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Acute care surgery services continue expanding to provide emergency general surgery (EGS) care. The aim of this study is to define the characteristics of the EGS population in Maryland. Retrospective review of the Health Services Cost Review Commission database from 2009 to 2013 was performed. American Association for the Surgery of Trauma-defined EGS ICD-9 codes were used to define the EGS population. Data collected included patient demographics, admission origin [emergency department (ED) versusnon-ED], length of stay (LOS), mortality, and disposition. There were 3,157,646 encounters. In all, 817,942 (26%) were EGS encounters, with 76 per cent admitted via an ED. The median age of ED patients that died was 74 years versus61 years for those that lived (P< 0.001). Twenty one per cent of ED admitted patients had a LOS > 7 days. Of 78,065 non-ED admitted patients, the median age of those that died was 68 years versus59 years for those that lived (P< 0.001). Twenty eight per cent of non-ED admits had LOS > 7 days. In both ED and non-ED patients, there was a bimodal distribution of death, with most patients dying at LOS = 2 or LOS > 7 days. In this study, EGS diagnoses are present in 26 per cent of inpatient encounters in Maryland. The EGS population is elderly with prolonged LOS and a bimodal distribution of death.

CD48, a glycosyl phosphatidylinositol anchored molecule has recently been shown to be a ligand for the T cell surface protein CD2 in mouse, human, and rat. It is expressed on practically all human T and B cells; however, its function remains unknown. We examined whether CD48 may be involved in the delivery of activating signals to human B cells. Costimulation with anti-CD48 J4-57 significantly increased CD40-mediated activation of tonsillar B cells. Costimulatory effect of anti-CD48 was observed on B cell aggregation, proliferation, and IgG secretion. Anti-CD48 alone did not stimulate resting B cells. Accessory signal provided through CD48 required the presence of IL-4 and/or IL-10, whereas responses of B cells to IL-2 was not affected. Ligation of CD48 by specific antibody induced CD23 expression on IL-4-stimulated Ramos B cell line but did not affect expression of CD25. We also examined the biochemical nature of the costimulatory effect of anti-CD40 and CD48. Ligation of CD40 or CD48 on the B cells induced tyrosine phosphorylation of proteins. CD40 induced earlier changes in the protein phosphorylation than CD48 did. Taken together, our data suggest that the stimulation via CD40 provides initial signals to activate B cells and CD48 may be involved in enhancing the activating signal to B cells, resulting in increased responsiveness of B cells to IL-4 and IL-10.

COVID-19 supportive quarantine care in the community is managed by primary care practices. There is no current guidance on how a primary care practice with high volumes of patients screened for COVID-19 can re-configure itself to become responsive to the pandemic. We examined Learning Health System guidance from the National Academies of Science, Engineering and Medicine and adapted it to our primary care practice to create an efficient, effective, adaptive response to the COVID-19 pandemic. We suggest evaluating this response in the future for effectiveness and efficiency.