Objective
To characterize the prevalence of nonalcoholic fatty liver disease (NAFLD) by race in a nationally representative sample of the U.S. population and to investigate potential explanatory ...factors for racial disparities.
Design and Methods
Cross‐sectional study of 4,037 non‐Hispanic white, 2,746 non‐Hispanic black, and 2,892 Mexican‐American adults in the Third National Health and Nutrition Examination Survey. NAFLD was defined using ultrasound and with elevated aminotransferases.
Results
Age‐adjusted prevalence of NAFLD was highest in Mexican‐Americans (21.2%), followed by non‐Hispanic whites (12.5%), and was lowest in non‐Hispanic blacks (11.6%). Even after adjustment for demographic, lifestyle, adiposity, and metabolic factors, compared to non‐Hispanic whites, Mexican‐Americans were more likely to have NAFLD (OR: 1.67, 95% CI: 1.26, 2.22). Non‐Hispanic blacks were significantly less likely to have NAFLD with elevated aminotransferases (OR: 0.51, 95% CI: 0.27, 0.97). Racial differences were attenuated among those with normal BMI and among “never drinkers.”
Conclusion
In this representative sample of the U.S. population, we found significant racial differences in the prevalence of ultrasound‐defined NAFLD (with and without elevated liver enzymes). The racial differences were not fully explained by lifestyle, adiposity, and metabolic factors. More works is needed to identify potential contributors.
Background & Aims Patients with non-alcoholic fatty liver disease (NAFLD) are thought to be at increased risk of cardiovascular morbidity and mortality. However, the relationships between NAFLD and ...subclinical myocardial injury or structural heart disease are unknown. Methods We conducted a cross-sectional analysis of 8668 participants from the Atherosclerosis Risk in Communities (ARIC) Study, who showed no clinical evidence of cardiovascular disease. We used levels of liver enzymes (alanine aminotransferase ALT, aspartate aminotransferase AST and gamma-glutamyl transpeptidase GGT), in the context of no history of elevated alcohol consumption as non-invasive surrogates of NAFLD. We used highly sensitive cardiac troponin T (hs-cTnT) and N-terminal pro-Brain natriuretic peptide (NT-proBNP) as biomarkers of myocardial damage and function. Results In this population-based study (mean age 63 years, 60% women, 78% white), higher levels of ALT, AST, and GGT, even within the normal range, were significantly and independently associated with detectable (hs-cTnT >3 ng/L) and elevated (hs-cTnT ⩾14 ng/L) concentrations of hs-cTnT. The adjusted odds ratios (95% confidence interval) for elevated liver enzymes ( vs. normal levels) with elevated hs-cTnT were: 1.65 (1.28–2.14) for ALT, 1.90 (1.36–2.68) for AST, and 1.55 (1.13–2.12) for GGT. Furthermore, there was evidence for inverse associations of ALT and AST with NT-proBNP. Conclusions Our results suggest that elevated liver enzyme levels in the absence of elevated alcohol consumption may be associated with subclinical myocardial injury. The inverse association between NT-proBNP and both ALT and AST supports the recently described metabolic role of natriuretic peptides.
This study evaluated the measurement properties of the Satisfaction With Life Scale (SWLS) in a sample of 17,897 people with spinal cord injury (48%, n = 8,566), traumatic brain injury (44%, n = ...7,941), and burn injury (8%, n = 1,390), 1 year following injury. We examined measurement invariance across the groups, unidimensionality, local independence, reliability from a classical test and item response theory (IRT) framework, and fit to a unidimensional IRT model. The results support unidimensionality and local independence of the SWLS. Reliability was adequate from a classical test and IRT perspective. IRT analysis found that the SWLS could be improved by using only five response categories rather than seven and by removing the fifth item, “If I could live my life over, I would change almost nothing.” This item functions poorly and reduces instrument reliability. With these revisions, the SWLS is a useful instrument to monitor an important outcome of trauma rehabilitation.
Water is central to life and earth processes, connecting physical, biological, chemical, ecological, and economic forces across the landscape. The vast scope of hydrologic sciences requires research ...efforts worldwide and across a wide range of disciplines. While hydrologic processes and scientific investigations related to sustainable agricultural systems are based on universal principles, research to understand processes and evaluate management practices is often site-specific to achieve a critical mass of expertise and research infrastructure to address spatially, temporally, and ecologically complex systems. In the face of dynamic climate, market, and policy environments, long-term research is required to understand and predict risks and possible outcomes of alternative scenarios. This special section describes the USDA-ARS's long-term research (1961 to present) in the Upper Washita River basin of Oklahoma. Data papers document datasets in detail (weather, hydrology, physiography, land cover, and sediment and nutrient water quality), and associated research papers present analyses based on those data. This living history of research is presented to engage collaborative scientists across institutions and disciplines to further explore complex, interactive processes and systems. Application of scientific understanding to resolve pressing challenges to agriculture while enhancing resilience of linked land and human systems will require complex research approaches. Research areas that this watershed research program continues to address include: resilience to current and future climate pressures; sources, fate, and transport of contaminants at a watershed scale; linked atmospheric-surface-subsurface hydrologic processes; high spatiotemporal resolution analyses of linked hydrologic processes; and multiple-objective decision making across linked farm to watershed scales.
Residual subclavian vein stenosis after thoracic outlet decompression in patients with venous thoracic outlet syndrome is often treated with postoperative percutaneous angioplasty (PTA). However, ...interval recurrent thrombosis before postoperative angioplasty is performed can be a vexing problem. Therefore we initiated a prospective trial at 2 referral institutions to evaluate the safety and efficacy of combined thoracic outlet decompression with intraoperative PTA performed in 1 stage.
Over 3 years 25 consecutive patients (16 women, 9 men; median age, 30 years) underwent treatment for venous thoracic outlet syndrome with a standard protocol at 2 institutions. Twenty-one patients (84%) underwent preoperative thrombolysis to treat axillosubclavian vein thrombosis. First-rib resection was performed through combined supraclavicular and infraclavicular incisions. Intraoperative venography and subclavian vein PTA were performed through a percutaneous basilic vein approach. Postoperative anticoagulation therapy was not used routinely. Venous duplex ultrasound scanning was performed postoperatively and at 1, 6, and 12 months.
Intraoperative venography enabled identification of residual subclavian vein stenosis in 16 patients (64%), and all underwent intraoperative PTA with 100% technical success. Postoperative duplex scans documented subclavian vein patency in 23 patients (92%). Complications included subclavian vein recurrent thrombosis in 2 patients (8%), and both underwent percutaneous mechanical thrombectomy, with restoration of patency in 1 patient. One-year primary and secondary patency rates were 92% and 96%, respectively, at life-table analysis.
Residual subclavian vein stenosis after operative thoracic outlet decompression is common in patients with venous thoracic outlet syndrome. Combination treatment with surgical thoracic outlet decompression and intraoperative PTA is a safe and effective means for identifying and treating residual subclavian vein stenosis. Moreover, intraoperative PTA may reduce the incidence of postoperative recurrent thrombosis and eliminate the need for venous stent placement or open venous repair.
Abstract
Corn is the most widely grown crop in the Americas, with annual production in the United States of approximately 332 million metric tons. Improved climate forecasts, together with ...climate-related decision tools for corn producers based on these improved forecasts, could substantially reduce uncertainty and increase profitability for corn producers. The purpose of this paper is to acquaint climate information developers, climate information users, and climate researchers with an overview of weather conditions throughout the year that affect corn production as well as forecast content and timing needed by producers. The authors provide a graphic depicting the climate-informed decision cycle, which they call the climate forecast–decision cycle calendar for corn.
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