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Spilled gallstones during laparoscopic cholecystectomy (LC) are common. Lost gallstones can lead to complications such as intra-abdominal abscesses, which can occur days, months, or even years after the procedure. Citrobacter koseri belongs to the family of Enterobacteriaceae. It is a low-virulence pathogen; however, it is linked to infections of the urinary tract and abdomen. We report the case of a 70-year-old diabetic male who presented with C. koseri - associated subhepatic abscess. Two years prior, he had emphysematous cholecystitis and liver abscess caused by C. koseri . During his LC, gallstones were spilled in the abdominal cavity and every effort was made to retrieve them. However, 2 years later, an aspiration of the subhepatic abscess revealed cholesterol fragments. We hypothesize that dislodged cholesterol gallstones and bile, contaminated with C. koseri , were the culprits for the appearance of the subhepatic abscess with the same organism 2 years after the LC.

As the magnitude of the coronavirus disease 2019 (COVID-19) pandemic became clear and with it came unprecedented stressors for clinicians, specifically trainees, the program leadership for the Geriatrics and Palliative Medicine Fellowship at Mount Sinai Hospital quickly recognized the urgent need to focus on trainee well-being. From March to June 2020, program leadership focused on implementation of five core strategies to assess and meet trainees' real-time physical and psychological support needs. To assess fellows' opinions of these strategies, a formal survey was administered six months after the initial COVID-19 surge. Results found that more than 75% of fellows agreed on the high value of four specific interventions: (1) flexible scheduling with (2) a built-in backup system and (3) a safe environment with (4) adequate personal protective equipment. These well-being strategies are feasible and broadly applicable to other training programs across the country. They may also be useful outside the scope of the pandemic crisis.

Malignant mesothelioma (MM) is an aggressive cancer with a median survival time of one year, often caused by asbestos exposure. Despite regulatory actions that led to decreased asbestos use beginning in the 1970s, the annual incidence of MM in the United States during 1999-2015 has not declined as expected, with 3,200 newly diagnosed cases in 2015. In California approximately 300 incident cases of mesothelioma are reported annually. We describe the epidemiology of MM in California over a >25-year period. Methods: Using California Cancer Registry data, we compared incidence and rates of MM in California by age, sex, race/ethnicity, and geographic area (All California