Hypothesis: Computed tomography (CT) and ultrasonography (US) do not improve the overall diagnostic accuracy for acute appendicitis.

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Many Americans fail to get life-saving vaccines each year, and the availability of a vaccine for COVID-19 makes the challenge of encouraging vaccination more urgent than ever. We present a large field experiment (N = 47,306) testing 19 nudges delivered to patients via text message and designed to boost adoption of the influenza vaccine. Our findings suggest that text messages sent prior to a primary care visit can boost vaccination rates by an average of 5%. Overall, interventions performed better when they were 1) framed as reminders to get flu shots that were already reserved for the patient and 2) congruent with the sort of communications patients expected to receive from their healthcare provider (i.e., not surprising, casual, or interactive). The best-performing intervention in our study reminded patients twice to get their flu shot at their upcoming doctor’s appointment and indicated it was reserved for them. This successful script could be used as a template for campaigns to encourage the adoption of life-saving vaccines, including against COVID-19.

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ObjectiveTo evaluate whether intravascular volume expansion would improve renal blood flow and function during prolonged CO 2 pneumoperitoneum. Summary Background DataAlthough laparoscopic living donor nephrectomies have a considerably reduced risk of complications for the donors, significant concerns exist regarding procurement of a kidney in the altered physiologic environment of CO 2 pneumoperitoneum. Recent studies have documented adverse effects of CO 2 pneumoperitoneum on renal hemodynamics. MethodsRenal and systemic hemodynamics and renal histology were studied in a porcine CO 2 pneumoperitoneum model. After placement of a pulmonary artery catheter, carotid arterial line, Foley catheter, and renal artery ultrasonic flow probe, CO 2 pneumoperitoneum (15 mmHg) was maintained for 4 hours. Pigs were randomized into three intravascular fluid protocol groups: euvolemic (3 mL/kg/hour isotonic crystalloid), hypervolemic (15 mL/kg/hour isotonic crystalloid), or hypertonic (3 mL/kg/hour isotonic crystalloid plus 1.2 mL/kg/hour 7.5% NaCl). ResultsIn the euvolemic group, prolonged CO 2 pneumoperitoneum caused decreased renal blood flow, oliguria, and impaired creatinine clearance. Both isotonic and hypertonic volume expansions reversed the changes in renal blood flow and urine output, but impaired creatinine clearance persisted. ConclusionsIntravascular volume expansion alleviates the effects of CO 2 pneumoperitoneum on renal hemodynamics in a porcine model. Hypertonic saline (7.5% NaCl) solution may maximize renal blood flow in prolonged pneumoperitoneum, but it does not completely prevent renal dysfunction in this setting. This study suggests that routine intraoperative volume expansion is important during laparoscopic live donor nephrectomy.Living donor renal transplantation has achieved a high level of acceptance from the general public and is the ideal renal replacement therapy for those with end-stage renal disease. Living donor nephrectomy has been proven safe and is associated with minimal complications and a negligible death rate. 1The recipient benefits of living donor renal transplantation are multiple: superior patient and graft survival, no prolonged waiting time, decreased incidence of delayed allograft function, and a shorter hospital stay.2 These superior results and the current shortage of cadaver kidneys provide an incentive to increase the frequency of living donor transplantation. However, a significant disincentive is the invasive nature of the donor nephrectomy and its relatively long postoperative recovery period. Recent reports of laparoscopically assisted living donor nephrectomy have shown that this less invasive approach results in reduced postoperative pain, a shorter hospital stay, and a more rapid return to the work for the donor. [3][4][5][6] In addition, decreased donor discomfort and a shorter convalescence have resulted in a substantially increased rate of consent to living donation and may help to alleviate the ongoing transplant organ shortage.