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The American, European, and Latin American liver societies have proposed a change in the nomenclature we use to describe alcohol-related liver disease and non-alcoholic fatty liver disease. Additionally, a term encompassing both is now advocated: steatotic liver disease, which includes metabolic dysfunction associated steatotic liver disease (MASLD) and MASLD with greater alcohol consumption (MetALD). These classifications offer increased relevance for clinicians, researchers, and patients alike. In this Viewpoint, we discuss the basis for this nomenclature shift and how it was developed. We also explore the challenges that will be faced in the adoption of such change. The proposed change seeks to banish stigma associated with phrasing such as alcoholic and fatty. However stigma, particularly related to the term fatty, is culturally nuanced, and reflects different entities depending on location. If such a change is internationally accepted, there will be wide-reaching effects on practitioners in primary care and metabolic medicine, and on patients. We discuss those effects and the opportunities the nomenclature change could offer, particularly for patients with alcohol and metabolic risk factors who represent a group previously ignored by clinical trials.

Non-alcoholic fatty liver disease (NAFLD) is common, affecting approximately 25% of the general population. The evidence base for the investigation and management of NAFLD is large and growing, but there is currently little practical guidance to support development of services and delivery of care. To address this, we produced a series of evidence-based quality standard recommendations for the management of NAFLD, with the aim of improving patient care. A multidisciplinary group of experts from the British Association for the Study of the Liver and British Society of Gastroenterology NAFLD Special Interest Group produced the recommendations, which cover: management of people with, or at risk of, NAFLD before the gastroenterology or liver clinic; assessment and investigations in secondary care; and management in secondary care. The quality of evidence for each recommendation was evaluated by the Grading of Recommendation Assessment, Development and Evaluation tool. An anonymous modified Delphi voting process was conducted individually by each member of the group to assess the level of agreement with each statement. Statements were included when agreement was 80% or greater. From the final list of statements, a smaller number of auditable key performance indicators were selected to allow services to benchmark their practice. It is hoped that services will review their practice against our recommendations and key performance indicators and institute service development where needed to improve the care of patients with NAFLD.

ABSTRACTCycling is promoted as a form of urban travel with well-established benefits to health, liveability and wellbeing. These benefits are comparatively large for older people, a growing segment in many populations. Yet, support for the normalisation of cycling mobilities for all ages varies considerably. It is usual to contrast low-cycling contexts, such as the UK, with high-cycling areas, typically favouring highest-rate paradigmatic urban centres. To challenge a too simplistic imitation and re-creation of engineering solutions elsewhere, we draw attention to diverse cycling habits and norms in residents of a more ordinary high-cycling area (suburban Rotterdam), and observe how cycling is normalised throughout the lifecourse. Using mobile and biographical methods, we argue that a more nuanced appreciation of cycling normalisation is gained from viewing ageing and cycling relationally and biographically. This is because the habit-forming realm of normalisation functions through both conscious decisions and unconscious practice, bound up with life events and the external environment. The findings suggest that age-friendly city strategies and urban mobility policies should more closely consider locally constituted social and cultural processes, beyond providing infrastructure. This article thus provides an in-depth account of what it takes for planning and policy to normalise positive, empowering, and age-friendly qualities in everyday mobility.

This final report of the LancetCommission into liver disease in the UK stresses the continuing increase in burden of liver disease from excess alcohol consumption and obesity, with high levels of hospital admissions which are worsening in deprived areas. Only with comprehensive food and alcohol strategies based on fiscal and regulatory measures (including a minimum unit price for alcohol, the alcohol duty escalator, and an extension of the sugar levy on food content) can the disease burden be curtailed. Following introduction of minimum unit pricing in Scotland, alcohol sales fell by 3%, with the greatest effect on heavy drinkers of low-cost alcohol products. We also discuss the major contribution of obesity and alcohol to the ten most common cancers as well as measures outlined by the departing Chief Medical Officer to combat rising levels of obesity—the highest of any country in the west. Mortality of severely ill patients with liver disease in district general hospitals is unacceptably high, indicating the need to develop a masterplan for improving hospital care. We propose a plan based around specialist hospital centres that are linked to district general hospitals by operational delivery networks. This plan has received strong backing from the British Association for Study of the Liver and British Society of Gastroenterology, but is held up at NHS England. The value of so-called day-case care bundles to reduce high hospital readmission rates with greater care in the community is described, along with examples of locally derived schemes for the early detection of disease and, in particular, schemes to allow general practitioners to refer patients directly for elastography assessment. New funding arrangements for general practitioners will be required if these proposals are to be taken up more widely around the country. Understanding of the harm to health from lifestyle causes among the general population is low, with a poor knowledge of alcohol consumption and dietary guidelines. The LancetCommission has serious doubts about whether the initiatives described in the Prevention Green Paper, with the onus placed on the individual based on the use of information technology and the latest in behavioural science, will be effective. We call for greater coordination between official and non-official bodies that have highlighted the unacceptable disease burden from liver disease in England in order to present a single, strong voice to the higher echelons of government.

This report presents further evidence on the escalating alcohol consumption in the UK and the burden of liver disease associated with this major risk factor, as well as the effects on hospital and primary care. We reiterate the need for fiscal regulation by the UK Government if overall alcohol consumption is to be reduced sufficiently to improve health outcomes. We also draw attention to the effects of drastic cuts in public services for alcohol treatment, the repeated failures of voluntary agreements with the drinks industry, and the influence of the industry through its lobbying activities. We continue to press for reintroduction of the alcohol duty escalator, which was highly effective during the 5 years it was in place, and the introduction of minimum unit pricing in England, targeted at the heaviest drinkers. Results from the introduction of minimum unit pricing in Scotland, with results from Wales to follow, are likely to seriously expose the weakness of England's position. The increasing prevalence of obesity-related liver disease, the rising number of people diagnosed with type 2 diabetes and its complications, and increasing number of cases of end-stage liver disease and primary liver cancers from non-alcoholic fatty liver disease make apparent the need for an obesity strategy for adults. We also discuss the important effects of obesity and alcohol on disease progression, and the increased risk of the ten most common cancers (including breast and colon cancers). A new in-depth analysis of the UK National Health Service (NHS) and total societal costs shows the extraordinarily large expenditures that could be saved or redeployed elsewhere in the NHS. Excellent results have been reported for new antiviral drugs for hepatitis C virus infection, making elimination of chronic infection a real possibility ahead of the WHO 2030 target. However, the extent of unidentified cases remains a problem, and will also apply when new curative drugs for hepatitis B virus become available. We also describe efforts to improve standards of hospital care for liver disease with better understanding of current service deficiencies and a new accreditation process for hospitals providing liver services. New commissioning arrangements for primary and community care represent progress, in terms of effective screening of high-risk subjects and the early detection of liver disease.

This article is an edited transcript of a panel discussion that was held in Melbourne in December 2017. The panel comprised four speakers, each with significant professional experience working at Cambodia’s hybrid tribunal, the Extraordinary Chambers in the Courts of Cambodia (ECCC). This panel was the first time such key insiders have come together outside of Cambodia and in an academic context to reflect on more than 10 years of the Court’s operation and their personal experiences there. There is much to be gained by enquiring into the lived experiences of those working at internationalised tribunals. In this article, unique insights are shared in relation to ECCC prosecution and the Court’s legacy of historical and procedural record, the Court’s establishment and outreach, the legal representation of ECCC participating victims (civil parties), and supporting witnesses across different cultural and legal contexts.

Chronic obstructive pulmonary disease (COPD) has a prevalence rate of between 4–10% in the UK (Halbert et al, 2003) and as such accounts for a large number of hospital admissions each year. Non-invasive ventilation (NIV) is now increasingly used to treat exacerbations of this condition and therefore nurses caring for these patients need an understanding of the rationale behind its instigation. This article reviews the literature pertaining to the use of NIV in the patient with COPD and provides a critique of the research available. The implications for practice have been highlighted through a discussion regarding the nursing management of the patient on NIV.

The effects of three types of stress/arousal on rat free-running circadian locomotor rhythms in constant darkness were investigated over a 93-day treatment period. Rats were subjected to 30-min daily immobilisation stress or 30-min novelty or to brief handling (n = 10/group). Seven of the 30 rats exhibited some changes in circadian parameters. Three rats (two immobilised, one handling) showed entrainment, three rats (one from each group) showed a change in r, and one rat (novelty) showed a phase advance. Thus, in total, 30% immobilisation, 20% percent novelty, and 20% handled rats showed circadian changes. These group changes paralleled changes in faecal boli and body weight, which were taken as indirect indices of the level of stress. Five of the seven changes took place when the end of the active phase (α), i.e., subjective dawn, coincided with the time of treatment and the other two when the onset of G, i.e., subjective dusk, coincided. Rat circadian locomotor rhythms appear much less susceptible to stress/arousal than those reported for hamsters.