Microbial community storm dynamics signal sources of "old" stream water.

Accurate characterization of the movement of water through catchments, particularly during precipitation event response, is critical for hydrological efforts such as contaminant transport modeling or prediction of extreme flows. Abiotic hydrogeochemical tracers are commonly used to track sources and ages of surface waters but provide limited details about transit pathways or the spatial dynamics of water storage and release. Alternatively, biotic material in streams is derived from thousands of taxa originating from a variety of environments within watersheds, including groundwater, sediment, and upslope terrestrial environments, and this material can be characterized with genetic sequencing and bioinformatics. We analyzed the stable water isotopes (δ18O and δ2H) and microbiome composition (16S rRNA gene amplicon sequencing) of the Marys River of western Oregon, USA during an early season storm to describe the processes, storage, and flowpaths that shape surface water hydrology. Stable water isotopes (δ18O and δ2H) typified an event response in which stream water is composed largely of 'old' water introduced to the catchment before the storm, a common though not well understood phenomenon. In contrast, microbial biodiversity spiked during the storm, consisting of early- and late-event communities clearly distinguishable from pre-event communities. We applied concentration-discharge (cQ) analysis to individual microbial taxa and found that most Alphaproteobacteria sequences were positively correlated (i.e., were mobilized) with discharge, whereas most sequences from phyla Gammaproteobacteria and Bacteroidota were negatively correlated with discharge (i.e., were diluted). Source predictions using the prokaryote habitat preference database ProkAtlas found that freshwater-associated microbes composed a smaller fraction of the microbial community during the stream rise and a larger fraction during the recession, while soil and biofilm-associated microbes increased during the storm and remained high during recession. This suggests that the "old" water discharged during the storm was likely stored and released from, or passed through, soil- and biofilm-rich environments, demonstrating that this approach adds new, biologically derived tracer information about the hydrologic pathways active during and after this event. Overall, this study demonstrates an approach for integrating information-rich DNA into water resource investigations, incorporating tools from both hydrology and microbiology to demonstrate that microbial DNA is useful not only as an indicator of biodiversity but also functions as an innovative hydrologic tracer.

Simulated herbicide drift alters native plant flowering phenology.

Data for herbicide effects on plant flowering are needed to determine potential impacts on plant reproduction. Thus, flowering phenology was determined for up to 12 weeks after herbicide treatment for native Willamette Valley plants growing in small plots on two Oregon State University experimental farms. Six perennial species were evaluated: Camassia leichtlinii (CALE), Elymus glaucus (ELGL), Eriophyllum lanatum (ERLA), Festuca idahoensis subsp. roemeri (FEID), Iris tenax (IRTE), and Prunella vulgaris var. lanceolata (PRVU). Effects of glyphosate and dicamba, alone and in combination, were determined using simulated drift rates of 0.1 or 0.2 x field application rates (FAR) of 1119 g ha-1 active ingredient (a.i.) (830 g ha-1 acid glyphosate) for glyphosate and 560 g ha-1 a.i. for dicamba. Flowering phenology was evaluated as stage of development on a scale from no buds (converted to 0), buds (1), pre-flowering (2), flowering (3), post-flowering (4), to mature seeds (5) before herbicide treatment and for 12 weeks after treatment. Flowering response to herbicides varied by species and farm; but, in general, dicamba and glyphosate resulted in earlier flowering stages (delayed or not full flowering) for the dicot ERLA, and to a lesser extent, PRVU; and glyphosate resulted in earlier flowering stages for the monocot IRTE. Based on these data, the concentration of herbicide affecting flowering stage was 0.1 x FAR. Once flowering stage was inhibited by dicamba and glyphosate, plants generally did not recover to full flowering. This study provided evidence that common herbicides can affect flowering phenology of native plants with implications for seed production.

Correlation between Viral Wastewater Concentration and Respiratory Tests, Oregon, USA.

We evaluated the association between wastewater concentration and weekly percent positivity of patient testing for SARS-CoV-2, influenza, and respiratory syncytial virus in Oregon, USA. We found strong, positive correlations for SARS-CoV-2 (ρ = 0.84, p<0.001), influenza (ρ = 0.73, p<0.001) and respiratory syncytial virus (ρ = 0.69, p<0.001).

Functional Medicine Care was Associated with Lower Pharmacy Claims Costs Among Ashland School District Employee Health Plan Participants With Musculoskeletal Disorders.

Background: Musculoskeletal disorders are a leading cause of healthcare utilization and disability among the millions of school employees in the United States. While school-based workplace wellness programs have demonstrated improvements in health behaviors, the long-term financial impact of these programs remains unclear. Objective: Identify factors associated with health insurance claims costs within a school district featuring a workplace wellness program emphasizing health behaviors aligned with the functional medicine model of care. Setting: Ashland School District in Oregon, USA. Participants: Ashland School District employee health plan participants. Methods: Medical and pharmacy claims from 2010 to 2021 were included for analysis. Multivariate linear regression models of medical and pharmacy claims costs were constructed including year of claim, age, sex, baseline comorbidities, and whether the participant received functional medicine care. Results: The sample included 1,178 participants with musculoskeletal disorders and a total of 92,922 claims. Older age ($46.28 per year, P < .0001) and comorbidities ($258.24 per comorbidity, P = .03) were associated with higher yearly per member medical claims. Older age ($21.84 per year, P < .0001) and comorbidities ($335.62 per comorbidity, P < .0001) were also associated with higher yearly per member pharmacy claims. Receiving functional medicine care (-$534.81, P = .0002) was associated with lower yearly per member pharmacy claims. There were no meaningful changes in total medical or pharmacy claims costs over time after adjustment for covariates (P > .4). Conclusion: Medical and pharmacy claims remained stable over the study period among employee health plan participants with musculoskeletal disorders, and functional medicine care was associated with significantly lower pharmacy claims costs.

Heterogeneous effects of Medicaid coverage on cardiovascular risk factors: secondary analysis of randomized controlled trial.

OBJECTIVES: To investigate whether health insurance generated improvements in cardiovascular risk factors (blood pressure and hemoglobin A1c (HbA1c) levels) for identifiable subpopulations, and using machine learning to identify characteristics of people predicted to benefit highly. DESIGN: Secondary analysis of randomized controlled trial. SETTING: Medicaid insurance coverage in 2008 for adults on low incomes (defined as lower than the federal-defined poverty line) in Oregon who were uninsured. PARTICIPANTS: 12 134 participants from the Oregon Health Insurance Experiment with in-person data for health outcomes for both treatment and control groups. INTERVENTIONS: Health insurance (Medicaid) coverage. MAIN OUTCOMES MEASURES: The conditional local average treatment effects of Medicaid coverage on systolic blood pressure and HbA1c using a machine learning causal forest algorithm (with instrumental variables). Characteristics of individuals with positive predicted benefits of Medicaid coverage based on the algorithm were compared with the characteristics of others. The effect of Medicaid coverage was calculated on blood pressure and HbA1c among individuals with high predicted benefits. RESULTS: In the in-person interview survey, mean systolic blood pressure was 119 (standard deviation 17) mm Hg and mean HbA1c concentrations was 5.3% (standard deviation 0.6%). Our causal forest model showed heterogeneity in the effect of Medicaid coverage on systolic blood pressure and HbA1c. Individuals with lower baseline healthcare charges, for example, had higher predicted benefits from gaining Medicaid coverage. Medicaid coverage significantly lowered systolic blood pressure (-4.96 mm Hg (95% confidence interval -7.80 to -2.48)) for people predicted to benefit highly. HbA1c was also significantly reduced by Medicaid coverage for people with high predicted benefits, but the size was not clinically meaningful (-0.12% (-0.25% to -0.01%)). CONCLUSIONS: Although Medicaid coverage did not improve cardiovascular risk factors on average, substantial heterogeneity was noted in the effects within that population. Individuals with high predicted benefits were more likely to have no or low prior healthcare charges, for example. Our findings suggest that Medicaid coverage leads to improved cardiovascular risk factors for some, particularly for blood pressure, although those benefits may be diluted by individuals who did not experience benefits.

Drug Decriminalization, Fentanyl, and Fatal Overdoses in Oregon.

Importance: With the implementation of Measure 110 (M110) in 2021, Oregon became the first US state to decriminalize small amounts of any drug for personal use. To date, no analysis of the association of this law with overdose mortality has fully accounted for the introduction of fentanyl-a substance that is known to drive fatal overdose-to Oregon's unregulated drug market. Objective: To evaluate whether the decriminalization of drug possession in Oregon was associated with changes in fatal drug overdose rates after accounting for the rapid spread of fentanyl in Oregon's unregulated drug market. Design, Setting, and Participants: In this cohort study, the association between fatal overdose and enactment of M110 was analyzed using a matrix completion synthetic control method. The control group consisted of the 48 US states and Washington, DC, all of which did not decriminalize drugs. The rapid spread of fentanyl in unregulated drug markets was determined using the state-level percentage of all samples reported to the National Forensic Laboratory Information System that were identified as fentanyl or its analogues. Mortality data were obtained from the Centers for Disease Control and Prevention for January 1, 2008, to December 31, 2022. Data analysis was performed from fall 2023 through spring 2024. Exposures: Measure 110 took effect in Oregon on February 1, 2021. Main Outcomes and Measures: The primary outcome assessed was fatal drug overdose rates per half-year. A changepoint analysis also determined when each state experienced a rapid escalation of fentanyl in its unregulated drug market. Results: In this analysis, rapid spread of fentanyl in Oregon's unregulated drug supply occurred in the first half of 2021, contemporaneous with enactment of M110. A positive crude association was found between drug decriminalization and fatal overdose rate per 100 000 per half year (estimate [SE], 1.83 [0.47]; P < .001). After adjusting for the spread of fentanyl as a confounder, the effect size changed signs (estimate [SE], -0.51 [0.61]; P = .41) and there was no longer an association between decriminalization and overdose mortality in Oregon. Sensitivity analyses were consistent with this result. Conclusions and Relevance: In this cohort study of fatal drug overdose and the spread of fentanyl through Oregon's unregulated drug market, no association between M110 and fatal overdose rates was observed. Future evaluations of the health effects of drug policies should account for changes in the composition of unregulated drug markets.

HPV self-collection for cervical cancer screening among survivors of sexual trauma: a qualitative study.

Intimate partner violence affects 20-30% of women in the United States. Disparities in routine cervical cancer surveillance have been demonstrated in certain populations, including victims of intimate partner violence (IPV). This study examined and assessed the acceptability of high-risk HPV (hrHPV) self-collection among individuals who have experienced IPV. We conducted an observational study using qualitative data collection and analysis. We interviewed individuals with a history of IPV and who currently reside in Oregon. This study identified key themes describing knowledge and attitudes towards cervical cancer screening for individuals who have experienced IPV. They include: guideline knowledge, prior office-based cervical cancer screening experience, barriers to cervical cancer screening, at-home hrHPV self-collection experience, and testing confidence. Participants experienced fewer barriers and expressed increased comfort and control with hrHPV self-collection process. Individuals with a history of IPV have lower rates of cervical cancer screening adherence and higher rates of cervical dysplasia and cancer than other populations. The patient-centered approach of hrHPV self-collection for cervical cancer screening can reduce barriers related to the pelvic exam and empower patients to reduce their risks of developing cervical cancer by enabling greater control of the testing process.

Criminal legal system engagement among people who use drugs in Oregon following decriminalization of drug possession.

BACKGROUND: In February 2021, Measure 110 (M110) in Oregon decriminalized noncommercial possession of drugs. We examined criminal legal system (CLS) involvement of people who use drugs (PWUD) 2 years after decriminalization. METHODS: We conducted a quantitative survey of PWUD (N=468) in eight Oregon counties between March and November 2023. We ran multivariable models to examine predictors of CLS involvement and law enforcement stops. RESULTS: The majority of PWUD (74 %) reported any past year CLS involvement; 67 % had at least one law enforcement stop (mean of 11.4 and median of 3 law enforcement stops) and 33 % had at least one jail incarceration. Among PWUD whom law enforcement had found to possess drugs (n=101), 77 % had their drugs seized at least once, and 63 % (n=56) were taken into custody for charges that did not include drug use or possession at least once. Younger age, cisgender male identity, unstable housing, and nonurban county location were associated with a higher prevalence of any CLS involvement. PWUD who were unstably housed had 6.80 more law enforcement stops than housed PWUD (95 % CI: 4.03-9.57). PWUD in nonurban counties experienced 9.73 more law enforcement stops than those in urban areas (95 % CI: 4.90-14.56). No significant differences were found by race or ethnicity and CLS involvement. Only 13 % of PWUD were aware that all drugs had been decriminalized. CONCLUSIONS: Despite drug decriminalization, the majority of PWUD in our study reported significant CLS engagement and limited M110 knowledge.

Peer-Assisted Telemedicine for Hepatitis C (PATHS): Process evaluation results from a State Opioid Response-funded program.

INTRODUCTION: The opioid crisis and the hepatitis C virus epidemic perpetuate and potentiate each other in a syndemic with escalating morbidity. Policy-driven funding can help resolve the syndemic through collaborative solutions that rapidly translate evidence-based interventions into real-world applications. METHODS: We report development and programmatic evaluation of Peer-Assisted Telemedicine for Hepatitis C (PATHS), which utilizes State Opioid Response (SOR) funding to scale-up a positive randomized trial of peer-assisted telemedicine HCV treatment. PATHS employs staff within an academic medical center and partners with people with lived experience of drug use, "peers," to recruit rural-dwelling people who use drugs living with HCV. PATHS staff record patient data by abstracting clinical records or directly communicating with patients and peers. Peers are funded by a separate SOR-supported program administered through the state health authority. Peers support patients through HCV screening, treatment initiation via telemedicine, adherence, and cure. RESULTS: Between March 2021 and June 2024, PATHS expanded to 18 of Oregon's 36 counties. In that time, PATHS diagnosed 198 rural PWUD with HCV. One hundred sixty-seven (84.3 %) linked to telemedicine and of these, 145 (86.8 %) initiated treatment. Of those who initiated treatment, 91 (62.8 %) completed treatment, of which 61 (67.0 %) are cured. CONCLUSIONS: By rapidly translating a clinical innovation in HCV treatment to achieve highly effective real-world results, PATHS models how policy-driven funding can facilitate collaboration between community partners, academic medical centers, and state health departments to end the opioid-HCV syndemic.

Buprenorphine discontinuation in telehealth-only treatment for opioid use disorder: A longitudinal cohort analysis.

INTRODUCTION: At the beginning of the COVID-19 pandemic, federal agencies permitted telehealth initiation of buprenorphine treatment for opioid use disorder (OUD) without in-person assessment. It remains unclear how telehealth-only buprenorphine treatment impacts time to discontinuation and patient reported treatment outcomes. METHODS: A longitudinal observational cohort study conducted September 2021 through March, 2023 enrolled participants with OUD initiating buprenorphine (≤ 45 days) with internet and phone access in Oregon and Washington. The intervention was a fully telehealth-only (THO) app versus treatment as usual (TAU) in office-based settings with some telehealth. We assessed self-reported buprenorphine discontinuation at 4-,12-, and 24-weeks. Generalized estimating equations (GEE) calculated unadjusted and adjusted relative risk ratios (RR) for discontinuation averaged over the study period. Secondary outcomes included change in the Brief Addiction Monitor (BAM) and the visual analogue craving scale. Generalized linear models estimated average within-group and between-group differences over time. RESULTS: Participants (n = 103 THO; n = 56 TAU) had a mean age of 37 years (SD = 9.8 years) and included 52 % women, 83 % with Medicaid insurance, 80 % identified as White, 65 % unemployed/student, and 19 % unhoused. There were differences in gender (THO = 54 % women vs. TAU = 44 %, p = .04), unemployed status (60 % vs 75 %, p = .02), and stable housing (84 % vs 73 %, p = .02). Rates of buprenorphine discontinuation were low in the THO (4 %) and TAU (13 %) groups across 24 weeks. In the adjusted analysis, the risk of discontinuation was 61 % lower in the THO group (aRR = 0.39, 95 % CI [0.17, 0.89], p = .026). Decreases occurred over time on the harms subscale of the BAM (within-group difference - 0.85, p = .0004 [THO], and - 0.68, p = .04 [TAU]) and cravings (within-group difference - 13.47, p = .0001 [THO] vs -7.65, p = .01 [TAU]). CONCLUSIONS: A telehealth-only platform reduced the risk of buprenorphine discontinuation compared to office-based TAU. In-person evaluation to receive buprenorphine may not be necessary for treatment-seeking patients. CLINICAL TRIALS IDENTIFIER: NCT03224858.

What Explains Hop Growers' Fungicide Use Intensity and Management Costs in Response to Powdery Mildew?

Methods for causal inference from observational data are common in human disease epidemiology and social sciences but are used relatively little in plant pathology. We draw upon an extensive data set of the incidence of hop plants with powdery mildew (caused by Podosphaera macularis) collected from yards in Oregon from 2014 to 2017 and associated metadata on grower cultural practices, cultivar susceptibility to powdery mildew, and pesticide application records to understand variation in and causes of growers' fungicide use and associated costs. An instrumental causal forest model identified growers' spring pruning thoroughness, cultivar susceptibility to two of the dominant pathogenic races of P. macularis, network centrality of yards during May-June and June-July time transitions, and the initial strain of the fungus detected as important variables determining the number of pesticide active constituents applied by growers and the associated costs they incurred in response to powdery mildew. Exposure-response function models fit after covariate weighting indicated that both the number of pesticide active constituents applied and their associated costs scaled linearly with the seasonal mean incidence of plants with powdery mildew. Although the causes of pesticide use intensity are multifaceted, biological and production factors collectively influence the incidence of powdery mildew, which has a direct exposure-response relationship with the number of pesticide active constituents that growers apply and their costs. Our analyses point to several potential strategies for reducing pesticide use and costs for management of powdery mildew on hop. We also highlight the utility of these methods for causal inference in observational studies.

Resolved genomes of wastewater ESBL-producing Escherichia coli and metagenomic analysis of source wastewater samples.

Extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli pose a serious threat to human health because of their resistance to the most commonly prescribed antibiotics: penicillins and cephalosporins. In this study, we provide a genomic and metagenomic context for the determinant beta-lactam resistance genes of ESBL-positive E. coli isolated from various wastewater treatment utilities in Oregon, USA. Class A beta-lactamase genes on chromosomes (blaCTX-M, blaTEM) were clustered with antibiotic resistance genes associated with other classes of antibiotics (sulfonamides and aminoglycosides) along with insertional elements. ESBL genes such as blaCTX-M, blaTEM, and blaSHV were also detected on conjugable plasmids of IncF and IncI incompatibility types. One novel IncF plasmid (pSHV2A_ESBLF) was identified, which carried a multidrug resistance genotype (blaSHV-2A, aadA22, aac3, aph6, tetA, and sul1) in addition to a mer (mercury resistance) operon, colicin, and aerobactin genes. Shotgun metagenomic analysis of the ESBL-producing E. coli-originating wastewater samples showed the presence of class A beta-lactamases; however, the ESBL genes identified in the E. coli genomes were below the detection limits. Other ESBL-associated genes (i.e., blaOXA.11, blaFOX.7, and blaGES.17) were identified in the wastewater samples, and their occurrences were correlated with the core microbial genera (e.g., Paraprevotella). In the E. coli genomes and wastewater samples, tetracycline, aminoglycoside, and beta-lactam resistance determinants frequently co-occurred. The combination of whole-genome and metagenomic analysis provides a holistic description of ESBL-producing organisms and genes in wastewater systems.IMPORTANCEUsing a hybrid sequencing and assembly strategy (short- and long-read sequencing), we identified the distribution of ARGs and virulence factors harbored on plasmids and chromosomes. We further characterized plasmids' incompatibility types and the co-occurrences of ARGs and virulence factors on plasmids and chromosomes. We investigated the transferability of plasmid-mediated beta-lactams via conjugation. Finally, using shotgun metagenomic analysis of the ESBL-producing Escherichia coli-originated wastewater samples, we described the microbial community, the resistome composition, and the potential associations with plasmid-mediated beta-lactam genes and other ARGs.

Contributions of Hanseniaspora species to Pinot Noir microbial terroir in Oregon's Willamette Valley wine region.

The apiculate yeast genus Hanseniaspora has appeared frequently in enological research for more than 100 years, mostly focused upon the species H. uvarum due to its notable capacity to cause spoilage. Recently, there has been increased research into the potential benefits of other Hanseniaspora species, such as H. vineae, in producing more complex wines. Furthermore, large-scale DNA sequencing-based (metabarcoding) vineyard ecology studies have suggested that Hanseniaspora species may not be evenly distributed. To address potential differences across geographical areas in Oregon, we sampled extensively from 12 vineyards within the Willamette Valley American Viticultural Area (AVA), across 2 sub-AVAs (Eola-Amity Hills and Yamhill-Carlton). Metabarcoding was then used to assess the contribution of Hanseniaspora to the grape berry fungal community and the impact of wine processing on diversity. While 6 of the 23 recognized Hanseniaspora species were present on Pinot Noir grapes in the Willamette Valley AVA, differences between vineyards were driven by the abundance of H. uvarum. Significant positive correlations between the amount of H. uvarum present in must and at cold soak, and then cold soak to early ferment were observed. While intuitive, it is worth noting that no prior studies have observed this across such a large number of grape samples from different vineyards. Our results provide clear evidence that the abundance of H. uvarum on grapes may be an important predictor of potential impacts on wine quality, particularly if performing cold soak, which acts as an enrichment step. IMPORTANCE: Hanseniaspora yeasts are frequently found in uninoculated wine fermentations, and depending upon the species present, their contributions to the wine may be positive or negative. We found that in Oregon's Willamette Valley, the most common species of Hanseniaspora in Pinot Noir vineyards was the known spoilage organism, H. uvarum. This species was one of the strongest contributors to differences in fungal communities between different vineyards and was enriched during typical Pinot Noir processing. These results support Hanseniaspora as an integral and functional component of vineyard "microbial terroir" within Oregon.

Resilience and Hassles Trajectories Among Older Adults During the COVID-19 Pandemic.

OBJECTIVES: Despite higher physical vulnerability to coronavirus disease 2019 (COVID-19), older adults reported less psychological stress than younger and midlife adults during the pandemic. However, little is known about age differences in stress within later life, and most COVID-19 studies have been cross-sectional. We examined weekly hassles exposure and severity trajectories and whether these trajectories differed by age, resilience factors (higher trait resilience and education), and vulnerability factors (identifying as a woman, being a person of color, and having chronic health conditions). METHODS: Community-dwelling adults aged 50+ in Oregon (Mage = 71.1, standard deviation = 7.3; 74% women, 89% non-Hispanic White) completed weekly online surveys across 8 weeks (April 28-June 22, 2020) during the COVID-19 stay-at-home mandate. A 2-part model estimated how age, resilience, and vulnerability factors predicted weekly odds of any hassle exposure and level of severity. RESULTS: Across time, hassles exposure decreased and the rate of severity declined, but these patterns differed by age and other demographics. The old-old (estimated at age 78) remained stable in odds of any exposure, whereas the young-old (estimated at age 64) evidenced a J-shaped curve; age did not moderate the severity slopes. Furthermore, both resilience factors were associated with exposure trajectories, whereas vulnerability factors (race/ethnicity and chronic illness) were associated with levels of hassles severity. DISCUSSION: There were age differences in patterns of hassles during the COVID-19 pandemic. Furthermore, resilience and vulnerability factors also showed complex patterns, underscoring the need for future studies to focus on age differences in well-being in later life.

"Moving beyond silos": focus groups to understand the impact of an adapted project ECHO model for a multidisciplinary statewide forum of substance use disorder care leaders manuscript authors.

BACKGROUND: Although clinical substance use disorder (SUD) care is multidisciplinary there are few opportunities to collaborate for quality improvement or systems change. In Oregon, the Project ECHO (Extension for Community Healthcare Outcomes) model was adapted to create a novel multidisciplinary SUD Leadership ECHO. The objective of this study was to understand the unique effects of the adapted ECHO model, determine if the SUD Leadership ECHO could promote systems change, and identify elements that enabled participant-leaders to make changes. METHODS: Four focus groups were conducted between August and September of 2022 with a purposive sample of participants from the second cohort of the Oregon ECHO Network's SUD Leadership ECHO that ran January to June 2022. Focus group domains addressed the benefits of the adapted ECHO model, whether and why participants were able to make systems change following participation in the ECHO, and recommendations for improvement. Thematic analysis developed emergent themes. RESULTS: 16 of the 53 ECHO participants participated in the focus groups. We found that the SUD Leadership ECHO built a multi-disciplinary community of practice among leaders and reduced isolation and burnout. Three participants reported making organizational changes following participation in the ECHO. Those who successfully made changes heard best practices and how other organizations approached problems. Barriers to initiating practice and policy changes included lack of formal leadership authority, time constraints, and higher-level systemic issues. Participants desired for future iterations of the ECHO more focused presentations on a singular topic, and asked for a greater focus on solutions, advocacy, and next steps. CONCLUSIONS: The adapted ECHO model was well received by focus group participants, with mixed reports on whether participation equipped them to initiate organizational or policy changes. Our findings suggest that the SUD Leadership ECHO model, with fine-tuning, is a promising avenue to support SUD leaders in promoting systems change and reducing isolation among SUD leaders.

Seismic hazard analysis and financial impact assessment of railway infrastructure in the US West Coast: A machine learning approach.

This research examines the seismic hazard impact on railway infrastructure along the U.S. West Coast (Washington, Oregon and California), using machine learning to explore how measures of seismic hazard such as fault density, earthquake frequency, and ground shaking relate to railway infrastructure accidents. By comparing linear and non-linear models, it finds non-linear approaches superior, particularly noting that higher fault densities and stronger peak ground shaking correlate with increased infrastructure accident rates. Shallow earthquakes with magnitudes of 3.5 or greater and hypocentral depths <20 km also exhibit a pronounced correlation with the incidence of railway infrastructure accidents The study extends to financial impact analysis through Net Present Value and Monte Carlo Simulation, and evaluates damage costs from 2000-2023 to guide financial planning and risk management strategies. It highlights the crucial role of advanced financial tools in optimizing maintenance and long-term planning that could result in better preparedness in high seismic hazard regions and emphasizes the need for robust risk management strategies in enhancing railway operational safety that considers the local and regional tectonic and seismic activity and local ground shaking intensity.

Oregon's Hospital Payment Cap and Enrollee Out-of-Pocket Spending and Service Use.

Importance: Enrollee cost-sharing and health insurance premiums have grown alongside rising hospital prices. To control prices and price growth, the Oregon State Employee plan instituted a cap on hospital facility payments in October 2019 that was found to reduce hospital prices. Yet the program's association with out-of-pocket spending and use among enrollees is unknown. Objective: To assess the association of the Oregon State Employee Plan's hospital payment cap with out-of-pocket spending and changes in service use among state employees enrolled in higher cost-sharing plans. Design, Setting, and Participants: Using data from the Oregon All Payer All Claims database (January 2014 to December 2021), a difference-in-differences analysis was conducted to examine the association of Oregon's hospital payment cap with enrollee out-of-pocket spending and service use. The main analysis focused on the outpatient setting, where there were significant declines in hospital prices. Changes in a subpopulation of employees enrolled in higher cost-sharing plans were also examined. Main Outcomes and Measures: The primary outcome was outpatient out-of-pocket spending per procedure, which included the copayment, coinsurance, and/or deductible paid at the point of service. Changes in service use were also examined by counting the number of outpatient procedures received per enrollee per year. Results: The outpatient sample included 1 094 083 procedures from 92 523 Oregon educators and 4 510 342 procedures from 473 621 control enrollees. During the period before implementation, Oregon educators had higher out-of-pocket spending per outpatient procedure than the control group ($69.26 vs $41.87). The hospital payment cap was associated with a $6.60, or 9.5%, reduction in out-of-pocket spending per procedure (95% CI, -12.7 to -0.5) and a 0.24, or 4.8%, increase in the number of outpatient procedures received per enrollee per year (95% CI, 0.09-0.39) among those in higher cost-sharing plans. Enrollees receiving outpatient services from October 2019 through December 2021 saved an estimated $1.8 million. However, savings for the state were $10.3 million less than they would have been absent increases in service use. Conclusions and Relevance: The study findings suggest that enrollees may benefit from reduced out-of-pocket spending due to hospital price regulations, but states should be mindful that price regulations may inadvertently increase health care service use.

Evaluating foliar insecticides and economic thresholds for Tychius picirostris (Coleoptera: Curculionidae) management in Oregon white clover seed production.

The clover seed weevil, Tychius picirostris Fabricius (Coleoptera: Curculionidae), is a major pest in Oregon white clover seed crops. Reliance on synthetic pyrethroid insecticides and limited availability of diverse modes of action (MoAs) has increased insecticide resistance selection in regional T. picirostris populations, emphasizing the need to evaluate novel chemistries and rotational strategies for effective insecticide resistance management (IRM). The efficacy of 8 foliar insecticide formulations for managing T. picirostris adult and larval life stages was determined in small and large-plot field trials across 2 crop years. In both years, bifenthrin (Brigade 2EC), the grower's standard, showed negligible adult and larval suppression. Insecticide formulations with isocycloseram and cyantraniliprole active ingredients reduced adult and larval populations when applied at BBCH 59-60 (prebloom) and BBCH 65-66 (full bloom) growth stages, respectively. While differences in T. picirostris abundance were observed among insecticide treatments, seed yield differences were not detected in large-plot trials. Larval abundance was correlated with reduced seed yield, and an economic threshold of ≥3 larvae per 30 inflorescences was determined as a conservative larval threshold to justify foliar applications of diamide insecticides. Additional commercial white clover seed fields were surveyed to compare larval scouting techniques, including a standard Berlese funnel and a grower's do-it-yourself funnel. Both larval extraction techniques were correlated and provided similar estimates of larval abundance. These findings demonstrate new MoAs, optimal insecticide application timing, and larval monitoring methods that can be incorporated into an effective T. picirostris IRM program in white clover seed crops.

Opioid Overdose After Medication for Opioid Use Disorder Initiation Following Hospitalization or ED Visit.

Importance: Hospitalizations related to opioid use disorder (OUD) represent an opportunity to initiate medication for OUD (MOUD). Objective: To assess whether starting MOUD after a hospitalization or emergency department (ED) visit is associated with the odds of fatal and nonfatal opioid overdose at 6 and 12 months. Design, Setting, and Participants: This population-based cohort study used data from the Oregon Comprehensive Opioid Risk Registry, which links all payer claims data to other administrative health datasets, for individuals aged 18 years or older who had diagnosis codes related to OUD recorded at an index ED visit or hospitalization from January 2017 to December 2019. Data were analyzed between May 2023 and January 2024. Exposures: Receipt of MOUD within the 7 days after an OUD-related hospital visit. Main Outcomes and Measures: The primary outcome was fatal or nonfatal overdose at 6 and 12 months after discharge. Sample characteristics, including age, sex, insurance plan, number of comorbidities, and opioid-related overdose events, were stratified by receipt or nonreceipt of MOUD within 7 days after an OUD-related hospital visit. A logistic regression model was used to investigate the association between receipt of MOUD and having an opioid overdose event. Results: The study included 22 235 patients (53.1% female; 25.0% aged 25-39 years) who had an OUD-related hospital visit during the study period. Overall, 1184 patients (5.3%) received MOUD within 7 days of their ED visit or hospitalization. Of these patients, 683 (57.7%) received buprenorphine, 463 (39.1%) received methadone, and 46 (3.9%) received long-acting injectable naltrexone. Patients who received MOUD within 7 days after discharge had lower adjusted odds of fatal or nonfatal overdose at 6 months compared with those who did not (adjusted odds ratio [AOR], 0.63; 95% CI, 0.41-0.97). At 12 months, there was no difference in adjusted odds of fatal or nonfatal overdose between these groups (AOR, 0.79; 95% CI, 0.58-1.08). Patients had a lower risk of fatal or nonfatal overdose at 6 months associated with buprenorphine use (AOR, 0.50; 95% CI, 0.27-0.95) but not with methadone use (AOR, 0.57; 95% CI, 0.28-1.17). Conclusions and Relevance: In this cohort study of individuals with an OUD-related hospital visit, initiation of MOUD was associated with reduced odds of opioid-related overdose at 6 months. Hospitals should consider implementing programs and protocols to offer initiation of MOUD to patients with OUD who present for care.

Suillus hypogaeus: First record of a truffle Suillus.

Suillus (order Boletales) is a diverse genus of epigeous, mushroom-forming fungi native to temperate forests across the Northern Hemisphere; however, some species are also present in areas where Pinaceae has been introduced in the Southern Hemisphere. Unlike the closely related genus Rhizopogon, there are no described hypogeous, sequestrate species of Suillus. Here, we describe Suillus hypogaeus, the first known species of the genus with hypogeous, sequestrate sporocarps. Collections were made on Marys Peak in Benton County, Oregon, USA, at an elevation of 800 m in forests dominated by Pseudotsuga menziesii var. menziesii. The peridium is white, quickly staining pink to purple-reddish where bruised or cut. The gleba is pale yellow when young, becoming purple with maturity, and the basidiospores are obovoid, light yellow in KOH, and amyloid in Melzer's reagent. Multilocus molecular phylogenetic analyses support the placement of S. hypogaeus among the Larix specialists in the spectabilis group of Suillus. Although Larix and Pseudotsuga are sister genera, Larix does not occur on Marys Peak or elsewhere in western Oregon. Suillus hypogaeus, therefore, represents both an independent origin of the hypogeous, sequestrate sporocarp within the Boletales and an independent host shift between Larix and Pseudotsuga within the genus Suillus.