When Resources Become Stressors: Dynamics of the Stress Process in the Flint Water Crisis.

Disasters create and intensify stress for communities, with many factors contributing to how that stress results in mental health outcomes. Guided by the stress process model, this article presents findings from a qualitative investigation of the meaning of stress among community leaders in the context of the water crisis in Flint, Michigan. Semi-structured interviews were conducted with six community leaders in Flint and analyzed using grounded theory techniques.

Serial biomarker measurements may be helpful to predict the successful application of high flow nasal cannula in COVID-19 pneumonia patients.

High flow nasal cannula (HFNC) can reduce the need for intubation in patients with coronavirus disease-19 (COVID-19) pneumonia induced acute hypoxemic respiratory failure (AHRF), but predictors of HFNC success could be characterized better. C-reactive protein (CRP) and D-dimer are associated with COVID-19 severity and progression. However, no one has evaluated the use of serial CRP and D-dimer ratios to predict HFNC success.

The pervasive impact of frailty on ovarian cancer care and the role of prehabilitation: Qualitative perspectives of key stakeholders.

Introduction: We performed a qualitative study to explore key stakeholders' perspectives about the impact of frailty on ovarian cancer care and evaluate a candidate prehabilitation intervention.

Materials And Methods: We conducted semi-structured interviews with patient-caregiver dyads and multi-disciplinary clinicians. Patients were ≥ 50 years of age with a new diagnosis of advanced stage (III/IV) ovarian cancer who received cancer-directed treatment (chemotherapy and/or surgery) during the past year and met criteria as pre-frail or frail using the FRAIL scale.

Material economic hardship is associated with adverse 1-year outcomes after pediatric liver transplantation: Prospective cohort results from the multi-center SOCIAL-Tx study.

Pediatric liver transplant outcomes exhibit disparities, necessitating identification of modifiable risk factors to develop targeted interventions. We characterized associations between household material economic hardship (e.g.

Pain in chronic liver disease compared to other chronic conditions: Results from a contemporary nationally representative cohort study.

Background: Pain is common in patients with chronic liver disease. Our limited understanding of patterns and severity of pain in this population hinders the development of effective cirrhosis-specific pain management strategies.

Methods: Using cross-sectional data from the 2016-2021 National Health Interview Survey, we examined rates, severity, and functional limitations due to pain in respondents with liver disease (viral hepatitis, cirrhosis, and liver cancer), compared to the general population and those with other chronic conditions associated with pain (ie, arthritis, diabetes, and chronic kidney disease).

Clinical Sentiment Analysis by Large Language Models Enhances the Prediction of Hepatorenal Syndrome in Decompensated Cirrhosis.

Background And Aims: Hepatorenal syndrome - Acute Kidney Injury (HRS-AKI) is a severe complication of decompensated cirrhosis that is challenging to predict. Sentiment analysis, a computational process of identifying and categorizing opinions and judgment expressed in text, may enhance traditional prediction methodologies based on structured variables. Large language models (LLMs), such as generative pretrained transformers (GPTs), have demonstrated abilities to perform sentiment analyses on non-clinical texts.

Sex Differences in Patient-Reported Outcomes and Perception of Ascites Burden Among Outpatients With Decompensated Cirrhosis and Ascites.

Introduction: Perception of the ascites burden and its effects on quality of life may be different between sexes. This study assessed sex differences in perception of ascites burden and its impact on health-related quality of life (HRQoL) in patients with recurrent or refractory ascites.

Methods: The North American Consortium for the Study of End-stage Liver Disease prospectively enrolled outpatients with cirrhosis and large ascites requiring repeat large volume paracenteses.

Prognostic Communication, Symptom Burden, Psychological Distress, and Quality of Life Among Patients With Decompensated Cirrhosis.

Background & Aims: Timely prognostic communication is a critical component of care for patients with decompensated cirrhosis (DC). However, few studies have examined the association of prognostic communication with symptoms, mood, and health-related quality of life (HRQOL) in this population.

Methods: In this cross-sectional study of 218 outpatients with DC, we assessed their self-reported health status (terminally ill vs not terminally ill), their prognostic communication with their hepatologists (Prognosis and Treatment Preferences Questionnaire), symptom burden (Revised Edmonton Symptom Assessment Scale), psychological distress (Hospital Anxiety and Depression Scale), and HRQOL (Short-Form Liver Disease Quality of Life scale).

Portal Hypertensive Gastropathy and MELD-Na Score Predict Recurrent Gastrointestinal Bleeding After TIPSS: An ALTA Group Study.

Background: Transjugular intrahepatic portosystemic shunt (TIPSS) is highly effective for treatment of variceal bleeding; however, factors contributing to rebleeding complications remain unclear.

Aims: In this study, we aim to determine risk factors for recurrent portal hypertensive gastrointestinal bleeding following TIPSS.

Methods: Utilising the Advancing Liver Therapeutic Approaches multicentre database, we retrospectively identified adult patients who underwent TIPSS for secondary prophylaxis of variceal bleeding and had a gastrointestinal rebleeding event within 1 year.

Psychological Distress Is Prevalent and Interdependent Among Patients With Decompensated Cirrhosis and Their Caregivers.

Introduction: Little is known about the interdependence of psychological distress among patients with decompensated cirrhosis and their caregivers.

Methods: In this cross-sectional study, we examined the interdependence of psychological distress (Hospital Anxiety and Depression Scale) among 127 patient-caregiver dyads using Actor-Partner Interdependence Modeling.

Results: Among dyads, 26% had both partners reporting clinically significant anxiety and 18% reporting clinically significant depression.

A patient-centered approach to dietary supplements for patients with chronic liver disease.

The use of dietary supplements by patients with chronic liver disease is prevalent and rising. Despite the known risks of dietary supplements, including hepatotoxicity, adulteration, and contamination, patients with chronic liver disease often turn to dietary supplements to support their liver and/or overall health but are not necessarily empowered with the information or guidance from their liver practitioner to do so. This article provides practitioners with a framework for balancing the risks and benefits of dietary supplements in patients with chronic liver disease, offering examples of independent resources and certifications to use this framework in clinical practice.

Connectomic reconstruction predicts visual features used for navigation.

Many animals use visual information to navigate, but how such information is encoded and integrated by the navigation system remains incompletely understood. In Drosophila melanogaster, EPG neurons in the central complex compute the heading direction by integrating visual input from ER neurons, which are part of the anterior visual pathway (AVP). Here we densely reconstruct all neurons in the AVP using electron-microscopy data.

Challenges in Liver Transplantation for Hepatocellular Carcinoma: A Review of Current Controversies.

Liver transplantation (LT) remains one of the most effective treatments for hepatocellular carcinoma (HCC) and significantly enhances patient survival. However, the application of LT for HCC faces challenges owing to advancements in cancer-specific treatment modalities and the increased burden of patients' comorbidities. This narrative review explores current controversies and advancements in LT for HCC.

Predictors of long-term clinical outcomes after TIPS: An ALTA group study.

Background And Aims: While TIPS is traditionally considered a bridge to liver transplant (LT), some patients achieve long-term transplant-free survival (TFS) with TIPS alone. Prognosis and need for LT should not only be assessed at time of procedure, but also re-evaluated in patients with favorable early outcomes.

Approach And Results: Adult recipients of TIPS in the multicenter advancing liver therapeutic approaches retrospective cohort study were included (N=1127 patients; 2040 person-years follow-up).

Investigating the Association between Steatotic Liver Disease and CKD in a Nationally Representative Sample.

Key Points: CKD is more common among those with steatotic liver disease compared with those without liver disease in the United States. Higher degrees of liver fibrosis are associated with greater prevalence of CKD independent of other common risk factors of kidney disease.

Background: Steatotic liver disease (SLD) and CKD are common conditions that are strongly associated.

IFNL4 genotype and other personal characteristics to predict response to 8-week sofosbuvir-based treatment for chronic hepatitis C.

Background: Shorter duration therapy for hepatitis C virus (HCV) infection might reduce treatment costs and increase the number of patients treated and cured. We determined factors associated with treatment response after an 8-week sofosbuvir-based therapy and developed a simple model to predict an individual's likelihood of treatment success.

Methods: Among 2907 patients who received ledipasvir/sofosbuvir for 8 weeks, we determined failure rates by demographic and clinical characteristics, and IFNL4-∆G/TT genotype.

Decreasing Case Fatality Rates for Patients With Cirrhosis Infected With SARS-CoV-2: A National COVID Cohort Collaborative Study.

Background & Aims: The virulence and severity of SARS-CoV-2 infections have decreased over time in the general population due to vaccinations and improved antiviral treatments. Whether a similar trend has occurred in patients with cirrhosis is unclear. We used the National COVID Cohort Collaborative (N3C) to describe the outcomes over time.

From prognostication to therapeutics: Four key questions to accelerate the development of therapeutics for patients with acute-on-chronic liver failure.

Acute-on-chronic liver failure (ACLF) has come a long way as a clinical concept within the hepatology and liver transplant communities. Though the term was proposed in 1995, the first recognition of the entity along with a consensus definition emerged in 2009. Subsequently, the entity has sparked great interest, inspired several consensus conferences, and inspired national societies to form professional ACLF affinity groups (eg, special interest group).

Liver transplantation provides survival benefit at all levels of frailty: From the Multicenter Functional Assessment in Liver Transplantation Study.

Background And Aims: Offering LT to frail patients may reduce waitlist mortality but may increase post-LT mortality. LT survival benefit is the concept of balancing these risks. We sought to quantify the net survival benefit with LT by liver frailty index (LFI).