Oregon Department of Human Services

Dollar spot is a major disease in many turfgrass species. Resistance to dollar spot is critical for fine fescues to be used on golf courses or as low-input turfgrass lawns. Many fine fescue species, including Festuca rubra and its subspecies, have coevolved with Epichloë festucae, a filamentous fungal endophyte with which they form long-term, symbiotic associations. These endophytes confer several benefits to their host, including pest and disease resistance. In fine fescues, different sources of resistance to dollar spot linked to genotypes of E. festucae could exist. Dollar spot resistance in strong creeping red fescue (F. rubra subsp. rubra) has been attributed to an antifungal protein gene, Efe-afpA. In hard fescue (F. brevipila), a diallel cross between three resistant endophyte-containing and three susceptible endophyte-free parents was performed to determine the inheritance of dollar spot disease resistance. The highly significant maternal effect demonstrated that dollar spot disease resistance is maternally inherited in hard fescue and linked with the maternal inheritance of E. festucae. However, Efe-afpA is absent in endophyte strains that associate with hard fescue. The mechanism of endophyte-mediated disease resistance in hard fescue is therefore unknown. It is possible that small effector proteins from E. festucae strains associated with hard fescue could function similarly to Efe-AfpA and/or trigger plant defence responses against fungal pathogens. Regardless of the source of resistance, E. festucae strains that confirmed dollar spot resistance can be transferred within or between turfgrass species. Our research suggested that artificially inoculating turfgrass species with Epichloë endophytes can generate novel dollar spot resistant germplasm, creating more opportunities for turfgrass breeding and cultivar development.

The ability to inhibit and adapt our behavior in response to changing stimuli is a critical component of everyday life. Individuals with Parkinson’s disease (PD) may struggle to inhibit behavior, particularly in the presence of dopaminergic therapy, which can result in impulsive behavior. Impulse control disorders are often operationalized in the laboratory using motor inhibition tasks. However, deficits of motor inhibition tasks are not always observed in PD, perhaps because of the nature of the motor inhibition that is engaged in typical tasks (e.g., suppression of incipient movement such as a button press). We employed a novel continuous movement stop task to investigate planned and unplanned motor inhibition during ongoing movement. EEG was recorded during task performance from individuals with PD (OFF and ON dopaminergic medication) and age-matched healthy controls (HC). Participants were of any sex. We found that the time it took for participants to stop a continuous movement was impaired (i.e., longer) in PD patients ON medication compared with both patients OFF medication and HC. This finding was accompanied by diminished midfrontal theta power following the stop signal in PD (ON and OFF) compared with HC. Additionally, an increase in midfrontal beta power was observed, which was higher in unplanned stopping compared with planned for all groups. However, this increase in beta occurred late—after the time of outright stopping. Together, these findings demonstrate that stopping ongoing movements was impaired in PD patients ON medication and theta and beta power play distinct roles in inhibition of movement.

Human papillomavirus (HPV) infection contributes to vaccine-preventable malignancies. Rural populations experience lower HPV vaccination rates despite similar rates of other childhood vaccinations. Individual- and clinic-level characteristics likely contribute to this disparity, but little is known about the separate roles of each. We compared clinic-level HPV vaccination rates among rural versus urban primary care clinics, identified factors associated with HPV vaccination, and separately assessed the impact of individual- and clinic-level characteristics on rural disparities in HPV vaccination. This cross-sectional study included 537 Oregon primary care clinics participating in the Vaccines for Children (VFC) program during 2019. Vaccination status was assessed using Oregon's ALERT Immunization Information System and included HPV vaccine ≥ 1 dose for ages 11 and 12; HPV vaccination up to date (UTD) for ages 13-17, and coadministration with tetanus, diphtheria, and acellular pertussis (Tdap). Rural versus urban clinic-level outcomes were assessed using negative binomial regression. Participating clinics were 24.5% rural and 75.6% urban. Family medicine clinics comprised 71.1%; pediatrics, 16.9%; and mixed, 12.1%. Across clinics, the average proportion of patients qualifying for VFC was 43%, and non-White patients were 14.1%. The mean rate of HPV vaccine ≥1 dose was lower among rural clinics (46.9%vs 51.1%, P = .039), as was vaccination UTD (40.5% vs 49.9%, P < .001). Adjusting for differences in individual- and clinic-level characteristics, rural disparities were no longer statistically significant. Both individual- and clinic-level characteristics play a role in rural disparities in HPV vaccination, and modifiable clinic-level differences may be opportune targets to address these disparities.

Internet of Things (IoT) enables the monitoring of various parts and devices in any system based on gathered data. Decentralized and single-point monitoring provides insight into the health of the system at the part level. However, not only each part of the system can be monitored from multiple perspectives but also the health of parts isn’t mutually independent from each other in some systems. This paper intends to apply a similar approach as a hierarchical decision-making model (HDM) and analytic hierarchical process (AHP) to calculate the comprehensive health score at multiple levels for a commercial refrigeration system. The main purpose of this approach is to improve the quality and cost of services by optimizing interventions based on a comprehensive health assessment of the refrigeration system. A comprehensive assessment is required for better planning of timely services.

The aim of the study was to describe trends in human papillomavirus (HPV) testing preceding diagnosis of cervical precancer during a time of changing screening recommendations. We conducted a cross-sectional analysis of data from active, population-based, laboratory surveillance among 1.5 million residents of 5 areas in the United States. We included women aged 21-39 years diagnosed with cervical intraepithelial neoplasia grades 2, 2/3, or 3 or adenocarcinoma in situ (collectively, CIN2+) during 2008-2016, who had a cytology and/or HPV test before diagnosis (n = 16,359). The proportion of women with an HPV test preceding CIN2+ increased from 42.9% in 2008 to 73.3% in 2016 (p < .01); testing increased in all age groups (21-24 y: 35.3% to 47.6%, 25-29 y: 40.9% to 64.1%, 30-39 y: 51.7% to 85.9%, all p < .01). The HPV testing varied by cytology result and was highest among women with atypical squamous cells of unknown significance (n = 4,310/4,629, 93.1%), negative for intraepithelial lesion or malignancy (n = 446/517, 86.3%), and atypical glandular cells (n = 145/257, 56.4%). By 2016, at least half of all cases in every surveillance area had an HPV test before diagnosis. During 2008-2016, the proportion of women with an HPV test preceding CIN2+ increased significantly for all age groups, cytology results, and surveillance areas. By 2016, most (85.9%) women aged 30-39 years had an HPV test, consistent with recommendations. Increasing utilization of HPV tests, which have demonstrated improved sensitivity for detecting cervical disease, may in part explain increasing rates of cervical precancer among women 30 years and older.

BackgroundChildren’s health and healthcare use are impacted by both medical conditions and social factors, such as their home and community environment. As healthcare systems manage a pediatric population, information about these factors is crucial to providing quality care coordination.MethodsThe authors developed a novel methodology combining medical complexity (using the Pediatric Medical Complexity Algorithm) and social complexity (using available family social factors known to impact a child’s health and healthcare use) to create a new health complexity model at both the population-level and individual-level. System-level data from Oregon’s Medicaid Management Information Systems and Integrated Client Services database was analysed, examining claims data and service utilization, to calculate the health complexity of children enrolled in Medicaid/Child Health Insurance Program (CHIP) across Oregon.ResultsOf the 390 582 children ages 0 to 17 enrolled in Medicaid/CHIP in Oregon from July 2015 to June 2016, 83.4% (n=325 900) had some level of medical and/or social complexity and 22.1% (n=85 839) had health complexity (both medical and social complexity). Statistically significant (p<0.05) differences in health complexity were observed among attributed patients by Oregon’s 16 Coordinated Care Organizations, as well as by a child’s age, county of residence and race/ethnicity.ConclusionsGiven the high proportion of children with health complexity, these findings demonstrate that a large number of Medicaid/CHIP-insured children could benefit from targeted care coordination and differential resource allocation. Reports have been shared with state, county and health system leaders to drive work across the state. This paper describes the collaborative process necessary for other states considering similar work.

Organizational spiritual maturity (OSM) is an important new way of understanding organizations. Two core elements of OSM are important for positive leaders when pursuing organizational change. First, all organizational attributes are rooted in an organization’s spirit, and unless the spiritual root is addressed, any negative or undesirable quality will not likely be resolved – even through the strategies of positive leadership. Second, in the highly interconnected and integral world, leaders must fully consider the pervasive impacts of their organization both internally and externally. OSM provides a clearer vision and new strategies that can help positive leaders be even more effective in improving the well-being, health, and effectiveness of the people and organizations they lead. A key quality of OSM is spiritually mature leadership and management approaches. Spiritually mature leaders are described and contrasted with positive leaders and the more general concept of spiritual leaders.KeywordsSpiritual leadershipSpirit at workOrganizational purposeOrganizational transformationOrganizational development

BackgroundPerioperative bridging in atrial fibrillation (AF) is associated with low thromboembolic rates but high bleeding rates. Recent guidance cautions the practice of bridging except in high risk patients. However, the practice of bridging varies widely and little data exist regarding appropriate anticoagulation intensity when using intravenous unfractionated heparin (UFH).HypothesisTo determine if high intensity UFH infusion regimens are associated with increased bleeding rates compared to low intensity regimens for bridging patients with AF.MethodsWe conducted a single center retrospective cohort study of admitted patients with non‐valvular AF receiving UFH for ≥24 hours. UFH intensities were chosen at the providers' discretion. The primary endpoint was the rate of bleeding defined by the International Society on Thrombosis and Hemostasis during UFH infusion or within 24 hours of discontinuation. The secondary endpoint was a composite of cardiovascular events, arterial thromboembolism, venous thromboembolism, myocardial infarctions and death during UFH infusion.ResultsA total of 497 patients were included in this analysis. Warfarin was used in 82.1% and direct acting oral anticoagulants in 14.1% of patients. The rate of any bleed was higher among high intensity compared to low intensity UFH regimens (10.5% vs 4.9%, odds ratio = 2.29, 95% confidence interval = 1.07‐4.90). Major bleeding was significantly higher among high intensity compared to low intensity UFH regimens. There was no difference in composite thrombotic events or death.ConclusionsLow intensity UFH infusions, targeting lower anticoagulation targets, were associated with decreased bleeding rates without a signal of increased thromboembolic events in hospitalized AF patients.