pediatric surgery divisions in the eastern United States. The research consortium was organized based on four major pillars, namely legal ownership of aggregate data, horizontal leadership structure, mandatory participation in adopted studies, and a broad research portfolio that encompasses the full breath of the specialty. Over the past five years, the number of research projects has dramatically expanded over time and includes participation from 24 different medical centers. Despite a lack of dedicated sponsored extramural support for most projects, there have been 28 abstracts presented at national conferences and 12 manuscripts published in peer-reviewed journals. It is our hope that sharing our experience with creating this organization can help to inform others interested in establishing the academic infrastructure to engage in multi-institutional, evidence-based clinical research in other medical specialties and beyond.

Runoff contributions from glacierized catchments are changing in response to accelerating mass loss. We reconstruct the 1980–2022 mass balance, runoff and water budget of the ∼70% glacierized Kaskawulsh River headwaters in Yukon, Canada, using an enhanced temperature-index model driven by downscaled and bias-corrected reanalysis data. Debris is treated using melt-scaling factors based on site-specific measurements of the critical debris thickness. Accumulation is estimated from downscaled precipitation bias corrected based on in situ measurements. Model tuning incorporates observations of the 2007–18 geodetic mass balance and seasonal snowline positions on the Kaskawulsh Glacier. We assess model sensitivity to the representation of supraglacial debris and accumulation, including treatments of these processes that can be applied in the absence of in situ data. Different representations of debris produce <1% variation in the catchment-wide runoff and water budget. In contrast, accumulation estimates that omit in situ data produce 33–40% variations in modelled runoff relative to those that use these data. This work identifies site-specific measurements of accumulation as critical to accurate estimates of mass balance and runoff for the Kaskawulsh Glacier, in contrast to site-specific characterization of the effects of debris which influence estimated thinning rates at the glacier terminus but have little impact on the glacier-wide runoff.

OBJECTIVES/GOALS: Physical therapy (PT) is key for treating functional decline that inpatients experience but is a constrained resource in hospital settings. The Activity Measure Post-Acute Care (AM-PAC) score is a mobility measurement tool that has been used to define misallocation of PT. We aim to optimize PT referrals using AM-PAC-based clinical decision support . METHODS/STUDY POPULATION: We conducted a prospective study of patients admitted to University of Chicago Medical Center. AM-PAC scores were assessed by nursing staff every 12 hours. Clinical decision support was designed using validated AM-PAC cutoffs (> 18, a predictor of discharge to home). The tool was embedded in hospital medicine note templates, requiring providers to indicate PT referral status based on current AM-PAC scores. The primary outcome, unskilled consult , was defined as PT referral for patients with AM-PAC > 18. Data were collected for one year prior to implementation and one year after implementation for intervention (hospital medicine) and control (general internal medicine) services. Difference in differences analysis was used to assess the association between the intervention and unskilled consults. RESULTS/ANTICIPATED RESULTS: Between October 2018 and March 2021, 18,241 admissions were eligible for the study. Compared to preintervention, there was a lower rate of referral to PT for patients with high AM-PAC mobility scores in the post-intervention period [18.5% vs 16.6%; X2(1) = 7.02; p < 0.01]. In the postintervention time period, the control group experienced a 2.6% increase in unskilled consults while the intervention group experienced a 2.3% decrease, a difference in differences of 4.9% (95% CI -0.07–-0.03 for difference in differences) controlling for age sex, race, LOS, and change in mobility. Compared to preintervention, there was no statistically significant difference in mean change in mobility score post-intervention for either group. DISCUSSION/SIGNIFICANCE: Our results suggest that clinical decision support can decrease unskilled PT consults. Many functionally independent patients can mobilize with nursing or other mobilization staff. Hospitals should consider mobility score-based decision support to prioritize PT for impaired and at-risk patients.