Evaluation of Out-of-Hospital Cardiac Arrests in Births and Neonates: Opportunities to Improve Care

INTRODUCTION: Home births have increased 77% from 2004 to 2017 and further increased with the COVID-19 pandemic. While the majority of home births are uneventful, some are complicated and require attendance of emergency medical services (EMS). Understanding characteristics of out-of-hospital births and EMS care is increasingly important to improve care. METHODS: We conducted a chart review of pediatric out-of-hospital cardiac arrests (POHCAs) from EMS agencies across the United States to evaluate the care provided by first responders. The study was approved by Oregon Health & Science University and respective IRBs. RESULTS: Of 1,020 POHCAs, 54 were responses to births and 43 were for other neonates. While most neonatal POHCAs occurred in a home or residence (84%), some births occurred at other locations such as a health care facility, public or commercial building, and street or highway. Bystander cardiopulmonary resuscitation was performed in less than half of births but more than half of other neonates. Return of spontaneous circulation was twice as likely for births as for other neonates (27% versus 13%). Overall, serious adverse safety events were observed in three-fourths of neonatal resuscitations. Births were more likely to be associated with failure to follow the correct resuscitation algorithm and lack of positive pressure ventilation. CONCLUSION: There are unique challenges in the care of out-of-hospital births for the EMS system. There is an opportunity to improve use of neonatal resuscitation protocols and early ventilation. [ FROM AUTHOR] Copyright of Obstetrics & Gynecology is the property of Lippincott Williams & Wilkins and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Educators Learning Lessons From Multilingual Family Engagement Through the COVID-19 Pandemic

We report on a project to support teachers and district administrators working with multilingual learners as they deepened relationships and understandings with multilingual families in five Oregon school districts. Due to the COVID-19 pandemic, which radically shifted the ways educators engaged with students' families, we repurposed this ongoing research to answer the question: How did teachers' and supporting administrators' conceptions of and actions to promote multilingual family engagement shift in response to the COVID-19 pandemic? Further influenced by the concurrent national protests for racial justice, we consider how teachers and administrators engaged in liberatory work as they questioned structures that had previously seemed inevitable or unproblematic. Framed using Harro's cycle of liberation, we discuss lessons learned based on systematic data collected from both teachers and administrators from multiple districts and multiple time points before and during pandemic-impacted schooling.

Storytelling and Deliberative Play in the Oregon Citizens' Assembly Online Pilot on COVID-19 Recovery

This article draws on the deliberative play framework to examine empirical examples of storytelling in an online deliberative forum: The Oregon Citizen Assembly (ORCA) Pilot on COVID-19 Recovery. ORCA engaged 36 citizens in deliberation about state policy through an online deliberative process spanning seven weeks. Drawing on literature on small stories in deliberation, we trace stories related to a policy proposal about paying parents to educate children at home. Our analysis demonstrates that storytelling activities accomplish aspects of deliberative play through introducing uncertainty, resisting premature closure, and promoting an "as if" frame that allows groups to explore the scope and implications of proposals. Forum design influences interaction and our analysis suggests that technology use and timing are key design features that can facilitate or inhibit deliberative play. [ FROM AUTHOR] Copyright of American Behavioral Scientist is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Equity-Based Optimization for Covid-19 Vaccine Allocation

Background: Despite the development of safe and effective vaccines and antiviral treatments against COVID- 19, marginalized racial/ethnic groups in the United States continue to be disproportionally burdened by COVID-19. In response to this inequity, public health officials in several states designed, usually in an ad-hoc manner, policies aimed to be more equitable in both access and distribution of COVID-19 interventions. Method(s): We constructed an age- and race-stratified mathematical model of SARS-CoV-2 transmission and COVID-19 vaccination. We fit our model to data from Oregon at the beginning of 2021. Next, we explored counterfactual scenarios where we determined the optimal use of limited amounts of vaccine over the first 4 months of 2021 with the goal of minimizing 1) number of deaths or Years of Life Lost (YLL), 2) the inequity in mortality or YYL between race groups, 3) a combination of both. We compared them to a base-case scenario without vaccination. Result(s): When vaccine supply is very limited (enough to cover 10% of the population), there is a trade-off between minimizing mortality or minimizing inequity (Fig.1). For minimizing mortality, it is optimal to allocate vaccine to the oldest age group, irrespective of race. To minimize inequity, vaccine needs to be allocated first to the marginalized populations in the young- and middle-aged groups, incurring significantly more deaths in all groups, including the marginalized ones, compared to minimizing mortality (Fig.1). When minimizing both deaths and inequity, the optimal vaccination strategy achieved a significant reduction in inequity while preserving most of the reduction in mortality (Fig.1). When minimizing YYL and inequity, the optimal allocation resulted in a more equitable distribution of resources and outcomes across race groups. Once vaccine supply was enough to cover 20% of the population, our results suggest that it is possible to minimize both mortality (or YYL) and inequity, by protecting marginalized communities and the oldest populations at the same time. Conclusion(s): With low vaccine supply, there is a trade-off between being more equitable and reducing mortality. This is true because COVID-19 related mortality is concentrated in the oldest population while marginalized populations are predominately young. This trade-off quickly disappears when more vaccine is available. An interdisciplinary approach is needed to address the inequitable distribution of resources and outcomes in public health. Mortality rate (left), Years of Life Lost (center) and Indices of Disparity (right) with no vaccination (top row), minimizing deaths (2nd row), inequity (3rd row) or both (4th row) with enough vaccine to cover 10% of the population.

Modifications in SARS-CoV-2 N Linker Region Regulate RNA Interactions and Phase Separation

The N protein of the SARS-CoV-2 virion is critical for viral genome packaging via RNA binding and regulation of viral transcription at the replication-transcription complex (RTC). The N protein can be divided into five main domains, and the central region is the linker, which is predicted to be primarily disordered and has not been heavily studied. The linker is Serine-Arginine Rich, which is phosphorylated at multiple sites by host kinases during infection, thereby promoting the N protein's role in viral transcription. Phosphorylation is a critical process for the regulation of many cellular processes and can provide recognition sites for binding complexes. In a study that examined the recognition of the SARS-CoV-2 N protein by the human 14-3-3 protein, the linker was found to contain critical phosphosites for 14-3-3 binding. The goals of this project are to determine the structure, dynamics, and RNA interactions of the Serine-Arginine Rich linker region. To accomplish this, we performed Nuclear Magnetic Resonance spectroscopy (NMR) experiments to analyze the structure of the linker region of the N protein and its ability to bind viral RNA. NMR confirms predictions that the linker is not entirely unstructured and it is able to bind RNA. The linker region of the N protein with phosphoserine incorporated at S188 was also examined via an NMR titration experiment with 1-1000 RNA. Compared to wild type, the incorporation of phosphorylation decreases binding. Other biophysical techniques such as Analytical Ultracentrifugation (AUC) and Multi-Angle Light Scattering (MALS) are used to identify the association state of the linker and the size of the resulting protein-RNA complex. We are currently working to biophysically characterize the structure, dynamics, and viral RNA binding ability of a mutation found in the Delta and Omicron variants: the R203M linker, which have been shown to enhance viral infectivity. This work was supported by the NSF EAGER grant NSF/ MCB 2034446 and URSA Engage. Support to facilities includes the Oregon State University NMR Facility funded in part by NIH, HEI Grant 1S10OD018518, and by the M. J. Murdock Charitable Trust grant # 2014162.Copyright © 2023 The American Society for Biochemistry and Molecular Biology, Inc.

Quantifying Population Immunity to Covid-19 in Washington State and Oregon

Background: Since early 2020, the novel SARS-CoV-2 virus has spread rapidly throughout the globe. Subsequently many individuals have developed some form of immunity due to either a prior infection, one or more vaccinations, or a combination of the two. Using local epidemic data and mathematical modeling, we enumerate the various immune populations in Washington State and Oregon and quantify the level of protection against infection and hospitalization. Method(s): We developed a compartmental model of ordinary differential equations, which stratifies the population by age (0-17 years, 18-49 years, 50-64 years, and 65+ years), region, type of immunity (naive, infectionderived, vaccine-derived, booster-derived, hybrid immunity, etc), and recency of immune conferring event (recent and waned). To track the number of individuals in each category we combine 1) literature-based estimates of susceptibility to infection and severe disease by age, immune status, and variant, 2) calibration to the number of severe infections (hospitalizations and deaths) and number of vaccinations and 3) validation with serological surveys of the population. Result(s): We estimate that by mid-April 2022 more than 95% of the populations of both Washington and Oregon had some immunity against COVID-19 infection and hospitalization. Younger age groups tended to have much higher rates of natural or hybrid immunity with 96% of 0-17-year-olds and 83% of 18-49-year-olds protected due to past infections. Overall, the population-level immunity against the Omicron variant reduced risk of infection by 59% (95% Credible Interval 54% - 62%) and risk of hospitalization by 79% (95% CI 77% - 81%) in Washington and 62% (95% CI 57% -66%) and 83% (95% CI 82% - 85%), respectively, in Oregon. There was similar population-level protection against Delta at the start of the Omicron wave in early December 2021, which reduced risk of infection by 60% (95% CI 56% - 63%) and risk of hospitalization 79% (95% CI 78% - 80%) in Washington and 66% (95%CI 63% - 70%) and 82% (81% - 83%), respectively, in Oregon. Conclusion(s): Very large waves of new infections throughout 2021 and early 2022, in addition to high levels of vaccination and boosting among the older age groups in Washington and Oregon have greatly reduced population susceptibility to currently circulating strains. However even very high population immunity has allowed for emergence of novel variants that escape existing immunity, highlighting the need for continued develop of new variantspecific boosters.

Using real-time data to improve patient no-shows and late cancellations

Background: The Cystic Fibrosis Foundation (CFF) advises that all persons with cystic fibrosis (PwCF) visit a cystic fibrosis (CF) care center every 3 months for evaluation, treatment, surveillance, counseling, and education [1]. In March 2020, our clinic went into modified operations in response to the COVID-19 pandemic, necessitating a temporary change in our ability to conduct routine face-to-face visits. Within 1 month, we operationalized virtual visits in addition to face-to-face visits. During the pandemic, staff noticed a drop in clinic attendance, and we implemented a quality improvement (QI) plan to study and address this trend. Method(s): Our QI team is a multidisciplinary group that is part of the Cystic Fibrosis Learning Network (CFLN). We defined the clinic fill rate (CFR) as the number of people seen over the number of available clinic slots. Each week, we determined the number of PwCF scheduled the following week and compared that number with no-shows and cancellations that occurred during that 7-day period. We also determined the number of PwCF scheduled 1 month ahead to compare it with weekly data. We used a key driver diagram to help focus our interventions (change ideas). Using run charts, we analyzed data each week to identify trends and variances. We used plan-do-study-act cycles and implemented initial interventions centered on publicizing CFF follow-up guidelines in town hall meetings, emails, and newsletters. We later identified PwCF who had a no-show history, and before clinics, our social worker communicated with each family (telephone or text) to remind them of the upcoming visit and identify any barriers to attending. During our study, Oregon experienced a surge in COVID-19 cases from the omicron variant, andwe overlaid our data with a graph of cases. Result(s): CFR was measured in 598 encounters over 28 weeks. CFR 1 month in advancewas 79%. In theweek before clinic, CFRwas 84%. After theweek, overall CFR was 66% (68% for face-to-face visits, 58% for virtual visits). Fifteen percent of our cancellations were COVID-related (increasing to 21% during the surge), but CFR did not change during the surge. After our intervention, those contacted in advance came to clinic 93% of the time, and our CFR improved to 74.8%. Conclusion(s): An 84% CFR, measured 1 week ahead of clinic, was dropping to an average of 66% because of late cancellations and no-shows, and widespread education about clinic attendance guidelines did not increase the rate. Having our social worker communicate directly with PwCF increased the overall CFR closer to our advance numbers, and 93% came to clinic. These communications also served as an additional patient interaction during which other social work needs were identified. Overall reduced clinic attendance may be related to the indirect impact of the pandemic and benefits of modulator therapy.We need to gather more postimplementation data and to consider different approaches to partnering with PwCF to achieve ideal follow-up.Copyright © 2022, European Cystic Fibrosis Society. All rights reserved

The Impact of Covid-19 Pandemic on Affective Concussion Symptoms in Adolescents

Purpose of Study: Affective symptoms, such as depression, nervousness, anxiety, and irritability, are common yet complicating aspects for concussion patients, therefore addressing exasperations of these symptoms is essential for injury management. This is an especially important consideration for patient populations increasingly susceptible to affective disorders, such as those in rural regions and adolescents. Increases in adolescent mental health problems during the time of the COVID-19 pandemic pose an additional challenge for clinicians managing affective concussion symptoms in rural adolescents. The aim of this study is to quantify the mental health effects of the pandemic by comparing affective concussion symptoms in groups of adolescents with concussion and without concussion in the Central Oregon region. Methods Used: The study is a secondary data analysis of ImPACT Concussion Test symptom scores from a cohort of non-concussed (Baseline) and concussed (Post-Injury) adolescents between the ages of 12-18, pre-pandemic (January 1, 2015 - March 20, 2020) and pandemic (March 21, 2020 - April 1, 2022). Subjects were excluded from the study if they received special education, had a diagnosis of learning disabilities, ADD, dyslexia, autism, or received treatment for headaches, migraines, epilepsy, brain surgery, meningitis, substance use or psychiatric conditions. Prevalence of symptoms of 'headache', 'trouble falling asleep', 'irritability', 'nervousness', 'sadness', and 'feeling more emotional' were noted for each group during each time period. Summary of Results: A total of pre-pandemic non-concussed (n =2667), pre-pandemic concussed (n=643), pandemic non-concussed (n = 593) and pandemic concussed (n=87) were included in the final analysis. There was a statistically significant increase in the proportions of 'nervousness' (p=0.0209) and 'sadness' (p=0.0117) in pre-pandemic and pandemic non-concussed groups. Furthermore, there were statistically significant increases in the proportions of 'headache' (p=0.0331), 'irritability' (p=0.0006), 'nervousness' (p=0.0135), 'sadness' (p=0.0357) and 'feeling more emotional' (p=0.0039) between pre-pandemic and pandemic concussed adolescents. Conclusion(s): This study demonstrates a significant increase in affective symptoms in both concussed and non-concussed groups during the COVID-19 pandemic consistent with other studies. However, those with concussion during the COVID-19 pandemic showed greater number of affective symptoms as well as somatic symptoms (headache) compared to concussed pre-pandemic adolescents. The results of this study support the broader body of research examining the mental health burden of the COVID-19 pandemic on adolescents, and further encourages a biopsychosocial approach to injury management, in which social and emotional components of a patient's life are considered.

Teledermoscopy-Aided Self-Skin Examinations for Remote Triage of Skin Lesions

Purpose of Study: Teledermatology, defined as the use of technology to provide dermatology services to individuals in a remote setting, has grown considerably in popularity since the onset of the COVID-19 era. Teledermoscopy utilizes a dermatoscope attachment paired with a smartphone camera to visualize colors and microstructures within the epidermis and superficial dermis that cannot be seen with the naked eye alone. When combined with store-and-forward technology, teledermoscopy of lesions concerning for skin cancer can improve virtual referral and triage workflow. Methods Used: Our retrospective case-control study evaluated the efficacy of a smartphone dermatoscope borrow program in the remote triage of individuals with self-selected skin lesions of concern and its effect on subsequent in-person follow-up visits. A retrospective medical record review was conducted of all Oregon Health and Science University (OHSU) Department of Dermatology spot check image submissions utilizing the smartphone dermatoscopes between August 2020-2022. Dermoscopic images of skin lesions that included corresponding non-dermoscopic clinical images in their submission were included in our review (n=70). A blinded expert dermoscopist then reviewed the clinical and dermoscopic images separately and utilized standard clinical algorithms for skin cancer (ABCD criteria: asymmetry, irregular borders, multiple colors, diameter>= 6mm for clinical images;3-point checklist: dermoscopic asymmetry, atypical network, blue-white structures for dermoscopy images) to determine whether the imaged lesion should translate to an in-person visit for further evaluation. Summary of Results: Of the 70 skin lesions submitted, 59 warranted in-person evaluation from clinical (non-dermoscopic) image review compared to 29 warranting in-person evaluation from dermoscopic images of the same lesion. Thus, this is a 51% reduction of conversion to in-person consultation with the addition of smartphone dermatoscope images in virtual lesion triage (P<0.001, McNemar's Test). Conclusion(s): Implementing patient-led teledermoscopy may reduce frequency of in-person visits for benign lesions, and thus, may decrease wait times for other patients with concerning and possibly malignant lesions. Decreasing the frequency of unnecessary visits may not only improve patient quality of life, but also promote cost-effective expenditures for health systems at large.

Developing a Community Standard of Care for Individuals Diagnosed with Breast Cancer Patients Across Oregon

Early in the pandemic, cancer centers across the nation and Oregon canceled their cancer support programs as non-essential medical care. Breast cancer patients were forced to look elsewhere for essential assistance and community support to move along their cancer journeys. Pink Lemonade Project (PLP), a Vancouver, WA based community based nonprofit, helped fill the gaps and expanded its local support for breast cancer patients. A virtual format allowed PLP to serve more individuals with our psychological, emotional and financial support programs. Next, PLP convened an informal coalition of all the local breast cancer support organizations including those that offer breast cancer support programs, community including dragon boating and rowing, and others that serve broader communities and more people of color. Then, as Komen National announced its restructuring, and closed the Oregon-Southwest Washington affiliate in Spring 2021, Pink Lemonade Project stepped up again to maintain two locally-grown Komen programs that met critical community need-the MBC Dinner Series and the Treatment Access Program (TAP), a transportation assistance program that served all of Oregon and reduced the geographic barrier to care. Through the coalition, PLP heard patients express concern that they were receiving outdated information and were struggling more to find needed support and resources from their providers. Understandably, nurse navigators and social workers could not maintain and/or update patient resources while they assisted COVID patients. The goal of the coalition was to increase communication across the organizations and to share more event schedules for the ease of patients to understand what support programs are available. This session, delivered by an all breast cancer patient panel, will give an overview of Pink Lemonade Project;its programs that helps with psychological, emotional, community and financial support for breast cancer patients, survivors and those living with metastatic breast cancer;and will highlight the results from the patient point of view of the systematic review of the contents of 6 regional health systems new patient binders and present recommendations for consistent, community-wide content for all future breast cancer patients. The project's main strength was that Pink Lemonade Project could draw upon on an existing coalition of local, community-based breast cancer organizations to help update and standardize breast cancer support information from the patient point of view. Then by acting as a neutral convener, PLP could request and receive the binders from all the region's healthcare providers to help standardize and update the community resources across all the region's cancer centers. The result is that any new breast cancer patient, regardless of where their access to care is, can receive consistent community-based information and resources. Another result of this project showed the importance of the partnership of healthcare and human service agencies, especially in a post-pandemic world. As the pandemic continues to strain healthcare, community-based nonprofits have a unique role to help coordinate community resources and improve the quality of life for those affected by breast cancer.

Exploring the effect of ethnic diversity on COVID-19-related mortality in the United States of America

Background: In the setting of COVID-19, hypertension, diabetes, and obesity are postulated to contribute to adverse outcomes. Among different ethnic groups in the United States of America, African Americans have a higher incidence of the above conditions. It is hypothesised that the African American population in the United States may bear a disproportionate burden of COVID-19-related mortality. Purpose(s): Evaluate the correlation between African American ethnicity and incidence of COVID-19-related mortality. Method(s): COVID-19-related fatalities reported for Oregon, Missouri, and Georgia between the 6th February and 30th April 2020 were obtained from state health departments. These states were selected due to similarities in the social distancing measures implemented but differences in their African American population (32.4% Georgia, 11.8% Missouri, 2.2% Oregon). Fatalities in each state were analysed using the Cox proportional hazard regression analysis. Result(s): Of the reported fatalities in Georgia, Missouri, and Oregon, 51.0%, 38.0%, and 4.0% were in African Americans, respectively. This corresponds to a 2.1 to 2.8-fold increase in the risk of COVID-19-related mortality in African Americans as compared to all other ethnicities. The incidence of African American fatalities for the total population of each state ranged from 0.12 to 3.22 deaths/population/mile2. As compared to Oregon, the risk of COVID-19-related mortality was significantly higher in Georgia (hazard ratio (HR)=4.4;p<0.001) and Missouri (HR=2.2;p=0.001) at the alpha=0.05 level, proportional to the increased population of African Americans. Conclusion(s): Initial results show that African American ethnicity may significantly contribute to an overall incidence of COVID-19-related mortality.

Engaging Latino Families About COVID-19 Vaccines: A Qualitative Study Conducted in Oregon, USA.

OBJECTIVES: Latinos are disproportionately vulnerable to severe COVID-19 due to workplace exposure, multigenerational households, and existing health disparities. Rolling out COVID-19 vaccines among vulnerable Latinos is critical to address disparities. This study explores vaccine perceptions of Latino families to inform culturally centered strategies for vaccine dissemination. METHOD: Semistructured telephone interviews with Latino families (22 mothers and 24 youth, 13-18 years old) explored COVID-19 vaccine perceptions including (1) sources of information, (2) trust of vaccine effectiveness and willingness to get vaccinated, and (3) access to the vaccine distribution. We identified thematic patterns using immersion-crystallization. RESULTS: We found that (1) 41% expressed optimism and willingness to receive the vaccine coupled with concerns about side effects; (2) 45% expressed hesitancy or would refuse vaccination based on mistrust, myths, fear of being used as "guinea pigs," and the perceived role of politics in vaccine development; (3) families "digested" information gathered from social media, the news, and radio through intergenerational communication; and (4) participants called for community-led advocacy and "leading by example" to dispel fear and misinformation. Optimistic participants saw the vaccine as a way to protect their families, allowing youth to return to schools and providing safer conditions for frontline essential workers. CONCLUSIONS: Culturally centered vaccine promotion campaigns may consider the Latino family unit as their target audience by providing information that can be discussed among parents and youth, engaging a range of health providers and advocates that includes traditional practitioners and community health workers, and disseminating information at key venues, such as schools, churches, and supermarkets.

Student Perspectives of Remote Teaching during the COVID-19 Pandemic

This qualitative study examines the student experience in a chemical engineering program at a large, public research-intensive university during the shift to remote teaching due to COVID-19. Data sources include a free response survey completed by 380 students and focus groups including 35 graduate and undergraduate student instructors. The most common challenge students identified was staying engaged in their studies, especially during class. Several instructional practices emerged that can transfer back to in-person instruction.

Health-System Introductory Pharmacy Practice Experience as an online course in the United States

Introductory Pharmacy Practice Experiences (IPPEs) provide early experiential education in the Doctor of Pharmacy (Pharm.D.) curriculum in the United States (US). In response to Oregon's 'Stay Home, Save Lives' executive order issued during the COVID-19 pandemic, an online health-system IPPE course was developed to simulate the practice experiences that have historically been conducted in person. This case study describes experience from the online health-system IPPE course offered for incoming second-year student pharmacists enrolled in a three-year Pharm.D. programme at Pacific University in Oregon, US. The goals of the course were: 1) to expose students to pharmacy practice common in health-system settings in the US;and 2) for students to earn 50 experiential clock hours through simulation activities. Copyright © 2020, International Pharmaceutical Federation. All rights reserved.

Interpersonal Firearm Injury and Death in Portland, Oregon: 2018 Through 2021.

The annual number of firearm injuries in Portland, Oregon has been higher in the years since 2020 than in any prior year in the city's history. This descriptive study analyzed data from Gun Violence Archives (GVA) from January 1, 2018, to December 31, 2021. All incidents in GVA of interpersonal firearm injury that occurred in Portland during this period were analyzed for location, number of people injured or killed, and demographic information for those injured or killed. Comparisons in firearm injury rates were made with Seattle and San Francisco. Interpersonal firearm injuries began to rise after the first COVID-19 case in Oregon; July 2020 had the most injuries in the four-year period. Black men suffered the highest rate of interpersonal fatalities, with more than 11-fold higher rate per 100,000 than White men in every year studied. Portland had a higher rate of total interpersonal firearm injuries and a higher rate of firearm fatalities from 2018 through 2021 compared to Seattle and San Francisco. Neighborhoods near Downtown and those on the Eastside of the city had the highest rates of interpersonal injuries and deaths from firearms, whereas those in the Southwest had the lowest. Defining the burden of disease from interpersonal firearm injuries is a fundamental step in designing future public health research and implementing interventions to curb the trauma brought by interpersonal firearm injury.

COVID-19 vaccine knowledge, beliefs and attitudes among Oregon healthcare provider types

Background: During this pandemic, the public has struggled to navigate the abundance of COVID-19 vaccine misinformation, and it is unclear how this misinformation has affected medical providers and their recommendations for patients. We sought to understand differences in COVID-19 vaccine knowledge, beliefs, and attitudes among Oregon healthcare provider types and regions of practice (rural, suburban, urban). Methods: A 36-question survey was constructed using Qualtrics with consultation from a survey methodologist. The survey was reviewed and approved by OHSU IRB and distributed via listserv or social media posting to provider societies in Oregon, including nurse practitioners (NPs), naturopathic doctors (NDs), physician assistants (PAs), doctors of medicine (MDs), doctors of osteopathic medicine (DOs), or practioners with a bachelor of medicine–bachelor of surgery (MBBS), and via the Oregon Health Authority (OHA) immunization practice listserv. The survey accepted responses from July 9 to August 12, 2021. Participants were volunteers and responses were anonymous. Results: We collected 101 responses. Among them, 87 participants completed 100% of survey questions. Survey respondents were predominantly White females aged 41–50 years with an MD, DO, or MBBS. The overall COVID-19 vaccination rate of respondents was 94.6%. The vaccination rate was highest among the 4 NDs and 7 PAs at 100%, followed by 78 MDs, DOs, and MBBSs at 96.2%, and 12 NPs at 75%. Of NP respondents, 67% practiced rurally;25.6% of MDs, DOs, and MBBSs practiced rurally;and 25% of NDs and 28.6% of PAs practiced rurally. In total, 22% of NPs did not feel comfortable recommending the COVID-19 vaccine to patients, compared to 1% of MDs, DOs, and MBBSs and 0% of NDs or PAs. All provider types had high rates of disagreement with the statement that the COVID-19 pandemic had increased their trust in vaccine safety: 44% of NPs;29% of PAs;25% of NDs;and 7% of MDs, DOs, and MBBSs. Among 19 rural providers, 19% indicated mistrust in public health to ensure that vaccines are safe versus 3% in suburban areas and 0% in urban areas. Conclusions: COVID-19 vaccine hesitancy is prevalent among healthcare providers and may be higher in NPs and those practicing rurally. Unfortunately, the response rate of NPs was low. Future research should focus on these providers to better understand their knowledge, beliefs, and attitudes about COVID-19 vaccines. These results can also inform future targeted vaccine education to healthcare providers during public health crises.Funding: NoneDisclosures: None

ABA SGLAID Public Defense Workload Studies Reveal Systems in Crisis

In early 2022, the American Bar Association Standing Committee on Legal Aid and Indigent Defense (ABA SCLAID), together with consulting firm Moss Adams LLP, released two reports on public defender workloads-one on Oregon, the other on New Mexico. To do this, OPDS contracts with providers of different types-public defender offices, law firms, consortia, nonprofit organizations, and individual attorneys. Or, a Chief Public Defender Bennet Baur stated in a blog post for the National Association for Public Defense, "each legal team member is straining under logistic and emotional weight three times what they can sustainably and ethically hold." For each of these open cases, a public defender must, at a minimum, regularly communicate with each client, continually seek to review and address ongoing detention and/or release conditions, prepare for and attend status hearings, and seek to keep track of witnesses and other critical evidence. The public defender in Gainesville, Florida, put it bluntly during a recent legislative session during which both public defenders and state attorneys were seeking salary increases: "We are in crisis.

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

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.

Vacancy Change in Vulnerable Census Tracts in Portland, Oregon

This article examines areas of suspected blight in Portland, Oregon, by analyzing the increase of vacant addresses in vulnerable census tracts between 2015 and 2019 using U.S. Postal Service (USPS) data on vacant residential or no-stat addresses that are reported to the U.S. Department of Housing and Urban Development (HUD). From 2015 to 2019,15.8 percent of vulnerable census tracts experienced suspected blight in the City of Portland, representing 11.4 percent of the total population of Portland. Trends from 2020 to 2021 indicate a general decline of vacancies reported by USPS, suggesting fewer instances of blight in Portland. Further analysis of 2020 to 2021 data and vulnerable census tracts is needed, pending the release of American Community Survey (ACS) data.