Nonalcoholic steatohepatitis (NASH) is a serious liver disease associated with obesity. Characterized by metabolic syndrome, hepatic steatosis, and liver inflammation, NASH is believed to be under the influence of the gut microflora. Here, the composition of gut bacterial communities of NASH, obese, and healthy children was determined by 16S ribosomal RNA pyrosequencing. In addition, peripheral blood ethanol was analyzed to monitor endogenous ethanol production of patients and healthy controls. UniFrac-based principle coordinates analysis indicated that most of the microbiome samples clustered by disease status. Each group was associated with a unique pattern of enterotypes. Differences were abundant at phylum, family, and genus levels between healthy subjects and obese patients (with or without NASH), and relatively fewer differences were observed between obese and the NASH microbiomes. Among those taxa with greater than 1% representation in any of the disease groups, Proteobacteria, Enterobacteriaceae, and Escherichia were the only phylum, family and genus types exhibiting significant difference between obese and NASH microbiomes. Similar blood-ethanol concentrations were observed between healthy subjects and obese non-NASH patients, but NASH patients exhibited significantly elevated blood ethanol levels. Conclusions: The increased abundance of alcohol-producing bacteria in NASH microbiomes, elevated blood-ethanol concentration in NASH patients, and the well-established role of alcohol metabolism in oxidative stress and, consequently, liver inflammation suggest a role for alcohol-producing microbiota in the pathogenesis of NASH. We postulate that the distinct composition of the gut microbiome among NASH, obese, and healthy controls could offer a target for intervention or a marker for disease. (HEPATOLOGY 2013;57:601-609) N onalcoholic fatty liver disease (NAFLD), the hepatic manifestation of metabolic syndrome, is the most common cause of elevated liver enzymes in the United States.1 NAFLD with inflammation and fibrosis is known as nonalcoholic steatohepatitis (NASH) because it resembles alcoholic liver disease (ALD) without a history of alcohol ingestion. The incidence of NASH has been increasing over the past 20 years. 3 In the United States, the current prevalence of NAFLD and NASH could be as high as 46% and 12%, respectively. 4 Without an effective available treatment, the prognosis of NASH is not optimistic. NASH is responsible for approximately 10% of liver transplants in the United States and is projected to become the most common indication for liver transplantation in the near future.

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Purpose The purpose of this paper is to identify strategic objectives that can be utilized by non-host communities to leverage the opportunities provided by mega sport events. The unique context and timing of this study facilitates discussion surrounding a particular non-host community and how it can plan relevant objectives to best identify appropriate leveraging mechanisms. Design/methodology/approach The study adopted a qualitative approach, drawing upon a case study of Kobe City, Japan, a non-host city of the Tokyo 2020 Olympic Games. Data were collected using diverse sources such as site visits, field notes, newspaper articles, destination marketing materials, archival data from sport and tourism facilities, and workshop with key stakeholders. Findings The within-case analysis identified four key objectives a non-host city could utilize to leverage mega sport events, namely, enhancing destination brand equity, integrating leveraging strategies with the existing event portfolio, fostering social capital, and strengthening corporate networks. Originality/value Research on event leveraging has typically focused on host cities, while there has been limited research attention on non-host cities. This paper highlights the importance of formulating shared objectives so as to provide a strong focus for relevant stakeholders, guide the deployment of resources, and create effective leveraging strategies. Few studies have focused on the planning of leveraging initiatives.

Targeting festival attendees based on key criterion can provide a greater return on investment for festival organizers. Despite considerable insight into festival attendee segmentation, studies have failed to validate targeted segments, which provides the impetus for this research note. This research segments and targets attendees to six small-scale festivals across three countries by applying Kotler's target marketing criteria (measurability, substantiality, accessibility, actionability). Results suggest that regardless of the country or event type, a targeted small-scale festival segment, labeled as satisfied, involved experience attendees, exists. Implications are outlined and opportunities for future research are considered.

Attention Restoration Theory is applied to explore the causes and consequences of mental fatigue in clergy and suggest practical interventions to restore cognitive wellbeing. Previous research has investigated the physical and emotional health and wellbeing of clergy, but has largely neglected clergy cognitive wellbeing. Due to the demanding nature of their work, clergy are particularly susceptible to mental fatigue and depletion of their capacity to maintain attention. Symptoms include inability to focus attention, inhibit distractions, make decisions or solve problems. Mental fatigue can be overcome, and cognitive capacity restored, by spending time in restorative environments that allow directed attention to rest.