Appointment Wait Times in Female Pelvic Medicine and Reconstructive Surgery: A Mystery Caller Study.

OBJECTIVE: The aim of the study was to evaluate the mean appointment wait time for a new patient visit at outpatient female pelvic medicine and reconstructive surgery (FPMRS) offices for U.S. women with the common and nonemergent concern of uterine prolapse. METHODS: The American Urogynecologic Society "Find a Provider" tool was used to generate a list of FPMRS offices across the United States. Each of the 427 unique listed offices was called. The caller asked for the soonest appointment available for her mother, in whom uterine prolapse was recently diagnosed. Data for each office were collected, including date of the earliest appointment, FPMRS physician demographics, and office demographics. Mean appointment wait time was calculated. RESULTS: Four hundred twenty-seven FPMRS offices were called in 46 states plus the District of Columbia. The mean appointment wait time was 23.1 business days for an appointment (standard deviation, 19 business days). The appointment wait time was 6 days longer when seeing a female FPMRS physician compared with a male FPMRS physician (mean, 26 business days vs 20 business days, P < 0.02). There was no difference in wait time by day of the week called. CONCLUSIONS: Wait times are a measure of access to care within the health care system. Shorter wait times are associated with increased patient satisfaction. Typically, a woman with uterine prolapse can expect to wait at least 4 weeks for a new patient appointment with an FPMRS board-certified physician listed on the American Urogynecologic Society website. The first available appointment is more often with a male physician. A patient can expect to wait 6 days longer to see a female FPMRS physician. As mean wait times across outpatient specialties continue to increase, FPMRS offices should strive to keep wait times at a minimum to allow women timely access to care.

COVID-19 infection presenting as pancreatitis in a pregnant woman: A case report.

BACKGROUND: The coronavirus 2019 (COVID-19) pandemic has posed unique challenges in healthcare. In obstetrics, there is little information available to guide practice. As new data emerge, the spectrum of initial presenting symptoms has expanded from fever, cough, and dyspnea to gastrointestinal and other symptoms in both pregnant and non-pregnant patients. CASE: A 36-year-old woman, G4P2, at 33 weeks of gestation presented very early in the COVID-19 course with four days of cough and fever, without recent travel or known exposure. She appeared well, with stable vital signs, and was sent home to self-quarantine after a specimen for COVID-19 testing was collected. Two days later, she presented with nausea, vomiting, and abdominal pain, and was diagnosed with acute pancreatitis. CONCLUSION: To date, no cases of human pancreatitis have been identified as related to a COVID-19 infection, although multiple other gastrointestinal symptoms have been described. Given the lack of other etiology, we consider the possibility that patient's acute pancreatitis could be secondary to COVID-19 infection.

Double-network gels and the toughness of terrestrial slug glue.

The terrestrial slug Arion subfuscus produces a defensive secretion that is sticky and tough, despite being a dilute gel. It is unusual in having high stiffness for a gel, yet retaining the high extensibility typical of mucus. In tensile tests, it sustains an average peak stress of 101 kPa, and fails at an average strain of 9.5. This gives the gel toughness; it requires much greater strain energy to fracture than most gels. This toughness may arise from a double-network type mechanism. In this mechanism, two separate, interpenetrating networks of polymers with different properties combine to give toughness that can be several orders of magnitude greater than either network individually. Native gel electrophoresis suggests that A. subfuscus glue consists of two networks: a network of negatively charged proteins ranging in Mr from 40×10(3) to 220×10(3) that can be dissociated by hydroxylamine and a network of heparan sulfate-like proteoglycans. The two networks are not tightly linked, though proteins of Mr 40×10(3) and 165×10(3) may associate with the carbohydrates. Targeted disruption of either network separately, using enzymatic hydrolysis, disulfide bond breakage or imine bond disruption completely disrupted the glue, resulting in no measurable toughness. Thus, the two networks separately provide little toughness, but together they work synergistically to create a tough material, as predicted in the double-network mechanism.