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- In a retrospective study of 185 patients with transitional cell carcinoma of the renal pelvis and ureter, of whom 127 were treated by total nephroureterectomy and 58 by conservative resection, the survival of those with superficial well differentiated tumours was > 90% in each group. When urothelium was left behind after conservative resection, there was a 22% rate of recurrence on the same side but this almost only occurred when the original tumour had been multifocal. Post-operative radiotherapy did not improve survival. [ABSTRACT FROM AUTHOR]

Changes in species and diameter class diversity were followed over time in uneven-aged northern hardwood and spruce-fir stands in New England that have been managed to maintain objectives for species composition and residual stand density. Plots in the northern hardwood stands have been treated for 25 years under uneven-age management a harvested to four residual basal area levels (40, 60, 80, and 100 ft2 per acre) while retaining three structural levels (30, 45, an 60% sawtimber). These plots were harvested once in the past 25 years with remeasurements approximately every 5 years. In addition, the spruce-fir stands have been managed under three uneven-age management regimes that vary in residual diameter class distribution and stand density. Over a 40-year period, these stands have been harvested every 5, 10, or 20 years, with remeasurements approximately every 5 years. Diversity profiles were constructed to follow changes in tree species and horizontal diameter class diversity. Criteria for assessing changes in diversity over time need to be based on the major control variable used in the management of the individual stands. Depending on themeasurement used in treatment -- basal area, volume, etc. can provide a more accurate assessment of diversity than number of individuals by species. (c) 1999 Elsevier Science B.V. [ABSTRACT FROM AUTHOR]

Nutrient sources to coastal waters with coral reefs are not well-characterized. This study documented spatial distributions of nutrients within coastal waters along two developments with coral reefs, and identified nutrient sources through nutrient mixing plots, δ 15 N measurements in macroalgal tissue, and NO 3 - stable isotope mixing models. Nutrients decreased from fresh groundwaters to offshore waters, with some surface waters higher in concentrations than benthic ones. Conservative and non-conservative mixing between fresh and ocean waters occurred, the latter suggestive of local nutrient sources and biological removal. δ 15 N in macroalgal tissue and NO 3 - concurred that fresh groundwater, ocean water, and fertilizers were dominant nutrient sources. Benthic salinity and NO 3 - + NO 2 - concentrations illustrated that submarine groundwater discharge delivered nutrients to reefs in pulses ranging from minutes to days. Information generated from this study is imperative for developing management actions to improve water quality and make coral reefs more resilient to stressors., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Most persons with chronic hepatitis C virus (HCV) infection in the United States are undiagnosed or linked to care. We describe a program for the management of Alaska Native patients infection utilizing a computerized registry and statewide liver clinics resulting in higher linkage to care (86%) than national estimates (~25%)., (© The Author(s) 2019. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.)

Long-term prospective studies of the outcomes associated with hepatitis C virus (HCV) infection are rare and critical for assessing the potential impact of HCV treatment. Using liver biopsy as a starting point, we analyzed the development of end-stage liver disease (ESLD), hepatocellular carcinoma (HCC), and liver-related death (LRD) according to fibrosis stage among a cohort of American Indian/Alaska Native persons in Alaska. Persons were classified as having no/mild (Ishak = 0,1), moderate (Ishak = 2), or severe (Ishak = 3,4) fibrosis or cirrhosis (Ishak = 5,6). We examined time until development of ESLD, HCC, and LRD and report survival probabilities at 3, 5, 7, and 10 years. Of 407 persons, 39% (n = 150) had no/mild fibrosis, 32% (n = 131) had moderate fibrosis, 22% (n = 88) had severe fibrosis, and 9% (n = 38) had cirrhosis. The average time of follow-up was 7.3 years. Within 5 years of biopsy, 1.7% (95% confidence interval [CI]: 0.4-6.8) of persons with no/mild fibrosis developed ESLD compared with 7.9% (95% CI, 4.0-15.2), 16.4% (95% CI, 9.6-27.2), and 49.0% (95% CI, 33.0-67.7) with moderate, severe fibrosis, and cirrhosis, respectively (P < 0.01). The 5-year outcome of HCC was 1.0% (95% CI, 0.1-7.0), 1.0% (95% CI, 0.1-6.6), 1.1% (95% CI, 0.2-7.7), and 13.4% (95% CI, 4.4-36.7) among persons with no/mild fibrosis, moderate fibrosis, severe fibrosis, and cirrhosis, respectively (P < 0.01). Five years after biopsy, 0.0% (95% CI, 0.0-14.8) of persons with no/mild fibrosis had suffered an LRD compared with 1.0% (95% CI, 0.2-7.5) of persons with moderate fibrosis, 4.7% (95% CI, 1.5-14.1) with severe fibrosis, and 16.3% (95% CI, 7.0-35.1) with cirrhosis (P < 0.01)., Conclusion: For prevention of HCC, LRD, and ESLD in the short term, HCV therapy should target individuals who have more than mild fibrosis. (Hepatology 2017;66:37-45)., (© 2017 by the American Association for the Study of Liver Diseases. This article has been contributed to by U.S. Government employees and their work is in the public domain in the USA.)

Background & Aims: Few studies have examined factors associated with disease progression in hepatitis C virus (HCV) infection. We examined the association of 11 risk factors with adverse outcomes in a population-based prospective cohort observational study of Alaska Native/American Indian persons with chronic HCV infection., Methods: We collected data from a population-based cohort study of liver-related adverse outcomes of infection in American Indian/Alaska Native persons with chronic HCV living in Alaska, recruited from 1995 through 2012. We calculated adjusted hazard ratios (aHR) and 95% confidence intervals (CIs) for end-stage liver disease (ESLD; presence of ascites, esophageal varices, hepatic encephalopathy, or coagulopathy), hepatocellular carcinoma (HCC), and liver-related death using a Cox proportional hazards model., Results: We enrolled 1080 participants followed up for 11,171 person-years (mean, 10.3 person-years); 66%, 19%, and 14% were infected with HCV genotypes 1, 2, and 3, respectively. On multivariate analysis, persons infected with HCV genotype 3 had a significantly increased risk of developing all 3 adverse outcomes. Their aHR for ESLD was 2.1 (95% CI, 1.5-3.0), their aHR for HCC was 3.1 (95% CI, 1.4-6.6), and their aHR for liver-related death was 2.4 (95% CI, 1.5-4.0) compared with genotype 1. Heavy alcohol use was an age-adjusted risk factor for ESLD (aHR, 2.2; 95% CI, 1.6-3.2), and liver-related death (aHR, 2.9; 95% CI, 1.8-4.6). Obesity was a risk factor for ESLD (aHR, 1.4; 95% CI, 1.0-1.9), and diabetes was a risk factor for ESLD (aHR, 1.5; 95% CI, 1.1-2.2). Male sex was a risk factor for HCC (aHR, 3.6; 95% CI, 1.6-8.2)., Conclusions: In a population-based cohort study of American Indian/Alaska Native persons with chronic HCV infection, we found those infected with HCV genotype 3 to be at high risk for ESLD, HCC, and liver-related death., (Copyright © 2017 AGA Institute. Published by Elsevier Inc. All rights reserved.)

Increasingly frequent severe coral bleaching is among the greatest threats to coral reefs posed by climate change. Global climate models (GCMs) project great spatial variation in the timing of annual severe bleaching (ASB) conditions; a point at which reefs are certain to change and recovery will be limited. However, previous model-resolution projections (~1 × 1°) are too coarse to inform conservation planning. To meet the need for higher-resolution projections, we generated statistically downscaled projections (4-km resolution) for all coral reefs; these projections reveal high local-scale variation in ASB. Timing of ASB varies >10 years in 71 of the 87 countries and territories with >500 km 2 of reef area. Emissions scenario RCP4.5 represents lower emissions mid-century than will eventuate if pledges made following the 2015 Paris Climate Change Conference (COP21) become reality. These pledges do little to provide reefs with more time to adapt and acclimate prior to severe bleaching conditions occurring annually. RCP4.5 adds 11 years to the global average ASB timing when compared to RCP8.5; however, >75% of reefs still experience ASB before 2070 under RCP4.5. Coral reef futures clearly vary greatly among and within countries, indicating the projections warrant consideration in most reef areas during conservation and management planning.

Chlorophyll is the basis for ecosystem productivity in most marine environments. We report on an ongoing effort to examine whether ambient sounds are tied to chlorophyll levels. We hypothesized that an increase in food-web available energy will be distributed across trophic levels, eventually reaching sound-producing animals and increasing acoustic levels. To test our hypothesis, we compared reef environments to explore links between soundscapes and chlorophyll a concentrations. The study sites resided in disparate oceanographic regimes that experienced substantially different oceanographic conditions. We anticipated that the results would show differing patterns of primary productivity between sites and therefore would be reflected in the soundscapes.

In this paper we describe the construction of an online GIS database system, hosted by WorldFish, which stores bio-physical, ecological and socio-economic data for the 'Coral Triangle Area' in South-east Asia and the Pacific. The database has been built in partnership with all six (Timor-Leste, Malaysia, Indonesia, The Philippines, Solomon Islands and Papua New Guinea) of the Coral Triangle countries, and represents a valuable source of information for natural resource managers at the regional scale. Its utility is demonstrated using biophysical data, data summarising marine habitats, and data describing the extent of marine protected areas in the region.

Nurses have shown a weakness both in recognising different types of exudate and in choosing an appropriate dressing (Smith and Gibson, 2011). In order to support nurses in identifying the correct dressing choice, an exudate wound decision algorithm has been developed. The algorithm suggests the type of dressing required for bleeding and infected wounds is a calcium alginate dressing with a silver component. This study has examined the efficacy of calcium alginate dressings with silver in bleeding and infected wounds, selected through the use of the exudate wound decision algorithm. Over four consecutive dressing changes the results show a consistent improvement in all parameters of wound measurement. This demonstrates that the choice of a calcium alginate with silver dressing in the exudate wound decision algorithm will, in appropriate circumstances, provide nurses with an effective dressing choice.

Background: In autoimmune hepatitis (AIH) patients treated with azathioprine, the utility of measuring thiopurine methyltransferase (TPMT) and azathioprine metabolites has been limited., Objective: To evaluate the association between TPMT genotype and enzyme activity, and the impact of TPMT enzyme activity on levels of azathioprine metabolites and leukopenia to assess the clinical utility of monitoring azathioprine metabolites in Alaska Native and other non-Caucasian AIH patients., Methods: Individuals with AIH were recruited at the Alaska Native Medical Center (Alaska, USA) and the University of Texas Southwestern Medical Center (Texas, USA). Identification of TPMT genotype and measurement of enzyme activity were performed. The metabolites 6-thioguanine nucleotides (6-TGN) and 6-methylmercaptopurine (6-MMP) were measured in participants who were on azathioprine, and the associations with disease remission and leukopenia were assessed., Results: Seventy-one patients with AIH were included. The distribution of TPMT genotypes was similar to that reported in other populationbased studies. TPMT genotype and phenotype were strongly associated (P<0.0001). Levels of 6-TGN and 6-MMP correlated with azathioprine dose only in individuals with normal TPMT enzyme activity. Patients with leukopenia due to azathioprine were no more likely to have abnormal TPMT enzyme levels than those without leukopenia (P=1.0). No specific level of 6-TGN metabolites was associated with remission or leukopenia., Discussion: Results of the present study were consistent with previous studies in Caucasian populations. TPMT genotype and phenotype correlated well, and levels of 6-TGN and 6-MMP metabolites were not associated with remission of AIH or toxicity of azathioprine., Conclusions: The present study confirmed the limited utility of monitoring levels of azathioprine metabolites in AIH patients.

Background: Streptococcus pneumoniae is a leading cause of invasive bacterial disease and pneumonia among children. Antimicrobial resistance among pneumococci has increased in recent years and complicates treatment. The introduction of heptavalent pneumococcal conjugate vaccine (PCV7) could reduce acquisition of antimicrobial-resistant pneumococci., Methods: We obtained 1350 nasopharyngeal swabs for culture from 1275 children aged 3-59 months presenting at 3 clinics in Anchorage, Alaska, during the winters of 2000, 2001, and 2002, as PCV7 was being introduced into the routine immunization schedule. We recorded the frequency of use of antibiotics as well as the dates of doses of PCV7 for enrolled children. We used multivariate logistic regression modeling to identify independent risk factors for overall carriage of pneumococci and carriage of PCV7-type pneumococci, cotrimoxazole-nonsusceptible (COT-NS) pneumococci, or penicillin-nonsusceptible (PCN-NS) pneumococci., Results: The proportion of children who were up-to-date for age, with respect to PCV7 vaccination, increased from 0% in 2000 to 55% in 2002. Carriage of PCV7-type pneumococci decreased by 43% (P<.0001). Risk of carriage of PCV7-type pneumococci was lower in 2002 than in 2000, independent of vaccination status, suggesting an indirect effect of vaccination. Carriage of COT-NS, but not PCN-NS, pneumococci also decreased (38%; P=.02), not only among vaccinated children but also among unvaccinated children without recent use of antibiotics., Conclusions: Introduction of PCV7 into the routine infant immunization schedule in a community with a high prevalence of antimicrobial-resistant pneumococci appears to reduce transmission of PCV7 vaccine serotypes and COT-NS pneumococci but has no impact on overall carriage of pneumococci or carriage of PCN-NS pneumococci.

Bronchiectasis among children living in developing regions is associated with respiratory infections during early childhood, but specific risk factors that precede childhood bronchiectasis are not fully characterized. We hypothesized that severe respiratory syncytial viral (RSV) infection in infancy would increase the risk of bronchiectasis among Alaska Native children in rural Alaska. This was a follow-up cohort study of a 1993-1996 case-control study of RSV-hospitalized case patients and their controls. For each 5-8-year-old former case-patient and control subject, we reviewed medical records, interviewed parents, performed physical examinations and spirometry, collected sera, and analyzed all historical chest radiographs. Ten (11%) RSV cases and 10 (9%) controls had radiographic evidence of bronchiectasis. The mean age at radiographic diagnosis of bronchiectasis was 3.3 years (range, 1.2-6.1 years). Children were more likely to develop bronchiectasis if their chest radiographs, when they were < 2 years of age, showed lung parenchymal densities (RR = 3.9, P < 0.013), persistent parenchymal densities > 6 months' duration (RR = 3.0, P = 0.02), or infiltrates on multiple episodes (test for trend, P = 0.003). Radiographic features of hyperinflation and atelectasis among children < 2 years old were not associated with eventual bronchiectasis. A single severe infection with RSV alone did not predispose Alaska Native infants to bronchiectasis. Childhood bronchiectasis was associated with lung and hence airway injury, manifested on radiographs by parenchymal densities or "pneumonia" rather than by hyperinflation or atelectasis., (Copyright 2004 Wiely-Liss, Inc.)