The clinical significance and outcome of nonanastomotic strictures and dilatations involving only the biliary tree of the graft with a radiological appearance of biliary ischemia is unknown. ...Therefore we analyzed the grafts of 128 patients to evaluate the biochemical, radiological and histological features that prompted the diagnosis of ischemic-type biliary stricture and the clinical outcome of this complication. Ischemic-type biliary strictures were diagnosed in 25 patients (19%). Initial graft function was similar in all patients, whether or not this complication developed. Most ischemic-type biliary strictures occurred between 1 and 4 mo after orthotopic liver transplantation. However, the appearance of ischemic-type biliary stricture in the month after transplantation was predictive for a poor outcome in all six grafts with early onset of ischemic-type biliary strictures. Eighteen patients (72%) were treated with biliary stents and repeated dilatations. Long-term patency was achieved in 88% of these patients. Repeat transplantation was performed in six patients (24%); five survived. Finally, patients with ischemic-type biliary strictures spent more time in the hospital during the first year after orthotopic liver transplantation than did patients without the complication (62 +/- 27 days vs. 37 +/- 20 days; p < or = 0.001). This was due to repeated hospitalizations and a higher incidence of retransplantation. One-year graft survival was lower in patients with ischemic-type biliary strictures than in patients without ischemic-type biliary strictures (69% vs. 88%; p = 0.006). However, 1-yr patient survival was similar in the two groups (91% vs. 89%). In conclusion, early appearance of ischemic-type biliary stricture features is associated with poor graft prognosis.
We used 25 years of conventional tagging data (n= 6173recoveries) and 3 years of ultrasonic telemetry data (n=105 transmitters deployed) to examine movement rates and directional preferences of four ...age classes of red drum (Sciaenops ocellatus) in estuarine and coastal waters of North Carolina. Movement rates of conventionally tagged reddrum were dependent on the age, region, and season of tagging. Age-1 and age-2 red drum tagged along the coast generally moved along the coast, whereas fish tagged in oligohaline waters far from the coast were primarilyrecovered in coastal regions in fall months. Adult (age-4+) red drum moved from overwintering grounds on the continental shelf through inlets into Pamlico Sound in spring and summer months and departed in fall. Few tagged red drum were recovered in adjacent states (0.6% of all recoveries); however, some adult red drum migrated seasonally from overwintering grounds in coastal North Carolina northward to Virginia in spring, returning in fall. Age-2 transmitter-tracked red drum displayed seasonalemigration from a small tributary, but upstream and downstream movements within the tributary were correlatedwith fluctuating salinity regimes and not season. Large-scale conventional tagging and ultrasonic telemetry programscan provide valuable insights into the complex movement patterns of estuarine fish.
Background When waiting times for new and return patient visits at Hershey Medical Center's Department of Dermatology approached 4 and 2 months, respectively, the Hershey access clinic was ...implemented to increase access for patients with acute problems. Objective The purpose of this study was to assess the impact of the Hershey access clinic on patient care. Results The great majority of patients were satisfied with the access clinic. However, there has been no effect on the no-show rates or patient waiting times for routine appointments. Fifty-seven percent of patients had eruptions, most commonly acne/rosacea, and 43% had neoplasms, most commonly warts. Limitations This study was limited by the fact that it was a survey filled out by the patients after their encounter. Conclusion The Hershey access clinic successfully provides acute problem-focused care, and patient satisfaction is high.
Patients are increasingly empowered, informed and active participants in their healthcare. Patients at Partners Healthcare in Boston, MA utilized a web- based portal, Patient Gateway, to submit ...pre-visit health status information through a journal to their provider. Results of a patient survey indicate that such tools have the potential to improve communication and patient satisfaction, and that the content of information influences the patients visit experience.
Patient involvement in their healthcare has increased with the use of electronic patient portals. The ability to submit updates to select sections of their medical record prior to a visit is shown to ...be effective in enhancing patients care experience. Those patients who discussed the updates with their physician at the visit reported an even more positive response.
This dissertation examines the effect of bluefish (Pomatomus saltatrix) predation on their prey populations in the Hudson River estuary during the summer and on the continental shelf in the autumn. ...Consumption rates of bluefish in both habitats were measured by coupling stomach content fullness estimates with gastric evacuation rate (GER) estimates. The effect of body size, prey type, and temperature on the GER in young-of-the-year (YOY) bluefish was examined. Temperature had a highly significant effect on YOY bluefish GER while bluefish body size and prey type did not. The temporal and spatial patterns of catch-per-unit-effort (CPUE) and gut fullness values were used to infer YOY bluefish movement and feeding chronology from twelve diel collections in the Hudson River estuary. Estimates of consumption rates were made from gut fullness values and GER data. Bluefish CPUE and gut fullness data suggest that bluefish feed in the nearshore during the day and move offshore and have reduced feeding at night. Bluefish weights, densities, diet, prey sizes and consumption rates were used to estimate the loss of YOY striped bass (Morone saxatilis) resulting from YOY bluefish predation. Bluefish show increased preference for striped bass as striped bass density increases. It is concluded that YOY bluefish are important predators of YOY striped bass and can have a substantial impact on their recruitment. The foraging ecology of bluefish on the continental shelf is investigated. The foraging ecology of both spring- and summer-spawned YOY bluefish differ based on size differences. Both YOY and adult bluefish consume a significant amount of prey biomass. The east coast bluefish population consumes a higher biomass of squid and butterfish than is harvested by the commercial fisheries for these species. Our findings suggest that stock assessments for resource species that are prey of bluefish should incorporate variation in natural mortality resulting from variation in bluefish abundance.
PDF
