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Insulin pump therapy in pediatric type 1 diabetes has been associated with better glycemic control than multiple daily injections. However, insulin pump use remains limited. This article describes an initiative from the T1D Exchange Quality Improvement Collaborative aimed at increasing insulin pump use in patients aged 12–26 years with type 1 diabetes from a baseline of 45% in May 2018 to >50% by February 2020. Interventions developed by participating centers included increasing in-person and telehealth education about insulin pump technology, creating and distributing tools to assist in informed decision-making, facilitating insulin pump insurance approval and onboarding processes, and improving clinic staff knowledge about insulin pumps. These efforts yielded a 13% improvement in pump use among the five participating centers, from 45 to 58% over 22 months.

There is an increased risk of complications among “high risk” patients (having elevated HbA1c scores). Social, racial, and economic factors contribute to the difficulty in reducing HbA1c. The T1DX-QI is a type 1 diabetes learning health system with over 10 endocrinology centers working collaboratively on the goal of improving outcomes for people with type 1 diabetes. The program is coordinated by the T1D Exchange in Boston, MA. “High-risk” patients are defined as having two clinic visits in the preceding 12 months and two HbA1cs above 9%. Centers shared data monthly with the coordinating office which used statistical process control charts to evaluate the effectiveness of the interventions. (Figure 1). This abstract describes how 10 centers used QI principles and interventions to reduce the proportion of high-risk patients. Successful efforts include: utilizing a patient navigator, workflow redesign, developing insulin pump and CGM education classes, depression screening, and addressing social determinants of health. The Collaborative set a goal to decrease percentage of high risk patients by 5% from baseline and made a significant 3% improvement; data is projected to meet goal by June 2020. Six of 10 centers met the goal, impacting over 200 patients. Continued efforts are needed to expand interventions to additional sites to reduce the number of high-risk patients. Disclosure N. Rioles: None. C. Bunker: None. M.A. Clements: Consultant; Self; Glooko, Inc. Other Relationship; Self; Glooko, Inc. K. Gallagher: None. A. Garrity: None. N. Jones: None. M.K. Kamboj: Research Support; Self; Type 1 Diabetes TrialNet, Unitio, Inc. S. Majidi: Advisory Panel; Self; Companion Medical. P. Prahalad: None. R.Y. Sonabend: None. K. Thivener: None. O. Ebekozien: None. Funding The Leona M. and Harry B. Helmsley Charitable Trust

Due to the rapid growth and the changing economy in recent years, spas have experienced increased challenges in the recruitment and retention of a quality workforce. This has resulted in greater co...

To determine if a structured teaching module improves resident competency in transvaginal sonographic cervical length measurements.This was a prospective cohort study involving obstetrics and gynecology residents at a single institution. Residents collected 10 transvaginal cervical images from patients with threatened preterm labor presenting to Labor and Delivery. After initial image acquisition, residents participated in a lecture-based teaching module involving a pre- and post-intervention assessment. Following the didactic session, they collected 10 additional images. All the images were scored independently by two Maternal-Fetal Medicine attending physicians based on the quality and accuracy of the measured cervical length. Pre-and post- intervention test results were compared, as well as pre- and post- intervention image scores. Parametric and nonparametric tests were used as appropriate with p 0.05 considered significant.Ninety-three percent of the residents (14/15) improved their scores from pre-test to post-test or maintained an already perfect score (p 0.01). Improvement was most significant with the junior residents. Seventy-nine percent of the residents (11/14) improved their cervical image scores after the educational session. Mean score for total residents was 73.7 + 12.6 pre-intervention and 90.2 + 9.9 post-intervention (p 0.01) out of a total of 120.There is an improvement in the competence of resident measured cervical lengths via transvaginal ultrasound when a structured educational module is implemented for resident education.

The US Environmental Protection Agency is developing a new guidance that outlines best practice in the submission, quality assurance, analysis and management of genomics data for environmental applications.

Genomics information has great potential to enhance assessment of risks to human health and the environment. Although understanding genomic responses with respect to adverse ecological and human health outcomes is not, as yet, established, it is important to consider the likely future impacts of genomics technologies on risk assessment and decision-making. Four areas are identified as those likely to be influenced by the generation of genomics information within, and the submission of such information to, the U.S. Environmental Protection Agency (USEPA): risk assessment, prioritization of contaminants and contaminated sites, monitoring, and reporting provisions. For each of these risk assessment and regulatory applications, representative activities are presented to illustrate the application. Three major challenges for the USEPA associated with genomics are also identified in the areas of research, technical development, and capacity. The USEPA's initial activities to address these challenges ar...

The US Environmental Protection Agency (EPA) has developed a framework for human health risk assessment to inform decision making. The National Research Council, in Science and Decisions, recommended that EPA adopt a framework for risk-based decision making, which maximises the utility of risk assessment. The framework considers the NRC's recommendations and builds upon existing agency guidance by emphasising the need to design risk assessments to provide information most applicable to the decision-making process. The framework ties together existing human health guidance, is flexible to accommodate the range of assessments conducted across the agency as well as future advances in risk assessment science, and considers overarching themes including environmental justice and susceptible lifestage risk. The framework integrates the concepts of planning and scoping and problem formulation and provides for incorporation of stakeholder involvement and peer review.

Genomics is expected to have significant implications for risk assessment and regulatory decision making. Since 2002, the U.S. Environmental Protection Agency (EPA) has undertaken a number of cross-agency activities to further prepare itself to receive, interpret, and apply genomics information for risk assessment and regulatory purposes. These activities include: (1) the issuance of an Interim Genomics Policy on the use of genomics information in risk assessments and decision making, (2) the release of the 2004 Genomics White Paper, which outlines potential applications and implications of genomics for EPA, and (3) the recent release of the external review draft of the Interim Guidance on Microarray-Based Assays, which outlines data submission, quality, analysis, management, and training considerations for such data. This manuscript discusses these activities and more recent follow-up activities with the aim of further communicating these efforts to the broader scientific and stakeholder community.