Smartphone App Will Be Able to Predict Diabetes Interview with:

Robert Avram MD MScDivision of CardiologyUniversity of California, San Francisco

Dr. Robert Avram

Robert Avram MD MSc
Division of Cardiology
University of California, San Francisco What is the background for this study? Would you briefly describe what is meant by Photoplethysmography?

While analyzing the heart rate data as collected using smartphones apps in the Health-eHeart study, we noticed that diabetic patients had, on average, a higher ‘free-living’ heart rate than non-diabetic patients when adjusted from multiple factors. This pushed us to analyze the signal to see if there were other features that would help differentiate diabetes patients from non-diabetes patients. By identifying these features, we saw a huge opportunity to develop a screening tool for diabetes using deep learning and a smartphone camera and flash, in order to classify patients as having prevalent diabetes/no-diabetes.

Photoplethysmography is the technique of measuring the difference in light absorption by the skin in order to detect blood volume changes in the microvasculature. Most modern mobile devices, including smartphones and many fitness trackers (Apple Wathc, FitBit), have the ability to acquire PPG waveforms, providing a unique opportunity to detect diabetes-related vascular changes at population-scale.  Continue reading

Changing Attitudes Toward Liver Transplant for Alcohol-Associated Liver Disease Interview with:

Norah Terrault, MD MPH Professor, Gastroenterology Department of Medicine University of California San Francisco

Prof. Terrault

Norah Terrault, MD MPH
Professor, Gastroenterology
Department of Medicine
University of California San Francisco What is the background for this study? What are the main findings?

Response: Rates of liver transplantation (LT) for alcohol-associated liver disease (ALD) are rising such that ALD recently became the most common reason for LT in the United States. Although some assume that the increase in LT for ALD is because LT for hepatitis C has declined since the advent of antiviral therapy, little research has been done to formally investigate this hypothesis, or other reasons for the increase.

This national registry study used the United Network for Organ Sharing database and included over 32,000 liver transplant recipients, including 9,438 patients with ALD. The main findings are that

1) liver transplantation for ALD has doubled in the past 15 years, but only 48% of the increase in LT for ALD can be explained by declining LT for hepatitis C;

2) Many liver transplantation centers require patients to be abstinent at least 6 months to be eligible for LT for alcohol-associated liver disease, but this is changing – our trends analysis strongly suggest that shifting attitudes of transplant providers to allow earlier LT for ALD are an important part of the increase in LT for ALD, and are variable across different geographic regions;

3) Late post- liver transplantation survival after 5-years is 11% lower for alcohol-associated liver disease (vs. non-ALD). What should readers take away from your report?

Response: Changing attitudes regarding liver transplantation for acute alcoholic hepatitis may be having broad effects on LT for alcohol-associated liver disease, as more LT providers believe that it is justified to pursue earlier LT for ALD. As attitudes continue to change with more data to suggest that early LT for ALD can be undertaken with acceptable outcomes, we may see further increases in liver transplantation for ALD in future years. Since attitudes are provider-specific, and there is no national transplant policy for LT eligibility in terms of pre-LT abstinence requirements, this study suggests that variable policies and provider attitudes may be leading to inequity in healthcare access for alcohol-associated liver disease patients in need of liver transplantation. What recommendations do you have for future research as a result of this work?

Response: Given the significant increase in liver transplantation for alcohol-associated liver disease, which was different across regions, there would be value in a national policy to guide the management of LT for ALD. It is unclear why late survival for ALD is inferior for non-ALD, but other studies have shown recurrent alcohol use, malignancy, and infections to be important causes of late death after liver transplantation — these should be specifically investigated in future studies of liver transplantation for ALD.

No disclosures


Lee BP, Vittinghoff E, Dodge JL, Cullaro G, Terrault NA. National Trends and Long-term Outcomes of Liver Transplant for Alcohol-Associated Liver Disease in the United States. JAMA Intern Med. Published online January 22, 2019. doi:10.1001/jamainternmed.2018.6536

Jan 22, 2019 @ 10:34 pm 

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Emergency-Only Dialysis For Undocumented Immigrants Costs More Money and Lives Interview with:

Oanh Kieu Nguyen, MD, MA Assistant Professor Division of Hospital Medicine Zuckerberg San Francisco General Hospital UCSF

Dr. Nguyen

Oanh Kieu Nguyen, MD, MA
Assistant Professor
Division of Hospital Medicine
Zuckerberg San Francisco General Hospital
UCSF What is the background for this study?

Response: In U.S. citizens and permanent residents with kidney failure or end-stage renal disease (ESRD), having health insurance, Medicare, or Medicaid guarantees access to regularly scheduled hemodialysis 2-3 times per week, the evidence-based standard of care for ESRD. This treatment helps people live relatively normal lives. In 40 of 50 U.S. states, undocumented immigrants with ESRD have limited access to hemodialysis because they are not eligible for any form of federal assistance including Medicare or Medicaid, and must wait until they are life-threateningly ill to receive dialysis through a hospital emergency department, a situation called “emergency-only hemodialysis.” There are an estimated 6,500 undocumented individuals in the U.S. suffering from ESRD.

A unique opportunity made it feasible for uninsured undocumented immigrants with ESRD receiving emergency-only dialysis in Dallas, Texas, to enroll in private, commercial health insurance plans in 2015 and made it possible for researchers to compare scheduled vs. emergency-only dialysis among undocumented immigrants with ESRD. This natural experiment included 181 undocumented immigrants, 105 of whom received insurance coverage and enrolled in scheduled dialysis and 76 of whom remained uninsured.  Continue reading