Pamela R. Davis

In erythropoietic protoporphyria (EPP), there is excessive production of protoporphyrin, primarily in the bone marrow, resulting in increased biliary excretion of this heme precursor. Some patients will develop progressive liver disease that may ultimately require liver transplantation. However, excessive production of protoporphyrin by the bone marrow continues after transplantation, which may cause recurrent disease in the allograft. This study was performed to define post-transplant survival, the risk of recurrent disease, and specific management issues in patients transplanted for EPP liver disease. The patients studied consisted of twelve males and eight females, with an average age of 31 (range, 13-56) years at the time of transplantation. The estimated maximum MELD score prior to transplant was 21 (range, 15-29). Unique complications in the perioperative period were light induced tissue damage in four patients and neuropathy in six, requiring prolonged mechanical ventilation in four. Patient and graft survival rates were 85% at 1 year, 69% at 5 years, and 47% at 10 years. Recurrent EPP liver disease occurred in 11 of 17 patients (65%) who survived more than 2 months. Three patients were retransplanted at 1.8, 12.6, and 14.5 years after the initial transplant for recurrent EPP liver disease. In conclusion, the 5-year patient survival rate in patients transplanted for EPP liver disease is good, but the recurrence of EPP liver disease appears to diminish long term graft and patient survival.

The transition from fossil fuel-powered to electric three-wheelers represents a critical step toward sustainable public transportation. This study examines factors influencing adoption and continued usage of electric three-wheelers among drivers in Kerala, India. Using the Push-Pull-Mooring framework and Extended Expectancy Confirmation Theory, this research focuses on drivers as primary users, addressing their unique challenges, often overlooked in prior electric vehicle research. Data from 457 potential electric three-wheeler drivers, analyzed using Structural Equation Modeling (SEM), reveals that environmental concerns, operating costs, non-monetary incentives, and perceived health benefits significantly drive adoption intentions, while showroom service quality has no impact. The study identifies that while electric three-wheeler drivers value the environmental benefits and enhanced comfort provided by electric vehicles, they still have concerns about the physical environment of hydrocarbon transport and performance of EVs compared to hydrocarbon-powered vehicles.

In 1990, approximately 101 million tons of freight were hauled by railroads in North Carolina. Because rail service is required by many of the state's basic industries, there is a need to support an adequate and efficient railroad system. Although railroads are crucial to the transportation requirements of many of North Carolina's industries, the state's rail system miles have been shrinking at an alarming rate. Many factors have contributed to the poor financial health of the railroad industry. These factors include poor labor productivity due to inefficient work rules, loss of revenue base to trucking competitors, poor investment decisions, government subsidies of competing modes and government regulation.