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Background and Aims Nonalcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease in the United States and is closely associated with obesity and insulin resistance (IR). Weight loss is the best treatment for NAFLD. Endoscopic sleeve gastroplasty (ESG) is a promising endoscopic procedure for treatment of obesity. Our aim is to evaluate the change in IR and estimated hepatic steatosis and fibrosis after ESG. Methods One hundred eighteen patients with obesity and NAFLD underwent ESG and were followed for 2 years. Weight loss was evaluated as % total body weight loss. IR was evaluated using the homeostasis model assessment of insulin resistance (HOMA-IR). The previously validated hepatic steatosis index and NAFLD fibrosis score were used to estimate hepatic steatosis and risk of fibrosis. Results Patients' mean body mass index was 40 ± 7 kg/m2 at baseline. Eighty-four percent of patients completed 2 years of follow-up. At 2 years, the mean total body weight loss was 15.5% (95% confidence interval, 13.3%-17.8%). Patients' HOMA-IR improved significantly from 6.7 ± 11 to 3.0 ± 1.6 after only 1 week from ESG (P = .019) with continued improvement up to 2 years (P = .03). Patients' hepatic steatosis index score improved significantly, decreasing by 4 points per year (P for trend, Conclusions Our results suggest a significant and sustained improvement in estimated hepatic steatosis and fibrosis after ESG in patients with NAFLD. Importantly, we showed an early and weight-independent improvement in insulin resistance, which lasted for 2 years after the procedure.

Rechargeable zinc-ion batteries (RZIBs) are mostly powered by aqueous electrolytes. However, uncontrolled water interactions often confer a small voltage window and poor battery capacity retention. Here, we explore replacing water with ethylene glycol as the primary solvent in zinc electrolyte formulations. The assembled batteries reveal suppressed electrolyte-induced parasitic reactions, leading to (1) expanded voltage stability windows up to 2.2 V, (2) prolonged zinc stripping/plating stability up to 2.4 times longer compared to the water-based counterparts, and (3) doubled cathode capacity retentions as observed in full-cell Zn-FeVO4 RZIBs. Using a combination of synchrotron EXAFS and FTIR, we investigate the molecular level salt-solvent interactions and explain how the chelation ability of EG ligands reduces parasitic reactions to enable the enhanced electrochemical performances. The structural insights should provide guidelines on the selection of salt, concentration, and chelating solvents for robust multivalent-ion battery systems. National Research Foundation (NRF) Accepted version This work was funded by the National Research Foundation of Singapore Investigatorship Award Number NRFI2017-08

Rechargeable Al-ion aqueous batteries (AIABs) are emerging contenders for massive battery systems due to economic, abundance, environmental, and safety advantages. However, the high capacity of metallic-Al remains untapped due to native oxide barrier formation. Engineering oxide removal by treating Al metal with an ionic liquid mixture solves this problem but the role of this treated-Al (TAl) in influencing full-cell battery performance is not yet fully understood. At the same time, the stability and compatibility of the coating layer applied on Al metal remain unexplored for long-term handling in full-cell assembly lines. Here, we explore the above two aspects of TAl in the context of a full-cell AIAB. First, a highly stable cathode material, NMnHCF, is demonstrated to successfully store an Al-ion by reversibly transforming from the monoclinic to tetragonal phase. A high energy density surpassing previous equivalent reports has been reported. Second, it is revealed that combinations of electrolyte–TAl pairings significantly influence the overall battery performance, wherein electrolyte conductivity influences the Al plating/stripping overpotential, which in turn dictates the overall battery performance. We also document that chlorinated coatings on TAl are stable under ambient atmosphere for at least 40 h and prevent reoxidation of the bulk aluminum metal during battery fabrication and electrochemical cycling National Research Foundation (NRF) Accepted version This work was financially supported by the National Research Foundation of Singapore (NRF) Investigatorship Award Number NRFI2017-08/NRF2016NRF-NRFI001-22.

BackgroundThere is growing recognition of the role of chronic liver disease in brain health, but the impact of liver fibrosis on dementia risk was unclear. We evaluated the association between liver fibrosis and incident dementia using data from a large prospective cohort study.MethodsWe performed a cohort analysis using data from the UK Biobank study, which prospectively enrolled approximately 500,000 adults starting 2007 and continues to follow them. Liver fibrosis was defined using validated cutoffs of the Fibrosis-4 (FIB-4) liver fibrosis score. The primary outcome was incident dementia, ascertained using a validated approach based on participants’ hospital record and mortality data. Secondary outcomes were Alzheimer’s disease and vascular dementia. We excluded participants with prevalent dementia. We used Cox proportional hazards models to evaluate the association between liver fibrosis and incident dementia while adjusting for potential confounders. In additional models, the FIB-4 score was used as a continuous independent variable. Prespecified interaction analyses tested for effect modification by sex, metabolic syndrome, and apolipoprotein E4 carrier status.ResultsAmong 455,226 participants included in this analysis, the mean age was 56.5 years and 54% were women. Standard liver chemistries were largely in the normal range. However, 2.17% (95% CI, 2.13-2.22%) had liver fibrosis based on their FIB-4 score. The rate of dementia per 1,000 person-years was 1.76 (95% CI, 1.50-2.07) in participants with liver fibrosis and 0.52 (95% CI, 0.50-0.54) in those without. After adjusting for demographics, socioeconomic deprivation, educational attainment, metabolic syndrome, hypertension, diabetes, dyslipidemia, and tobacco and alcohol use, liver fibrosis was associated with an increased risk of dementia (HR, 1.52; 95% CI, 1.22-1.90). An independent association was also noted between FIB-4, treated as a continuous variable, and dementia (HR per unit, 1.29; 95% CI, 1.20-1.39). Effect modification by sex, metabolic syndrome, and apolipoprotein E4 carrier status was not seen.ConclusionLiver fibrosis in middle age was associated with an increased risk of incident dementia, independent of metabolic syndrome and shared risk factors. Liver fibrosis may be an underrecognized risk factor for dementia.

Challenged by the Covid-19 crisis, CEOs must rethink about how to operate and exist in the new working environment. We examine if managerial ability of the CEO impacts firm performance during the crisis period. We find a positive and significant association between the CEO managerial ability and both the cumulative raw and abnormal returns. We also find that firms with better CEO managerial ability are more resilient and have higher ROE than their counterparts. We find that the CEOs with higher managerial ability have higher pre-pandemic liquidity which in part explains the better performance amid the Covid-19 crisis.

Acute-on-chronic liver failure (ACLF) carries high short-term mortality. The North American Consortium for the Study of End-Stage Liver Disease (NACSELD)-ACLF score, positive if ≥2 organ failures are present, is a bedside tool that predicts short-term mortality in patients with cirrhosis. However, it was created using major liver referral centers, where a minority of patients with cirrhosis are hospitalized. Therefore, this study used the Nationwide Inpatient Sample, a nationally representative database, from 2005 to 2014 to externally validate the NACSELD-ACLF score in a cohort of patients with decompensated cirrhosis who were identified by a validated algorithm. Organ failures were identified using diagnosis codes. The primary objective was to evaluate the association between the NACSELD-ACLF score and inpatient mortality, whereas secondary objectives compared outcomes depending on presence of infection or hospitalization at a transplant center. Multivariate logistic regression was used to compare outcomes, and area under the curve was calculated. There were 1,523,478 discharges that were included with 106,634 (7.0%) having a positive NACSELD-ACLF score. Patients were a mean 58 years old, and a majority were white men. Infection was present in 33.7% of the sample. Inpatient survival decreased with each organ failure and if infection was present. Patients with the NACSELD-ACLF score had significantly lower inpatient survival on crude (94% versus 48%; P < 0.001) and multivariate analysis (odds ratio [OR], 0.08; 95% confidence interval [CI], 0.07-0.08) and area under the receiver operating characteristic curve 0.77 (95% CI, 0.77-0.78). Liver transplant centers had clinically similar but significantly better survival at each organ failure, in patients with the NACSELD-ACLF score, and on multivariate analysis (OR, 1.17; 95% CI, 1.13-1.22). Using a national cohort, our study validated the NACSELD-ACLF score as an excellent, simple bedside tool to predict short-term survival in patients with decompensated cirrhosis.

Aqueous rechargeable aluminium-ion batteries (AIBs) are promising post lithium-ion battery candidates. However, the capacity and cycling stability are limited by the cathode materials, hindering their widespread application. Herein, bronze-type vanadium dioxide (VO2–B) holey nanobelts have been designed as the cathode material to improve both the capacity and cycling stability for high-performance aqueous AIBs. Benefiting from the unique shear structure and two-dimensional holey nanobelt morphology, the VO2–B electrode delivers a superior specific capacity of up to 234 mA h g−1 at 150 mA g−1 and exhibits a high capacity retention of 77.2% over 1000 cycles at 1 A g−1, which are among the best cathode performances reported for aqueous AIBs. Moreover, a combination of electro-kinetic analysis and ex situ structural evolution characterization experiments reveals the reaction storage mechanism underlying the superior performance. Specifically, proton and Al3+ ions can reversibly co-intercalate/de-intercalate into/from VO2–B. The integration of shear structure and unique holey nanobelts may open the route to the design of high-performance cathodes for multi-valence ion batteries. National Research Foundation (NRF) Accepted version This work was financially supported by the National Research Foundation of Singapore (NRF) Investigatorship Award Number NRFI2017-08/NRF2016NRF-NRFI001-22.

Purpose There are limited and conflicting data regarding the impact of comorbid hepatitis C virus (HCV) infection on diabetic retinopathy (DR). This study sought to compare the prevalence and severity of DR among patients with diabetes mellitus (DM) with and without HCV. Patients and methods This was a retrospective, case-control study of patients with DM comparing 120 patients with comorbid HCV and 120 age-matched controls. DR prevalence and several measures of severity were compared between groups. Subgroup analyses were performed among HCV patients with cirrhosis, comorbid HIV, or history of treatment with interferon. Statistical analysis for between-group comparisons utilized both univariate and multivariate analyses. Results Cases and controls exhibited similar baseline characteristics: average hemoglobin A1c, DM duration, and age (p>0.05). Among cases and controls, there was no difference in DR prevalence (35.8% versus 42.5%, respectively, p=0.29) or severity (p>0.05). Within the HCV subgroup, DR severity was reduced in patients with HIV or cirrhosis. However, multivariate analysis identified reduced DM duration in these subgroups as the primary contributor to lesser DR severity, rather than HIV or cirrhosis. Conclusion In this study, comorbid HCV did not modulate the prevalence or severity of DR among patients with DM. These findings may inform clinical monitoring among HCV-positive diabetics undergoing ophthalmic evaluation.

Developing an aluminum-ion aqueous battery is extremely attractive for prospects of creating a super cheap, environmentally friendly and safe energy storage system. However, a lack of reversible cathode materials hampers the use of metallic Al as a high-capacity anode in an aqueous electrolyte. As opposed to insertion-type cathodes, the performance of conversion-type cathodes for Al-ion electrochemistry in an aqueous electrolytic environment remains poorly explored. As a first attempt to understand the performance of such conversion type materials for Al-ion intake, we herein report FeVO4 as a potential cathode material with a significantly high capacity of 350 mA h g−1. We use a combination of inhouse and synchrotron-based characterization techniques to confirm Al-ion electrochemical reaction with FeVO4, and also determine how electrolyte pH has a mechanistic influence on the reversibility of aluminum-ion aqueous batteries. Accepted version

Background & Aims Chronic liver disease (CLD) represents a major global health burden. We undertook this study to identify the factors associated with adverse outcomes in patients with CLD who acquire the novel coronavirus-2019 (COVID-19). Methods We conducted a multi-center, observational cohort study across 21 institutions in the United States (US) of adult patients with CLD and laboratory-confirmed diagnosis of COVID-19 between March 1, 2020 and May 30, 2020. We performed survival analysis to identify independent predictors of all-cause mortality and COVID-19 related mortality, and multivariate logistic regression to determine the risk of severe COVID-19 in patients with CLD. Results Of the 978 patients in our cohort, 867 patients (mean age 56.9 ± 14.5 years, 55% male) met inclusion criteria. The overall all-cause mortality was 14.0% (n = 121), and 61.7% (n = 535) had severe COVID-19. Patients presenting with diarrhea or nausea/vomiting were more likely to have severe COVID-19. The liver-specific factors associated with independent risk of higher overall mortality were alcohol-related liver disease (ALD) (hazard ratio [HR] 2.42, 95% confidence interval [CI] 1.29–4.55), decompensated cirrhosis (HR 2.91 [1.70–5.00]) and hepatocellular carcinoma (HCC) (HR 3.31 [1.53–7.16]). Other factors were increasing age, diabetes, hypertension, chronic obstructive pulmonary disease and current smoker. Hispanic ethnicity (odds ratio [OR] 2.33 [1.47–3.70]) and decompensated cirrhosis (OR 2.50 [1.20–5.21]) were independently associated with risk for severe COVID-19. Conclusions The risk factors which predict higher overall mortality among patients with CLD and COVID-19 are ALD, decompensated cirrhosis and HCC. Hispanic ethnicity and decompensated cirrhosis are associated with severe COVID-19. Our results will enable risk stratification and personalization of the management of patients with CLD and COVID-19. Clinicaltrials.gov number NCT04439084

Rechargeable zinc-ion batteries (RZIBs) utilizing aqueous electrolytes can offer high safety, low cost, and fast charge/discharge ratings for large-scale energy storage. The use of water as electrolyte solvent facilitates low cost, facile processing, reduced safety concerns, and fast ion kinetics. However, free water molecules also instigate many simultaneously occurring undesired reactions in the RZIB system, leading to capacity fade and limited operational lifetime. Here, our review traces each undesired reaction and its cascade of detrimental ramifications on RZIB cycling. We discuss balancing merits, reported strategies, and future perspectives to mitigate these undesired reactions and further improve the RZIBs’ operational lifetimes. National Research Foundation (NRF) Submitted/Accepted version This work was funded by the National Research Foundation of Singapore Investigatorship Award Number NRFI2017-08.

Social network platforms are generally used to share positive, constructive, and insightful content. However, in recent times, people often get exposed to objectionable content like threat, identity attacks, hate speech, insults, obscene texts, offensive remarks or bullying. Existing work on toxic speech detection focuses on binary classification or on differentiating toxic speech among a small set of categories. This paper describes the system proposed by team Cisco for SemEval-2021 Task 5: Toxic Spans Detection, the first shared task focusing on detecting the spans in the text that attribute to its toxicity, in English language. We approach this problem primarily in two ways: a sequence tagging approach and a dependency parsing approach. In our sequence tagging approach we tag each token in a sentence under a particular tagging scheme. Our best performing architecture in this approach also proved to be our best performing architecture overall with an F1 score of 0.6922, thereby placing us 7th on the final evaluation phase leaderboard. We also explore a dependency parsing approach where we extract spans from the input sentence under the supervision of target span boundaries and rank our spans using a biaffine model. Finally, we also provide a detailed analysis of our results and model performance in our paper., Comment: 9 pages, accepted at SemEval-2021 co-located with ACL-IJCNLP 2021

Objective The 2019 novel coronavirus disease (COVID-19) has triggered a rapidly expanding global pandemic in which patients exhibit a wide spectrum of disease severity. Given the high prevalence of obesity in the United States, we hypothesized that the presence of obesity may play a role in the clinical course of patients with COVID-19. Methods This is a retrospective review of adult patients admitted with confirmed severe acute respiratory syndrome coronavirus 2. Demographics, clinical characteristics, laboratory data, and clinical outcomes were abstracted. BMI (kilograms per meter squared) was analyzed with regard to a composite outcome of intensive care unit (ICU) admission or death and intubation rate. Results About 770 patients were included (61% male, mean age 63.5 years). Patients with obesity were more likely to present with fever, cough, and shortness of breath. Obesity was also associated with a significantly higher rate of ICU admission or death (RR = 1.58, P = 0.002) even after adjusting for age, race, and troponin level. Conclusions Patients with obesity had an increased risk for critical illness leading to ICU admission or death compared with normal weight individuals. This study confirms that obesity is a major risk factor for COVID-19 disease severity, significantly impacting disease presentation and critical care requirements.

Elemental aluminum is an exciting battery anode material due to its high abundance and volumetric capacity (8040 mAh cm−3). However, it tends to form a stubborn surface oxide layer that blocks ion transport through the electrode–electrolyte interphase and stops battery cyclability. To circumvent this problem, here we engineer an artificial protective barrier layer on metallic Al by using AlCl3 + urea and AlCl3 + triethylamine hydrochloride eutectic coating formulations. We find both coatings provide significantly facile ion migration kinetics at the anode/electrolyte interface, enabling a drastic reduction in anodic electroplating/stripping overpotentials, but AlCl3 + urea is superior. Using depth-profiling XPS spectroscopy and impedance studies, we find that the AlCl3 + urea derived artificial interphase is also stable in ambient air, affording extended protection for metallic Al anodes from air-oxidation in the form of a battery electrode SEI. We demo the eutectic-treated Al anode (UTAl) based on a FeHCF | 2 m AlTFS | UTAl full cell chemistry and obtain a stable battery performance of ∼ 60 Wh kg−1 over 100 cycles. Our study promotes the strategic viability of using facile, inexpensive reagent treatments to enable the application of water-based electrolytes for rechargeable Al-ion batteries, and specifically encourages systematic exploration of analogue coating formulations using our anode enhancement protocol for similar high-capacity metal/alloy battery chemistries. National Research Foundation (NRF) Submitted/Accepted version This work was financially supported by the National Research Foundation of Singapore (NRF) Investigatorship Award Number NRF-NRFI2017-08.

Although “water-in-salt” electrolytes have opened a new pathway to expand the electrochemical stability window of aqueous electrolytes, the electrode instability and irreversible proton co-insertion caused by aqueous media still hinder the practical application, even when using exotic fluorinated salts. In this study, an accessible hybrid electrolyte class based on common sodium salts is proposed, and crucially an ethanol-rich media is introduced to achieve highly stable Na-ion electrochemistry. Here, ethanol exerts a strong hydrogen-bonding effect on water, simultaneously expanding the electrochemical stability window of the hybridized electrolyte to 2.5 V, restricting degradation activities, reducing transition metal dissolution from the cathode material, and improving electrolyte–electrode wettability. The binary ethanol–water solvent enables the impressive cycling of sodium-ion batteries based on perchlorate, chloride, and acetate electrolyte salts. Notably, a Na0.44MnO2 electrode exhibits both high capacity (81 mAh g–1) and a remarkably long cycle life >1000 cycles at 100 mA g–1 (a capacity decay rate per cycle of 0.024%) in a 1 M sodium acetate system. The Na0.44MnO2/Zn full cells also show excellent cycling stability and rate capability in a wide temperature range. The gained understanding of the hydrogen-bonding interactions in the hybridized electrolyte can provide new battery chemistry guidelines in designing promising candidates for developing low-cost and long-lifespan batteries based on other (Li+, K+, Zn2+, Mg2+, and Al3+) systems. NRF (Natl Research Foundation, S’pore) Accepted version

BackgroundThe 2019 novel coronavirus disease (COVID-19) has created unprecedented medical challenges. There remains a need for validated risk prediction models to assess short-term mortality risk among hospitalized patients with COVID-19. The objective of this study was to develop and validate a 7-day and 14-day mortality risk prediction model for patients hospitalized with COVID-19.MethodsWe performed a multicenter retrospective cohort study with a separate multicenter cohort for external validation using two hospitals in New York, NY, and 9 hospitals in Massachusetts, respectively. A total of 664 patients in NY and 265 patients with COVID-19 in Massachusetts, hospitalized from March to April 2020.ResultsWe developed a risk model consisting of patient age, hypoxia severity, mean arterial pressure and presence of kidney dysfunction at hospital presentation. Multivariable regression model was based on risk factors selected from univariable and Chi-squared automatic interaction detection analyses. Validation was by receiver operating characteristic curve (discrimination) and Hosmer-Lemeshow goodness of fit (GOF) test (calibration). In internal cross-validation, prediction of 7-day mortality had an AUC of 0.86 (95%CI 0.74-0.98; GOF p = 0.744); while 14-day had an AUC of 0.83 (95%CI 0.69-0.97; GOF p = 0.588). External validation was achieved using 265 patients from an outside cohort and confirmed 7- and 14-day mortality prediction performance with an AUC of 0.85 (95%CI 0.78-0.92; GOF p = 0.340) and 0.83 (95%CI 0.76-0.89; GOF p = 0.471) respectively, along with excellent calibration. Retrospective data collection, short follow-up time, and development in COVID-19 epicenter may limit model generalizability.ConclusionsThe COVID-AID risk tool is a well-calibrated model that demonstrates accuracy in the prediction of both 7-day and 14-day mortality risk among patients hospitalized with COVID-19. This prediction score could assist with resource utilization, patient and caregiver education, and provide a risk stratification instrument for future research trials.

Aqueous rechargeable zinc-ion batteries are emerging as attractive alternatives for post-lithium-ion batteries. However, their electrochemical performances are restricted by the narrow working window of materials in aqueous electrolytes. Herein, a Ni-mediated VO2–B nanobelt [(Ni)VO2] has been designed to optimize the intrinsic electronic structure of VO2–B and thus achieve much more enhanced zinc-ion storage. Specifically, the Zn/(Ni)VO2 battery yields a good rate capability (182.0 mA h g–1 at 5 A g–1) with a superior cycling stability (130.6 mA h g–1 at 10 A g–1 after 2000 cycles). Experimental and theoretical methods reveal that the introduction of Ni2+ in the VO2 tunnel structure can effectively provide high surface reactivity and improve the intrinsic electronic configurations, thus resulting in good kinetics. Furthermore, H+ and Zn2+ cointercalation processes are determined via in situ X-ray diffraction and supported by ex situ characterizations. Additionally, quasi-solid-state Zn/(Ni)VO2 soft-packaged batteries are assembled and provide flexibility in battery design for practical applications. The results provide insights into the interrelationships between the intrinsic electronic structure of the cathode and the overall electrochemical performance. National Research Foundation (NRF) Accepted version R.C. and Y.C. contributed equally to this work. This work was financially supported by the National Research Foundation of Singapore (NRF) Investigatorship award number NRFI2017-08/NRF2016NRF-NRFI001-22. The authors thank Synchro-tron Light Research Institute (Public Organization), Muang, Nakhon Ratchasima, 30000, Thailand, for XANES measure-ments in Beamline 8.

Electrocatalysts are one of the most important parts for oxygen evolution reaction (OER) to overcome the sluggish kinetics. Herein, amorphous Fe–Ni–P–B–O (FNPBO) nanocages as efficient OER catalysts are synthesized by a simple low-cost and scalable method at room temperature. The samples are chemically stable, in clear contrast to reported unstable or even pyrophoric boride samples. The Fe/Ni ratio of the FNPBO nanocages can be continuously adjusted to optimize the OER catalytic performance. The FNPBO nanocages composed of multicomponent elements can weaken the metal–metal bonds, thus rearranging the electron density around the catalytic metal atom centers and reducing the energy barrier for intermediate formation. Hence the optimized FNPBO (Fe6.4Ni16.1P12.9B4.3O60.2) catalyst shows superior intrinsic electrocatalytic activity for OER. The low overpotential to afford the current density of 10 mA cm–2 (236 mV), the small Tafel slope (39 mV dec–1), and the high specific current density (26.44 mA cm–2) at a given overpotential of 300 mV make a sharp contrast to state-of-the-art RuO2 (327 mV, 136 mV dec–1, and 0.028 mA cm–2, respectively). NRF (Natl Research Foundation, S’pore) MOE (Min. of Education, S’pore) Accepted version

Background and aimsThis article provides expert guidance on the management of pruritus symptoms in patients receiving obeticholic acid (OCA) as treatment for primary biliary cholangitis (PBC). PBC is a chronic, autoimmune cholestatic liver disease that affects intrahepatic bile ducts. If not adequately treated, PBC can lead to cholestasis and end-stage liver disease, which may require transplant. Timely treatment is therefore vital to patient health. Pruritus is a common symptom in patients with PBC. Additionally, the use of OCA to treat PBC can contribute to increased pruritus severity in some patients, adding to patient discomfort, decreasing patient quality of life (QoL), and potentially affecting patient adherence to OCA treatment.MethodsIn May 2018, a group of physician experts from the fields of gastroenterology, hepatology, and psychiatry met to discuss the management of pruritus in OCA-treated patients with PBC. Recognizing the importance of optimizing treatment for PBC, these experts developed recommendations for managing pruritus symptoms in the OCA-treated PBC patient based on their experience in clinical practice.ResultsThese recommendations include a comprehensive list of management strategies (including over-the-counter, prescription, and alternative therapies), guidance on titration of OCA to minimize pruritus severity, and an algorithm that outlines a practical approach to follow up with patients receiving OCA, to better assess and manage pruritus symptoms.ConclusionsPruritus associated with OCA therapy is dose dependent and often manageable, and with the proper education and tools, most pruritus cases can be effectively managed to minimize treatment discontinuation.