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Background & aimsA recent panel of international experts proposed the disease acronym metabolic (dysfunction)-associated fatty liver disease (MAFLD) in lieu of nonalcoholic fatty liver disease (NAFLD). We aimed to estimate the burden of and risk factors for NAFLD and MAFLD, and to examine the concordance between definitions in a Veterans population.MethodsWe conducted a cross-sectional study among randomly selected patients within primary care at the Houston Veterans Affairs (VA) facility. Participants completed a survey, provided blood, and underwent Fibroscan. In the absence of heavy alcohol, hepatitis C virus and hepatitis B virus, a controlled attenuation parameter median ≥290 dB/m was used to define NAFLD, whereas MAFLD was defined as controlled attenuation parameter median ≥290 dB/m and either body mass index ≥25 kg/m2 or diabetes, or 2 or more of the following: hypertension, high triglycerides, low high-density lipoprotein cholesterol, and high low-density lipoprotein cholesterol.ResultsThe mean age of participants was 50.9 years, 55.4% were women, 42.8% were white, and 43.8% were Black. The prevalence of NAFLD was 40.6% (82/202). All 82 patients with NAFLD had a body mass index ≥25 kg/m2, and therefore met our criteria for MAFLD (ie, 100% concordance). Compared with patients with no metabolic trait, patients with ≥3 traits had a 48-fold (adjusted odds ratio, 47.6; 95% confidence interval, 11.3-200) higher risk of NAFLD/MAFLD. Overall, 19 participants (9.4% of the total, 15.9% of those with NAFLD) had at least moderate fibrosis.ConclusionsNAFLD was present in 40% of Veterans registered in primary care; 9.4% of veterans had at least moderate hepatic fibrosis, with most having concurrent NAFLD. There was perfect concordance between NAFLD and the alternative MAFLD definition.

BackgroundDiet is associated with metabolic (dysfunction)-associated fatty liver disease (MAFLD), but the dietary composition associated with MAFLD risk has not been well-examined.AimThe purpose of this study was to assess the association of two healthy eating indices with the presence and severity of MAFLD in a sample of Veterans in a primary care setting.MethodsThis was a single center cross-sectional study using a random stratified sample of Veterans enrolled in primary care. Participants underwent a Fibroscan and completed an interviewer-administered Diet History Questionnaire II from which we calculated the Healthy Eating Index-2015 and Alternate Mediterranean Diet Score. We used multivariable logistic regression models to assess associations of dietary quality with MAFLD.ResultsWe analyzed data from 187 participants, 53.5% of whom were female. On average, participants were 50.2 years of age (SD, 12.3 years) with an average BMI of 31.7 kg/m2. MAFLD was detected in 78 (42%) and at least moderate fibrosis in 12 (6%) participants. We found that the Alternate Mediterranean Diet Score was inversely associated with MAFLD (adjusted OR = 0.85, 95%CI 0.72-1.00), but controlling for BMI and total energy intake attenuated the association (adjusted OR = 0.92, 95%CI 0.74-1.15). We found no statistically significant associations between the Healthy Eating Index-2015 and MAFLD or advanced fibrosis.DiscussionWe found that the Alternate Mediterranean Diet Score was significantly associated with lower MAFLD risk in Veterans; however, the association was mediated by BMI and total energy intake. A Mediterranean-style diet could potentially help reduce the risk of MAFLD, particularly if it helps control total energy intake and weight.

Most of the academic literature indicates that high administrative status positively influences the development of a city, while the loss of such status leads to marginalisation. Most of these studies, however, investigated national capitals, and relatively little research has analysed the effect of a change in status at lower levels of government. Poland is an obvious subject for such research, due to the recent extensive reforms of its system of territorial government. This article presents the recent dynamics of socio-economic development in Polish cities and their relation to whether a city maintained or lost its status as a regional capital. These results enable us to identify correlations between the dynamics of socio-economic development and the status of a city. The nature of these correlations is more ambiguous than the results presented in previous studies. The findings of this study give new insight into the effect of changes in a city’s administrative status.

Purpose: To retrospectively analyze clinical outcomes of patients with "treatment‐resistant" neovascular age‐related macular degeneration or diabetic macular edema who were switched to intravitreal faricimab injections (IFIs) using a "real‐world" treat‐and‐extend (TAE) protocol. Methods: Seventy‐one eyes from 62 patients receiving antivascular endothelial growth factor injections were evaluated before and after switching to IFI. Demographic and clinical data were collected. Primary endpoints were treatment interval extension and presence of intraretinal or subretinal fluid on spectral‐domain optical coherence tomography (OCT) after switching to IFI. Secondary endpoints included best‐corrected visual acuity, average OCT central subfield thickness, and presence of a pigment epithelium detachment and pigment epithelium detachment height. Results: The average treatment interval after switching to IFI significantly increased from 37.6 ± 10.8 days to 45.2 ± 16.6 days (p = 0.0016). At the last follow‐up, 35% of eyes were able to achieve a fluid‐free status post‐IFI. A chi‐square test of independence validated this finding by showing a significant difference in the OCT findings trending towards less or no fluid on follow‐up (X2 [3, N = 71] = 13.0705; p = 0.0003). The average central subfield thickness decreased from 327.2 ± 89.1 μm to 294.8 ± 86.5 μm (p = 0.0294). Best‐corrected visual acuity, intraocular pressure, pigment epithelium detachment presence, and height had no significant difference after switching to IFI. Conclusions: In "treatment‐resistant" patients receiving anti‐VEGF therapy for neovascular age‐related macular degeneration or diabetic macular edema, switching to IFI in a "real‐world" TAE protocol led to statistically significant improvements in treatment interval and retinal fluid on spectral domain OCT. [ABSTRACT FROM AUTHOR]

The aim of this article is to determine and assess the changes in the central functions of major Polish cities in the context of Poland's 1999 administrative reform. This study covers a period of twenty-two years (1998–2019), which provides a solid perspective for evaluating the functional changes occurring within the current territorial division of the country. The conclusions indicate that the dynamics of changes in central functions in former provincial capitals differed from those in cities that retained this status. At the same time, it was found that the administrative reform sanctioned the scope and scale of earlier socio-economic dependencies in the present regional centers. The research results suggest that administrative reforms in Poland solidified existing socio-economic development paths in cities, but were not the sole catalyst for change. They point to a complex interaction of factors influencing urban evolution. By utilizing indicators that measure the centrality of cities in relation to their demographic potential, this research offers a quantitative assessment of the level of development of central functions, which is crucial for monitoring progress towards sustainable urbanization. By providing this information, this research also contributes to a broader discussion on the advancement and dynamics of sustainable urban development. [ABSTRACT FROM AUTHOR]

The course travelled by corneal epithelial cells from their stem cell niche at the limbus toward the vertex of the cornea is normally not evident due to their transparency, but in certain conditions, the epithelial cells can be rendered visible to the clinician. In such cases, the pathway taken by epithelial cells can manifest as a whorl pattern described using a variety of terms including hurricane keratitis/keratopathy, vortex keratopathy, whorl keratopathy, cornea verticillata, and at times, named after causative agents as exemplified by amiodarone keratopathy. Here, we briefly discuss the terminology used and the spectrum of conditions that can result in keratopathies with whorl patterns in human patients. We review the manifestations of such patterns in veterinary patients and discuss the state of understanding of the underlying forces that create the whorl distribution of epithelial cells on the ocular surface.

Purpose: Assessing front end engineering design (FEED) accuracy is significant for project owners because it can support informed decision-making, including confidence in cost and schedule predictions. A framework to measure FEED accuracy does not exist in the literature or in practice, not does systematic data directly linking FEED accuracy to project performance. This paper aims to focus first on gauging and quantifying FEED accuracy, and second on measuring its impact on project performance in terms of cost change, schedule change, change performance, financial performance and customer satisfaction. Design/methodology/approach: A novel measurement scheme was developed for FEED accuracy as a comprehensive assessment of factors related to the project leadership and execution teams, management processes and resources; to assess the environment surrounding FEED. The development of this framework built on a literature review and focus groups, and used the research charrettes methodology, guided by a research team of 20 industry professionals and input from 48 practitioners representing 31 organizations. Data were collected from 33 large industrial projects representing over $8.8 billion of installed cost, allowing for a statistical analysis of the framework's impact on performance. Findings: This paper describes: (1) twenty-seven critical FEED accuracy factors; (2) an objective and scalable method to measure FEED accuracy; and (3) data showing that projects with high FEED accuracy outperformed projects with low FEED accuracy by 20 percent in terms of cost growth in relation to their approved budgets. Practical implications: FEED accuracy is defined as the degree of confidence in the measured level of maturity of the FEED deliverables to serve as a basis of decision at the end of detailed scope, prior to detailed design. Assessing FEED accuracy is significant for project owners because it can support informed decision-making, including confidence in cost and schedule predictions. Originality/value: FEED accuracy has not been assessed before, and it turned out to have considerable project performance implications. The new framework presented in this paper is the first of its kind, it has been tested rigorously, and it contributes to both the literature body of knowledge as well as to practice. As one industry leader recently stated, "it not only helped to assess the quality and adequacy of the technical documentation required, but also provided an opportunity to check the organization's readiness before making a capital investment decision." [ABSTRACT FROM AUTHOR]

Peripheral neuropathy (PN) is one of the most common diseases of the peripheral nervous system. Symptoms range from mild sensory signs to severe neuropathic pain. Untreated PN is progressive and can lead to complications and impair quality of life (QoL). However, PN prevalence is underestimated in the general population and affected individuals often remain undiagnosed. This study aimed to contribute to the global generation of prevalence data and determine sociodemographic and disease-related characteristics of PN sufferers. This cross-sectional study collected information on PN prevalence and associated factors in the adult population (40–65 years) of the Mexico City area. Participants were recruited in public places and screened for PN using the Michigan Neuropathy Screening Instrument (MNSI). Subjects with PN answered the Neuropathy Total Symptom Score-6 (NTSS-6), the Short Form-36 Health Survey (SF-36), and the QoL Pharmacoeconomic Questionnaire. Statistical analysis included descriptive methods and calculation of PN prevalence with 95% confidence intervals. Of 3066 participants, 448 had PN based on the MNSI physical examination. The overall PN prevalence was 14.6%, with the highest (18.9%) seen in subjects aged 61–65 years. PN was undiagnosed in 82.6%, and 62.9% had never heard of PN. Although half of all subjects had only mild PN symptoms, QoL was impacted in 91.8%. The results confirm that PN prevalence in the general population is high. Despite the disease burden, most affected persons are undiagnosed and unaware of the disease. Almost all felt their QoL was impacted. The data highlight the need to raise awareness and identify undiagnosed individuals to prevent complications. [ABSTRACT FROM AUTHOR]