Is Language a Barrier in the Management of Acute Appendicitis?

BACKGROUND: Language preference is a contributing factor for prolonged time from symptom onset to appendectomy within pediatrics, but is poorly characterized in adults. We aimed to investigate associations between language barriers and delays to assessment and treatment for adults with acute appendicitis. METHODS: In a multiethnic community, patients age ⪰18 years old who underwent appendectomy were identified between 1/2017-8/2022 at a single institution. Negative binomial regression was used to compare interval wait times to imaging, medication administration, and surgical evaluation between patients with limited English proficiency and those who are English proficient. RESULTS: Of the 1,469 patients included, 48% (n=699) had limited English proficiency. Average age was higher for patients with limited English proficiency (45 vs. 36, p<0.001) and majority were Asian (54%) and without private insurance (65%, p<0.001). Symptom duration, incidence of septic shock, and date/time of presentation to the Emergency Department were similar. Patients with limited English proficiency presented more frequently with gangrenous appendicitis (20% vs. 15%, p=0.013) but not perforated appendicitis (23% vs. 20%, p=0.065). They experienced longer wait times for surgical evaluation (376 vs. 348min, IRR 1.08, p=0.002) but similar times for imaging, and medications administered. On adjusted analysis for demographics, triage acuity, and hospital factors, longer wait times for surgical evaluation persisted (IRR adjusted 1.07, p=0.038). There was no significant difference in hospital length-of-stay, post-operative infection, or 30-day readmission rate. CONCLUSION: Adult patients with limited English proficiency may experience longer wait times for surgical evaluation for acute appendicitis, but this may not result in clinically significant delays in initiation of treatment.

Maintaining disorder: estimating the association between policing and psychiatric hospitalization among youth in New York City by neighborhood racial composition, 2006-2014.

PURPOSE: To assess whether neighborhood-level measures of policing are spatio-temporally associated with psychiatric hospialization among adolescents and young adults in New York City, and whether this association varies by neighborhood racial composition. METHODS: We derived population-based measures of policing from the New York City Police Department (NYPD), psychiatric hospitalization from Statewide Planning and Research Cooperative System (SPARCS) data, and socio-demographic data from the American Community Survey (ACS), aggregated by month and ZIP Code Tabulation Area (ZCTA) from 2006 to 2014. Multi-level negative binomial regression models assessed hospitalization-time of youth aged 10-24 as the dependent variable and the rate of policing events as the primary independent variable, adjusting for neighborhood poverty, unemployment, and educational attainment. Multiplicative interaction was assessed between policing and tertiles of the percentage of Black residents. RESULTS: A total of 11,900,192 policing incidents and 2,118,481 person-days of hospitalization were aggregated to 19,440 ZCTA-months. After adjusting for neighborhood-level sociodemographic characteristics, an increase in one policing incident per 1,000 residents was associated with a 0.3% increase in the rate of youth psychiatric hospitalization time (IRR 1.003 [1.001-1.005]). Neighborhood racial composition modified this effect; not only was the rate of psychiatric hospitalization and policing higher in neighborhoods with a higher proportion of Black residents, but the association between these was also significantly higher in neighorhoods with a larger share of Black residents compared with predominantly non-Black neighborhoods. CONCLUSION: Neighborhoods experiencing higher rates of policing during the study period experienced higher burdens of psychiatric hospitalization among adolescent and young adult residents. This association was larger in neighborhoods of color which have been disproportionately targeted by "hot spot" and order-maintenance policing practices and policies.

Limiting the number of fresh donor oocytes inseminated with sperm as a strategy to minimize supernumerary embryos.

OBJECTIVE: To determine the optimal number of fresh donor oocytes to expose to sperm for patients who want to prioritize reducing surplus embryos while preserving live birth rate. DESIGN: Cross-sectional study SUBJECTS: Patients who underwent their first in vitro fertilization of fresh donor oocytes at a single academic institution between 1/2013 and 11/2022. Patients were excluded if they used a directed oocyte donor, donor greater than 32 years old, gestational carrier, surgically retrieved sperm, or preimplantation genetic testing. EXPOSURE: Number of fresh mature donor oocytes fertilized via intracytoplasmic sperm injection. MAIN OUTCOME MEASURES: The primary outcome was the number of cryopreserved supernumerary blastocysts. The number of supernumerary blastocysts was defined as the number of blastocysts remaining after the first live birth, or if the patient did not have a live birth, the number of supernumerary blastocysts was determined by the number of blastocysts remaining after the last transfer cycle. Kruskal-Wallis rank sum test was used to determine differences in number of supernumerary blastocysts. RESULTS: 543 patients who underwent 750 embryo transfer cycles utilizing fresh donor oocytes were included. The average recipient age was 42.9 ± 3.8 years, and the average oocyte donor age was 26.6 ± 3.0 years. For our cohort, patients received a median of 10 (IQR 8,14) mature donor oocytes; 8 (IQR 6,11) were injected with sperm, 4 (IQR 3,6) usable embryos were developed, and 2 (IQR 0,5) supernumerary blastocysts remained. Patients were then divided into four quartiles based on the number of mature donor oocytes received (≤7, 8-10, 11-14, or ≥15). There was a significant increase in the median number of cryopreserved supernumerary blastocysts as the number of mature donor oocytes exposed to sperm increased (1 vs. 2 vs. 3 vs. 6 blastocysts in the first, second, third, and fourth quartiles, respectively, P<.01). There were no statistically significant differences in live birth rates between the quartiles (P=.06). CONCLUSION: The number of supernumerary blastocysts increased significantly as more mature donor oocytes were exposed to sperm. This study can serve as a counseling tool for patients with concerns regarding excess cryopreserved embryos when using fresh donor oocytes.

Evaluation of radiology resident well-being at a single institution with a dedicated wellness curriculum.

INTRODUCTION: Increasing rates of physician burnout over recent years have resulted in the need for formal tools and programming dedicated to physician well-being. The Accreditation Council for Graduate Medical Education (ACGME) has taken measures to prioritize trainee well-being by revising its common program requirements. Widespread departmental initiatives have been developed in line with these changes. At the authors' institution, a committee was developed to design and implement a holistic wellness curriculum for radiology trainees. OBJECTIVE: The objective of this study was to assess overall well-being in a cohort of radiology residents at a training program with a dedicated wellness curriculum. METHODS: A wellness curriculum for radiology residents was developed and implemented. Over a 3-year period, data was collected using the Maslach Burnout Inventory (MBI), Brief Resilience Scale (BRS). RESULTS: Rates amongst respondents were low, compared to average, for emotional exhaustion (below 17, average 25.2), depersonalization (6, average 10), and of personal accomplishment were moderate to high (37.5, average 32.9). PGY-4 level residents had the highest rates of burnout (p = 0.042 for depersonalization, p = 0.006 for emotional exhaustion). PGY-4 residents also had the lowest rates of resilience based on the BRS, and PGY-3 the highest (p = 0.037). There were no statistically significant differences between gender or differing relationship status for MBI or BRS. The most commonly cited barriers to wellness practices included fatigue, competing responsibilities, and not knowing where to start. CONCLUSION: Radiology residents at a single institution with a dedicated wellness curriculum demonstrated overall lower rates of burnout compared to their peers.

Long COVID incidence in adults and children between 2020 and 2023: a real-world data study from the RECOVER Initiative.

Estimates of post-acute sequelae of SARS-CoV-2 infection (PASC) incidence, also known as Long COVID, have varied across studies and changed over time. We estimated PASC incidence among adult and pediatric populations in three nationwide research networks of electronic health records (EHR) participating in the RECOVER Initiative using different classification algorithms (computable phenotypes). Overall, 7% of children and 8.5%-26.4% of adults developed PASC, depending on computable phenotype used. Excess incidence among SARS-CoV-2 patients was 4% in children and ranged from 4-7% among adults, representing a lower-bound incidence estimation based on two control groups - contemporary COVID-19 negative and historical patients (2019). Temporal patterns were consistent across networks, with peaks associated with introduction of new viral variants. Our findings indicate that preventing and mitigating Long COVID remains a public health priority. Examining temporal patterns and risk factors of PASC incidence informs our understanding of etiology and can improve prevention and management.

Acute Appendicitis in the Epicenter of the COVID-19 Pandemic: A New York City Single-Center Experience.

BACKGROUND: Appendectomy is the gold standard for simple appendicitis. During the coronavirus-19 pandemic, it was estimated that appendectomies in the United States decreased by 24%. We aimed to describe trends in acute appendicitis management at a center located in one of the largest epicenters of the pandemic. METHODS: This is a retrospective cohort study in a single institution located in Queens, New York, of patients who presented with acute appendicitis. A pre-COVID time period, March-June 2019, was compared to peak-COVID, March-June 2020, and late-COVID, March-June 2021. RESULTS: Of the 382 patients admitted with appendicitis during the time periods, 164 were admitted pre-COVID. Appendicitis presentations decreased by 44% during peak-COVID and 23% in late-COVID. Patients were younger during peak-COVID compared to pre-COVID (39 vs 34 years old, P = .036). Incidence of complicated appendicitis in pre-, peak-, and late-COVID was equivalent (41% vs 46% vs 45%) and operative management was similar (85% vs 76% vs 79%). Non-operative patients had shorter lengths of stay (pre- vs peak-COVID: 4.6 vs 2.9 days, P = .006). Readmission rates were similar between the cohorts across time periods. CONCLUSIONS: During peak-COVID, there was a significant decrease in presentation of acute appendicitis but clinical presentation and outcomes remained similar between the cohorts. Patients who were managed non-operatively may be discharged earlier without increased rates of readmissions.

Annexin A2 promotes phagophore assembly by enhancing Atg16L⁺ vesicle biogenesis and homotypic fusion.

Plasma membrane budding of Atg-16L-positive vesicles represents a very early event in the generation of the phagophore and in the process of macroautophagy. Here we show that the membrane curvature-inducing protein annexin A2 contributes to the formation of these vesicles and their fusion to form phagophores. Ultrastructural, proteomic and FACS analyses of Atg16L-positive vesicles reveal that 30% of Atg16L-positive vesicles are also annexin A2-positive. Lipidomic analysis of annexin A2-deficient mouse cells indicates that this protein plays a role in recruiting phosphatidylserine and phosphatidylinositides to Atg16L-positive vesicles. Absence of annexin A2 reduces both vesicle formation and homotypic Atg16L vesicle fusion. Ultimately, a reduction in LC3 flux and dampening of macroautophagy are observed in dendritic cells from Anxa2(-/-) mice. Together, our analyses highlight the importance of annexin A2 in vesiculation of a population of Atg16L-positive structures from the plasma membrane, and in their homotypic fusion to form phagophore structures.