Charisma, often seen as an innate trait, is now understood as leader signaling grounded in values, symbols, and emotions, suggesting it can be developed through interventions. However, the method for cultivating charisma remains unclear. This study examines nonverbal communication strategies, highlighting the potential of body language, facial expressions, and vocal modulation to enhance charisma. Additionally, we introduce a virtual reality training program focused on these cues and explore the role of audience presence in boosting the intervention’s effectiveness by fostering self-awareness and behavioral adjustments. Results of a controlled randomized experiment with virtual reality-trained participants and online charisma assessors demonstrated significant improvements in observer-rated charisma from pre- to post-training compared to the control group. Moreover, training in front of a virtual audience yielded the expected outcomes. This study sheds light on charisma theory, its potential virtual reality training application, and its implications for leadership development.

Background: The molecular and epidemiological landscape of C. difficile infection (CDI) has evolved markedly in the last decade; however, limited information is available contrasting differences between adult and pediatric populations. We describe a multicenter study evaluating healthcare-associated (HA) and community-associated (CA) adult and pediatric-CDI identified in the Canadian Nosocomial Infection Surveillance Program (CNISP) network from 2015 to 2022. Methods: Hospitalized patients with CDI were identified from up to 84 hospitals between 2015–2022 using standardized case definitions. Cases were confirmed by PCR, cultured, and further characterized using ribotyping and E-test. We used two-tailed tests for significance (p≤0.05). Results: Of 30,817 cases reported, 29,245 were adult cases [HA-CDI (73.2%), CA-CDI (26.8%)] and 1,572 were pediatric cases [HA-CDI (77.7%), CA-CDI (22.3%)]. From 2015 to 2022, HA-CDI rates decreased 19.7% (p=0.007) and 29.4% (p=0.004) in adult and pediatric populations, respectively (Figure 1). CA-CDI rates remained relatively stable in the adult population (p=0.797), while decreasing 60.7% in the pediatric population (p=0.013). Median ages of adult and pediatric patients were 70 (interquartile range (IQR), 58–80) and seven (IQR, 3–13) years, respectively. Thirty-day all-cause mortality was significantly higher among adult vs. Pediatric CDI patients (11.0% vs 1.4%, p < 0.0001). No significant differences in other severe outcomes were found. Ribotyping and susceptibility data were available for 4,620 samples: 3,558 adult (77.0%) and 1,062 pediatric (23.0%). The predominant adult and pediatric ribotypes (RT) were 106 (12.2/16.2%), 027 (11.4/3.2%), and 014 (8.8/8.2%). Overall, RT027 prevalence significantly decreased from 17.9% in 2015 to 3.2% in 2022 (p=0.003), while RT106 increased from 8.5% to 14.4%. Resistance rates among adult and pediatric isolates were similar for all antimicrobials tested except moxifloxacin (16.2% vs. 6.2%, p < 0.0001, respectively). Adult moxifloxacin resistance decreased from 30% to 6.3% from 2015 to 2022 (p=0.006). Adults with moxifloxacin-resistant CDI were older (median: 74 vs. 69 years, p < 0.001) and had higher thirty-day all-cause mortality (13% vs. 9.8%, p=0.041) and recurrence (10% vs. 5.7%, p < 0.001) compared to those with moxifloxacin non-resistant CDI, while these trends were not observed in pediatric patients. Among RT027 strains, moxifloxacin resistance decreased from 91.0% in 2015 to 7.1% in 2022. There was one metronidazole-resistant pediatric sample in 2018 and no resistance to vancomycin or tigecycline in either population. Conclusion: We have found differences in the epidemiological and molecular characteristics of adult and pediatric CDI, with higher thirty-day all-cause mortality among adults. Overall, RT106 has replaced RT027 as the predominant ribotype with a concomitant decrease in fluoroquinolone resistance.

Background: Nursing home (NH) residents are at high risk of COVID-19 from exposure to infected staff and other residents. Understanding SARS-CoV-2 viral RNA kinetics in residents and staff can guide testing, isolation, and return to work recommendations. We sought to determine the duration of antigen test and polymerase chain reaction (PCR) positivity in a cohort of NH residents and staff. Methods: We prospectively collected data on SARS-CoV-2 viral kinetics from April 2023 through November 2023. Staff and residents could enroll prospectively or upon a positive test (identified through routine clinical testing, screening, or outbreak response testing). Participating facilities performed routine clinical testing; asymptomatic testing of contacts was performed within 48 hours if an outbreak or known exposure occurred and upon (re-) admission. Enrolled participants who tested positive for SARS-CoV-2 were re-tested daily for 14 days with both nasal antigen and nasal PCR tests. All PCR tests were run by a central lab with the same assay. We conducted a Kaplan-Meier survival analysis on time to first negative test restricted to participants who initially tested positive (day zero) and had at least one test ≥10 days after initially testing positive with the same test type; a participant could contribute to both antigen and PCR survival curves. We compared survival curves for staff and residents using the log-rank test. Results: Twenty-four nursing homes in eight states participated; 587 participants (275 residents, 312 staff) enrolled in the evaluation, participants were only tested through routine clinical or outbreak response testing. Seventy-two participants tested positive for antigen; of these, 63 tested PCR-positive. Residents were antigen- and PCR-positive longer than staff (Figure 1), but this finding is only statistically significant (p=0.006) for duration of PCR positivity. Five days after the first positive test, 56% of 50 residents and 59% of 22 staff remained antigen-positive; 91% of 44 residents and 79% of 19 staff were PCR-positive. Ten days after the first positive test, 22% of 50 residents and 5% of 22 staff remained antigen-positive; 61% of 44 residents and 21% of 19 staff remained PCR-positive. Conclusions: Most NH residents and staff with SARS-CoV-2 remained antigen- or PCR-positive 5 days after the initial positive test; however, differences between staff and resident test positivity were noted at 10 days. These data can inform recommendations for testing, duration of NH resident isolation, and return to work guidance for staff. Additional viral culture data may strengthen these conclusions.

Disclosure: Stefan Gravenstein: Received consulting and speaker fees from most vaccine manufacturers (Sanofi, Seqirus, Moderna, Merck, Janssen, Pfizer, Novavax, GSK, and have or expect to receive grant funding from several (Sanofi, Seqirus, Moderna, Pfizer, GSK). Lona Mody: NIH, VA, CDC, Kahn Foundation; Honoraria: UpToDate; Contracted Research: Nano-Vibronix

Background: Antibiotic prescribing for children is highest in rural areas. Tele-stewardship allows for implementation of antimicrobial stewardship (AS) via telecommunication with providers. This study addresses need for better AS in rural areas by implementing and evaluating bundled outpatient AS interventions using tele-stewardship in rural pediatric primary care (PC) clinics and emergency departments (EDs) affiliated with Vanderbilt University Medical Center. Methods: The bundle includes (1) patient/guardian educational materials, (2) antibiotic use commitment posters (3) provider education through quarterly teaching pearls and app-based microlearning modules (QuizTime), and (4) quarterly audit/feedback with peer comparison on guideline-concordant antibiotic use via tele-meeting and email. Participants are pediatric prescribers (physician, physician assistant, nurse practitioner). We compared antibiotic prescription data for children < 1 8 years collected during the baseline period (Jan–Dec 2022) to the intervention period (Jan-Sept 2023). Two academic PC clinics and one ED where interventions were not implemented were included as “controls”. The primary outcome is percent of encounters that result in an antibiotic prescription. Secondary outcomes include (1) percent of encounters with guideline-concordant antibiotic choice for otitis media (AOM), streptococcal pharyngitis (GAS), sinusitis, and community-acquired pneumonia (CAP); (2) percent of encounters with 5-day antibiotic duration for AOM, sinusitis, and CAP; and (3) percent of encounters with rapid GAS testing. ED sinusitis data not analyzed due to small N. Significance was determined by calculating 95% confidence intervals for the difference of proportions. Results: There were 139,474 PC encounters (91,706 baseline and 47,768 intervention) and 94,205 ED encounters (54,138 baseline and 40,067 intervention) among 20 PC prescribers and 38 ED prescribers from January 2022-September 2023. Compared to baseline, the antibiotic prescription rate decreased 1.1% in intervention PCs but increased 0.9% in control PCs (Figure 1). Compared to baseline, the antibiotic prescription rate decreased by 0.4% in the intervention EDs but increased 3.1% in the control ED (Figure 1). Secondary outcomes showed significantly increased proportions of guideline concordant ED AOM prescriptions, 5-day PC AOM prescriptions (Figure 2), guideline concordant ED streptococcal pharyngitis prescriptions (Figure 3), and guideline concordant PC sinusitis prescriptions (Figure 4). There was a decrease in GAS tests in intervention PCs and EDs (Figure 6). Conclusions: Interim analysis shows bundled implementation strategies using tele-AS led to significantly decreased overall antibiotic use in rural PC clinics compared to control sites. The study is ongoing and will continue to evaluate outcomes over a longer intervention period to reduce seasonal bias.

Disclosure: Sophie Katz: Research Grant - Pfizer; Research Grant - Dolly Parton Pediatric Infectious Diseases Research Fund; Consultant - Optum

Hybrid whole genome sequencing was used to investigate if nosocomial Verona integron-encoded metallo-β-lactamase (VIM) carbapenemase transmission occurred between two patients without epidemiological links or common pathogens. Challenges in genomic methodology and appropriate analytical depth for mobile carbapenemase outbreaks are described including how inappropriate choices can mislead results and impact infection control practices.

Reading and study were among the central values of traditional Jewish society. Indeed, it is impossible to explain the continuity of the Jewish people without reference to the unique status of the book. Any analysis of contemporary Israeli culture, therefore, must look first to the fate of the book as it is affected by the weight of tradition and of modernity. This task is attempted here. It is part of a comprehensive national study of the sociology of Israeli culture in the ‘70s.

In traditional Jewish society, the book refers, of course, to the Holy Scriptures and the body of rabbinic literature that was built upon them throughout the ages. The Jews came to be called the “People of the Book” by virtue of living according to the rules of the Book with which they were so preoccupied.

Background: We evaluated vorasidenib (VOR), a dual inhibitor of mIDH1/2, in patients with mIDH1/2 glioma (Phase 3; NCT04164901). Methods: Patients with residual/recurrent grade 2 mIDH1/2 oligodendroglioma or astrocytoma were enrolled (age ≥12; Karnofsky Performance Score ≥80; measurable non-enhancing disease; surgery as only prior treatment; not in immediate need of chemoradiotherapy). Patients were stratified by 1p19q status and baseline tumor size and randomized 1:1 to VOR 40 mg or placebo (PBO) daily in 28-day cycles. Endpoints included imaging-based progression-free survival (PFS), time to next intervention (TTNI), tumor growth rate (TGR), health-related quality of life (HRQoL), neurocognition and seizure activity. Results: 331 patients were randomized (VOR, 168; PBO, 163). The median age was 40.0 years. 172 and 159 patients had histologically confirmed oligodendroglioma and astrocytoma, respectively. Treatment with VOR significantly improved PFS and TTNI. Median PFS: VOR, 27.7 mos; PBO, 11.1 mos (P=0.000000067). Median TTNI: VOR, not reached; PBO, 17.8 mos (P=0.000000019). Treatment with VOR resulted in shrinkage of tumor volume. Post-treatment TGR: VOR, -2.5% (95% CI: -4.7, -0.2); PBO, 13.9% (95% CI: 11.1, 16.8). HRQoL and neurocognition were preserved and seizure control was maintained. VOR had a manageable safety profile. Conclusions: VOR was effective in mIDH1/2 diffuse glioma not in immediate need of chemoradiotherapy.

This method abstract details the Green School Program, piloted across three schools in maritime Fijian islands, addresses critical issues faced by Fijian and Pacific Island communities. These encompass malnutrition, food security, health hazards, and the urgency of integrating traditional knowledge, governance, and social-ecological systems approaches into creating healthier school environments. Non communicable diseases have emerged as a pervasive concern within Pacific Island communities, creating a challenge for public health systems, driven greatly by dietary habits(1). This complex health landscape underscores the need to safeguard traditional knowledge and agri-food practices and develop neo-traditional approaches to local food systems(2). Furthermore, the Green School Program recognizes the essential role of schools as community hubs, enabling enhancing heathy school environments by embracing traditional wisdom and sustainable farming practices and foods, ultimately empowering communities to address these multifaceted challenges(3). Developing the school environment as a sustainable setting for governance framework led by women and the school administration, rooted in traditional knowledge and practices. Additionally, it aims to design facilities that support efficient organic farming while integrating these into school activities. Economic sustainability through the sale of surplus farm products, as well as the enhancement of sustainable land-use management, health, wellbeing, and cultural identity. The program unfolds within a distinctive community-based framework with the establishment of robust governance, with a notable emphasis on the leadership of women and mothers who play a pivotal role in steering the green school initiative and ensuring community ownership. Collaborative governance spans multiple stakeholders, including school management, community-based school committees, youth groups, women groups, and traditional leaders. This inclusive engagement ensures both shared responsibility in program design and ownership during implementation phases. Sustainable facilities are strategically designed to include biodigesters, water storage and irrigation systems, composting, organic fertilizers, and seedling nurseries, enhancing the program’s capacity to create healthier school food environments while embracing traditional practices and values. The program has witnessed the active engagement of women in governance roles, promoting community unity and ownership. Traditional knowledge integration has enhanced crop diversity and sustainability. Economic sustainability has been achieved through surplus farm product sales, reducing dependency on external funding sources. Health improvements are evident, with reduced exposure to indoor air pollution from open fires. Cultural identity preservation and increased student engagement are also notable outcomes. The Green School Program’s holistic approach, rooted in traditional knowledge and sustainable practices, has yielded positive outcomes in governance, agriculture, nutritional food security, health, and cultural identity preservation. The program’s success demonstrates the potential for community-based initiatives to address critical issues and empower remote island communities. These results provide valuable insights into sustainable development approaches that prioritize community wellbeing and cultural heritage preservation in similar contexts.

While mentors can learn general strategies for effective mentoring, existing mentorship curricula do not comprehensively address how to support marginalized mentees, including LGBTQIA+ mentees. After identifying best mentoring practices and existing evidence-based curricula, we adapted these to create the Harvard Sexual and Gender Minority Health Mentoring Program. The primary goal was to address the needs of underrepresented health professionals in two overlapping groups: (1) LGBTQIA+ mentees and (2) any mentees focused on LGBTQIA+ health. An inaugural cohort (N = 12) of early-, mid-, and late-career faculty piloted this curriculum in spring 2022 during six 90-minute sessions. We evaluated the program using confidential surveys after each session and at the program’s conclusion as well as with focus groups. Faculty were highly satisfied with the program and reported skill gains and behavioral changes. Our findings suggest this novel curriculum can effectively prepare mentors to support mentees with identities different from their own; the whole curriculum, or parts, could be integrated into other trainings to enhance inclusive mentoring. Our adaptations are also a model for how mentorship curricula can be tailored to a particular focus (i.e., LGBTQIA+ health). Ideally, such mentor trainings can help create more inclusive environments throughout academic medicine.

This article analyzes the question of how the size of bribes should impact criminal sanctions. In contrast to the commonly held view that punishment should increase with the size of the bribe, we argue to the contrary: that the punishment of the bribee should decrease with the size of the bribe. Our conclusion is based both on a philosophical argument and an economic argument. We argue that all else being equal, as an agent’s reservation price for selling public interests decreases, the culpability of the agent willing to receive a bribe increases. In addition, from an economic perspective, the expected social harm of an official acting with a low reservation price for bribes is much greater than one acting with a high reservation price: both the susceptibility of being bribed as well as the potential for social harm is much greater when the reservation price is low.

Simultaneous time-resolved measurements of wall deformation and the 3-D velocity field in boundary layers over a compliant surface are performed by integrating Mach Zehnder interferometry with tomographic particle tracking velocimetry. The pressure is calculated by spatially integrating the material acceleration. Combining data obtained from several references, trends of the deformation r.m.s. scaled by the compliant wall thickness collapse when plotted vs pressure fluctuations scaled by the material shear modulus. For the present data, at all Reynolds numbers, the deformation waves travel at 53% of the free-stream velocity and have a preferred wavelength of three times the thickness. The latter is consistent with theoretical models. Adopting insight derived from atmospheric wind–wave interactions, the pressure–deformation correlations peak at or slightly above the ‘critical layer’, where the mean flow speed is equal to the surface wave speed. This layer is located within the log layer, and when expressed using inner variables, increases in elevation with increasing Reynolds number. For the entire region below the critical layer, wavenumber–frequency spectra of pressure and vertical velocity fluctuations indicate that the turbulence is phase locked and travels with the deformation, even for deformation amplitudes much smaller than a wall unit. In contrast, above the critical layer, the turbulence is advected at the local mean streamwise velocity, and its correlation with the deformation decays rapidly. These findings indicate that the height of the zone dominated by flow-deformation interactions is determined by the surface wave speed, and its variations are caused by deformation-induced modifications to the mean velocity profile.

Critical-zone reactions involve inorganic and biogenic colloids in a cation-rich environment. The present research defines the rates and structure of purified Mg-montmorillonite aggregates formed in the presence of monovalent (K+) and divalent (Ca2+, Mg 2+) cations using light-extinction measurements. Time evolution of turbidity was employed to determine early-stage aggregation rates. Turbidity spectra were used to measure the fractal dimension at later stages. The power law dependence of the stability ratios on cation concentration was found to vary with the reciprocal of the valence rather than the predicted reciprocal of valence-squared, indicating that the platelet structure may be a factor influencing aggregation rates. The critical coagulation concentrations (CCC) (3 mM for CaCl2, 4 mM for MgCl2, and 70 mM for KCl) were obtained from the stability ratios. At a later time and above a minimal cation concentration, turbidity reached a quasi-stable state, indicating the formation of large aggregates. Under this condition, an approximate turbidity forward-scattering correction factor was applied and the fractal dimension was determined from the extinction spectra. For the divalent cations, the fractal dimensions were 1.65 ± 0.3 for Ca2+ and 1.75 ± 0.3 for Mg2+ and independent of cation concentrations above the CCC. For the monovalent cation, the fractal dimension increased with K+ concentration from 1.35 to 1.95, indicating a transition to a face-to-face geometry from either an edge-to-edge or edge-to-face orientation.