Front Cover -David Scott of the Savannah River Ecology Laboratory (SREL) provided this year's cover photo. The photo was taken in the Mixed Swamp Forest Set-Aside, which is part of the Savannah River swamp. This Set-Aside is one of the original ten SREL habitat reserve areas selected in 1968 to represent a diversity of bottomland hardwood/ fl oodplain forest communities of a southern river swamp system. Represented are aquatic, semi-aquatic, and terrestrial habitats associated with cypress-tupelo ponds, mixed hardwood sloughs, and mixed hardwood ridges. This Set-Aside is important because seasonally fl ooded hardwood forests are becoming increasingly rare habitats that are particularly vulnerable to habitat destruction and/or alteration due to drainage, water control projects, industrial or urban waste discharge, or power plant cooling effl uents. The fl ower in the foreground is called Lizard's Tail (Latin name Saururus cernuus). It grows in a variety of aquatic habitats, but on SRS it can be particularly abundant in some of the swamp forests.For more information about this report, or to obtain additional copies, contact Amy Meyer Savannah River Nuclear Solutions, LLC Building 735-B, Savannah River Site P. O. Box A Aiken, SC 29802-9969 Telephone: (803) 952-8660 E-mail address: Amy.meyer@srs.gov This document was prepared in conjunction with work accomplished under Contract No. DE-AC09-08SR22470 with the U.S. Department of Energy. This work was conducted under an agreement with, and funded by, the U.S. Government. Neither the U.S. Government nor its employees, nor any of its contractors or subcontractors or their employees, makes any expressed or implied 1) warranty or assumes any legal liability for the accuracy or completeness -or for the use or results of such use -of any information, product, or process disclosed; or 2) representation that such use or results of such use would not infringe on privately owned rights; or 3) endorsement or recommendation of any specifically identifi ed commercial product, process, or service. Any views and opinions of authors expressed in this document do not necessarily state or refl ect those of the U.S. Government, or of its contractors or subcontractors. Special thanks to Taressa Barnes for providing expert word processing and design support.Special thanks to David Scott of the Savannah River Ecology Laboratory (SREL) for providing the cover photo.Special thanks to Emily Macdonald and Kevin Kytola of Sapere Consulting, Inc. for providing technical editing services.Thanks to Rachel Baker, Roy Blackwell, and James Tussey for providing computer hardware and software support.Marvin Stewart is acknowledged with appreciation for providing Internet expertise and computer software support. USFS-SR Mark CramerA special acknowledgement for our late friend and colleague, Mark Cramer, who passed away June 5, 2013, for his support of our efforts to produce a quality document for the Site.A special thanks to Gail Whitney for coordinating the DOE-SR review and approval process, which req...

MD. Utilization of program-estimated stone volume may improve clinical decision making and patient counseling by facilitating more accurate expectations for stone passage.

The experience of patients who choose observation or surgery for kidney stones has not been well established. We compared these patients using qualitative interviews, the Wisconsin Quality of Life questionnaire (WISQOL), and the Cambridge Renal Stone Patient Reported Outcome Measure (CReSP). Adult patients with upper tract urinary calculi for whom observation or intervention were options underwent qualitative interviews at baseline and at 2 months. WISQOL and CReSP were administered at baseline, and at 6-16 weeks post operatively if surgery was selected. Comparisons in patient experiences and quality of life measures were performed between groups. Among 15 patients who opted for surgery and 10 patients who opted for observation, we identified major themes in patient experiences related to context, health care episodes, patient responses, and perceived outcomes. A conceptual framework for the domains of patient experience during kidney stone disease was developed, which can be used by clinicians and patients to shape discussion. Baseline standardized WISQOL and CReSP scores were comparable between groups. In the surgery group, both WISQOL and CReSP scores improved after surgery (WISQOL 58 to 83, higher is better, p = 0.003; CReSP 31 to 23, lower is better, p = 0.009). Patients who underwent surgery for kidney stones reported improvements in quality of life after treatment via WISQOL and CReSP. A conceptual framework was developed for the patient experience of kidney stones which provides a common language for patients and clinicians.