Using a relational leadership lens, this study aims to gain a deeper understanding of empathic conversations with a focus on leadership ethics. It adopts an entitative perspective in relational leadership and examines leadership conversations as a two-way influence relationship, highlighting their interdependencies and collective role in the co-construction of meaning. Data from facial expression software and perception surveys are analyzed. The results of this study reveal the influence of gendered leadership on emotions, emotional bonding moments triggered by humor, and cultural dynamics in leadership conversations. Leaders’ feeling-based questions and participants’ willingness to share their emotions, coupled with emotion synchronization, create a constructive space where both feel invited, cared for, and valued. The study shows that emotional bonds foster the expression of generosity, care, and responsibility, enhancing satisfaction for both leaders and participants. Overall, this study enriches relational leadership theory and practice by underscoring the connection between empathy and leadership ethics.

Single-use plastic pens are commonly used to mark surgical sites on the skin of patients. In laboratory testing, an ultraviolet-C (UV-C) light device was effective for decontamination of marking pens with plastic caps designed to allow transmission of UV-C. Decontamination of marking pens could reduce plastic and carbon footprints.

Penicillin allergy delabeling may benefit antimicrobial stewardship (AS). Cost of initial penicillin treatments following risk-stratified inpatient delabeling were compared to two hypothetical treatment regimens if delabeling had not occurred: (1) AS-guided and (2) Common Treatment. Penicillin allergy delabeling improved antimicrobial spectrum index, was cost-neutral, and averted unnecessary penicillin desensitizations.

Staphylococcus aureus infection patterns in Yuma, Arizona show a 2.25x higher infection rate in non-Hispanics. Males had higher infection rates in most age classes. These disparities in infection are mostly consistent with previously observed patterns in colonization, suggesting that sex and ethnicity do not differentially impact colonization and infection.

Background: Identification and timely reporting of multi-drug resistant organisms (MDROs) drives efficacy of infection prevention efforts. Data on MDRO reporting timeliness and inter-facility variability are limited. Facility-dependent variability in MDRO reporting across Tennessee was examined to identify opportunities for MDRO surveillance improvement. Methods: Data for reported Tennessee MDROs including carbapenem-resistant Enterobacterales (CRE), carbapenem-resistant Acinetobacter baumannii (CRAB), Carbapenem-resistant Pseudomonas aeruginosa (CRPA) and Candida auris, were obtained from the southeast regional Antibiotic Resistance Laboratory Network (ARLN) from 2018-2022, excluding screening and colonization specimens. Variance in days accrued from specimen collection to ARLN receipt was analyzed using one-way analysis of variance (ANOVA) with Tukey’s test (SAS 9.4). Facilities were categorized as fast (1-10 days), slow (11-20 days), or delayed (21-100 days) reporters. Results: There were 9,569 MDRO isolates reported. CRPA was reported faster than other MDROs (p < 0.001), while specimens from West Tennessee compared to other regions (p < 0.001) (Figure) and blood cultures compared to other specimens were reported more slowly (p < 0.001) (Table). There was no difference in reporting times for facilities using on-site microbiology laboratories versus reference laboratories (P = 0.062). Conclusion: MDRO reporting times varied across Tennessee by region, specimen, and organism. Future work to elucidate drivers of variability will consist of surveys and focused interviews with laboratory personnel to identify shared and unique barriers and opportunities for improvement.

Background: In rural areas, antimicrobial stewardship programs often have limited access to infectious disease (ID) expertise. Videoconference Antimicrobial Stewardship Teams (VASTs) pair rural Veterans Affairs (VA) medical centers with an ID expert to discuss treatment of patients with concerns for infection. In a pilot study, VASTs were effective at improving antimicrobial use. Here, we evaluated 12-month operating costs for staffing for 3 VASTs. Methods: We used the following data to describe 12 months of clinical encounters for 3 VASTs operating from January 2022 – March 2023: the number of VAST sessions completed and clinical encounters; Current Procedural Terminology (CPT) codes associated with clinical encounters; session attendees (by role) and the time spent (percent effort) on VAST-related activities. The annual operating cost was based on the annual salaries and percent effort of VAST attendees. We used these characteristics combined with private-sector and Medicare reimbursements to evaluate the cost of implementation and number of clinical encounters needed to offset those costs (breakeven) for each site. Results: Three VASTs recorded 229 clinical encounters during 117 sessions (Table 1). Based on CPT codes, the approximate revenue per patient was $516.46. Site A, the only site to break even, had the most sessions and clinical encounters as well as the lowest operating costs. For Site B, a slight increase in the clinical encounters, which might be achieved by 3 additional VAST sessions, would help achieve breakeven. For Site C, increasing the number of clinical encounters to 3-4 per session would have helped their VAST break even without requiring a decrease in operating costs. Conclusions: The frequency of VAST sessions, volume of clinical encounters, and low operating costs all contributed the VAST at Site A achieving a financial break-even point within 12 months. Consideration of the potential number of clinical encounters and sessions will help other VASTs achieve financial sustainment, independent of cost-savings related to potential decreases in expenditures for antibiotics and antibiotic-related adverse events. These results also provide insight into possible adoption and diffusion of VAST-like programs in the Medicare hospital setting.

Poor mental health is a leading contributor to the global burden of disease but there is poor understanding of how it is influenced by people's interactions with ecological systems. In a theory-generating case study we asked how interactions with ecosystems were perceived to influence stressors associated with psychological distress in a rural setting in Uganda. We conducted and thematically analysed 45 semi-structured interviews with residents of Nyabyeya Parish. Poverty and food insecurity were the primary reported causes of ‘thinking too much’ and related idioms suggesting psychological distress. Households bordering a conservation area reported that crop losses from wildlife contributed to food insecurity. However, forest resources represented important safety nets for those facing poverty and food insecurity. Commercial agricultural expansion also emerged as a salient theme in the lives of residents, reportedly exacerbating poverty and food insecurity amongst poorer households but contributing incomes to wealthier ones. Our exploratory study suggests how two globally prevalent land uses, nature conservation and commercial agriculture, may influence social determinants of psychological distress in the study area. We highlight co-benefits and trade-offs between global sustainability goals that could be managed to improve mental health.

OBJECTIVES/GOALS: To demonstrate a successful example of clinical and translational research at a busy veterinary teaching hospital and highlight a collaborative effort in Comparative Oncology between the University of Florida’s (UF) Colleges of Medicine and Veterinary Medicine. METHODS/STUDY POPULATION: The UF College of Veterinary Medicine (CVM) is a full-time teaching hospital with multiple departments actively recruiting patients for clinical trials. These departments include but are not limited to Oncology, Internal Medicine, Dermatology, Cardiology, and Emergency and Critical Care. The Oncology department collaborates with the doctors at the UF Health Cancer Center (UFHCC) as part of a Comparative Oncology Initiative, which has many ongoing canine and feline trials focusing on immunotherapy. RESULTS/ANTICIPATED RESULTS: As of August 2023, there are 60 clinical trials actively recruiting and enrolling patients at the UF CVM. 57% of these trials are interventional studies, while the other 43% are observational studies. The UFHCC Comparative Oncology Initiative has successfully completed one clinical trial focusing on canine gliomas; has 4 clinical trials that are actively recruiting patients, and 6 trials that are opening for enrollment in the near future. These studies focus on osteosarcoma, melanoma, and squamous cell carcinoma. It is anticipated that with continued successful collaborations, more clinical trials will be possible, and new treatment options will become available for not only veterinary patients but human patients as well. DISCUSSION/SIGNIFICANCE: Clinical and translational research is an important part of veterinary medicine to further patient care. Due to ongoing collaborative efforts, not only veterinary patients but also human patients will benefit from the research being conducted at the UF CVM.

Terrestrial and marine protected areas have long been championed as an approach to biodiversity conservation. For protected areas to be effective, equitable and inclusive, the involvement of local residents in their management and governance is considered important. Globally, there are many approaches to involving local residents in protected area law enforcement. However, opportunities for comparing different approaches have been limited by the lack of a clear common framework for analysis. To support a more holistic understanding, we present a framework for analysing the contributions of local residents to protected area law enforcement. Informed by a review of the literature and discussions with conservation practitioners, the framework comprises five key dimensions: (1) the different points in the enforcement system at which local residents are involved, (2) the nature of local participation in decision-making, (3) the type of external support provided to local residents, (4) the different motivating forces for participation, and (5) the extent to which local participation is formalized. We apply the framework to three real-world case studies to demonstrate its use in analysing and comparing the characteristics of different approaches. We suggest this framework could be used to examine variation in local participation within the enforcement system, inform evaluation and frame constructive discussions between relevant stakeholders. With the global coverage of protected areas likely to increase, the framework provides a foundation for better understanding the contributions of local residents to protected area law enforcement.

Background: Antimicrobial stewardship programs (ASPs) often rely on International Classification of Diseases, Tenth Revision (ICD-10) codes to assess antibiotic appropriateness for provider feedback. Concordance between encounter ICD-10 codes and documented indication for antibiotics based on manual chart review varies greatly (74%–95%) in the inpatient setting. Data on concordance between documented indication and ICD-10 code in the outpatient setting are scarce. Methods: We conducted a retrospective cohort study of 650 randomly selected outpatient encounters with antibiotic prescriptions from walk-in and retail clinics between July 15 and September 15, 2021, at Vanderbilt University Medical Center. We performed chart review to compare documented antibiotic indication to the 3 most frequent encounter-associated ICD-10 codes. Also, 12 encounters were excluded due to insufficient available written documentation. The 95% CI for proportion of encounters with concordant antibiotic indications was calculated using Stata version 15.1 software. Results: Of the 638 antibiotic prescriptions with written documentation available for chart review, 204 (32%) were for amoxicillin, 102 (16%) were for amoxicillin-clavulanate, 61 (10%) were for cefdinir, and 56 (9%) were for azithromycin. Overall, 540 (84.6%; 95% CI, 81.6%–87.4%) of 638 encounters had concordant antibiotic indication based on documentation in the note and associated ICD-10 for the encounter. Of the 540 encounters with concordant ICD-10 and documented indications, 348 (64%), 130 (24%), and 35 (6%) were listed as the first, second, and third ICD-10 codes, respectively. An additional 27 (5%) had a concordant ICD-10 code listed beyond the third position. In total, 125 (19.6%) of 638 encounters did not have the intended antibiotic indication as documented in the note in the 3 most frequent encounter-associated ICD-10 codes (whether a lower position or incongruent ICD-10 code with documentation). Of those 125 encounters, 42 (34%) had a documented diagnosis of strep pharyngitis, 16 (13%) had a documented diagnosis of skin or soft-tissue infection, 11 (9%) had a documented diagnosis of urinary tract infection, and 11 (9%) had a documented diagnosis of acute otitis media. Conclusions: Our data suggest that outpatient antimicrobial prescriptions correlate relatively well with encounter ICD-10 codes. However, most ASP prescribing goals aim to reduce inappropriate prescribing to 10% or fewer of prescriptions based on indication. Therefore, providers may not trust individual prescribing feedback that is based on data that is only correct 85% of the time. For ASPs to accurately assess prescribing and provide trusted, meaningful recommendations and specific feedback to individual prescribers, more reliable and valid data are needed. We intend to evaluate whether requiring outpatient antibiotic indications on prescriptions increases data reliability and validity.

Disclosures: None