As Tenured Professor at Virginia Commonwealth University with a joint appointment at the Richmond VA Medical Center, my research focus is the clinical and translational investigation of the gut-liver-brain axis in patients with chronic liver disease and cirrhosis. Patients with cirrhosis with hepatic encephalopathy have impaired cognition, which permeates in all aspects of their daily life and can impact their overall prognosis. We have developed tests that are user-friendly, yet rigorous in the identification of these patients with cognitive impairment in App and computerized format. The brain consequences of altered gut microbiota function and composition has been studied using brain MRI and cognitive function in the context of systemic inflammation by our group. Specifically, the interaction between bile acids, alcohol and microbiota as effectors of this change are key components of this research. Further studies on probiotics, non-absorbable antibiotics and fecal microbial transplant have been done or are underway to modulate the  gut-liver-brain axis.