Understanding Degassing Pathways Along the 1886 Tarawera (New Zealand) Volcanic Fissure by Combining Soil and Lake CO₂ Fluxes

CO₂ flux measurements are often used to monitor volcanic systems, understand the cause of volcanic unrest, and map sub-surface structures. Currently, such measurements are incomplete at Tarawera (New Zealand), which erupted with little warning in 1886 and produced a ∼17 km long fissure. We combine new soil CO₂ flux and C isotope measurements of Tarawera with previous data from Rotomahana and Waimangu (regions also along the 1886 fissure) to fingerprint the CO₂ source, understand the current pathways for degassing, quantify the CO₂ released along the entire fissure, and provide a baseline survey. The total CO₂ emissions from the fissure are 1227 t⋅d⁻¹ (742–3398 t⋅d⁻¹ 90 % confidence interval), similar to other regions in the Taupō Volcanic Zone. The CO₂ flux from Waimangu and Rotomahana is far higher than from Tarawera (>549 vs. ∼4 t⋅d⁻¹ CO₂), likely influenced by a shallow silicic body at depth and Okataina caldera rim faults increasing permeability at the southern end of the fissure. Highly localized regions of elevated CO2 flux occur along the fissure and are likely caused by cross-cutting faults that focus the flow. One of these areas occurs on Tarawera, which is emitting ∼1 t⋅d⁻¹ CO₂ with a δ¹³CO₂ of −5.5 ± 0.5 ‰, and comparison with previous observations shows that activity is declining over time. This region highlights the spatial and temporal complexity of degassing pathways at volcanoes and that sub-surface structures exert a primary control on the magnitude of CO₂ flux in comparison to the surface mechanism (i.e., CO₂ released through the soil or lake surface)

Portal vein thrombosis and outcomes for pediatric liver transplant candidates and recipients in the United States

The effect of occlusive portal vein thrombosis (PVT) on the mortality of pediatric liver transplant candidates and recipients is poorly defined. Using standard multivariate techniques, we studied the relationship between PVT and waiting‐list and posttransplant survival rates with data from the Scientific Registry of Transplant Recipients (September 2001 to December 2007). In all, 5087 liver transplant candidates and 3630 liver transplant recipients were evaluated during the period. PVT was found in 1.4% of the liver transplant candidates (n = 70) and in 3.7% of the liver transplant recipients (n = 136). PVT was not associated with increased wait‐list mortality [hazard ratio (HR) = 1.1, 95% confidence interval (CI) = 0.5‐2.4, P = 0.77]. Conversely, PVT patients had a significantly lower unadjusted survival rate in the posttransplant period ( P = 0.01). PVT was independently associated with increased posttransplant mortality in multivariate models (30‐day survival: HR = 2.9, 95% CI = 1.6‐5.3, P = 0.001; overall survival: HR = 1.7, 95% CI = 1.1‐2.4, P = 0.01). The presence of PVT in pediatric liver candidates was not associated with increased wait‐list mortality but was clearly associated with posttransplant mortality, especially in the immediate postoperative period. Liver Transpl 17:1066–1072, 2011. © 2011 AASLD.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/87010/1/22371_ftp.pd

Biliary complications following liver transplantation in the model for end-stage liver disease era: Effect of donor, recipient, and technical factors

Biliary complications remain a significant problem following liver transplantation in the Model for End-Stage Liver Disease (MELD) era. We hypothesized that donor, recipient, and technical variables may differentially affect anastomotic biliary complications in MELD era liver transplants. We reviewed 256 deceased donor liver transplants after the institution of MELD at our center and evaluated these variables' association with anastomotic biliary complications. The bile leak rate was 18%, and the stricture rate was 23%. Univariate analysis revealed that recipient age, MELD, donor age, and warm ischemia were risk factors for leak, whereas a Roux limb or stent was protective. A bile leak was a risk factor for anastomotic stricture, whereas use of histidine tryptophan ketoglutarate (HTK) versus University of Wisconsin (UW) solution was protective. Additionally, use of a transcystic tube/stent was also protective. Multivariate analysis showed that warm ischemia was the only independent risk factor for a leak, whereas development of a leak was the only independent risk factor for a stricture. HTK versus UW use and transcystic tube/stent use were the only independent protective factors against stricture. Use of an internal stent trended in the multivariate analysis toward being protective against leaks and strictures, but this was not quite statistically significant. This represents one of the first MELD era studies of deceased donor liver transplants evaluating factors affecting the incidence of anastomotic bile leaks and strictures. Donor, recipient, and technical factors appear to differentially affect the incidence of anastomotic biliary complications, with warm ischemia, use of HTK, and use of a stent emerging as the most important variables. Liver Transpl 14:73–80, 2008. © 2007 AASLD.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/57538/1/21354_ftp.pd

Bayesian Network Modeling and Expert Elicitation for Probabilistic Eruption Forecasting: Pilot Study for Whakaari/White Island, New Zealand

Bayesian Networks (BNs) are probabilistic graphical models that provide a robust and flexible framework for understanding complex systems. Limited case studies have demonstrated the potential of BNs in modeling multiple data streams for eruption forecasting and volcanic hazard assessment. Nevertheless, BNs are not widely employed in volcano observatories. Motivated by their need to determine eruption-related fieldwork risks, we have worked closely with the New Zealand volcano monitoring team to appraise BNs for eruption forecasting with the purpose, at this stage, of assessing the utility of the concept rather than develop a full operational framework. We adapted a previously published BN for a pilot study to forecast volcanic eruption on Whakaari/White Island. Developing the model structure provided a useful framework for the members of the volcano monitoring team to share their knowledge and interpretation of the volcanic system. We aimed to capture the conceptual understanding of the volcanic processes and represent all observables that are regularly monitored. The pilot model has a total of 30 variables, four of them describing the volcanic processes that can lead to three different types of eruptions: phreatic, magmatic explosive and magmatic effusive. The remaining 23 variables are grouped into observations related to seismicity, fluid geochemistry and surface manifestations. To estimate the model parameters, we held a workshop with 11 experts, including two from outside the monitoring team. To reduce the number of conditional probabilities that the experts needed to estimate, each variable is described by only two states. However, experts were concerned about this limitation, in particular for continuous data. Therefore, they were reluctant to define thresholds to distinguish between states. We conclude that volcano monitoring requires BN modeling techniques that can accommodate continuous variables. More work is required to link unobservable (latent) processes with observables and with eruptive patterns, and to model dynamic processes. A provisional application of the pilot model revealed several key insights. Refining the BN modeling techniques will help advance understanding of volcanoes and improve capabilities for forecasting volcanic eruptions. We consider that BNs will become essential for handling ever-burgeoning observations, and for assessing data's evidential meaning for operational eruption forecasting

Variability of Care and Access to Transplantation for Children with Biliary Atresia Who Need a Liver Replacement

Background & Aims: Biliary atresia (BA) is the commonest single etiology indication for liver replacement in children. As timely access to liver transplantation (LT) remains challenging for small BA children (with prolonged waiting time being associated with clinical deterioration leading to both preventable pre- and post-transplant morbidity and mortality), the care pathway of BA children in need of LT was analyzed—from diagnosis to LT—with particular attention to referral patterns, timing of referral, waiting list dynamics and need for medical assistance before LT. Methods: International multicentric retrospective study. Intent-to-transplant study analyzing BA children who had indication for LT early in life (aged < 3 years at the time of assessment), over the last 5 years (2016–2020). Clinical and laboratory data of 219 BA children were collected from 8 transplant centers (6 in Europe and 2 in USA). Results: 39 patients underwent primary transplants. Children who underwent Kasai in a specialist -but not transplant- center were older at time of referral and at transplant. At assessment for LT, the vast majority of children already were experiencing complication of cirrhosis, and the majority of children needed medical assistance (nutritional support, hospitalization, transfusion of albumin or blood) while waiting for transplantation. Severe worsening of the clinical condition led to the need for requesting a priority status (i.e., Peld Score exception or similar) for timely graft allocation for 76 children, overall (35%). Conclusions: As LT currently results in BA patient survival exceeding 95% in many expert LT centers, the paradigm for BA management optimization and survival have currently shifted to the pre-LT management. The creation of networks dedicated to the timely referral to a pediatric transplant center and possibly centralization of care should be considered, in combination with implementing all different graft type surgeries in specialist centers (including split and living donor LTs) to achieve timely LT in this vulnerable population

Variability of Care and Access to Transplantation for Children with Biliary Atresia Who Need a Liver Replacement

Background & Aims: Biliary atresia (BA) is the commonest single etiology indication for liver replacement in children. As timely access to liver transplantation (LT) remains challenging for small BA children (with prolonged waiting time being associated with clinical deterioration leading to both preventable pre- and post-transplant morbidity and mortality), the care pathway of BA children in need of LT was analyzed—from diagnosis to LT—with particular attention to referral patterns, timing of referral, waiting list dynamics and need for medical assistance before LT. Methods: International multicentric retrospective study. Intent-to-transplant study analyzing BA children who had indication for LT early in life (aged < 3 years at the time of assessment), over the last 5 years (2016–2020). Clinical and laboratory data of 219 BA children were collected from 8 transplant centers (6 in Europe and 2 in USA). Results: 39 patients underwent primary transplants. Children who underwent Kasai in a specialist -but not transplant- center were older at time of referral and at transplant. At assessment for LT, the vast majority of children already were experiencing complication of cirrhosis, and the majority of children needed medical assistance (nutritional support, hospitalization, transfusion of albumin or blood) while waiting for transplantation. Severe worsening of the clinical condition led to the need for requesting a priority status (i.e., Peld Score exception or similar) for timely graft allocation for 76 children, overall (35%). Conclusions: As LT currently results in BA patient survival exceeding 95% in many expert LT centers, the paradigm for BA management optimization and survival have currently shifted to the pre-LT management. The creation of networks dedicated to the timely referral to a pediatric transplant center and possibly centralization of care should be considered, in combination with implementing all different graft type surgeries in specialist centers (including split and living donor LTs) to achieve timely LT in this vulnerable population

Variability of Care and Access to Transplantation for Children with Biliary Atresia Who Need a Liver Replacement

Background & Aims: Biliary atresia (BA) is the commonest single etiology indication for liver replacement in children. As timely access to liver transplantation (LT) remains challenging for small BA children (with prolonged waiting time being associated with clinical deterioration leading to both preventable pre- and post-transplant morbidity and mortality), the care pathway of BA children in need of LT was analyzed-from diagnosis to LT-with particular attention to referral patterns, timing of referral, waiting list dynamics and need for medical assistance before LT. Methods: International multicentric retrospective study. Intent-to-transplant study analyzing BA children who had indication for LT early in life (aged < 3 years at the time of assessment), over the last 5 years (2016-2020). Clinical and laboratory data of 219 BA children were collected from 8 transplant centers (6 in Europe and 2 in USA). Results: 39 patients underwent primary transplants. Children who underwent Kasai in a specialist -but not transplant- center were older at time of referral and at transplant. At assessment for LT, the vast majority of children already were experiencing complication of cirrhosis, and the majority of children needed medical assistance (nutritional support, hospitalization, transfusion of albumin or blood) while waiting for transplantation. Severe worsening of the clinical condition led to the need for requesting a priority status (i.e., Peld Score exception or similar) for timely graft allocation for 76 children, overall (35%). Conclusions: As LT currently results in BA patient survival exceeding 95% in many expert LT centers, the paradigm for BA management optimization and survival have currently shifted to the pre-LT management. The creation of networks dedicated to the timely referral to a pediatric transplant center and possibly centralization of care should be considered, in combination with implementing all different graft type surgeries in specialist centers (including split and living donor LTs) to achieve timely LT in this vulnerable population.Peer reviewe