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To analyze demographic, psychosocial, and clinical factors in pediatric liver transplant recipients for their association with death or loss to follow up in adulthood. We aimed to better understand known health disparities in transplant outcomes and identify potentially modifiable risk factors prior to transfer. A retrospective cohort study of children who underwent liver transplantation at a large tertiary transplant center and were transferred to adult care between 2000 and 2015. During the study period, 101 qualifying patients were transferred. Ninety-three individuals followed with an adult provider, while 8 were lost to follow up. In total 23 of 93 patients died after transfer (24.7%). Several childhood factors were associated with adult death: Black race [odds ratio (OR) 6.59, P< 0.001]; psychiatric illness or substance use (OR 2.81, P= 0.04); failure to graduate high school before transfer (OR 9.59, P< 0.001); posttransplant tacrolimus medication-level variability index >2.5 (OR 5.36, P= 0.04); provider documentation of medication nonadherence (OR 4.72, P= 0.02); acute cellular rejection (OR 4.44, P= 0.03); the presence of diabetes mellitus (OR 5.71, P= 0.001), and chronic kidney disease (OR 2.82, P= 0.04). Failure to graduate HS was associated with loss to follow up (P< 0.001). On multivariate analysis, Black race, substance use, diabetes, and failure to graduate HS retained association with adult death (each P< 0.05). Complex, intertwined patient characteristics are associated with increased odds of death in pediatric liver transplant recipients transferred to adult care. Early recognition of high-risk patients and intervention for modifiable factors, such as improved HS graduation and substance use prevention, may improve long-term outcomes.

Non-alcoholic steatohepatitis (NASH) is a common type of chronic liver disease that can lead to cirrhosis. Obeticholic acid, a farnesoid X receptor agonist, has been shown to improve the histological features of NASH. Here we report results from a planned interim analysis of an ongoing, phase 3 study of obeticholic acid for NASH.

The initial “Frontiers in Fontan Failure” conference in 2015 in Atlanta, GA, provided an opportunity for experts in the field of pediatric cardiology and adult congenital heart disease to focus on the etiology, physiology, and potential interventions for patients with “Failing Fontan” physiology. Four types of “Fontan Failure” were described and then published by Dr Book et al. The acknowledgment that even Dr Fontan himself realized that the Fontan procedure “imposed a gradually declining functional capacity and premature late death after an initial period of often excellent palliation.” The purpose of the second “Frontiers in Fontan Failure” was to further the discussion regarding new data and technologies as well as novel interventions. The 2017 “Frontiers in Fontan Failure: Innovation and Improving Outcomes” was sponsored by Children’s Healthcare of Atlanta, Sibley Heart Center Cardiology, and Emory University School of Medicine. Future directions in the management of Fontan failure include further investigations into the risk of sudden cardiac death and how to properly prevent it, achievable interventions in modifying the Fontan physiology to treat or prevent late complications, and improved and refined algorithms in Fontan surveillance. Finally, further research into the interventional treatment of lymphatic‐related complications hold the promise of marked improvement in the quality of life of advanced Fontan failure patients and as such should be encouraged and contributed to.

“Frontiers in Fontan Failure” was the title of a 2015 conference sponsored by Children's Healthcare of Atlanta and Emory University School of Medicine. In what is hoped to be the first of many such gatherings, speakers and attendees gathered to discuss the problem of long‐term clinical deterioration in these patients. Specific focuses included properly defining the problem and then discussing different treatment strategies, both medical and surgical. The health of the liver after Fontan palliation was a particular point of emphasis, as were quality of life and future directions.

A personal narrative is presented which explores the authors' experience of going on a cross-country drive in the U.S. to photograph vintage rest stops built by state governments in the 1950s and 1960s in locations such as Lajitas in Texas, Avon in Minnesota, and Courtland, Mississippi.

Objectives:The combination of simeprevir (SMV) and sofosbuvir (SOF) was found to be well-tolerated with high sustained virologic response (SVR) rates in patients with genotype 1 chronic hepatitis C in clinical trials. Previous experience with hepatitis C virus (HCV) therapy has shown that patient tolerability and treatment efficacy described in controlled clinical trials did not necessarily mirror the “real world” experience. The goal of this study was to define SVR rates in a “real world” analysis and to explore predictors of treatment response with SMV and SOF.Methods:This is a retrospective study examining the “real world” treatment of 170 patients with chronic HCV genotype 1 using the combination of SMV and SOF with or without ribavirin (RBV) for a fixed 12-week duration irrespective of prior interferon therapy, transplant status or fibrosis stage. Differences between SVR cohorts were analyzed by both intention-to-treat (ITT) and per protocol.Results:The vast majority of patients were genotype 1a, 77% were cirrhotic in the non-LT group, and 35% of the entire cohort was African-American. Combination treatment with SMV and SOF in genotype 1 chronic HCV patients achieved an overall SVR rate at 12 weeks after completion of therapy (SVR12) of 78% by ITT and 86% by per protocol (84% in non-liver transplant (LT) patients and 89% in post-LT recipients). The presence of hepatocellular carcinoma was found to be a significant negative predictor of SVR12, whereas an undetectable week eight VL was a significant positive predictor of SVR in the entire cohort.Conclusions:Our data confirm excellent SVR outcomes with favorable safety and tolerability profiles in patients who carry many traditional high-risk features for non-response, including post-LT recipients and patients with advanced liver disease.

Liver fibrosis is a growing concern among adults with congenital heart disease, particularly for those who have undergone a Fontan operation. Liver fibrosis leads to cirrhosis, a precursor of hepatocellular carcinoma. A few cases of hepatocellular carcinoma in patients with prior palliative surgery for congenital heart disease have been identified in the literature. The current case reports the first known case of hepatocellular carcinoma in a 45‐year‐old male with repaired tetralogy of Fallot.

Inland waters are optically complex and provide an ongoing challenge to effective water quality monitoring through remote sensing. Imaging satellites with spectral sampling designed for this task often have coarse spatial resolutions, preventing any capture of information from small lakes. Medium resolution satellite systems such as Landsat 8 have the appropriate spatial resolution and sensitivity required to resolve these waterbodies, but the spectral sampling is not optimal. This work uses system simulation to explore potential changes to Landsat spectral sampling to determine if its ability to monitor inland waters could be improved. The HydroLight and MODTRAN radiative transfer models are used for simulation in a Look Up Table and spectrum matching approach to provide maximum flexibility intesting spectral sampling scenarios. To isolate the testing to the impacts of spectral sampling, all simulations were performed based on the known system noise characteristics of Landsat 8. Spectral sampling changes tested include the addition of yellow and red edge spectral bands as well as conversion to an imaging spectrometer. Simulated spectra of inland waters undergoing a cyanobacteria bloom, including atmospheric effects and sensor noise, were implemented with the Look-Up-Table retrieval process to extract estimated concentrations of waterbody components. The retrieval accuracy of each potential system is compared to that of a modeled Landsat 8 baseline. All potential systems show an increase of retrieval accuracy over the baseline. The best performing system design is an imaging spectrometer, followed by the addition of both a yellow and red edge band simultaneously, and the addition of either band individually. Testing also demonstrates that resampling an imaging spectrometer with 20 ​nm spectral resolution to the Landsat 8 band responses produces outputs matching those available from Landsat 8. Our results indicate that future Landsat missions should aim to add as much spectral sampling as is feasible, while maintaining at least the same sensitivity. The minimum change to improve water quality monitoring capability is the addition of a red edge spectral band.

Five days after a series of hard fouls on Detroit Mercy guard Antoine Davis meant to prevent a record 3-point performance riled up Mike Davis, his coach (and father), the UDM guard finally got his record. [ABSTRACT FROM AUTHOR]