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This study examines how Samoa improved the capacity of Samoa Water Authority (SWA) by implementing integrated cooperation with water utilities in Okinawa Prefecture, and hardware and software development to reduce the high non-revenue water (NRW) ratio and improve water supply quality and inadequate water pressure. Standard operation procedures were formulated to enhance the capacity of SWA. The cooperation method adopted continuous on-the-job training with a bottom-up approach. Consequently, the NRW ratio was reduced from 68 per cent to 36 per cent and water supply with proper pressure was achieved in the targeted area. The quality of the tap water, in which many coliform bacteria were detected before the cooperation, achieved 100 per cent compliance with standards. The cooperation evidenced that improving water services can help users' understanding of tariff payments, although the water tariff increased for most consumers due to a shift from fixed to metered tariff. [ABSTRACT FROM AUTHOR]

Background: Multiple class I and class IIa recommendations exist related to surgical ablation (SA) of atrial fibrillation (AF) in patients undergoing cardiac surgery., Objective: Examine temporal trends and predictors of SA for AF in a large US healthcare system., Methods: We retrospectively analyzed data from the Society for Thoracic Surgery (STS) Adult Cardiac Surgery Database for 21 hospitals in the Providence St. Joseph Health system. All patients with preoperative AF who underwent isolated coronary artery bypass graft (CABG) surgery, isolated aortic valve replacement (AVR), AVR with CABG surgery (AVR+CABG), isolated mitral valve repair or replacement (MVRr), and MVRr with CABG surgery (MVRr+CABG) from July 1, 2014, to March 31, 2020 were included. Temporal trends in SA were evaluated using the Cochran-Armitage trends test. A multilevel logistic regression model was used to examine patient-, hospital-, and surgeon-level predictors of SA., Results: Among 3124 patients with preoperative AF, 910 (29.1%) underwent SA. This was performed most often in those undergoing isolated MVRr (n = 324, 44.8%) or MVRr+CABG (n = 75, 35.2%). Rates of SA increased over time and were highly variable between hospitals. Years since graduation from medical school for the primary operator was one of the few predictors of SA: odds ratio (95% confidence interval) = 0.71 (0.56-0.90) for every 10-year increase. Annual surgical (both hospital and operator) and AF catheter ablation volumes were not predictive of SA., Conclusion: Wide variability in rates of SA for AF exist, underscoring the need for greater preoperative collaboration between cardiologists, electrophysiologists, and cardiac surgeons., (© 2021 Heart Rhythm Society. Published by Elsevier Inc.)