Emergency Department Testing and Disposition of Deaf American Sign Language Users and Spanish-Speaking Patients

Objectives: Non-English speaking patients frequently present to the emergency department (ED) for acute care and may present a challenge to efficient clinical ED management and disposition. This study aimed to assess differences in the disposition and clinical management of Spanish-speaking patients and Deaf American Sign Language (ASL) users, who worked with a certified, in-person interpreter, compared with English proficient patients who did not utilize interpreter services. Methods: A retrospective study querying electronic medical records was performed at an academic medical center ED. Patients with a chief complaint of abdominal pain were chosen for this study, as this is a common chief complaint and these patients often require numerous tests. Variables obtained from the query included patient demographic information, number of tests and imaging studies ordered, and arrival and disposition times. Bivariate tests were used to assess differences in the management and disposition of patients who worked with an in-person, certified Spanish or ASL interpreter compared with those who did not utilize interpreter services. Results: The study sample was comprised of 310 patients, 155 of whom utilized interpreter services and 155 controls who did not. Of those who utilized interpreter services, 69% were Spanish speaking and 31% Deaf ASL users. For patients who worked with an interpreter, compared with those who did not, the median door-to-ED disposition time was significantly longer (398 minutes vs. 322 minutes; p=0.0049). There were also more imaging studies ordered (p=0.0135) in the non-English speaking group. For English proficient patients, there was a higher rate of leaving before complete evaluation (2.6% vs. 0.0%) or against medical advice (3.2% vs. 0.0%) [p\u3c0.0088]. Conclusions: In a sample of ED patients with a chief complaint of abdominal pain, there were statistically significant differences in the door-to-disposition time and number of imaging tests among those who were non-English speaking, utilizing in-person certified interpreter services, compared with those who were proficient in English. These results underscore the need for future research to further investigate the reasons for the differences in the evaluation and timely management of Deaf ASL users and Spanish-speaking ED patients

An Intermittent Live Cell Imaging Screen for siRNA Enhancers and Suppressors of a Kinesin-5 Inhibitor

Kinesin-5 (also known as Eg5, KSP and Kif11) is required for assembly of a bipolar mitotic spindle. Small molecule inhibitors of Kinesin-5, developed as potential anti-cancer drugs, arrest cell in mitosis and promote apoptosis of cancer cells. We performed a genome-wide siRNA screen for enhancers and suppressors of a Kinesin-5 inhibitor in human cells to elucidate cellular responses, and thus identify factors that might predict drug sensitivity in cancers. Because the drug's actions play out over several days, we developed an intermittent imaging screen. Live HeLa cells expressing GFP-tagged histone H2B were imaged at 0, 24 and 48 hours after drug addition, and images were analyzed using open-source software that incorporates machine learning. This screen effectively identified siRNAs that caused increased mitotic arrest at low drug concentrations (enhancers), and vice versa (suppressors), and we report siRNAs that caused both effects. We then classified the effect of siRNAs for 15 genes where 3 or 4 out of 4 siRNA oligos tested were suppressors as assessed by time lapse imaging, and by testing for suppression of mitotic arrest in taxol and nocodazole. This identified 4 phenotypic classes of drug suppressors, which included known and novel genes. Our methodology should be applicable to other screens, and the suppressor and enhancer genes we identified may open new lines of research into mitosis and checkpoint biology