Full Lead Service Line Replacement: A Case Study of Equity in Environmental Remediation

In the U.S., approximately 9.3 million lead service lines (LSLs) account for most lead contamination of drinking water. As the commitment to replace LSLs with safer materials grows, empirical evidence is needed to understand which households are benefitting most from current replacement practices. This exploratory study analyzes factors predictive of whether an LSL was replaced fully (from water main to premise) or partially (only the portion on public property). Conventional ordinary least squares, negative binomial, and geographically weighted regression models are used to test the hypothesis that full lead service line replacements (LSLRs) were less common in lower-income, higher-minority neighborhoods under a cost-sharing program design in Washington, D.C. between 2009 and 2018. The study finds supportive evidence that household income is a major predictor of full replacement prevalence, with race also showing significance in some analyses. These findings highlight the need for further research into patterns of full versus partial LSLR across the U.S. and may inform future decisions about LSLR policy and program design.

Reducing Health Care Burden of Emergency General Surgery with a 24-Hour Dedicated Emergency General Surgery Service

Background Emergency general surgery (EGS) diagnoses account for 11% of surgical admissions and 50% of surgical mortality. In this population, 7 specific operations are associated with 80.3% of deaths, 78.9% of complications, and 80.2% of hospital costs. In 2016, our institution established a comprehensive in-house EGS service. Herein, we hypothesize that formation of a dedicated EGS service is associated with a significant reduction in morbidity for patients undergoing the most common EGS procedures. Methods All patients undergoing one of the most common EGS procedures within 2 days of admission were identified from 1/1/2013 to 5/9/2019 via a retrospective chart review. Patients were cohorted as pre- and post-EGS implementation. The primary outcome measure was the overall complication rate. Secondary endpoints included mortality, individual complication rate, time to operation, overnight operation, and length of stay. Finally, both cohorts were benchmarked to national outcomes. Results 718 patients met inclusion criteria (pre-EGS = 409 and post-EGS = 309). Overall complication rate decreased significantly (19.8% vs 13.9%, P = .0387) and overnight operations increased significantly in the post-EGS group (7.8%-16.5%, P = .0003). Pre-EGS complications were higher than national data in all but 1 procedure group, whereas post-EGS complications rates were lower in all but 2 categories. Discussion Implementation of a dedicated EGS service line was associated with a significant decrease in complication rate among the most complication-prone EGS procedures. Number of operations within 24 hours did not increase significantly; however, overnight operations did increase. Our results indicate that establishing a service-specific EGS line is reasonable and beneficial.

Barriers to Sustained Implementation of STAR-VA and Strategies to Overcome Them

STAR-VA is an evidence-based, interdisciplinary program helping CLC teams effectively manage DBD. We conducted interviews with 42 key informants involved with STAR-VA implementation in 20 CLCs, guided by a sustainment framework, to understand facilitators and barriers to sustained implementation. We used directed content analysis to identify barriers and mapped them to the CFIR-ERIC Mapping Tool to identify associated implementation strategies. We identified six barriers: 1) staffing issues, 2) lack of written policies, 3) staff buy-in, 4) limited leadership support, 5) exclusion of STAR-VA criteria in performance evaluations, and 6) service line silos. We identified six strategies to overcome these barriers, three strategies most frequently mapped to reported barriers to STAR-VA sustainment: 1) assessing local CLC readiness, facilitators and addressable barriers; 2) identifying and preparing new champions; and 3) altering incentive/allowance structures. The identified strategies can be packaged to further integrate STAR-VA into usual CLC care processes to optimize program sustainability.

Integrating Telemedicine in Assisting Poison Center Service: Line Application

Objective: To characterize Line, a mobile chat application, usage in Ramathibodi Poison Center (RPC) for further improvement of toxicological consultation services. Materials and Methods: Retrospective data were retrieved from Line messages together with concurrently recorded cases in the RPC database for six months, between November 16, 2018 and May 15, 2019. Time of consultation, time to response, types of toxins, reasons for consultation, and delivered content were recorded. Results: Over six months, 12,686 consultations were made via the hotline with 1,181 cases that used Line as an adjunct with 1,301 conversations. Median response time was three minutes. The most common poisonings were pesticides with 525 contacts (40.4%), followed by pharmaceutical agents and animal toxins. Most requests were for treatment suggestions with 731 contacts (56.2%), followed by notifying case progression and substance or animal identification. Among 1,030 files sent by consultees, the most common were photos of substances and animals for identification. Among 997 responses, most RPC staff used Line as an adjunct for treatment suggestions at 659 times (66.1%), followed by substance or animal identification and providing diagnoses. Overall, 602 protocols were delivered. Conclusion: Ten percent of all consultations were accompanied by Line usage. Most contacts were about pesticides and for appropriate treatment. RPC also used Line to effectively deliver diagnoses and treatment and increase coverage nationally. Keywords: Telemedicine, Line, Application, Poison center

Facilities of Badminton Field in West Sumatera

This study aims to reveal the suitability of badminton field facilities in West Sumatera based on badminton regulatory indicators. The criteria used are the criteria issued by the Badminton game rules of the World Federation. The method in this research uses quantitative methods with a descriptive approach. Data were collected by conducting direct observations in the field and interviews with field owners. The results of the research were that 78% of the field meets the criteria related to the width of the field line, 81% was related to the height of the pole, 73% was related to the depth of the net, 78% was related to the width of the net, 71% was related to the net height in the middle of the field, 79% was related to the net height at double pile area, 34% related to no gap between the netting and the netting posts, 90% to the length of the court, 86% was related to the width of the doubles court, 77% to the width of the single court, 75% to the net distance to the short service line, 79% to the long service area of ​​the singles. Information from interviews found that carpet-based fields met the requirements of the field because they were installed directly by the consultant, while fields with other materials only expected information from the internet and did not get clear source information.

Diplomatic Service of Italian Diplomat J.-C. de Ludolf (1805–1861)

The issue of periodization and establishment of chronological frames of the stages of the diplomatic service of J.-C. de Ludolf, who represented the Kingdom of Naples abroad from 1805, and after its unification with the Sicilian Kingdom in 1816 and un til the abolition in 1861 — the Kingdom of the Two Sicilies. It is shown that, despite Ludolf's many years of work in the Russian direction in various qualities, the coverage of the role and place of his figure in foreign policy processes is very fragmentary in Russian historiography. With the aim of the initial reconstruction of the key milestones in the diplomatic career of this historical person, study of foreign sources: materials from the State Archives of Naples, the memoirs of his daughter, as well as biographical works was carried out. By analyzing and systematizing the information presented in them, four periods of Ludolf's diplomatic activity are highlighted and briefly characterized. His most important achievements at each of the respective stages are outlined, while it is noted that a long stay in the service line in the Russian Empire at least had a significant impact on the professional development of a diplomat. It was revealed that St. Petersburg became the first and last point of his career path, during which he managed to work there as an attaché, plenipotentiary envoy and ambassador-at-large.

Improving the Standard of Care for All—A Practical Guide to Developing a Center of Excellence

Pancreatic surgery is one of the more challenging procedures performed by surgeons. The operations are technically complex and have historically been accompanied by a substantial risk for mortality and postoperative complications. Other pancreatic pathologies require advanced therapeutic procedures that are highly endoscopist-dependent, requiring specific, knowledge-based training for optimal outcomes. An increase in diagnosed pancreatic pathologies every year reinforces a critical need for experienced surgeons, gastroenterologists/endoscopists, hospitals, and support personnel in the management of complex pancreatic cases and thus, well-designed Centers of Excellence (CoE). In this paper, we outline the framework for a Pancreas CoE across three developmental domains: (1) establishing the foundation; (2) formalizing the program; (3) solidifying the CoE status. This framework can likely be translated to any disease or procedure-specific service-line and facilitate the development of a successful CoE.