Background: External comparisons of antimicrobial use (AU) may be more informative if adjusted for encounter characteristics. Optimal methods to define input variables for encounter-level risk-adjustment models of AU are not established. Methods: This retrospective analysis of electronic health record data included 50 US hospitals in 2020-2021. We used NHSN definitions for all antibacterials days of therapy (DOT), including adult and pediatric encounters with at least 1 day present in inpatient locations. We assessed 4 methods to define input variables: 1) diagnosis-related group (DRG) categories by Yu et al., 2) adjudicated Elixhauser comorbidity categories by Goodman et al., 3) all Clinical Classification Software Refined (CCSR) diagnosis and procedure categories, and 4) adjudicated CCSR categories where codes not appropriate for AU risk-adjustment were excluded by expert consensus, requiring review of 867 codes over 4 months to attain consensus. Data were split randomly, stratified by bed size as follows: 1) training dataset including two-thirds of encounters among two-thirds of hospitals; 2) internal testing set including one-third of encounters within training hospitals, and 3) external testing set including the remaining one-third of hospitals. We used a gradient-boosted machine (GBM) tree-based model and two-staged approach to first identify encounters with zero DOT, then estimate DOT among those with >0.5 probability of receiving antibiotics. Accuracy was assessed using mean absolute error (MAE) in testing datasets. Correlation plots compared model estimates and observed DOT among testing datasets. The top 20 most influential variables were defined using modeled variable importance. Results: Our datasets included 629,445 training, 314,971 internal testing, and 419,109 external testing encounters. Demographic data included 41% male, 59% non-Hispanic White, 25% non-Hispanic Black, 9% Hispanic, and 5% pediatric encounters. DRG was missing in 29% of encounters. MAE was lower in pediatrics as compared to adults, and lowest for models incorporating CCSR inputs (Figure 1). Performance in internal and external testing was similar, though Goodman/Elixhauser variable strategies were less accurate in external testing and underestimated long DOT outliers (Figure 2). Agnostic and adjudicated CCSR model estimates were highly correlated; their influential variables lists were similar (Figure 3). Conclusion: Larger numbers of CCSR diagnosis and procedure inputs improved risk-adjustment model accuracy compared with prior strategies. Variable importance and accuracy were similar for agnostic and adjudicated approaches. However, maintaining adjudications by experts would require significant time and potentially introduce personal bias. If findings are confirmed, the need for expert adjudication of input variables should be reconsidered.

Disclosure: Elizabeth Dodds Ashley: Advisor- HealthTrackRx. David J Weber: Consultant on vaccines: Pfizer; DSMB chair: GSK; Consultant on disinfection: BD, GAMA, PDI, Germitec

OBJECTIVES/GOALS: Contingency management (CM) procedures yield measurable reductions in cocaine use. This poster describes a trial aimed at using CM as a vehicle to show the biopsychosocial health benefits of reduced use, rather than total abstinence, the currently accepted metric for treatment efficacy. METHODS/STUDY POPULATION: In this 12-week, randomized controlled trial, CM was used to reduce cocaine use and evaluate associated improvements in cardiovascular, immune, and psychosocial well-being. Adults aged 18 and older who sought treatment for cocaine use (N=127) were randomized into three groups in a 1:1:1 ratio: High Value ($55) or Low Value ($13) CM incentives for cocaine-negative urine samples or a non-contingent control group. They completed outpatient sessions three days per week across the 12-week intervention period, totaling 36 clinic visits and four post-treatment follow-up visits. During each visit, participants provided observed urine samples and completed several assays of biopsychosocial health. RESULTS/ANTICIPATED RESULTS: Preliminary findings from generalized linear mixed effect modeling demonstrate the feasibility of the CM platform. Abstinence rates from cocaine use were significantly greater in the High Value group (47% negative; OR = 2.80; p = 0.01) relative to the Low Value (23% negative) and Control groups (24% negative;). In the planned primary analysis, the level of cocaine use reduction based on cocaine-negative urine samples will serve as the primary predictor of cardiovascular (e.g., endothelin-1 levels), immune (e.g., IL-10 levels) and psychosocial (e.g., Addiction Severity Index) outcomes using results from the fitted models. DISCUSSION/SIGNIFICANCE: This research will advance the field by prospectively and comprehensively demonstrating the beneficial effects of reduced cocaine use. These outcomes can, in turn, support the adoption of reduced cocaine use as a viable alternative endpoint in cocaine treatment trials.

We present a demonstration version of a commensal pipeline for Fast Radio Burst (FRB) searches using a real-time incoherent beam from the Murchison Widefield Array (MWA). The main science target of the pipeline are bright nearby FRBs from the local Universe (including Galactic FRBs like from SGR 1935+2154) which are the best candidates to probe FRB progenitors and understand physical mechanisms powering these extremely energetic events. Recent FRB detections by LOFAR (down to 110 MHz), the Green Bank Telescope (at 350 MHz), and Canadian Hydrogen Intensity Mapping Experiment (CHIME) detections extending down to 400 MHz, prove that there is a population of FRBs that can be detected below 350 MHz. The new MWA beamformer, known as the ‘MWAX multibeam beamformer’, can form multiple incoherent and coherent beams (with different parameters) commensally to any ongoing MWA observations. One of the beams is currently used for FRB searches (tested in 10 kHz frequency resolution and time resolutions between 0.1 and 100 ms). A second beam (in 1 Hz and 1 s frequency and time resolutions, respectively) is used for the Search for Extraterrestrial Intelligence (SETI) project. This paper focuses on the FRB search pipeline and its verification on selected known bright pulsars. The pipeline uses the FREDDA implementation of the Fast Dispersion Measure Transform algorithm (FDMT) for single pulse searches. Initially, it was tested during standard MWA observations, and more recently using dedicated observations of a sample of 11 bright pulsars. The pulsar PSR J0835-4510 (Vela) has been routinely used as the primary probe of the data quality because its folded profile was always detected in the frequency band 200 – 230 MHz with typical signal-to-noise ratio $>$10, which agrees with the expectations. Similarly, the low dispersion measure pulsar PSR B0950+08 was always detected in folded profile in the frequency band 140–170 MHz and so far has been the only object for which single pulses were detected. We present the estimated sensitivity of the search in the currently limited observing bandwidth of a single MWA coarse channel (1.28 MHz) and for the upgraded, future system with 12.8 MHz (10 channels) of bandwidth. Based on expected sensitivity and existing FRB rate measurements, we project an FRB detection rate between a few and a few tens per year with large uncertainty due to unknown FRB rates at low frequencies.

The neuropsychology of babies, toddlers, and young children is a rapidly evolving frontier within our discipline. While there is an inaccurate perception among referral sources that neuropsychological services are not useful before school-age, pediatric neuropsychologists are especially well-suited to identify delay or dysfunction in the years before school entry (Baron and Anderson, 2012). Patterns of neurodevelopmental strengths and weaknesses can be detected very early on in development and used to make inferences about brain-behavior relationships integral for guiding treatment across a number of medical and neurodevelopmental diagnoses. As such, there is a need to foster ongoing clinical interest and expertise and promote the utility of neuropsychological services within this age range. The INS BabIes, ToddlerS, and Young children (BITSY) SIG was recently developed to bring together scientists and clinicians from across the world who conduct research and provide neuropsychological services within this age range to foster collaboration and learning. A priority of the BITSY SIG is not only to promote awareness of the novel needs of this age range, but to consider historical and ongoing disparities in service access, representation in research, and neuropsychological practice. For this inaugural BITSY SIG symposium, four members of the SIG will discuss innovations in infant, toddler, and young child neuropsychological models of care. This topic was developed in direct response to survey results from the first BITSY SIG meeting held during INS 2022, indicating the need for the development and refinement of clinical approaches that incorporate diverse perspectives as well as training opportunities in models of care for very young children. As such, speakers will cover innovations in neuropsychological service models from the prenatal period to formative early years that are inclusive of diverse neurological and neurodevelopmental populations commonly served by neuropsychologists including spina bifida, prematurity, hypoxic-ischemic encephalopathy (HIE), congenital heart disease (CHD), autism (ASD) and attention-deficit/hyperactivity disorder (ADHD). The first talk will highlight the unique role of the neuropsychologist in prenatal and infant consultation, whereas the second talk will focus on the state of the field with regard to the utility of neuroimaging in neonatal populations and the integration of this tool in neuropsychological care. The third talk will discuss early screening and assessment models in a diverse range of conditions within an interdisciplinary setting. The final talk will illustrate a novel neuropsychological intervention designed with and for the empowerment of caregivers for young children impacted by neurological and neurodevelopmental conditions. The unifying theme across the talks is how unplanned discoveries and acute observations of children and families during the critical early years have led to these inclusive care models that prioritize family preferences, values, and culture. Upon conclusion of this course, learners will be able to:

1. 1. Summarize several novel models of neuropsychological care for infants, toddlers, and young children.

2. 2. Recognize ways in which neuropsychologists work within interdisciplinary teams to serve infants, toddlers, and young children and their families.

3. 3. Apply these models of care to your conceptualization of the scope of neuropsychological services available for infants, toddlers, and young children.

State Medical Boards (SMBs) can take severe disciplinary actions (e.g., license revocation or suspension) against physicians who commit egregious wrongdoing in order to protect the public. However, there is noteworthy variability in the extent to which SMBs impose severe disciplinary action. In this manuscript, we present and synthesize a subset of 11 recommendations based on findings from our team’s larger consensus-building project that identified a list of 56 policies and legal provisions SMBs can use to better protect patients from egregious wrongdoing by physicians.