Hybrid revisional surgery: biliary limb distalization plus endoscopic transoral outlet reduction (eTOR).

Roux-en-Y gastric bypass (RYGB) is one of the best procedures for the treatment of obesity and associated comorbidities. However, the percent of revisional procedures after a gastric bypass by weight regain has been increased, therefore several surgical options are available for the treatment of weight regain. In this case report, we combined a biliary limb distalization with endoscopic transoral outlet reduction (eTOR).

Plasmid diversity in Escherichia coli isolated from processed poultry and poultry processors.

Plasmids of bacteria selected from different bacterial populations because they shared a distinctive antimicrobial resistance phenotype have sometimes had identical restriction fragments. Such identical plasmids are thought to belong to small and thus epidemic clones because the plasmid content of unselected resistant isolates has seemed diverse. To survey this presumed diversity and its implications for the lineage of resistance plasmids we examined the transferability, sizes and EcoR1 restriction fragment sizes of plasmids in both Escherichia coli isolated randomly from poultry raised by 16 growers as they were being processed through two plants and in isolates from the urine of women processing poultry in those plants.

Controlling disenrollment in health maintenance organizations.

With increasing competition, health maintenance organizations (HMOs) are struggling to maintain their enrollment levels. As a result, growing interest has emerged in studies of disenrollment, including factors associated with disenrollment and its implications for the HMO manager, as well as approaches for measuring and monitoring disenrollment.

Managing liability/recovery programs in health maintenance organizations.

Liability/recovery programs play a major role in attempts by insurers to contain the cost of health care. Because of the controls they have over their organization, HMOs are in an exceptional position to take advantage of the monetary rewards that accompany a liability/recovery program.