Operational Factors Research Articles

Building a theoretical framework for financial risk management in emerging markets: Applying global best practices to the oil and gas industry in developing economies

Financial risk management is crucial for the sustainability and growth of the oil and gas industry in developing economies, where volatility and regulatory uncertainties present significant challenges. This abstract explores the construction of a theoretical framework for financial risk management, adapting global best practices to the specific contexts of emerging markets within the oil and gas sector. In developing economies, the oil and gas industry faces unique risks such as geopolitical instability, currency fluctuations, and regulatory changes. Effective financial risk management mitigates these risks through proactive strategies that balance risk exposure with strategic objectives. Adopting global best practices involves the integration of comprehensive risk assessment methodologies, scenario planning, and hedging techniques tailored to local market conditions. Key components of the theoretical framework include risk identification through comprehensive analysis of market, operational, and financial factors. This approach enables oil and gas companies to anticipate and mitigate risks before they escalate, ensuring financial stability and resilience in volatile environments. Furthermore, the application of global best practices in financial risk management fosters transparency and accountability, enhancing investor confidence and facilitating access to capital. By aligning risk management strategies with international standards and benchmarks, developing economy oil and gas firms can navigate uncertainty more effectively, thereby optimizing operational performance and sustaining long-term growth. However, challenges such as limited access to sophisticated financial instruments and expertise may hinder effective implementation. Overcoming these barriers requires capacity building, collaboration with experienced partners, and continuous adaptation of strategies to evolving market dynamics. In conclusion, building a theoretical framework for financial risk management in the oil and gas industry in developing economies is essential for mitigating volatility and maximizing opportunities. By applying global best practices tailored to local contexts, companies can strengthen their resilience, attract investment, and drive sustainable development in emerging markets.

Estimate and Extend the Time between Overhauls for the Railcar Body

This paper addresses the challenge of estimating and extending the time between overhauls of railcar bodies, which are crucial components in rail freight transportation. Railcar bodies endure significant operational loads, leading to damage and the need for frequent repairs. In response to this issue, a novel approach has been proposed: the use of an operational factor of safety that considers both the probability of failure-free operation and the likelihood of load occurrence on the railcar body. A new equation has been introduced to determine the time between overhauls of these bodies. The focus of this paper is on the development of innovative engineering solutions aimed at enhancing the strength and reliability of railcar bodies. Theoretical and experimental studies were conducted to validate the effectiveness of the proposed design. The results demonstrate that the implementation of these solutions can extend the time between overhauls of the railcar body by 1.21 to 2.06 times, depending on operating conditions.

Energy-conversion efficiency for producing oxy-hydrogen gas using a simple generator based on water electrolysis

Producing hydrogen efficiently through water electrolysis could greatly reduce fossil fuel consumption. As well as this renewable energy source will also help combat global warming and boost economic investment opportunities. This paper studied some factors affecting the performance of oxy-hydrogen/hydroxy (HHO) gas generator, such as applied voltage (from 10.5 to 13.0 V) and electrolyte solution concentration (from 0.05 to 0.20 M), using a dry fuel cell based on the electrolyzing technique of water. The results revealed that the HHO gas production rate, power consumption, and temperature change of electrolyte solution increased significantly with increasing the tested applied voltage and electrolyte concentration. This study concluded that the optimum conditions for producing HHO gas ranged from 11.5 to 12.0 V for applied voltage and from 0.05 to 0.10 M for KOH concentration according to the lowest specific energy and highest HHO gas generator efficiency. Under the previous optimum conditions, the highest productivity, specific energy, and efficiency of the HHO gas generator were 343.9 cm3 min−1, 3.43 kW h m−3, and 53.79%, respectively, using 12.0 V for applied voltage and 0.10 M for electrolyte solution concentration. These findings provide an unambiguous direction for adjusting the operational factors (applied voltage and electrolyte concentration) for efficient HHO gas production and use in different applications. Furthermore, the required energy to operate the HHO gas generator can be obtained from renewable sources.

Boosting Islamic Bank Profitability: Governance, Disclosure, And Stakeholder Satisfaction

This study investigates how financial disclosure (SBFd), governance implementation (GGIsb), and social responsibility disclosure (SBSRd) affect profitability (SBP) and stakeholder satisfaction (SS), which are also mediating factors. This study uses a quantitative approach with secondary data in financial reports. The sample study involved 65 data of financial statements and reports annually collected during 2019-2022 from 13 Islamic Banks in Indonesia. The results show that SBFd and GGIsb positively impact SS and SBP. In contrast, SBSRd does not affect SBP and SS. Meanwhile, SS positively impacts SBP and has a good mediator effect on all correlations. This study confirms the stakeholder theory of the importance of transparency and good governance in improving the performance of finance and the mediating role of stakeholder satisfaction. Practical implications include recommendations to raise financial disclosure quality and strengthen governance mechanisms initiatives more effectively. The findings provide new insights for academics and practitioners in understanding the dynamics between operational factors and financially optimized banking sharia in the Indonesian context.

Evaluating Benchtop Additive Manufacturing Processes Considering Latest Enhancements in Operational Factors

With the evolution of additive manufacturing technologies, concerning their material processing techniques, range of material choices and deposition speed, 3D printers are extensively employed in academia and industry for a number of purposes. It is no longer uncommon to have a portable, desktop 3D printer and build specific designs in a matter of minutes or hours. The functionality, costs, materials and applications of desktop 3D printers differ. Among the several desktop 3D printers with a variety of characteristics, it might be challenging to choose which one is optimal for the intended applications and uses. In this study, a variety of commercially available thermoplastic and photopolymer resin desktop 3D printers are presented and compared for user selection. This article intends to provide end-users of desktop 3D printers with fundamental information and guidelines via a comparison of desktop 3D-printing technologies and their technical characteristics, enabling them to assess and select appropriate desktop 3D printers for a variety of applications.

Identifying Factors for Predicting Postoperative Segmental Motor Paralysis in Patients Undergoing Anterior Cervical Spine Surgery: A Multicenter Study.

Retrospective cohort study. To investigate the incidence of and risk factors for segmental motor paralysis after anterior cervical spine surgery. Segmental motor paralysis is a potential complication following both anterior and posterior cervical decompression procedures; however, previous studies investigating risk factors for segmental motor paralysis after anterior cervical spine surgery were limited by small sample sizes. Consequently, the exact pathogenesis and risk factors for this complication remain poorly understood, highlighting the need for larger-scale investigations focused exclusively on anterior cervical spine surgeries. We retrospectively reviewed the clinico-demographic and operative factors and postoperative outcomes of 1,428 patients undergoing anterior cervical spine surgery at three spine centers in Japan. Postoperative segmental motor paralysis was defined as deterioration of upper extremity muscle strength by ≥1 grade; recovery was defined as a return to preoperative muscle strength levels. Univariate and multivariate analyses were performed to identify risk factors. Ninety-nine patients (6.9%) developed segmental motor paralysis, mostly involving the C5 segment (81.8%), the incidence being highest in patients with ossification of the posterior longitudinal ligament (OPLL) and those undergoing anterior cervical corpectomy and fusion or hybrid fusion (discectomy + corpectomy). Older age, male sex, higher body mass index, OPLL, and cervical corpectomy were independent risk factors for paralysis, with these patients having significantly worse clinical outcomes at 1 year postoperatively. Most patients (74/99, 79.6%) regained preoperative muscle strength levels an final follow up. This study identified important clinico-demographic and operative risk factors for segmental motor paralysis after anterior cervical spine surgery. Patients undergoing corpectomy, with or without OPLL, were found to be at particularly high risk. While most patients recover well, worse outcomes with segmental motor paralysis highlight the importance of preventing this complication, particularly for OPLL patients and corpectomy procedures. III.

Identification of Risk Factors for Bus Operation Based on Bayesian Network

Public transit has been continuously developing because of advocacy for low-carbon living, and concerns about its safety have gained prominence. The various factors that constitute the bus operating environment are extremely complex. Although existing research on operational security is crucial, previous studies often fail to fully represent this complexity. In this study, a novel method was proposed to identify the risk factors for bus operations based on a Bayesian network. Our research was based on monitoring data from the public transit system. First, the Tabu Search algorithm was applied to identify the optimal structure of the Bayesian network with the Bayesian Information Criterion. Second, the network parameters were calculated using bus monitoring data based on Bayesian Parameter Estimation. Finally, reasoning was conducted through prediction and diagnosis in the network. Additionally, the most probable explanation of bus operation spatial risk was identified. The results indicated that factors such as speed, traffic volume, isolation measures, intersections, bus stops, and lanes had a significant effect on the spatial risk of bus operation. In conclusion, the study findings can help avert dangers and support decision-making for the operation and management of public transit in metropolitan areas to enhance daily public transit safety.

Multi-Task Learning Network-Based Prediction of Hydraulic Fracturing Effects in Horizontal Wells Within the Ordos Yanchang Formation Tight Reservoir

Accurate prediction of fracture volume and morphology in horizontal wells is essential for optimizing reservoir development. Traditional methods struggle to capture the intricate relationships between fracturing effects, geological variables, and operational factors, leading to reduced prediction accuracy. To address these limitations, this paper introduces a multi-task prediction model designed to forecast fracturing outcomes. The model is based on a comprehensive dataset derived from fracturing simulations within the Long 4 + 5 and Long 6 reservoirs, incorporating both operational and geological factors. Pearson correlation analysis was conducted to assess the relationships between these factors, ranking them according to their influence on fracturing performance. The results reveal that operational variables predominantly affect Stimulated Reservoir Volume (SRV), while geological variables exert a stronger influence on fracture morphology. Key operational parameters impacting fracturing performance include fracturing fluid volume, total fluid volume, pre-fluid volume, construction displacement, fracturing fluid viscosity, and sand ratio. Geological factors affecting fracture morphology include vertical stress, minimum horizontal principal stress, maximum horizontal principal stress, and layer thickness. A multi-task prediction model was developed using random forest (RF) and particle swarm optimization (PSO) methodologies. The model independently predicts SRV and fracture morphology, achieving an R2 value of 0.981 for fracture volume predictions, with an average error reduced to 1.644%. Additionally, the model’s fracture morphology classification accuracy reaches 93.36%, outperforming alternative models and demonstrating strong predictive capabilities. This model offers a valuable tool for improving the precision of fracturing effect predictions, making it a critical asset for reservoir development optimization.

Optimal circuit breaker allocation strategy in DC transmission-connected systems

The purpose of this study is to provide data for the best possible circuit breaker allocation in power grids with HVDC transmission while taking circuit breaker failure into account. The lack of a suitable selection of HVDC circuit breakers is one of the primary obstacles to establishing an appropriate protection system for HVDC transmission. This research focuses on finding the optimal circuit breaker allocation strategy with respect to the transient response of the system, especially when the grid operator is using existing circuit breakers, rather than on the necessary steps to improve the technology of circuit breakers. Case studies are simulated using PSCAD/EMTDC in order to verify the transient response of the transmission system corresponding to the allocation of circuit breakers and the circumstance of circuit breaker failure. It is crucial to remember that there isn’t a strategy that is always the best. Consequently, a detailed analysis of the suggested approach is required, taking into account the benefits and drawbacks from the standpoints of fault clearing, power system planning, and operational factors. In the context of HVDC transmission, the authors hope that their research will spark and start conversations about circuit breaker allocation strategies.

Factors affecting the growth of small and medium Enterprises in Luangnamtha Province

The purpose of this study is to study the operating conditions and factors affecting the growth of small and medium enterprises in LuangNamtha Province. which uses descriptive study methods, surveys, and questionnaires to collect data from small and medium-sized enterprise operators who have registered enterprises at the Department of Industry and Trade in LuangNamtha Province according to the law in the number of 233 business units using basic statistics such as average value and standard deviation and analyzed with an ordinary least squares regression model. The results of the study found that most of the business operators are males aged between 37-43 years old, have a high degree of specialization, and have previous experience in the service sector, which a business is owned by a single Lao person. The registered capital of the business is less 100,000,000 kip, it is a source of funds for the family, there are between 5-20 people, the duration of the business operation is less 5 years, the customer group is in the province, the business is mainly in the commercial sector, but the performance is not good compared to last year. Such as, revenue and net profit decreased. The importance of factors affecting the growth of small and medium-sized enterprises in LuangNamtha province is very important. The factors affecting the growth of enterprises include four factors that have a relationship in the same direction, such as leadership factors affecting the growth of enterprises with a statistical significance level of 0.1, strategic decision-making factors affecting the growth of enterprises with a statistical significance level of 0.05, financial factors affecting the growth and stability of enterprises with a statistical significance level of 0.01 and 0.1, respectively, and marketing factors affecting the stability of the enterprise with a statistical significance level of 0.1.

Time delayed fractional diabetes mellitus model and consistent numerical algorithm

The diabetes mellitus model (DMM) is explored in this study. Many health issues are caused by this disease. For this reason, the integer order DMM is converted into the time delayed fractional order model by fitting the fractional order Caputo differential operator and delay factor in the model. It is proved that the generalized model has the advantage of a unique solution for every time t. Moreover, every solution of the system is positive and bounded. Two equilibrium states of the fractional model are worked out i.e. disease free equilibrium state and the endemic equilibrium state. The risk factor indicator, R0 is computed for the system. The stability analysis is carried out for the underlying system at both the equilibrium states. The key role of R0 is investigated for the disease dynamics and stability of the system. The hybridized finite difference numerical method is formulated for obtaining the numerical solutions of the delayed fractional DMM. The physical features of the numerical method are examined. Simulated graphs are presented to assess the biological behavior of the numerical method. Lastly, the outcomes of the study are furnished in the conclusion section.

Physical Restraint Use in Hospitalized Patients: A Study of Routinely Collected Health Records Data.

The use of restraints in hospitalized patients is associated with physical and psychological adversity for patients and staff. The minimization of restraint use is a key goal in the hospital setting. Reaching this goal requires an accurate assessment of existing patterns of use across clinical settings. This study reports the rate of physical restraints among patients hospitalized within a multi-entity healthcare network along with stratification by care context, diagnostic, and demographic factors, and examines the sensitivity and specificity of ICD-10 code Z78.1 "physical restraint status" for defining physical restraints relative to electronic health record (EHR) documentation. The EHR was used for a retrospective analysis of all adults hospitalized between 2017 and 2022. Hospitalized adults. Patient demographics, structured diagnostic information, care area, length of stay, and in-hospital mortality, Z78.1 coding for physical restraints, restraint documentation in orders and flowsheets. Among 742,607 hospitalizations, 6.3% (n=47,041) involved the use of physical restraint based on coding or EHR documentation. Treatment in the intensive care unit (ICU) included restraint in 39% of encounters whereas treatment outside the ICU included restraint use in 1.3% of encounters. Besides critical illness, demographic factors including increasing age (adjusted odds ratio (aOR)=1.21 [1.19-1.23]), male gender (aOR=1.56, [1.52-1.60]), unknown race (aOR=1.27 [1.19-1.35]), and preferred language other than English (aOR=1.24, [1.18-1.29]) were associated with higher odds of restraint utilization. As compared to EHR orders or documentation of restraint, the ICD-10 code for physical restraint had a sensitivity of 1.5% and a specificity of 99.99%. Among adults admitted to acute care hospitals, clinical, demographic, and operational factors were associated with increased odds of restraint, with care in the ICU associated with greatly increased odds of restraint. Research into restraint utilization using coded administrative claims data is likely limited by the sensitivity of physical restraint coding.

Impact of Combining Iliac Branch Endoprosthesis and Physician-Modified Fenestrated-Branched Endovascular Repair for Complex Abdominal and Thoracoabdominal Aortic Aneurysms with Concomitant Iliac Artery Aneurysms

ObjectivesTreatment of iliac artery aneurysms (IAA) with the Iliac Branch Endoprosthesis (IBE) during endovascular repair of infrarenal abdominal aortic aneurysm (EVAR) has been well-documented as effective. However, limited data exists evaluating the safety and efficacy of treating complex abdominal (cAAA) and thoracoabdominal aortic aneurysms (TAAA) with associated IAA with combined physician-modified fenestrated branched endovascular aortic repair (PM-FBEVAR) and IBE. Moreover, limited studies exist assessing the impact of adding IBE on the outcomes following PM-FBEVAR. Therefore, we compared the clinical outcomes of patients who underwent PM-FBEVAR with and without IBE for the treatment of cAAA and TAAA. MethodsA single institution retrospective review of consecutive patients who underwent PM-FBEVAR between September 2015 and February 2021 was conducted. Patients with both unilateral and bilateral IBE implantation were included. Infected aneurysms and pseudoaneurysms were excluded. Demographics, technical success, and operative factors were analyzed. Primary outcomes were incidence of pelvic ischemia including buttock and thigh claudication, bowel and spinal cord ischemia, patency of internal and external limbs of IBE, and target vessel instability. Secondary outcomes included technical success, 30-day major adverse events (MAE), 30-day and all-cause mortality, and endoleaks. ResultsAmong 183 patients identified who underwent PM-FBEVAR, 22 patients underwent PM-FBEVAR and IBE with 3 patients treated with bilateral IBEs. There was no pelvic ischemia in the PM-FBEVAR and IBE group. Technical success, fluoroscopy time, and procedure time were comparable between the two groups. Contrast usage was higher in the PM-FBEVAR and IBE group (p=0.01). Thirty-day MAE and mortality were not statistically different between the two groups. At mean follow-up of 23 months, all-cause mortality was similar for both groups (21% vs 27%; p=0.47). Patency of internal iliac artery limb and external iliac artery limb of the IBE were 96% (24 of 25) and 100%, respectively, during mean follow-up of 23 months. The patient with occlusion of internal iliac limb was asymptomatic and received no re-intervention. ConclusionTreatment of cAAA and TAAA associated with IAA using combined PM-FBEVAR and IBE is feasible with high efficacy and safety, and without adverse effect on outcomes. Long-term follow-up is planned to assess durability of repair with PM-FBEVAR and IBE.

Effect of Gas Exchange Rate, Vessel Type, Planting Density, and Genotype on Growth, Photosynthetic Activity, and Ion Uptake of In Vitro Potato Plants.

The growth of high-quality in vitro potato plants (Solanum stenotomum subsp. stenotomum, Solanum stenotomum subsp. goniocalyx, and Solanum tuberosum subsp. andigena) is affected by multiple biological, operational, and environmental factors. Research on in vitro culture is frequently focused on the species, explant, composition of the culture medium, and incubation conditions, but only limited information is available on the effect of the gas exchange rate and volume of in vitro culture vessels under variable planting densities. In the present study, these factors were evaluated with a set of seven diverse potato landraces. The results were compared to the plants' responses in routinely used in vitro culture vessels, i.e., 13 × 100 mm and 25 × 150 mm test tubes, and GA7® magenta vessels. In vitro potato plants grown in plastic vessels equipped with a HEPA filter delivering a high gas exchange rate developed thicker stems (0.95 mm), a higher total average leaf area (2.51 cm2), increased chlorophyll content in leaves (32.2 ppm), and lower moisture content in their tissues (90.1%) compared to filter systems with lower gas exchange rates. A high planting density of 10 × 10 plants per vessel (360 and 870 mL) negatively affected the average stem width and root length but increased the plant height (3.4 cm). High fluctuations of ion-uptake of NO3-, Ca++, K+, and Na+ were observed between genotypes, with some accessions having a 4.6-times higher Ca++-ion concentration in their tissues (190-234 ppm). The in vitro plants developed more robust stems, longer roots, and larger leaves within in vitro culture vessels equipped with a HEPA filter (high gas exchange rate) compared to the control vessels, in contrast to the chlorophyll content in leaves, which was higher in plants grown in narrow test tubes. Depending on the purpose of the subculture of in vitro plants, their growth and development can be molded using different gas exchange rates, planting densities, and vessel volumes.

Comprehensive Analysis of Needle Bearing Failures in Fuel Transfer Pumps: Insights from Testing and Finite Element Analysis

<div>This study investigates the failure mechanisms of needle bearings within fuel transfer pump assemblies through a comprehensive approach combining endurance testing, detailed inspection, the Dykem blue method, proximity sensors, and finite element analysis (FEA). The findings reveal critical insights into the causes of failure, highlighting significant axial displacement, with a maximum of 0.37 mm measured by proximity sensors. The Dykem technique identified distinct wear patterns across various components, pinpointing areas of high stress and potential failure. Detailed bearing inspections uncovered trunnion damage and abrasive wear, corroborated by FEA, which quantified displacements of 0.144 mm in the x-direction, 0.030 mm in the y-direction, and 0.015 mm in the z-direction. The primary operational factors contributing to bearing failure were contamination and inadequate axial control. These insights are pivotal, as they align with and expand upon established literature on bearing failures, providing a deeper understanding of the interplay between mechanical wear and operational conditions. Despite the robustness of the methodology, challenges included ensuring the accuracy of axial displacement measurements and replicating real-world operational stresses in a controlled environment. The study proposes several recommendations to enhance axial support and optimize system design to mitigate the identified issues. The societal impact of this research is significant, offering potential improvements in machinery reliability, which can lead to enhanced industrial efficiency and safety standards. This work advances the current knowledge in the field and provides practical solutions for extending the lifespan and performance of critical mechanical components in fuel transfer systems.</div>

Relationship Between Operational Factors and Cost Efficiency in Defined Contributions Pension Schemes

Pension schemes in Kenya provide income for individuals who attain the retirement age and consequently boost economic growth as well as accelerate domestic savings. The industry is regulated by the Retirement Benefits Authority (RBA). The purpose of the study was to determine the relationship between operational practices on cost efficiency in defined contributions pension schemes in Kenya. The specific objectives were to determine the relationship between service provider costs on cost efficiency in defined contributions pension schemes, to examine the relationship between fund size on cost efficiency in defined contributions pension schemes, to determine the relationship between portfolios mix on cost efficiency in defined contributions pension schemes and to examine the relationship between investment strategy on cost efficiency in defined contributions pension schemes. The study will be significant to the management of defined contributions pension schemes in Kenya and other researchers. The study adopted a descriptive research design. The target population was all the 1,262 pension schemes in Kenya. Stratified random sampling was employed to select small schemes, medium schemes, large schemes and mega pension schemes in Kenya and obtained a total of 304 sample population. The study used secondary data. Descriptive statistics was performed by getting frequencies, means, and standard deviation for the purpose of understanding the results, which was displayed in tables, charts, and graphs. A multiple regression model was fitted to the data and the results revealed that there was a relationship between cost efficiency and service provision expenses, portfolio mix, fund size and investment strategies. Service provision expenses for a pension scheme should be able to cover the cost of administration without unduly compromising the growth of pension savings. Further, while a substantial fund size offered advantages, it should be complemented by strategic acumen and diligent oversight to ensure the scheme delivers on its mandate. A balanced and diversified portfolio is considered a cornerstone providing a buffer against market volatility and therefore enhancing the prospects of sustainable goals and cost efficiency. Finally, the cost associated with portfolio mix and risk management was a necessary investment in securing the long-term sustainability and stability of the pension fund. Recommendation for further studies on cost efficiency of defined benefits schemes should be done as well as further studies on challenges facing pension schemes in Kenya

Bibliometric Analysis of Global Research on Port Infrastructure Vulnerability to Climate Change (2012–2023): Key Indices, Influential Contributions, and Future Directions

This article analyzes the climate vulnerability of seaports through a bibliometric review of 45 articles published between 2012 and 2023. The research highlights the increase in publications focusing on the vulnerability of port infrastructure to climate impacts, a topic that previously received less attention compared to operational, economic, and logistical factors, which are frequently discussed in the existing literature. The analysis reinforces the relevance of this study, with the United States, Spain, and the United Kingdom emerging as the most influential countries in this research area. This article also reveals the predominance of methods based on the Coastal Vulnerability Index (CVI), which includes ports in its assessments, and emphasizes the need to develop a more robust index for evaluating port vulnerability. Additionally, it discusses current topics, such as sea level rise and the use of global climate models and suggests future research directions to enhance the assessment of port vulnerability in the face of climate change.

Operational and Design Factors in Air Staging and Their Effects on Fouling from Biomass Combustion

Operational and Design Factors in Air Staging and Their Effects on Fouling from Biomass Combustion

Anastomotic Leak and its Implications: A Multicenter Analysis of “Type C” Esophageal Atresia / Tracheo-esophageal fistula (EA/TEF)

PurposeRepair of type C esophageal atresia with tracheo-esophageal fistula (EA/TEF) may be complicated by esophageal anastomotic leak. Risk factors associated with leak and the impact of leak on inpatient outcomes remains uncertain. Our objectives are to estimate the associations between clinical factors and esophageal anastomotic leak and quantify the association of leak with length of stay (LOS) in infants who underwent repair of type C EA/TEF. MethodsUsing the Children’s Hospitals Neonatal Database (CHND), we identified infants with type C EA/TEF from 2021-2023. The main outcomes were anastomotic leak and LOS. Multivariable associations between patient and clinical factors and these outcomes were quantified using logistic regression (leak) and Cox proportional hazards modelling (LOS). ResultsAmong 365 infants at 36 centers, anastomotic leak occurred in 55 (15.1%) infants, and thoracoscopic approach, lower birthweight, small for gestational age less than 10th percentile, male sex, staged repair, ventricular septal defect, and center were independently associated with leak (area under receiver operating curve = 0.853). Also, LOS was increased in infants with leak compared to those without [hazard ratio (HR): 0.655, 95% CI = 0.431 – 0.996, p=0.044], independent of birth weight, surgical approach, male sex, or VSD. The adjusted LOS demonstrated a 11-fold inter-center variation (p=0.034). ConclusionsSeveral clinical and operative factors are associated with esophageal anastomotic leak in infants after type C EA/TEF repair. Leak significantly prolongs LOS. The magnitude of inter-center variability in LOS also suggests that identifying best practices could aid in improving patient care in this patient population. Type of StudyRetrospective Comparative Study Level of EvidenceIII

Comparison of Telemedicine Usage at Two Distinct Medicaid-Focused Pediatric Clinics.

Objective: To compare telemedicine versus office visit use at two Medicaid-focused pediatric primary care clinics. Methods: Retrospective cohort study from March 15, 2020 - March 15, 2021 at two Medicaid-focused pediatric primary care clinics. Site A and Site B care for different populations (Site B care for mostly immigrant families with preferred language Spanish). Outcomes included the percent of visits conducted through telemedicine and reason for visit. Descriptive statistics, univariable and multivariable mixed multilevel logistic regression, were used to assess relationship between patient demographics and telemedicine use. Results: Out of 17,142 total visits, 13% of encounters at Site A (n = 987) and 25% of encounters at Site B (n = 2,421) were conducted using telemedicine. Around 13.8% of well-child care (n = 1,515/10,997), 36.2% of mental health care (n = 572/1,581), and 25.0% of acute care/follow-up (n = 1,893/7,562) were telemedicine visits. After adjustment for covariates, there was no difference in odds of a patient having any telemedicine use by preferred language, sex, or payor. Patients 1-4 years of age had the lowest odds of telemedicine use. At Site A, patients who identified as Non-Hispanic Black (odds ratio [OR] = 0.33, 95% confidence interval [CI] = 0.24-0.45), Hispanic/Latinx (OR = 0.40, 95% CI = 0.24-0.66), or other race/ethnicity (OR = 0.35, 95% CI = 0.23-0.55) had lower odds of telemedicine use in comparison to Non-Hispanic White. Conclusions: Telemedicine was successfully accessed by Medicaid enrollees for different types of pediatric primary care. There was no difference in telemedicine use by preferred language and payor. However, differences existed by age at both sites and by race/ethnicity at one site. Future research should explore operational factors that improve telemedicine access for marginalized groups.