Reduced turnaround times through multi-sectoral community collaboration during the first surge of SARS-CoV-2 and associated effect on patient care and hospital operations

Background In March 2020, an influx of admissions in COVID-19 positive patients threatened to overwhelm healthcare facilities in East Baton Rouge Parish, Louisiana. Exacerbating this problem was an overall shortage of diagnostic testing capability at that time, resulting in a delay in time-to-result return. An improvement in diagnostic testing availability and timeliness was necessary to improve the allocation of resources and ultimate throughput of patients. The management of a COVID-19 positive patient or patient under investigation requires infection control measures that can quickly consume personal protective equipment (PPE) stores and personnel available to treat these patients. Critical shortages of both PPE and personnel also negatively impact care in patients admitted with non-COVID-19 illnesses. Methods A multisectoral partnership of healthcare providers, facilities and academicians created a molecular diagnostic lab within an academic research facility dedicated to testing inpatients and healthcare personnel for SARS-CoV-2. The purpose of the laboratory was to provide a temporary solution to the East Baton Rouge Parish healthcare community until individual facilities were self-sustaining in testing capabilities. We describe the partnership and the impacts of this endeavor by developing a model derived from a combination of data sources, including electronic health records, hospital operations, and state and local resources. Findings Our model demonstrates two important principles: the impact of reduced turnaround times (TAT) on potential differences in inpatient population numbers for COVID-19 and savings in PPE attributed to the more rapid TAT.

Congenital syphilis in East Baton Rouge parish, Louisiana: providers’ and women’s perspectives

Background Congenital syphilis is completely preventable through screening and treatment, but rates have been rising in the United States. Certain areas are at particularly high risk. We aimed to assess attitudes, knowledge, and barriers around effective prevention of congenital syphilis among health care providers and community women potentially at risk. Methods Two parallel studies were conducted: in-depth interviews with health care providers and focus groups with community women in the area of Baton Rouge, Louisiana. Each group was questioned about their experience in providing or seeking prenatal care, knowledge and attitudes about congenital syphilis, sources of information on testing and treatment, perceptions of risk, standards of and barriers to treatment. Results were transcribed into QSR NVivo V10, codes developed, and common themes identified and organized. Results Providers identified delays in testing and care, lack of follow-through with partner testing, and need for community connection for prevention, as major contributors to higher rates of congenital syphilis. Women identified difficulties in accessing Medicaid contributing to delayed start of prenatal care, lack of transportation for prenatal care, and lack of knowledge about testing and prevention for congenital syphilis. Conclusions Providers and community members were in broad agreement about factors contributing to higher rates of congenital syphilis, although some aspects were emphasized more by one group or another. Evidence-based interventions, likely at multiple levels, need to be tested and implemented to eliminate congenital syphilis.

Reduced turnaround times through multi-sectoral collaboration during the first surge of SARS-CoV-2 in Louisiana, March-April 2020

BackgroundIn March 2020, an influx of admissions in COVID-19 positive patients threatened to overwhelm healthcare facilities in East Baton Rouge Parish, Louisiana. Exacerbating this problem was a shortage of diagnostic testing capability, resulting in a delay in time-to-result return. An improvement in diagnostic testing availability and timeliness was necessary to improve the allocation of resources and ultimate throughput of patients. The management of a COVID-19 positive patient or patient under investigation requires infection control measures that can quickly consume personal protective equipment (PPE) stores and personnel available to treat these patients. Critical shortages of both PPE and personnel also negatively impact care in patients admitted with non-COVID-19 illnesses.MethodsA multisectoral partnership of healthcare providers, facilities and academicians created a molecular diagnostic lab within an academic research facility dedicated to testing inpatients and healthcare personnel for SARS-CoV-2. The purpose of the laboratory was to provide a temporary solution to the East Baton Rouge Parish healthcare community until individual facilities were self-sustaining in testing capabilities. We describe the partnership and the impacts of this endeavor by developing a model derived from a combination of data sources, including electronic health records, hospital operations, and state and local resources.FindingsOur model demonstrates two important principles: the impact of reduced turnaround times (TAT) on potential differences in inpatient population numbers for COVID-19 and savings in PPE attributed to the more rapid TAT.InterpretationOverall, we provide rationale for and demonstration of the utility of multisectoral partnerships when responding to public health emergencies.

Disseminated Mycobacterium kansasii infection in a white-tailed deer and implications for public and livestock health

We document a case of Mycobacterium kansasii, a rare, zoonotic bacterium, in a white-tailed deer (WTD; Odocoileus virginianus) in East Baton Rouge Parish, Louisiana. Grossly, the deer had fibrinous pleuropneumonia with yellow, mineralized nodules scattered throughout the lungs and extending to the pleura. The kidneys were enlarged and had numerous pale foci in the cortex. Microscopically, the pulmonary architecture was replaced by variably sized, multifocal-to-coalescing granulomas with peripheral histiocytes and fewer multinucleate giant cells, and necrotic centers with mineralization and hemorrhage. The latter rarely contained one to a few acid-fast, slender, 7-µm long bacteria, for which beaded morphology was sometimes evident. Similar acid-fast bacteria were also within histiocytes in the kidney. PCR assay of fresh lung sample and subsequent sequencing revealed a non-tuberculosis mycobacterium, M. kansasii. These lesions were similar to those that result from infection with M. bovis in WTD. Both M. bovis and M. kansasii are zoonotic. WTD are a reservoir of M. bovis, which is a major concern in regions in which WTD and cattle can come into close contact.

Influence of land use on total suspended solid and dissolved ion concentrations: Baton Rouge, Louisiana area

Past studies in the Baton Rouge, Louisiana area considered streamwater quality during storm events but ignored water quality during low flow periods. This study includes determination of streamwater quality during low flow time periods for none watersheds in East Baton Rouge Parish, Louisiana. These samples were collected during dry-low flow periods as indicated by water levels at USGS stream gauging sites for each stream. Chemical analysis for ions was completed using colorimeters and gravimetric analysis for total dissolved solids (TDS) and total suspended solids (TSS). Land use appears to impact concentrations of ions, TDS and TSS in a variety of ways during periods of low flow. The two most rural watersheds, which are mainly underdeveloped, have higher concentrations of Fe and Mn. By contrast the three most urban watersheds, that are mainly commercial, industrial or residential, have higher concentrations of Si, SO4 and TDS.

Advanced Spatial Analysis

The last chapter presented several ideas of how to perform relatively simple forms of spatial analysis. Many of these approaches, though insightful, have been superceded by more advanced analytical techniques. This chapter will present a few of these approaches, namely methods of clustering, interpolation, and spatial association. Other concepts will also be addressed, such as spatial autocorrelation and the measures that can be used to find spatial clusters of significantly high (hot spots) or low (cold spots) values. Two additional cluster methods will also be discussed, these being nearest neighbor hierarchical clustering and the spatial filter. Kernel density interpolation will be introduced as the interpolation method for discrete incident locations. A discussion about spatial regression analysis will conclude this chapter. The analyses and examples shown in this chapter will again be based upon linked birth and death certificate data for East Baton Rouge Parish.

Explaining the Geography of Infant Health

During a seminar presentation to the Geography and Anthropology Faculty at Louisiana State University, a series of summary statistics were presented concerning the racial inequality in infant health outcomes in Baton Rouge. The numbers were quite startling, spurring one colleague to question the accuracy of the findings, as, in their words, “that would put us at developing world levels.” This sentiment was echoed by a National Science Foundation reviewer (I suspect from the United Kingdom) who read one of our proposals and expressed disbelief. The United States is a modern developed country, and yet in geographical pockets the infant mortality rate is alarmingly high. For some neighborhoods, between 1996 and 1998, in East Baton Rouge Parish the infant mortality rate was consistently above 40/1,000, reaching its highest rate in 1998 of 70/1,000. This means if 1,000 babies were born in this 0.25-mile neighborhood, 70 would die in the first year of life. Obviously, there is a problem. This book will investigate a host of ways to consider, and hopefully move towards solving, problems such as these using a Geographic Information System (GIS). In this chapter we will provide an introduction to the main themes of the book, namely negative pregnancy outcomes and the role geography and geographic techniques can play in their improvement.