Unfair Advantages for Hepatocellular Carcinoma Patients Listed for Liver Transplant in Short-Wait Regions Following 2015 Hepatocellular Carcinoma Policy Change.

For patients with hepatocellular carcinoma (HCC) listed for liver transplantation (LT), United Network for Organ Sharing (UNOS) enacted policy changes in 2015 to improve equity between HCC and non-HCC patients. We evaluated the impact of these changes on regional disparities in wait-list dropout and LT. We included patients in the UNOS database listed with Model for End-Stage Liver Disease HCC exceptions in long-wait regions (LWRs), mid-wait regions (MWRs), and short-wait regions (SWRs) before these policy changes (era 1, January 1 to December 31, 2013) and after (era 2, October 7, 2015, to October 7, 2016). Cumulative incidence of wait-list dropout and LT were evaluated using competing risk regression. Median time to LT increased by 3.6 months (3.1 to 6.7 months) in SWRs and 1.3 months (6.9 to 8.2 months) in MWRs (P < 0.001), with a slight decrease in LWRs (13.4 to 12.9 months; P = 0.02). The 2-year cumulative incidence of dropout increased from 9.7% to 14.8% in SWRs (P = 0.03) and from 18.9% to 22.6% in MWRs (P = 0.18) but decreased in LWRs from 26.7% to 24.8% (P = 0.31). Factors predicting wait-list dropout included listing in era 2 (hazard ratio [HR], 1.17), in LWRs (HR, 2.56), and in MWRs (HR, 1.91). Regional differences in wait-list outcomes decreased with policy changes, but HCC patients in SWRs remain advantaged. Recent policy change may narrow these disparities.

Disseminated Acanthamoeba infection in a heart transplant recipient treated successfully with a miltefosine-containing regimen: Case report and review of the literature.

Disseminated acanthamoebiasis is a rare, often fatal, infection most commonly affecting immunocompromised patients. We report a case involving sinuses, skin, and bone in a 60-year-old woman 5 months after heart transplantation. She improved with a combination of flucytosine, fluconazole, miltefosine, and decreased immunosuppression. To our knowledge, this is the first case of successfully treated disseminated acanthamoebiasis in a heart transplant recipient and only the second successful use of miltefosine for this infection among solid organ transplant recipients. Acanthamoeba infection should be considered in transplant recipients with evidence of skin, central nervous system, and sinus infections that are unresponsive to antibiotics. Miltefosine may represent an effective component of a multidrug therapeutic regimen for the treatment of this amoebic infection.

A bottom up approach to on-road CO2 emissions estimates: improved spatial accuracy and applications for regional planning.

On-road transportation is responsible for 28% of all U.S. fossil-fuel CO2 emissions. Mapping vehicle emissions at regional scales is challenging due to data limitations. Existing emission inventories use spatial proxies such as population and road density to downscale national or state-level data. Such procedures introduce errors where the proxy variables and actual emissions are weakly correlated, and limit analysis of the relationship between emissions and demographic trends at local scales. We develop an on-road emission inventory product for Massachusetts-based on roadway-level traffic data obtained from the Highway Performance Monitoring System (HPMS). We provide annual estimates of on-road CO2 emissions at a 1 × 1 km grid scale for the years 1980 through 2008. We compared our results with on-road emissions estimates from the Emissions Database for Global Atmospheric Research (EDGAR), with the Vulcan Product, and with estimates derived from state fuel consumption statistics reported by the Federal Highway Administration (FHWA). Our model differs from FHWA estimates by less than 8.5% on average, and is within 5% of Vulcan estimates. We found that EDGAR estimates systematically exceed FHWA by an average of 22.8%. Panel regression analysis of per-mile CO2 emissions on population density at the town scale shows a statistically significant correlation that varies systematically in sign and magnitude as population density increases. Population density has a positive correlation with per-mile CO2 emissions for densities below 2000 persons km(-2), above which increasing density correlates negatively with per-mile emissions.

Inflammatory bowel disease in pregnancy and breastfeeding.

Inflammatory bowel disease (IBD) has a peak age of diagnosis before the age of 35 years. Concerns about infertility, adverse pregnancy outcomes, and heritability of IBD have influenced decision-making for patients of childbearing age and their care providers. The interplay between the complex physiology in pregnancy and IBD can affect placental development, microbiome composition and responses to therapy. Current evidence has shown that effective disease management, including pre-conception counselling, multidisciplinary care and therapeutic agents to minimize disease activity, can improve pregnancy outcomes. This Review outlines the management of IBD in pregnancy and the safety of IBD therapies, including novel agents, with regard to both maternal and fetal health. The vast majority of IBD therapies can be used with low risk during pregnancy and lactation without substantial effects on neonatal outcomes.

Modeling and validation of on-road CO2 emissions inventories at the urban regional scale.

On-road emissions are a major contributor to rising concentrations of atmospheric greenhouse gases. In this study, we applied a downscaling methodology based on commonly available spatial parameters to model on-road CO(2) emissions at the 1 × 1 km scale for the Boston, MA region and tested our approach with surface-level CO(2) observations. Using two previously constructed emissions inventories with differing spatial patterns and underlying data sources, we developed regression models based on impervious surface area and volume-weighted road density that could be scaled to any resolution. We found that the models accurately reflected the inventories at their original scales (R(2) = 0.63 for both models) and exhibited a strong relationship with observed CO(2) mixing ratios when downscaled across the region. Moreover, the improved spatial agreement of the models over the original inventories confirmed that either product represents a viable basis for downscaling in other metropolitan regions, even with limited data.