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In obese individuals, nonalcoholic fatty liver disease (NAFLD) is common but often goes undiagnosed, and therefore untreated. The presence of significant fibrosis is a key determinant of NAFLD progression, and liver steatosis has substantial cardiovascular implications. We aimed to determine the diagnostic accuracy of common noninvasive diagnostic tests for steatosis and fibrosis in the obese. We recruited 182 severely and morbidly obese individuals undergoing bariatric surgery (age 44 ± 12 years, body mass index 45.1 ± 8.3 kg/m2). Medical history, blood tests and liver biopsy were taken on the day of surgery. Serum steatosis and fibrosis scores were calculated. In a subgroup of patients, transient elastography with controlled attenuation parameter (TE/CAP) (n= 82) and proton magnetic resonance spectroscopy (1H-MRS) (n= 49) were performed. 1H-MRS had excellent diagnostic accuracy for steatosis, with strong correlation to steatosis (r= 0.647, p< 0.001), good AUROC (0.852, p= 0.001), sensitivity (81.3%) and specificity (87.5%). However, due to low feasibility in this cohort (65.3% success), this was substantially decreased with intention-to-diagnose analysis (sensitivity 50.0%, specificity 60.9%). CAP had good feasibility (80.5%), and performed better in intention-to-diagnose analysis (AUROC 0.688, sensitivity 84.8%, specificity 47.2%). Serum steatosis scores performed poorly, with comparable accuracy to ALT. For significant fibrosis, TE had the best accuracy (AUROC 0.903, p= 0.007), which remained reasonable after intention-to-diagnose analysis (sensitivity 100%, specificity 59.0%). A combination approach using CAP with ALT for steatosis and TE with Forn index for fibrosis yielded reasonable overall accuracy. 1H-MRS and TE/CAP had greatest accuracy for NAFLD-related steatosis and fibrosis. Failure rates in obesity significantly diminished diagnostic ability. Use of a combination of serum and imaging tests improved overall feasibility of assessment and diagnostic accuracy in obese individuals.

AbstractOptimizing research on the developmental origins of health and disease (DOHaD) involves implementing initiatives maximizing the use of the available cohort study data; achieving sufficient statistical power to support subgroup analysis; and using participant data presenting adequate follow-up and exposure heterogeneity. It also involves being able to undertake comparison, cross-validation, or replication across data sets. To answer these requirements, cohort study data need to be findable, accessible, interoperable, and reusable (FAIR), and more particularly, it often needs to be harmonized. Harmonization is required to achieve or improve comparability of the putatively equivalent measures collected by different studies on different individuals. Although the characteristics of the research initiatives generating and using harmonized data vary extensively, all are confronted by similar issues. Having to collate, understand, process, host, and co-analyze data from individual cohort studies is particularly challenging. The scientific success and timely management of projects can be facilitated by an ensemble of factors. The current document provides an overview of the ‘life course’ of research projects requiring harmonization of existing data and highlights key elements to be considered from the inception to the end of the project.

AbstractThe herbicides that inhibit 4-hydroxyphenylpyruvate dioxygenase (HPPD) are primarily used for weed control in corn, barley, oat, rice, sorghum, sugarcane, and wheat production fields in the United States. The objectives of this review were to summarize 1) the history of HPPD-inhibitor herbicides and their use in the United States; 2) HPPD-inhibitor resistant weeds, their mechanism of resistance, and management; 3) interaction of HPPD-inhibitor herbicides with other herbicides; and 4) the future of HPPD-inhibitor-resistant crops. As of 2022, three broadleaf weeds (Palmer amaranth, waterhemp, and wild radish) have evolved resistance to the HPPD inhibitor. The predominance of metabolic resistance to HPPD inhibitor was found in aforementioned three weed species. Management of HPPD-inhibitor-resistant weeds can be accomplished using alternate herbicides such as glyphosate, glufosinate, 2,4-D, or dicamba; however, metabolic resistance poses a serious challenge, because the weeds may be cross-resistant to other herbicide sites of action, leading to limited herbicide options. An HPPD-inhibitor herbicide is commonly applied with a photosystem II (PS II) inhibitor to increase efficacy and weed control spectrum. The synergism with an HPPD inhibitor arises from depletion of plastoquinones, which allows increased binding of a PS II inhibitor to the D1 protein. New HPPD inhibitors from the azole carboxamides class are in development and expected to be available in the near future. HPPD-inhibitor-resistant crops have been developed through overexpression of a resistant bacterial HPPD enzyme in plants and the overexpression of transgenes for HPPD and a microbial gene that enhances the production of the HPPD substrate. Isoxaflutole-resistant soybean is commercially available, and it is expected that soybean resistant to other HPPD inhibitor herbicides such as mesotrione, stacked with resistance to other herbicides, will be available in the near future.

ABSTRACT:Polybius (c. 200–118 bc) is a notoriously combative historian, gleefully attacking his fellow historians for their moral failings and intellectual crimes, and their works for their misleading errors and grave distortions. But Polybius sometimes appears guilty himself of some of the same faults he finds in others. This paper aims to assess Polybius’ quality and reliability as a writer of history on his own terms, that is, according to the strict standards he sets for other historians, with the ultimate aim of determining whether his Histories marks a return to the high historiographical standards set by Polybius’ famous predecessor Thucydides, or perpetrates the same historiographical high crimes and misdemeanours he accuses his contemporary historical writers of committing.

Editor: A further nine-month extension to the commercial property eviction moratorium in many cases only delays the inevitable--it's unlikely in itself to save the occupier but could cause terminal damage [...]

AimsHip fracture commonly affects the frailest patients, of whom many are care-dependent, with a disproportionate risk of contracting COVID-19. We examined the impact of COVID-19 infection on hip fracture mortality in England.MethodsWe conducted a cohort study of patients with hip fracture recorded in the National Hip Fracture Database between 1 February 2019 and 31 October 2020 in England. Data were linked to Hospital Episode Statistics to quantify patient characteristics and comorbidities, Office for National Statistics mortality data, and Public Health England’s SARS-CoV-2 testing results. Multivariable Cox regression examined determinants of 90-day mortality. Excess mortality attributable to COVID-19 was quantified using Quasi-Poisson models.ResultsAnalysis of 102,900 hip fractures (42,630 occurring during the pandemic) revealed that among those with COVID-19 infection at presentation (n = 1,120) there was a doubling of 90-day mortality; hazard ratio (HR) 2.09 (95% confidence interval (CI) 1.89 to 2.31), while the HR for infections arising between eight and 30 days after presentation (n = 1,644) the figure was greater at 2.51 (95% CI 2.31 to 2.73). Malnutrition (1.45 (95% CI 1.19 to 1.77)) and nonoperative treatment (2.94 (95% CI 2.18 to 3.95)) were the only modifiable risk factors for death in COVID-19-positive patients. Patients who had tested positive for COVID-19 more than two weeks prior to hip fracture initially had better survival compared to those who contracted COVID-19 around the time of their hip fracture; however, survival rapidly declined and by 365 days the combination of hip fracture and COVID-19 infection was associated with a 50% mortality rate. Between 1 January and 30 June 2020, 1,273 (99.7% CI 1,077 to 1,465) excess deaths occurred within 90 days of hip fracture, representing an excess mortality of 23% (99.7% CI 20% to 26%), with most deaths occurring within 30 days.ConclusionCOVID-19 infection more than doubles the rate of early hip fracture mortality. Those contracting infection between 8 and 30 days after initial presentation are at even higher mortality risk, signalling the potential for targeted interventions during this period to improve survival.Cite this article: Bone Joint J2022;104-B(10):1156–1167.

According to the 2011 census, people 65 and older make up more than 13 percent of the U.S. population. Perhaps you have seen an elderly or visually impaired person attempting [...]

Aggressive patients often target psychiatrists and psychiatric residents, yet most clinicians are insufficiently trained in violence risk assessment and management. Consequently, many clinicians are reluctant to diagnose and treat aggressive and assaultive features in psychiatric patients and instead focus attention on other axis I mental disorders with proven pharmacological treatment in the hope that this approach will reduce the aggressive behavior. Unclear or nonexistent reporting policies or feelings of self-blame may impede clinicians from reporting assaults, thus limiting our knowledge of the impact of, and best response to, aggression in psychiatric patients. The authors present the case of a young adult inpatient with a long history of antisocial and assaultive behavior who struck and injured a psychiatric resident. With this case in mind, the authors discuss the diagnostic complexities related to violent patients, the importance of assessing violence risk when initially evaluating a patient, and the relevance of risk assessment for treatment considerations and future management. This report illustrates common deficiencies in the prevention of violence on inpatient psychiatric units and in the reporting and response to an assault, and has implications for residency and clinician training.

Dear Retro Gamer, Let us take a moment to think of all the incredible games that were released in 1991, which is now 30 years ago. Lemmings, Street Fighter II, [...]

The article discusses the three pillars of Irregular Warfare education: institutional training and professional military education, personal self-study, and unit-level experiential learning. It emphasizes the importance of Irregular Warfare education due to a lack of intellectual thought and discourse on counterinsurgency, counterterrorism, and other key activities. The article suggests that the Department of Defense should prioritize educating commissioned and noncommissioned officers at all levels to mitigate policy strategy disconnects. It also highlights the role of self-study and experience in developing a comprehensive understanding of Irregular Warfare. Ultimately, the article argues that a proper Irregular Warfare education is essential for the United States to gain a strategic and operational advantage in the present peer competition. [Extracted from the article]

Byline: Paul Burton Rhode Island's pension fund earned more than $530 million in investment gains in 2016, the most in three years, General Treasurer Seth Magaziner told members of the [...]

Byline: Paul Burton Rhode Island wants to modernize its manufacturing industries with an initiative focused on economic development and expansion. It's all with an eye toward boosting the state's economy. [...]

Australia is currently facing a severe housing crisis, with an increasing number of people experiencing housing stress and homelessness. The housing market has not been able to meet the needs and preferences of most people, and there has been a shortage of new homes being built. Factors such as changes in household types and a decline in social housing have contributed to the crisis. The article suggests that temporary and mobile housing options, such as tents, caravans, and mobile homes, could be a solution to the housing crisis, similar to how they are used after natural disasters. However, there is reluctance to accept these unconventional measures due to concerns about human rights, long-term solutions, and potential negative impacts. [Extracted from the article]

Public sector net debt, which is derived from the consolidated debt of the public sector by deducting the public sector's holdings of liquid assets, as at end March 2002, is discussed. It was found that the net debt was around four million pound sterling more than that at end-March 2001.

Recognizing clinical instability in Australian hospital patients before cardiac arrest or unanticipated admission to intensive care should be a hospital goal, although very few patients suffer a critical event (CE) in the hospital. A retrospective study of medical records of all CE patients has been carried out in a 300-bed metropolitan teaching hospital with a 7-bed ICU. For comparison, data on hospital and ICU patients were assembled. Before a CE, patients usually manifest abnormalities in simple physical observations and laboratory test results.

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Byline: Paul Burton New York's Metropolitan Transportation Authority put business with Wells Fargo Securities and the firm's approval as a senior manager for bond transactions on hold pending its review [...]

One of the biggest undertakings the Australian gold industry for some time, Cadia is poised to take Newcrest into the next millennium. Newcrest Mining's Cadia project, near Orange in New [...]

A two part survey is discussed addressing regulating access and controlling access to Internet sites by others.

Introduction Neonatal encephalopathy is an important clinical problem in infants born full term, associated with neonatal mortality and morbidity as well as unfavourable long term neurodevelopmental outcome. Neonatal encephalopathy is [...]

Teleworkers working either from their homes or from offices were interviewed to identify differences and similarities existing between them and to see if teleworking stereotypes described in the literature would be confirmed. Results offered evidence supporting the stereotypical image of teleworkers as women having to look after children and familial responsibilities. However, no conclusive evidence was obtained to support the view that isolation was a major problem for these workers. On the contrary, teleworkers emphasized the benefits of being able to work alone. Differences were found in terms of the environmental aspects of their profession.

Abstract Objective--To determine the cumulative prevalences of wheeze and doctor diagnosed asthma and the point prevalences of recurrent cough and wheeze in children aged 5 years and under. Design--Questionnaire survey [...]

The article discusses the state of planning for the 2032 Olympic and Paralympic Games in Brisbane, Australia. The Queensland government has faced criticism for its handling of the planning process, particularly regarding the proposed venues. The International Olympic Committee (IOC) introduced the "new norm" principles to reduce costs and encourage the use of temporary and reusable venues, but the review recommended building a new stadium at Victoria Park, which was rejected. Instead, Suncorp Stadium will be the main stadium for the opening and closing ceremonies, and the Queensland Sport and Athletics Centre (QSAC) will be upgraded for athletics events. The article raises questions about the long-term benefits and legacy of these venues for the community. [Extracted from the article]

The ethical aspects of the collection and dissemination of information by librarians while selecting books for libraries are discussed.

Background: Liver biopsy remains the gold standard for characterizing and evaluating treatment response in nonalcoholic fatty liver disease (NAFLD). Liver heterogeneity and sampling variability can affect the reliability of results. This study aimed to compare histological variability of intraoperative wedge and core liver biopsies from different lobes in bariatric patients, to better inform surgeons on biopsy method and guide interpretation of results. Methods: We prospectively recruited bariatric surgical patients. Intraoperative core biopsies were taken from the left and right lobe, with a wedge biopsy taken from the left. All biopsies were graded by a specialist liver pathologist, blinded to clinical details and biopsy site. Concordance of histological findings between sites was evaluated. Results: There were 91 participants (72.2% female), mean age 46.8?±?12.0 years, body mass index 45.9?±?9.4 kg/m2. There was no significant pattern for up- or down-grading disease dependent on biopsy technique. Moderate to strong agreement was seen in the presence of NAFLD and nonalcoholic steatohepatitis (NASH, ??=?0.609–0.865, p?&lt;?0.001) between biopsy sites. Individual components (steatosis, inflammation, ballooning) showed weaker agreement (??=?0.386–0.656, p?&lt;?0.01). Fibrosis showed particularly poor agreement (??=?0.223–0.496, p?&lt;?0.01). Detection of pathology improved with a combination of biopsy techniques, compared to a single biopsy method. Conclusion: Overall diagnosis of NAFLD or NASH shows good agreement between biopsy sites, but individual components, particularly fibrosis stage, vary significantly. Clinicians should consider biopsies from varied sites, to better assess liver disease severity. These data have important implications in fibrosis assessment of NAFLD and are relevant in the interpretation of histological efficacy of investigational pharmacotherapies.

This article introduces the concept of ‘Sea Cities’ to emphasize a range of tactics to acknowledge the relationship between the sea and cities. This concept is critical for the possibility of integrating future aquatic-based urbanism to address climate change, and in particular, the issue of rising sea levels, which is currently faced by the majority of coastal cities. We compare and assess the tactics of four sea cities (i.e., to fortify, accommodate, release, and floating) against the case study of Jakarta. Jakarta is deemed to be among the metropolitan cities most vulnerable to sea level rise, owing to overpopulation alongside the fact that its land is sinking rapidly due to massive urban development. In order to understand the prospects and pitfalls of each tactic for Jakarta, we analyse scholarly literature on the subject, official government reports and documents, as well as policy briefs released by governments at the national level. This study finds that massive hard structural solutions are not only insufficient but also ineffective towards solving the challenges of climate change in Jakarta, especially the rising sea level. At the same time, it also identifies that while the combination of accommodating and floating tactics has never been considered as future a planning option, this could enable more resilient and adaptive solutions for the future development trajectory of Jakarta. In doing so, it could also provide important transferrable lessons for other coastal cities, especially those within developing countries.

Byline: Paul Burton Post-Sandy rebuilding again dominated the agenda as U.S. Housing and Urban Development Secretary Shaun Donovan visited New York City Mayor Michael Bloomberg and New Jersey Gov. Chris [...]

ABSTRACTMessenger RNA (mRNA)-based vaccine platforms used for the development of mRNA-1273 and BNT162b2 have provided a robust adaptable approach to offer protection against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). However, as variants of concern (VoCs), such as omicron and associated sub-variants, emerge, boosting strategies must also adapt to keep pace with the changing landscape. Heterologous vaccination regimens involving the administration of booster vaccines different than the primary vaccination series offer a practical, effective, and safe approach to continue to reduce the global burden of coronavirus disease 2019 (COVID-19). To understand the immunogenicity, effectiveness, and safety of heterologous mRNA-based vaccination strategies, relevant clinical and real-world observational studies were identified and summarized. Overall, heterologous boosting strategies with mRNA-based vaccines that are currently available and those in development will play an important global role in protecting individuals from COVID-19 caused by emerging VoCs.

Abstract Objective--To assess whether mini flow meters used to measure peak expiratory flow can track changes in lung function and indicate clinically important changes. Design--Comparison of measurements with a spirometer [...]

Byline: Paul Burton Budget realignments at the Pentagon could prove a boon for investment bankers as defense contractors look to consolidate or acquire new business lines in hot areas. The [...]

Byline: Paul Burton Gleacher & Co., a firm long known for its M&A advisory work, wants to beef up the business of selling debt and equity for companies, and it [...]

Byline: Paul Burton Bluestone Capital Partners has brought on 10 bankers since its inception in October, and its co-founders plan to add on some more seasoned dealmakers in the coming [...]

Byline: Paul Burton Cross-border mergers and acquisitions kept Wall Street busy last year, and this year has had a lively start, because of strength in the financial markets and expectations [...]

Byline: Paul Burton Williams Capital, a firm best known for its work in debt markets, has expanded into equity research in the hopes of filling a void left by some [...]

Byline: Paul Burton At first blush, Houlihan Lokey may appear to be a specialist in middle-market companies, but as its co-chief executive, Jeff Werbalowsky, will tell you, its work goes [...]