Liver imaging reporting and data system: An expert consensus statement

The increasing incidence and high morbidity and mortality of hepatocellular carcinoma (HCC) have inspired the creation of the Liver Imaging Reporting and Data System (LI-RADS). LI-RADS aims to reduce variability in exam interpretation, improve communication, facilitate clinical therapeutic decisions, reduce omission of pertinent information, and facilitate the monitoring of outcomes. LI-RADS is a dynamic process, which is updated frequently. In this article, we describe the LI-RADS 2014 version (v2014), which marks the second update since the initial version in 2011

Structural frame selection processes: case studies of hybrid concrete construction projects

Selection of the most appropriate structural frame for a building during the conceptual design stage is crucial to the overall performance and value delivered to the client. Despite this, the decision making process is commonly characterised by subjectivity and heuristic reasoning making it difficult to map / analyse the factors underlying structural frame selection. This paper uses both live and retrospective case studies of Hybrid Concrete Construction (HCC) projects to gain an understanding of decision making for structural frames. These two case studies represent different building types: one is bespoke; and the other is a more standardised type of building. HCC comprises a combination of in-situ and precast concrete elements. Interviews with relevant members of the project teams were used as the main data collection technique. This paper explores various stakeholder views on the reasons for adopting a particular solution, and the particular challenges associated with the use of hybrid concrete. Although the small sample prevents generalisation to a wider population, the findings suggest that HCC is used for buildings where cost and time performance are not the most important criteria, but where architectural aesthetics and longer-term issues, such as sustainability prevail. Clients and architects were found to be the most influential team members in the frame selection process. Due to the increased complexity of HCC projects, team members need to be involved early and, most importantly, adopt a cooperative attitude which should be nurtured throughout the duration of the project. These findings provide useful lessons learnt and highlight the implications for practitioners using hybrid concrete structural frames in the future

Establishing a Fair Playing Field for Payment by Results

The English government has encouraged private providers – known as Independent Sector Treatment Centres (ISTCs) – to treat publicly funded (NHS) patients. Providers are paid a fixed price per patient treated, adjusted to reflect geographical differences in input costs. But there may be other legitimate cost variations between providers. This report considers the regulatory and production-process constraints that could cause public and private providers costs to differ. Most of these exogenous cost differentials can be rectified by adjustments to the regulatory system or to the payment method. We find evidence that ISTCs are treating different types of patients than NHS hospitals. If these differences drive costs, payments for treatment might need to be differentiated by setting.

Stealing Organs?

Every nine minutes, a new person joins a waitlist for an organ transplant, and every day, seventeen people die waiting for an organ that will never come. Because the need for organ transplants far outstrips the number of available organs, the policies and rules governing organ allocation in the United States are critically important and highly contentious. Recently, proponents of a new allocation system—one focused more on sharing organs across the nation instead of allocating organs primarily to local transplant candidates—have gained ground. Bolstered by two separate lawsuits in the past five years, advocates of greater national sharing have succeeded in changing the allocation rules for lungs and livers, with policies for other organs in development. This Article engages with the debate over whether national or local patients should receive priority under organ allocation systems. Focusing specifically on liver allocation, it provides an innovative empirical analysis of the primary arguments and evidence that those in favor of national allocation policies have used to support their preferred policies—that the sickest patients should receive donated organs first, regardless of their location. While this argument is both ethically and intuitively appealing, those opposed to greater national organ sharing have argued that measures of “sickest patients” are both flawed and subject to manipulation. Greater national organ sharing can also exacerbate existing inequities in the organ transplant system as wealthy urban areas generally import organs from poorer and more rural parts of the country. Analyzing a dataset of every patient waitlisted for a liver between 2002 and 2017, this Article reveals, for the first time, a deeply troubling reality. The results of the analysis suggest that transplant professionals have routinely manipulated the waitlist priority of their patients. Moreover, this manipulation occurs more often in areas of the country that argue most vehemently in favor of national allocation policies. This Article argues that these recent policy changes, favoring greater national organ sharing, are extensions of the manipulative tactics revealed by the empirical analysis. Given the results of the empirical analysis, this Article argues that the time has come to formalize local priority in organ allocation policy by amending the National Organ Transplant Act. This amendment would roll back recent changes to promote greater national organ sharing that have been justified with manipulated evidence and prevent organs from moving from poorer to wealthier areas of the country. This rollback represents an important first step in combating inequities in the transplant system

Model of fibrolamellar hepatocellular carcinomas reveals striking enrichment in cancer stem cells

The aetiology of human fibrolamellar hepatocellular carcinomas (hFL-HCCs), cancers occurring increasingly in children to young adults, is poorly understood. We present a transplantable tumour line, maintained in immune-compromised mice, and validate it as a bona fide model of hFL-HCCs by multiple methods. RNA-seq analysis confirms the presence of a fusion transcript (DNAJB1-PRKACA) characteristic of hFL-HCC tumours. The hFL-HCC tumour line is highly enriched for cancer stem cells as indicated by limited dilution tumourigenicity assays, spheroid formation and flow cytometry. Immunohistochemistry on the hFL-HCC model, with parallel studies on 27 primary hFL-HCC tumours, provides robust evidence for expression of endodermal stem cell traits. Transcriptomic analyses of the tumour line and of multiple, normal hepatic lineage stages reveal a gene signature for hFL-HCCs closely resembling that of biliary tree stem cells-newly discovered precursors for liver and pancreas. This model offers unprecedented opportunities to investigate mechanisms underlying hFL-HCCs pathogenesis and potential therapies

Evidence‐based development of liver allocation: a review

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/87029/1/j.1432-2277.2011.01274.x.pd

Stealing Organs?

Every nine minutes, a new person joins a waitlist for an organ transplant, and every day, seventeen people die waiting for an organ that will never come. Because the need for organ transplants far outstrips the number of available organs, the policies and rules governing organ allocation in the United States are critically important and highly contentious. Recently, proponents of a new allocation system one focused more on sharing organs across the nation instead of allocating organs primarily to local transplant candidates have gained ground. Bolstered by two separate lawsuits in the past five years, advocates of greater national sharing have succeeded in changing the allocation rules for lungs and livers, with policies for other organs in development. This Article engages with the debate over whether national or local patients should receive priority under organ allocation systems. Focusing specifically on liver allocation, it provides an innovative empirical analysis of the primary arguments and evidence that those in favor of national allocation policies have used to support their preferred policies that the sickest patients should receive donated organs first, regardless of their location. While this argument is both ethically and intuitively appealing, those opposed to greater national organ sharing have argued that measures of sickest patients are both flawed and subject to manipulation. Greater national organ sharing can also exacerbate existing inequities in the organ transplant system as wealthy urban areas generally import organs from poorer and more rural parts of the country. Analyzing a dataset of every patient waitlisted for a liver between 2002 and 2017, this Article reveals, for the first time, a deeply troubling reality. The results of the analysis suggest that transplant professionals have routinely manipulated the waitlist priority of their patients. Moreover, this manipulation occurs more often in areas of the country that argue most vehemently in favor of national allocation policies. This Article argues that these recent policy changes, favoring greater national organ sharing, are extensions of the manipulative tactics revealed by the empirical analysis. Given the results of the empirical analysis, this Article argues that the time has come to formalize local priority in organ allocation policy by amending the National Organ TransplantAct. This amendment would roll back recent changes to promote greater national organ sharing that have been justified with manipulated evidence and prevent organs from moving from poorer to wealthier areas of the country. This rollback represents an important first step in combating inequities in the transplant system

Early Hepatocellular Carcinoma: Transplantation versus Resection: The Case for Liver Resection

The optimal surgical treatment of hepatocellular carcinoma on well-compensated cirrhosis is controversial. Advocates of liver transplantation cite better long-term survival, lower risk of recurrence, and the ability of transplantation to treat both the HCC and the underlying liver cirrhosis. Transplantation, however, is not universally available to all appropriate-risk candidates because of a lack of sufficient organ donors and in addition suffers from the disadvantages of requiring a more complex pre- and postoperative management associated with risks of inaccessibility, noncompliance, and late complications. Resection, by contrast, is much more easily and widely available, avoids many of those risks, is by many accounts as effective at achieving similar long-term survival, and still allows for safe, subsequent liver transplantation in cases of recurrence. Here, arguments are made in favor of resection being easier, safer, simpler, and comparably effective in the treatment of HCC relative to transplantation, and therefore being the optimal initial treatment in cases of hepatocellular carcinoma on well-compensated cirrhosis