Urban Design of Bristol Waterfront, Lower Thames Street

The marketplace is going to be one of the highlights on Thames Street, serving as a destination for leisure, shopping and dining. The concept of the project is to have indoor space continue out to the water, providing an outdoor space for dining and leisure, but also giving the boardwalk a resting point. The building is planned as two floors, with the fish market and multipurpose area on the first and an eatery, sitting area, balcony and facilities on the second. The building will be made of a light metal frame with panels to enclose the space and is designed with a folded glass panel that can be opened up to the outside, yet decrease wind pressure in a storm

Feasibility of Emergency Department–initiated, Mobile Health Blood Pressure Intervention: An Exploratory, Randomized Clinical Trial

ObjectivesWe aimed to assess the feasibility of a text messaging intervention by determining the proportion of emergency department (ED) patients who responded to prompted home blood pressure (BP) self‐monitoring and had persistent hypertension. We also explored the effect of the intervention on systolic blood pressure (sBP) over time.MethodsWe conducted a randomized, controlled trial of ED patients with expected discharge to home with elevated BP. Participants were identified by automated alerts from the electronic health record. Those who consented received a BP cuff to take home and enrolled in the 3‐week screening phase. Text responders with persistent hypertension were randomized to control or weekly prompted BP self‐monitoring and healthy behavior text messages.ResultsAmong the 104 patients enrolled in the ED, 73 reported at least one home BP over the 3‐week run‐in (screening) period. A total of 55 of 73 reported a home BP of ≥140/90 and were randomized to SMS intervention (n = 28) or control (n = 27). The intervention group had significant sBP reduction over time with a mean drop of 9.1 mm Hg (95% confidence interval = 1.1 to 17.6).ConclusionsThe identification of ED patients with persistent hypertension using home BP self‐monitoring and text messaging was feasible. The intervention was associated with a decrease in sBP likely to be clinically meaningful. Future studies are needed to further refine this approach and determine its efficacy.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/149295/1/acem13691.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/149295/2/acem13691_am.pd

Ulcerative colitis disease activity as subjectively assessed by patient-completed questionnaires following orthotopic liver transplantation for sclerosing cholangitis

To assess whether or not liver transplantation and subsequent immunosuppression with cyclosporine and prednisone affect ulcerative colitis symptomatology, we surveyed by questionnaire all 23 surviving patients with pretransplant colonoscopy-documented ulcerative colitis who were transplanted for primary sclerosing cholangitis between June 1982 and September 1985. At follow-up [89.8±7.6 weeks (mean±sem], all six patients who had had asymptomatic colonoscopy-documented ulcerative colitis reported continued ulcerative colitis quiescence. Among the 17 patients who had had symptomatic colonoscopydocumented ulcerative colitis at time of liver transplantation, 88.2% reported improvement in overall ulcerative colitis severity (P<0.001), with significant improvement in the frequency of bowel movements reported by 100%, in crampy abdominal pain by 87.5%, in bowel urgency by 75%, in the occurrence of pus or mucus in stool by 87.5%, in the incidence of ulcerative colitis flares by 81.8%, and in the number of days unable to function normally due to ulcerative colitis symptoms by 78.6% (all at least P<0.01). These data demonstrate that ulcerative colitis symptom severity significantly improves following liver transplantation with immunosuppression with cyclosporine and prednisone. © 1991 Plenum Publishing Corporation

Interactive Spaced Online Education in Pediatric Trauma

Pediatric resident trauma education is suboptimal due to lack of a curriculum and limited trauma experience and education resources. The objective of the study was to test knowledge retention and acceptability of interactive spaced education (ISE) in pediatric trauma. Prospective, randomized trial involving 40 physicians in a pediatric emergency department was used. Instrument was comprised of 48 multiple-choice questions (evaluative component) and answer critiques (educational component) on pediatric trauma divided into two modules. The instrument was assessed for test–retest reliability, item difficulty, and construct validity. Intervention consisted of online administration of each module as eight spaced emails (3 questions each) over a course of 4 weeks and was repeated after 2 and 4 months. Participants received an answer critique on committing to an answer. Primary outcome was difference in mean percentage of correct answers at 2 and 4 months versus baseline. Paired t test and effect size (d) were performed. Secondary outcome was exit-survey of ISE acceptability. There was significant improvement at 2 months (8.0, 95% confidence intervel [CI] = [3.6, 12.5], d = 0.75), but improvement at 4 months (1.6, 95% CI = [−4.5, 7.7], d = 0.18) was not significant. Sixty percent would retake and recommend ISE to others. Interactive, spaced education improves knowledge in pediatric trauma and is well accepted. Studies are required to determine the optimal spacing interval for this form of education

Clinical presentations and outcomes of bile duct loss caused by drugs and herbal and dietary supplements

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/136514/1/hep28967.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/136514/2/hep28967_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/136514/3/hep28967-sup-0001-suppinfo.pd

Distinctive Features and Outcomes of Hepatocellular Carcinoma in Patients With Alcohol-Related Liver Disease: A US Multicenter Study

Introduction: The burden of hepatocellular carcinoma (HCC) occurring in patients with alcoholic liver disease (ALD) is increasing at an alarming rate. The aims of this study were to compare the patient and tumor characteristics of HCC occurring in ALD-alone relative to and in addition to other chronic liver diseases. Methods: Patients diagnosed with HCC between 2000 and 2014 were identified at 5 US clinical centers. The patients were categorized as ALD-alone, ALD plus viral hepatitis, or a non-ALD etiology. Clinical and tumor characteristics among the 3 groups were compared, and survival probability was estimated by the Kaplan-Meier method. The frequency of noncirrhotic HCC was compared across the 3 groups. Results: A total of 5,327 patients with HCC were analyzed. Six hundred seventy (12.6%) developed HCC due to underlying ALD. Ninety-one percent of ALD-related HCC arose in men, in contrast to non-ALD etiologies where men accounted for 70% of HCCs cases (P < 0.001). Patients with ALD-alone-related HCC were older at diagnosis and had tumors less likely to be detected as part of routine surveillance. The ALD-alone cohort was least likely to be within the Milan criteria and to undergo liver transplantation. Overall survival in the ALD-alone HCC cohort was lower than the other 2 groups (1.07 vs 1.31 vs 1.41 years, P < 0.001). HCC in the noncirrhotic ALD cohorts occurred in only 3.5% of the patients compared with 15.7% in patients with non-ALD etiologies (P < 0.001). Discussion: HCC occurring in patients with ALD occurred mostly in older men and almost exclusively in a cirrhotic background. They present with advanced tumors, and their survival is lower than HCCs occurring in non-ALD

Risk factors for hepatocellular carcinoma in cirrhosis due to nonalcoholic fatty liver disease: A multicenter, case-control study

AIM To identify risk factors associated with hepatocellular carcinoma (HCC), describe tumor characteristics and treatments pursed for a cohort of individuals with nonalcoholic steatohepatitis (NASH) cirrhosis. METHODS We conducted a retrospective case-control study of a well-characterized cohort of patients among five liver transplant centers with NASH cirrhosis with (cases) and without HCC (controls). RESULTS Ninety-four cases and 150 controls were included. Cases were significantly more likely to be male than controls (67% vs 45%, P < 0.001) and of older age (61.9 years vs 58 years, P = 0.002). In addition, cases were more likely to have had complications of end stage liver disease (83% vs 71%, P = 0.032). On multivariate analysis, the strongest association with the presence of HCC were male gender (OR 4.3, 95%CI: 1.83-10.3, P = 0.001) and age (OR = 1.082, 95%CI: 1.03-1.13, P = 0.001). Hispanic ethnicity was associated with a decreased prevalence of HCC (OR = 0.3, 95%CI: 0.09-0.994, P = 0.048). HCC was predominantly in the form of a single lesion with regional lymph node(s) and distant metastasis in only 2.6% and 6.3%, respectively. Fifty-nine point three percent of individuals with HCC underwent locoregional therapy and 61.5% underwent liver transplantation for HCC. CONCLUSION Male gender, increased age and non-Hispanic ethnicity are associated with HCC in NASH cirrhosis. NASH cirrhosis associated HCC in this cohort was characterized by early stage disease at diagnosis and treatment with locoregional therapy and transplant

Comparative analysis of portal hepatic infiltrating leucocytes in acute drug‐induced liver injury, idiopathic autoimmune and viral hepatitis

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/110851/1/cei12558.pd

Pushing the boundaries in liver graft utilisation in transplantation:Case report of a donor with previous bile duct injury repair

Introduction: Liver transplantation is a recognised treatment for extensive bile duct injuries with secondary biliary cirrhosis or recurring sepsis. However, there have been no reports of successful liver transplantation from a donor who sustained a previous bile duct injury. Presentation of case: Here we discuss the case of a liver transplant from a 51-year-old brain dead donor who had suffered a Strasberg E1 bile duct injury and had undergone a Roux-en-Y hepaticojejunostomy 24 years prior to donation. The liver was successfully recovered and transplanted into a 56-year-old male recipient with end stage liver disease consequent to alpha 1 antitrypsin deficiency. The graft continues to function well 36 months post-transplant, with normal liver function tests and imaging revealing a patent hepaticojejunostomy. Discussion: The potential associated vascular injuries should be identified during bench preparation whilst the management of biliary reconstruction at the time of transplant should follow the principles of biliary reconstruction in cases with biliary injuries, extending the hilar opening into the left duct. Conclusion: This case highlights the successful utilisation of a post bile duct injury repair liver, employing an experienced procurement team and careful bench assessment and reconstruction