Keeping patients safe from summertime illnesses

"5 However, more recent findings, such as the presentation of joint swelling without EM in Black children, are the result of research efforts to identify differences among racial and ethnic groups in presentations of disease symptoms, with the aim of greater diagnostic accuracy and reduced health care disparities.4 Treatment of Lyme disease Although most resources, such as the CDC's website,1 published articles and sites,2,3 and the Red Book,5 recommend that pediatric, adolescent, and young adult patients with Lyme disease receive an antibiotic, such as doxycycline, amoxicillin, or cefuroxime (for penicillin-allergic patients), these publications differ in recommended dosage and duration of treatment. [...]PHCPs who are unfamiliar with antibiotic treatments for Lyme disease should consult with infectious disease specialists. Children who have evidence of Lyme carditis, Lyme arthritis, cranial neuritis, Lyme meningitis, or radiculoneuritis should immediately be referred to infectious disease and the appropriate pediatric specialists.2 Respiratory infections and health care inequities Although researchers have reported studies on racial and ethnic inequities among children related to respiratory diseases over the last 20 years, few randomized controlled trials have scientifically investigated the problem or have identified and rigorously investigated evidencebased interventions. The COVID-19 pandemic brought a new focus in pediatric health care on the inequities experienced by Black, Hispanic, American Indian or Alaska Native, and Pacific Islander children living in poverty, who regularly experience a disproportionate number of respirator y illnesses and infections.6 Several studies have shown increased hospitalization rates for Blac k and H ispan ic children who contracted COVID-19.6 One team of researchers studying children from birth to 4 years old reported a hospitalization rate of 55% for Black and Hispanic children.7 For years, PHCPs have observed and treated children for asthma in all health care settings. Bhavnani et al reported that Black children had a 7-fold higher rate of emergency department visits compared with White children in 2019, 1 year before the pandemic began.8 However, the difference decreased to a 2-fold increase for Black children compared with White children in 2020, when COVID-19 measures such as masking, social distancing, and school closures were in place.8 Researchers are continuing to investigate why Black and Hispanic children are more vulnerable to upper respiratory infections with viruses such as influenza, rhinovirus, and adenovirus.8 Summertime prevention of respiratory infections Talking about prevention strategies with families is the first step toward reducing asthma episodes and exacerbations.

How the Judiciary Has Driven Systemic Innovation During the Pandemic

In 1998, the Conference of State Court Administrators (COSCA)8 urged member state courts throughout the United States to join a national effort to exchange data and integrate information systems in ways that would improve case management.9 COSCA issued a position paper on information sharing in 2002,10 followed by joint resolutions adopted by the Conference of Chief Justices (CCJ)11 and COSCA that called for public access to electronic court records and removal of Social Security numbers from court records.12 In 2004, COSCA joined with the National Association for Court Management (NACM)13 to issue a policy statement for court acceptance of information technology.14 It established a "nine part agenda" that emphasized serving the court's business needs, stressed the importance of effective implementation, and addressed security and privacy issues.15 A series of incremental resolutions followed over several years, including one from the CCJ entitled "The Emergence of E-Everything. The Landscape of Civil Litigation determined that nonfamily civil litigation in state courts "takes too long and costs too much," which undermined access to justice.18 Court dockets were dominated by "lowervalue contract and small claims" cases that rarely were adjudicated on the merits.19 Courts were using outdated automated case management systems, and they were giving self-represented parties (involved in 76% of cases) and lawyers too much control over the pace of litigation.20 The Landscape of Civil Litigation lamented the decline in funding for court systems and observed that courts were expected to dispense more justice using fewer resources.21 B.The Call to Action in Civil Cases One year later, the NCSC published its influential Call to Action: Achieving Civil Justice for All22 That report built upon the Landscape of Civil Litigation and criticized the "cost, delay, and unpredictability of civil litigation" under existing court processes.23 It recommended that courts update differentiated case management processes to assign cases to three "pathways," which it designated as "Streamlined," "Complex," and "General. "31 States should design courthouses that incorporate emerging changes in technology.32 Six months before the CCJ and COSCA endorsed the Call to Action, the American Bar Association (ABA) House of Delegates approved the ABA Model Regulatory Objectives for the Provision of Legal Services (Model Regulatory Objectives).33 The Model Regulatory Objectives were drafted by the ABA's Commission on the Future of Legal Services not long before it released its innovative and controversial 2016 Report on the Future of Legal Services in the United States 24 The Model Regulatory Objectives provided guidelines for state courts to regulate nontraditional legal services providers, and discouraged blanket exclusions of nonlawyers based on unauthorized practice of law rules.35 The CCJ agreed, and resolved that state courts should consider broadening their regulatory frameworks to nonlawyers who provide legal services.36 Expanding the regulatory framework would give courts greater flexibility to implement the Call to Action21 In 2011, the NCSC advised state courts on how to automate court processes so that information technology could help assign cases to one of the three pathways.38 Pathway assignments should be data-driven and involve less human discretion. The NCSC joined in partnership with the Institute for the Advancement of the American Legal System (IAALS)41 and the National Council of Juvenile and Family Court Judges (NCJFCJ)42 to launch the Family Justice Initiative (FJI).43 The FJI would operate in collaboration with the CCJ and COSCA to build upon the research contained in the Landscape of Civil Litigation and the policy directives in the Call to Action 44 While the FJI was ramping up its operations, the NCSC issued a 2017 white paper that examined existing case management systems in family courts throughout the United States, titled Triage Protocols for Divorce and Child Custody Cases.45 The white paper noted "tension between what should ideally be done, what courts can afford to do, and what litigants want," and that courts may need to "identify[] 'good enough' solutions" that are more feasible due to resource limitations.46 "As long as budget constraints exist, a court that provides more services to one case is essentially reducing services in another case, so some sense of cost/benefit is definitely helpful in making these kinds of service and process tradeoffs. .

Trends in and Risk Factors for Recurrent Clostridioides difficile Infection, New Haven County, Connecticut, USA, 2015-2020.

Recurrent Clostridioides difficile infection (RCDI) causes an increased burden on the healthcare system. We calculated RCDI incidence and identified factors associated with RCDI cases in New Haven County, Connecticut, USA, during 2015-2020 by using data from population-based laboratory surveillance. A subset of C. difficile cases had complete chart reviews conducted for RCDI and potentially associated variables. RCDI was defined as a positive C. difficile specimen occurring 2-8 weeks after incident C. difficile infection. We compared cases with and without RCDI by using multiple regression. RCDI occurred in 12.0% of 4,301 chart-reviewed C. difficile cases, showing a U-shaped time trend with a sharp increase in 2020, mostly because of an increase in hospital-onset cases. Malignancy (odds ratio 1.51 [95% CI 1.11-2.07]) and antecedent nitrofurantoin use (odds ratio 2.37 [95% CI 1.23-4.58]) were medical risk factors for RCDI. The 2020 increase may reflect the impact of the COVID-19 pandemic.

Economies of community in local agriculture: farmers in New London, Connecticut, respond to the COVID-19 pandemic

The COVID-19 pandemic highlighted the weaknesses of the U.S. national food system, with grocery store shelves emptied in March and April 2020 and COVID outbreaks reported throughout the summer of 2020 at meat processing plants across the country. Fleetingly, Americans turned to local farms to ensure they could access food safely in a time of uncertainty. This paper examines the economies of community that formed around local farms and how direct engagements between consumers and producers in the face of the pandemic deepened these economic structures that often put community well-being above profits. Within a capitalist system that prioritizes efficient mass production, economies of community illustrate that solidarity can improve local food system resilience. Based on qualitative and quantitative research carried out in the summer of 2020 in New London County in southeastern Connecticut, this research draws on ethnographic interviews with small-scale farmers who developed innovative ways to feed some of their community's most vulnerable members. Community economies show that we should not only depend on standardized large-scale farms and giant retail distribution;the American food system needs to continue to cultivate small-scale local production in order to improve resilience and food access. At present, the sustainability of producing and distributing food occurs at the farmer's expense. The government needs to support local food producers so they can continue to play an integral part in community well-being.

Olfactory rehabilitation in non-severe COVID-19 patients: a randomized double-blinded clinical trial

Introduction: Olfactory loss is prevalent in SARS-CoV-2 infected patients. Some therapies have been tested to help patients, but both time to symptom recovery and prevalence of full recovery are unknown, and prospective studies testing any method of therapy are rare. Objective(s): Compare olfactory training effectivity in improving smell sense in COVID-19 patients with olfactory loss after acute disease. Method(s): subjects that had olfactory loss during confirmed COVID-19 performed Connecticut Chemosensory Clinical Research Center olfactory test. Those who presented with some grade of olfactory loss were invited to participate this trial, in which they were randomized in 2 groups (olfactory training versus a control group with olfactory training without smell sensation). Patients were evaluated monthly until full olfactory recovery or until 6 months of follow-up. Result(s): among 182 individuals, 149 presented with abnormal olfactory test. 123 patients finished the study (treatment: n=68;control: n=55). Both groups showed olfactory improvement along the follow-up period with significant statistical difference until the second reevaluation (1st-2nd test: p<.001;2nd-3rd test: p<.001;3rd-4th test: p=.08;4th-5th test: p=1;5th-6th test: p=1;6th-7th test: p=1). Olfactory test was significant better at control group at the beginning (p=.001) and persisted until the second reevaluation (p=.004 and p=.009, respectively), in which treatment group had similar test results (p>.05). Conclusion(s): Olfactory training demonstrated good results as treatment modality after COVID-19 smell loss, with significant improvement after 70 days of therapy.

What do patients with asthma want to know? Google Trends insights into U.S. general population interest between 2004 and 2022 can help structure patient education initiatives

Rationale: The aim of this study is to use the research tool Google Trends to analyze U.S. general population interest in asthma. Methods: The research tool Google Trends (trends.google.com) was used to access data sets for the searched term "asthma” between 2004 and 2022 (English language, U.S. location). Data were normalized and adjusted to make comparisons between search terms substantiated. Each data point was divided by the total searches of the geography and time range it represented. Results: Searches for asthma detected have remained stable in terms of volume between 2004 and 2022 apart from a spike during February-May 2020 which corresponded with one of the peaks of the COVID pandemic. Top 5 states for asthma searches in 2022 were Kentucky, Tennessee, Connecticut, Mississippi, Maryland. The list of the top states is dynamic and has changed since 2004.Top search terms in the U.S. in 2022 were: allergy, allergy asthma, asthma and allergy, asthma symptoms, asthma attack. Searches for allergy have consistently been present in the top 5 terms when patients searched for asthma during the last 18 years, between 2004 and 2022. Conclusions: Asthma-related Google searches reveal topics of high interest that could supplement the understanding about general population interest. Searches for allergy have consistently been present in the top 5 terms when patients searched for asthma during the last 18 years, emphasizing the role of allergists/immunologists in asthma care. Knowledge of variability in search patterns and specific topics could help allergy organizations and practicing allergists focus their educational programs towards patients' interests.

The Trump vote and Covid-19 vaccination across US states, US counties, and Connecticut towns

In the United States over the past 40 years national issues and allegiances have increasingly displaced state and local concerns and identities in shaping the preferences of voters and the internal processes of political parties. This study finds that such nationalization has also manifested itself in health-related behaviour, specifically in the takeup of Covid-19 vaccines. Despite the heterogeneities of US states, counties, and towns, the share of the vote that Trump received in the 2020 US presidential election is found at each level to be a strong and robust predictor of a lower June 2022 Covid-19 vaccination initiation rate, even after adjusting for sociodemographic composition, spatial effects, and diverse provisioning- and takeup-related factors. At each of the three subnational levels, the Trump 2020 vote share was also correlated more closely than the Trump 2016 vote share or the Romney 2012 vote share with the June 2022 Covid-19 vaccination initiation rate. © 2023 Informa UK Limited, trading as Taylor & Francis Group.

Partnering with primary care to implement evidence based interventions (EBI) to address overdue colorectal cancer (CRC) screening in Connecticut (CT)

PURPOSE: Partnering with the largest Federally Qualified Health Center (FQHC) in New Haven, CT, the goal is to implement and test 4 evidence-based interventions (EBI) to increase CRC screening, while evaluating real-world implementation. Here, we report on the six-month (approximate) follow up of a cohort of 3,127 patients overdue for CRC screening who received 1 or more EBIs in October 2021. BACKGROUND: Sociocultural and medical concerns are barriers to colonoscopy uptake contributing to disparities in CRC screening. An additional barrier is system level capacity. COVID-19 associated delays exacerbated the existing backlog of individuals overdue for CRC screening, underscoring the need to expand Fecal Immunochemical Testing (FIT) capacity. This was particularly evident in the safety-net primary care setting that serves lower socio-economic status individuals living in urban New Haven, CT. METHOD(S): We are testing the unique and additive value of multiple evidence-based interventions (EBIs) for increasing CRC screening. The EBIs include the use of medical reminders, addressing the structural barriers (social determinants of health [SDOH]), and providing assistance from community health workers (CHW). We randomized 3,127 patients overdue for CRC screening to one of 4 arms of the study. All individuals received a reminder from their providers that they were due/overdue for CRC screening with instructions to contact the FQHC. Arm 2 also included information on SDOH barriers, Arm 3 included this same information with offer of navigation from CHW/navigator;and Arm 4 included the offer of CHW educational video and support if needed. Six-month (approximate) outcomes include: 1) Engagement with FQHC resulting in ordered test;2) completed test. Results by intervention will be assessed at 12 months. RESULT(S): Of the 3,127 randomized patients, ages 50-75, 77% were Hispanic (33%) or Black (44%). At 6+ months, a preliminary look at EMR data show that a minimum of 1,275 (40.8%) patients "engaged" with providers resulting in an ordered FIT Kit (n= 1174) or COMPLETED screening colonoscopy that was not associated with a positive FIT result (n = 102). 217 (18.5%) individuals completed the FIT testing with 13 requiring confirmatory colonoscopy (31% completed at this time). Thus, a minimum of 319 (10%) of 3,127 individuals in the cohort completed CRC screening at approximately 6 months post intervention. DISCUSSION: Despite investments in community engagement, stakeholder input, and FIT kit capacity building, the pandemic presented unforeseen challenges. Flexibility and steadfast commitment from FQHC providers and staff were critical to successful implementation during multiple waves of COVID-19, resulting in CRC screening ordered for 41% of cohort within 6 months of intervention. SUMMARY: At 6 months follow up of 3,127 individual who were overdue for CRC screening, one or more of 4 EBIs, in addition to system level efforts to address CRC screening, resulted CRC screening tests ordered for 41% of cohort with at least 10% completed screening.

Special Issues Brief: How Region 2 States Are Leveraging Innovative Strategies to Address Critical Shortages of Education Personnel

This special issues brief provides an overview of the education workforce shortage trends both nationally and in Region 2 states (Connecticut, New York, and Rhode Island). The brief also highlights examples of how Region 2 states are innovating to address these shortages and provides additional considerations for strategies to address shortages in both the short term and the long term.

The Promise and Challenges of Pandemic Innovation in High Schools

In summer 2020, the Center on Reinventing Public Education (CRPE), with support from the Barr Foundation, began observing and learning from students, parents, and educators in New England high schools as they navigated the uncertainty of the pandemic. The authors wanted to see what challenges and opportunities they faced, the ways in which they adapted to disruptions, and the new strategies and capacities that took hold. After more than a year of disruption, the boundaries of what it means to "reinvent" high school stretched, and in some systems, the momentum for change accelerated. Students and teachers learned to work in new ways and reached new understandings about each other. When COVID wanes, schools will encounter a host of new and complex demands as they make sense of the pandemic's challenges and opportunities, including addressing unfinished learning, spending a tidal wave of federal funding, and navigating continued calls for racial and social justice amid a national culture war. The path forward raises a host of critical questions: (1) Will school systems leverage momentum from the pandemic to remake high school? If so, what adaptations and innovations will they embrace? And which students will benefit from these shifts?, (2) How do school system leaders, educators, families, and students redefine success in high school? To what extent and how are these aspirations reflected in the adaptations and innovations that school systems embrace?, and (3) What opportunities and obstacles do school system leaders, educators, families, and students confront as they seek to chart a new course to high school? How can they avoid the pitfalls that threaten to stall progress, especially for the most marginalized students? As the pandemic endures, and as we emerge from it, CRPE will continue to investigate whether and how the trends described lead to a more equitable, student-centered high school experience. In this effort, Think Forward New England explores not only what shifts emerge postpandemic but also why, for whom, and with what effect.

Multisystem Inflammatory Syndrome in Children associated with COVID-19: A comparison study between cohorts from different geographic locations

Introduction. We aim to evaluate the sociodemographic and clinical differences between hospitalized children with multisystem inflammatory syndrome in children (MIS-C) in the United States vs. Colombia. Materials and methods. Multicenter prospective observational study of children diagnosed with MIS-C' according to the US CDC definition were enrolled between 03Mar2020-06Apr2022 at one US site (Connecticut Children's Medical Center [CT cohort]) and two Colombian sites (Clinica Imbanaco [CI] and Hospital Universitario del Valle [HUV] in Cali [CI/HUV cohort]). Data was collected in a standardized' online case-collection form developed in REDCap. Cohorts were compared using Fisher's Exact test or Mann-Whitney U test as appropriate. Results. Sixty-four MIS-C cases were included' 40 in CT and 24 in CI/HUV. Median age was 8.6 years (IQR 5,3-13,0)' 53% were male' and almost one-third had a co-morbid condition. A higher median BMI and obesity prevalence were reported in the CT cohort. Overall' most children presented with fever' mucocutaneous findings' or gastrointestinal symptoms. 13% had systolic hypotension. More children in the CI/HUV cohort presented with upper respiratory symptoms compared to the CT cohort (88% vs 28%) while fewer presented with systemic symptoms (50% vs 85%). Laboratory and radiologic findings were similar across both cohorts. Children in the CT cohort received steroids' combined IVIg/steroids' and antibiotics more frequently. Outcomes were similar across both cohorts' except for a longer hospital stay in the CI/HUV cohort. Conclusions. Despite different interventions in comparable cohorts' outcomes were similar. Data from larger studies are needed to evaluate whether these differences are intrinsic to individual conditions or different treatment protocols.

LUNG TRANSPLANTATION IN THE UNITED STATES: COMPARISON OF SOCIODEMOGRAPHIC TRENDS BETWEEN 2001 AND 2021

SESSION TITLE: Lung Transplantation: New Issues in 2022 SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/19/2022 11:15 am - 12:15 pm PURPOSE: This population-based study describes the changing demographic trends of Lung Transplants (LT) across the United States (U.S.) over the last two decades (2001 vs 2021). METHODS: We utilized the Organ Procurement and Transplantation Network (OPTN) registry to gather data on LT recipients across the U.S. for the year 2001 and 2021. Total yearly lung transplant numbers were recorded from 1988 to 2021. The recipients were categorized into subgroups based on age (<1, 1-5, 6-10, 11-17, 18-49, 50-64 and >65 years), race (Whites, Blacks, Hispanic/Latino, Asians, and Others) and most common diagnosis, and data was tabulated to compare for the years 2001 and 2021. RESULTS: From 1988 to 2021, 46,109 LTs were performed in the U.S. The yearly LT recipients increased from 1,059 in 2001 to 2,524 in 2021. The most common reason for LT was Emphysema/COPD (Chronic Obstructive Pulmonary Disease) in 2001 (n=464) and IPF (Idiopathic Pulmonary Fibrosis) in 2021 (n=899). In both 2001 and 2021, most LT recipients were in the age group 50-64 years (45.8% vs 58.1%) but the proportion of patients > 65 years receiving LT increased noticeably from 3.4% in 2001 to 36.9% 2021. Most LT recipients in both 2001 vs 2021, had “O” blood group (~ 45%). White patients comprised the majority of those registered for and those who underwent LT in both 2001 (n=940;88.80%) and 2021 (n=1,778;70.40%), although the relative percentage reduced by 18.40%. The relative percentages for Blacks, Asians, Hispanics receiving LTs increased from 2001 to 2021 by 2%, 3.3% and 11.8% respectively. In both 2001 and 2021, the states where maximum LTs were performed included– California (10.8% vs 12.6%), Pennsylvania (9.6% vs 9.3%) and Texas (7.3% vs 10.7%) while the states with the least LTs included– Connecticut, Mississippi, Oregon. CONCLUSIONS: There has been a general uptrend in the total number of LTs year-on-year, and the likely drop in LT recipients in 2020 and 2021 was due to the COVID-19 pandemic. The most common diagnosis for transplant changed from Emphysema/COPD in 2001 to IPF in 2021. There are appreciable racial and geographical disparities in receiving LTs in the United States but there are encouraging improvements in 2021 compared to 2001. There is an increasing trend of LTs in elderly patients (> 65 years), likely due to increased supportive care and improved life expectancy. CLINICAL IMPLICATIONS: Changes in socio-demographic trends in lung transplant recipients help us understand existing disparities and access to advanced lung disease centers so that we can better address these with equitable healthcare delivery tailored to changing transplant trends. DISCLOSURES: No relevant relationships by FNU Amisha No relevant relationships by Perminder Gulani No relevant relationships by Manuel Hache Marliere No relevant relationships by paras malik No relevant relationships by Divya Reddy

A RETROSPECTIVE ANALYSIS OF POSTACUTE SEQUELAE OF SARS-COV-2 INFECTION

SESSION TITLE: Post-COVID-19 Outcomes SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/19/2022 11:15 am - 12:15 pm PURPOSE: The World Health Organization defines post-acute sequelae of SARS-COV-2 infection (Long-COVID) as persistent symptoms after COVID-19 for more than two months. Although many studies show associations of comorbidities with prolonged COVID-19 symptoms, to our knowledge, there is no study with a comparison group for Long-COVID. We performed a retrospective study looking at risk factors for the development of Long-COVID. METHODS: We retrospectively reviewed 2,234 records of patients with a history of COVID-19 diagnosed by RT-PCR who followed up as outpatients at multiple pulmonary clinics in Hartford, Connecticut, USA, from March 2020 to December 2021. Data included the patient's age, sex, comorbidities, oxygen device including FiO2 level, and duration of symptoms. We evaluated patient characteristics, duration of symptoms, comorbidities, and disease severity. Analyses comprised the Mann-Whitney U test, χ2 test, or Fisher's exact test Using SPSS v. 26 at an alpha of 0.05. RESULTS: Of the 2,234 patients evaluated, 471 patients were included. The mean age was 56 ± 15 years (± SD), and 62.6% were female. 212 (45%) required hospital admission, and 23 (4.9%) required mechanical ventilation. Of those patients, 351 had symptoms for more than two months (Long-COVID) and 121 for two months or less (no Long-COVID). Both groups had similar characteristics. Hospitalization was more common in the Long-COVID group (51.6% vs. 21.8%, p<0.001). Increased FiO2 requirement was associated with prolonged symptoms (p<0.001), and patients requiring high-flow, non-invasive and invasive ventilation were more likely to develop Long-COVID (p=0.002). The mean duration of symptoms in patients with long-COVID was 7.9 ± 3.9 months versus 0.5 ± 0.8 months in the comparison group (p<0.001). Obesity, asthma, COPD, heart failure, interstitial lung disease, pulmonary hypertension, and immunosuppression were not found to be associated with Long-COVID. Regarding vaccination status, our analysis was limited since only 15 patients were vaccinated prior to developing COVID-19. CONCLUSIONS: Current data on Long-COVID suggests that prolonged symptoms are associated with older age, comorbidities, duration of hospitalization, and ICU stay. Our results, however, suggest that infection severity is the most important factor related to prolonged COVID-19 symptoms rather than comorbidities and age. Our study did contain limitations due to its retrospective nature, subjective duration of symptoms rather than objective 6-minute walk test, and lastly, patients may have been affected by different SARS-COV2 variants and received different treatments. CLINICAL IMPLICATIONS: Our results suggest that patients with severe COVID-19 are more predisposed to develop prolonged symptoms. Based on disease severity, this knowledge can inform providers and patients about prognosis and anticipated duration of symptoms post COVID-19 infection. DISCLOSURES: No relevant relationships by Brian Bustos No relevant relationships by Christopher Dipollina No relevant relationships by David O'Sullivan No relevant relationships by Eduardo Padrao No relevant relationships by Ravneet Randhawa No relevant relationships by Tejal Shah No relevant relationships by Pooja Shekar

RETROSPECTIVE ANALYSIS OF PULMONARY FUNCTION DURING THE POSTACUTE SEQUELAE OF SARS-COV-2 INFECTION

SESSION TITLE: Long COVID: It Can Take Your Breath Away SESSION TYPE: Original Investigations PRESENTED ON: 10/16/2022 10:30 am - 11:30 am PURPOSE: The World Health Organization has defined post-acute sequelae of SARS-CoV-2 infection, or Long-COVID, as prolonged symptomatology after initial recovery lasting more than 2 months. Changes in respiratory function associated with this syndrome are not fully understood. Therefore, we performed a retrospective analysis of patients with pulmonary function tests (PFT) after COVID-19. METHODS: We retrospectively reviewed records of 2,234 patients with a history of COVID-19 diagnosed by RT-PCR who followed up in pulmonary clinics in Hartford, Connecticut from March 2020 to December 2021. Data included the patients’ age, sex, comorbidities, PFT results, and the maximum oxygen requirement during acute illness: room air (RA), low-flow oxygen (LF), high-flow nasal cannula (HFNC), non-invasive ventilation (NIV) or mechanical ventilation (MV). We performed an adjusted logistic regression analysis to evaluate if the disease severity (defined by oxygen requirement) was associated with the presence of obstructive and restrictive disease during follow-up. SPSS 26.0 was used with an alpha level of 0.05. RESULTS: Of the 2,234 records, 471 (21.1%) had available PFTs. Only PFTs done between 2 and 12 months post COVID-19 were included. The mean age (± SD) of the sample was 56 ± 15 years;62.6% were female. Twenty three (4.9%) patients required MV, 17 (3.6%) NIV, 45 (9.5%) HFNC, 111 (23.6%) LF and 275 (58.4%) remained on RA. Obstructive disease was seen in 106 (22.5%), and bronchodilator response was seen in 34 (9.1%). Restrictive disease was seen in 129 (27.4%) and was associated with use of HFNC, NIV and MV (OR: 2.44, 3.67, 3.26;p<0.01). The presence of obstruction did not correlate with disease severity, however use of HFNC did correlate with the absence of obstruction (OR: 0.24;p=0.019). CONCLUSIONS: Our results show a significant association between disease severity and restrictive disease during follow up. This is compatible with smaller studies and is likely related to the fibrotic stage of Acute Respiratory Distress Syndrome. There was an association of HFNC use with the absence of obstruction. Perhaps, patients with the pre-existing obstruction and severe COVID were less likely to tolerate HFNC and required higher support for recovery. Bronchodilator responsiveness was only present in a small portion of patients. Severe disease did not appear to predispose patients to the development of obstructive disease during the follow up period. Studies including pre- and post-COVID PFTs would further strengthen this assertion. CLINICAL IMPLICATIONS: We did find an association between severity of COVID-19 and restrictive disease during follow up. Conversely, disease severity did not correlate with obstruction. These data will help to define the typical course of progression in patients suffering from Long-COVID and may imply that management should mirror strategies employed in other pulmonary conditions that cause restriction. DISCLOSURES: No relevant relationships by Brian Bustos No relevant relationships by Christopher Dipollina No relevant relationships by David O'Sullivan No relevant relationships by Eduardo Padrao No relevant relationships by Ravneet Randhawa No relevant relationships by Tejal Shah No relevant relationships by Pooja Shekar

Survey of State Laws Governing Fees Associated With Late Payment of Rent

The information used in developing this survey was obtained through an exhaustive review of each state's relevant statute and court rules, as well as a thorough review of appellate court opinions interpreting a relevant statute or providing guidance in the absence of statutory directive. In most instances, tenants are provided the lease on a take-it-or-leave-it basis with no opportunity to negotiate any of its terms, including provisions related to late fees.1 States that impose late fee maximums vary greatly on the amount and form of the limitation. In most of these states, the reasonableness requirement is established by courts rather than through legislation. * Arizona: For residential tenancies, it is implied within its eviction statutes that late fees must be reasonable. * California: Must be reasonably related to costs the landlord faces as a result of rent being late. * Connecticut: Fees must bear a reasonable relationship to the actual damage that the landlord sustains, and the court may void if excessive. * Illinois: Must be a reasonable forecast of damage caused by the breach. * Kentucky: Must be reasonable;$20 or 20 percent of the rental fee for each month is deemed reasonable. * Ohio: Must be reasonable in proportion to the rental rate and have a rational basis supporting the imposition of the charge. * Oklahoma: Must be reasonably related to actual costs incurred. * Pennsylvania: Late fees must be reasonable. * Texas: Must be reasonable;presumed reasonable if not more than 12 percent of the amount of rent for a dwelling located in a structure that contains no more than four units or 10 percent for a structure that contains more than four units. * Vermont: Late fee allowed if reasonably related to costs incurred. * Washington: Presumably must be reasonable. * West Virginia: Presumably must be reasonable. Most of these moratoriums were expired as of the date of the initial publication of this survey. * California: Renters who have submitted a declaration of COVID-19-related financial distress cannot be charged a late fee for the late payment of rental payments (no expiration date). * Colorado: Executive order prohibited landlords and lenders from charging late fees for any rent incurred between May 1, 2020, and April 27, 2021, due to the pandemic (expired). * Connecticut: Executive order 7X granted tenants an automatic 60-day grace period for April 2020 rent and made a 60-day grace period for May 2020 rent available upon request.

Medical Boards: Impact of Growing Virtual Care and Need for Integrated Approach to Enhance Quality and Safety

The increased amount of virtual care during the COVID-19 pandemic has exacerbated the challenge of providing appropriate medical board oversight to ensure proper quality of care delivery and safety of patients. This is partly due to the conventional model of each state medical board (SMB) holding responsibility for medical standards and oversight only within the jurisdiction of that state board and partly due to regulatory waivers and reduced enforcement of privacy policies. Even with a revoked license in one state, significant number of physicians have continued to practice by obtaining a medical license in a different state. Individualized requests were sent to 63 medical boards with questions related to practice of telemedicine and digital health by debarred or penalized medical doctors. The responses revealed major deficiencies and the urgent need to adopt a nationwide framework and to create an anchor point to serve as the coordinator of all relevant information related to incidents of improper medical practice. The ability to cause damage to large number of patients is significantly more now. Federal and state agencies urgently need to provide more attention and funding to issues related to quality of care and patient care in the changing ecosystem that includes medical specialists at a distance and the use of evolving digital health services and products. The creation, maintenance, and use of an integrated information system at national and multinational levels is increasingly important.

Don’t Read the Comments: Examining Social Media Discourse on Trans Athletes

How are transgender athletes understood in popular discourse? This paper adapts and merges Glaser and Strauss’ 1967 Grounded Theory Method with computerized Automated Text Analysis to provide clarity on large-n datasets comprised of social media posts made about transgender athletes. After outlining the procedures of this new approach to social media data, I present findings from a study conducted on comments made in response to YouTube videos reporting transgender athletes. A total of 60,000 comments made on three YouTube videos were scraped for the analysis, which proceeded in two steps. The first was an iterative, grounded analysis of the top 500 “liked” comments to gain insight into the trends that emerged. Automated Text Analysis was then used to explore latent connections amongst the 60,000 comments. This descriptive analysis of thousands of datapoints revealed three dominant ways that people talk about transgender athletes: an attachment to biology as determinative of athletic abilities, a racialized understanding of who constitutes a proper “girl”, and perceptions of sex-segregated sports as the sole way to ensure fairness in athletic opportunities. The paper concludes by drawing out the implications of this research for how scholars understand the obstacles facing transgender political mobilizations, presents strategies for addressing these roadblocks, and underscores the importance of descriptive studies of discourse in political science research concerned with marginalization and inequality.

Nomad Librarianship: Outreach Challenges and New Horizons in the Remote Hospital Library Setting

The article presents the discussion on outreach and remote hospital librarianship. Topics include clinical librarian showing new territory for the author causing moments of pause and concern navigating the most effective outreach methods working from home;and COVID-19 pandemic amplifying the need for virtual services and resources best serving the fluctuating workforce and patron base of hospital libraries.

Summary of the Current Status of Health Insurance Enrollment in Connecticut.

The state of Connecticut is considering a number of policy options to improve health insurance affordability, access, and equity. To create policies designed to increase insurance coverage and access to care in underserved communities and reduce racial and ethnic disparities, state policymakers need an accurate picture of the current distributions of insurance enrollment across these dimensions. The authors combine data from the American Community Survey Public Use Microdata Sample, which includes demographic characteristics, as well as insurance status, with various data sources from the state to provide a fuller picture of insurance enrollment among those under the age of 65 in Connecticut. They also use existing high-level estimates of 2020 insurance enrollment to provide estimates of how enrollment in the state was affected during the early months of the pandemic. The authors find that insurance enrollment in Connecticut in 2019 was generally high but that there were substantial differences in insurance coverage by race and ethnicity. Asian individuals had the highest rates of employer-sponsored insurance coverage, and Black individuals had the highest rates of Medicaid coverage. Hispanic individuals had a higher rate of Medicaid coverage than non-Hispanic individuals. High-level estimates of changes in insurance coverage during the early months of the COVID-19 pandemic suggest that uninsurance decreased slightly, Medicaid coverage increased, and private insurance coverage fell. This study provides the state of Connecticut with estimates of enrollment in detailed health insurance categories by age, gender, race, and ethnicity and highlights the need for better, more-detailed health insurance enrollment data.

A Retrospective Analysis of DLCO Changes in Post-Acute Sequelae of SARS-CoV-2 Infection

Rationale: Over 350,000,000 people have had SARS-CoV-2 infection worldwide. COVID-19 poses many challenges in the management of patients causing a long-term and significant burden on the healthcare system. Understanding the long-term complications is a challenge that the healthcare community and patients will face. To our knowledge, this is one of the largest retrospective analyses with the aim to understand the functional lung sequelae of the disease. Methods: We retrospectively reviewed 782 survivors who had COVID-19 diagnosed by RT-PCR and followed up at an outpatient pulmonary clinic in Hartford, Connecticut, USA, from March 2020 to June 2021. Data included patient's age, sex, comorbidities, pulmonary function tests (PFT), the maximal requirement of low-flow oxygen (LF), high-flow nasal cannula (HFNC), non-invasive ventilation (NIV) and mechanical ventilation (MV). We performed an adjusted logistic regression model to evaluate if severity of disease according to maximal oxygen support is associated with DLCO<80% in follow-up. SPSS IBM was used for the statistical modeling. Results: Of the 782 patients evaluated, 314 patients had PFT results available post COVID-19 for analysis. The mean age was 58.9±14.5 years, and of the total number of patients, 200 were female (63.7%). Other demographics are as follows: 156 (49.7%) were obese, 129 (41.2%) had asthma, 48 (15.3%) had COPD, 5 (1.6%) had Interstitial Lung Disease, 35 (11.1%) had anemia, 70 (22.3%) had diabetes mellitus, 164 (52.2%) had hypertension, 26 (8.3%) had heart failure. Only 14 (4.4%) required MV, 14 (4.5%) NIV, 29 (9.2%) HFNC, 94 (29.9%) LF and 153 (51.9%) remained on room air. Altered DLCO was seen in 107 patients (34.1%), 189 (60.1%) had normal DLCO, and 18 (5.7%) did not have DLCO, of which the latter were excluded from the analysis. Maximal oxygen support was associated with DLCO<80% on unadjusted analysis (p=0.003). However, it was not associated with DLCO<80% (p=0.2) when adjusted. Other variables associated with a higher risk of DLCO<80% were age (p<0.001) and COPD (p<0.028). Asthma was associated with lower risk of developing DLCO<80% (p<0.001). Conclusion: Patients with post-acute sequelae of SARS-CoV-2 infection can develop DLCO<80%, which may contribute to long-term symptoms. Altered DLCO was not associated with maximal oxygen support in the adjusted logistic regression analysis. However, this may be due to the low number of cases requiring MV or NIV, resulting in selection bias, given there was a higher mortality rate in patients requiring positive pressure ventilation. Additionally, age and COPD were correlated with DLCO<80%.