Non-alcoholic fatty liver disease : can ultrasound assist in early diagnosis of prediabetes and delay progression to type2 diabetes mellitus

Non Alcoholic Fatty Liver Disease (NAFLD) is a condition that is frequently seen but seldom investigated. Until recently, NAFLD was considered benign, self-limiting and unworthy of further investigation. This opinion is based on retrospective studies with relatively small numbers and scant follow-up of histology data. (1) The prevalence for adults, in the USA is, 30%, and NAFLD is recognized as a common and increasing form of liver disease in the paediatric population (1). Australian data, from New South Wales, suggests the prevalence of NAFLD in “healthy” 15 year olds as being 10%.(2) Non-alcoholic fatty liver disease is a condition where fat progressively invades the liver parenchyma. The degree of infiltration ranges from simple steatosis (fat only) to steatohepatitis (fat and inflammation) steatohepatitis plus fibrosis (fat, inflammation and fibrosis) to cirrhosis (replacement of liver texture by scarred, fibrotic and non functioning tissue).Non-alcoholic fatty liver is diagnosed by exclusion rather than inclusion. None of the currently available diagnostic techniques -liver biopsy, liver function tests (LFT) or Imaging; ultrasound, Computerised tomography (CT) or Magnetic Resonance Imaging (MRI) are specific for non-alcoholic fatty liver. An association exists between NAFLD, Non Alcoholic Steatosis Hepatitis (NASH) and irreversible liver damage, cirrhosis and hepatoma. However, a more pervasive aspect of NAFLD is the association with Metabolic Syndrome. This Syndrome is categorised by increased insulin resistance (IR) and NAFLD is thought to be the hepatic representation. Those with NAFLD have an increased risk of death (3) and it is an independent predictor of atherosclerosis and cardiovascular disease (1). Liver biopsy is considered the gold standard for diagnosis, (4), and grading and staging, of non-alcoholic fatty liver disease. Fatty-liver is diagnosed when there is macrovesicular steatosis with displacement of the nucleus to the edge of the cell and at least 5% of the hepatocytes are seen to contain fat (4).Steatosis represents fat accumulation in liver tissue without inflammation. However, it is only called non-alcoholic fatty liver disease when alcohol - >20gms-30gms per day (5), has been excluded from the diet. Both non-alcoholic and alcoholic fatty liver are identical on histology. (4).LFT’s are indicative, not diagnostic. They indicate that a condition may be present but they are unable to diagnosis what the condition is. When a patient presents with raised fasting blood glucose, low HDL (high density lipoprotein), and elevated fasting triacylglycerols they are likely to have NAFLD. (6) Of the imaging techniques MRI is the least variable and the most reproducible. With CT scanning liver fat content can be semi quantitatively estimated. With increasing hepatic steatosis, liver attenuation values decrease by 1.6 Hounsfield units for every milligram of triglyceride deposited per gram of liver tissue (7). Ultrasound permits early detection of fatty liver, often in the preclinical stages before symptoms are present and serum alterations occur. Earlier, accurate reporting of this condition will allow appropriate intervention resulting in better patient health outcomes. References 1. Chalasami N. Does fat alone cause significant liver disease: It remains unclear whether simple steatosis is truly benign. American Gastroenterological Association Perspectives, February/March 2008 www.gastro.org/wmspage.cfm?parm1=5097 Viewed 20th October, 2008 2. Booth, M. George, J.Denney-Wilson, E: The population prevalence of adverse concentrations with adiposity of liver tests among Australian adolescents. Journal of Paediatrics and Child Health.2008 November 3. Catalano, D, Trovato, GM, Martines, GF, Randazzo, M, Tonzuso, A. Bright liver, body composition and insulin resistance changes with nutritional intervention: a follow-up study .Liver Int.2008; February 1280-9 4. Choudhury, J, Sanysl, A. Clinical aspects of Fatty Liver Disease. Semin in Liver Dis. 2004:24 (4):349-62 5. Dionysus Study Group. Drinking factors as cofactors of risk for alcohol induced liver change. Gut. 1997; 41 845-50 6. Preiss, D, Sattar, N. Non-alcoholic fatty liver disease: an overview of prevalence, diagnosis, pathogenesis and treatment considerations. Clin Sci.2008; 115 141-50 7. American Gastroenterological Association. Technical review on nonalcoholic fatty liver disease. Gastroenterology.2002; 123: 1705-25

Equal employment opportunity and diversity management : can either live up to the promise of achieving gender equity?

This paper examines the extent to which women movement into management positions. Like many other countries, this progress in Australia is slow. The paper includes discussion of the theoretical explanations for this and the extent to which these are borne out in Australia. We are aware this group represents only a minority of Australian women workers, and there are many other groups of women workers for whom constraints to women’s access to senior management may not be the most pressing issue. We have, however, chosen to focus on women in management in this paper, as while there was considerable research and public policy attention directed towards this group in the 1980s and early 1990s, over the past decade there seems to have been a reluctance to continue to address this group, despite the numerical evidence that women continue to be disproportionately represented in senior management positions. We believe it’s timely to refocus on women in management.

How can preservice teachers be measured against advocated professional teaching standards?

Australia has had many inquiries into teaching and teacher education over the last decade. Standards for teaching have been produced by national education systems with many state systems following suit. The Queensland College of Teachers (QCT) advocates ten professional teaching standards for teachers and preservice teachers. How can preservice teachers be measured against advocated professional standards? This study investigated 106 second-year preservice teachers’ perceptions of their development against the QCT standards. A pretest-posttest survey instrument was developed based on the QCT standards and administered to these preservice teachers before and after their science education coursework. Percentages, ANOVAs and t-tests were generated to analyse the results. Findings indicated that 22 of the 24 paired pretest-posttest items were highly significant (p<.001). Percentage increases ranged from as low as 27% in the pretest to as high as 97% in the posttest, yet, there were two items with lower significance (i.e., working in professional science education teams and supporting students’ participation in society). Understanding preservice teachers’ perceptions of their abilities to implement these standards may be a step towards the process of determining the achievement of teaching standards; however, more rigorous measurements will need to be developed for both teachers and preservice teachers. University coursework and related assessments can provide an indication of achieving these standards, especially authentic assessment of preservice teachers’ practices.

'Anyone Can Edit' : Vom Nutzer zum Produtzer

Über die letzten Jahre hat sich einige öffentliche und kommerzielle Aufmerksamkeit auf ein Phänomen gerichtet, das sich anschickt, die Medienlandschaft grundlegend zu verändern. Yahoo! kaufte Flickr. Google erwarb YouTube. Rupert Murdoch kaufte MySpace, und erklärte, die Zukunft seines NewsCorp-Imperiums läge eher in der nutzergesteuerten Inhaltserschaffung innerhalb solcher sozialer Medien als in seinen vielen Zeitungen, Fernsehsendern und anderen Medieninteressen (2005). Schließlich brach TIME mit seiner langetablierten Tradition, eine herausragende Persönlichkeit als „Person des Jahres“ zu nominieren, und wählte stattdessen „You“: uns alle, die wir online in Kollaboration Inhalte schaffen (2006). Allerdings liegt die Bedeutung dieses nutzergesteuerten Phänomens nicht in solchen (letztlich unwichtigen) Ehrungen, oder auch nur in den Inhalten zentraler Websites wie YouTube und Flickr – vielmehr findet man sie in logischer Folge der ihr zugrunde liegenden Prinzipien (die wir hier weiter untersuchen werden) viel flächendeckender über das World Wide Web verbreitet; was wichtig ist am neuen Phänomen ist nicht nur der Erfolg seiner sichtbarsten Exponenten, sondern auch der „Long Tail“ (Anderson 2006) der vielen anderen nutzergesteuerten Projekte, die sich überall in der Online-Welt etabliert haben und jetzt beginnen, sich sogar in die Offline-Welt hinein auszubreiten.

Can governments use their construction contracts to improve training outcomes?

This paper explores the likely efficacy of government agencies using their contracting relationships with private firms to affect training outcomes in the construction industry. Specifically, it reports on the results of a study of two training policies of theWestern Australian government. Empirical data is drawn from the government’s Tender Registration System between 1997 and 2006. The main finding of the quantitative analysis is that in the absence of strong industry commitment to policy objectives, the contracting approach is likely to result in high levels of avoidance activity and generate very few benefits. The results of a qualitative investigation also support these findings.

Can B.I.M be civil?

After many years of development BIM (Building Information Modelling) is starting to achieve significant penetration into the building sector of the construction industry. This paper describes the current status of BIM and the drivers that are motivating the change from 2D CAD to BIM within the building sector. The paper then discusses what the implications of the technology underlying BIM may be for the civil construction sector of the construction industry. A project carried out by the Cooperative Research Centre for Construction Innovation is used as an example of this technology as well as several international examples.

The interaction order of Second Life : how micro sociology can contribute to online games innovation

This paper uses the virtual world Second Life (as Web 2.0 environment) to discuss how sociological theory is a relevant tool for innovation in the area of games design as a methodological strategy. Via the theories of Erving Goffman’s interaction order the paper illustrates how micro studies of online interaction demonstrate active accounts of membership and complex interactivity. In order to achieve this, the paper outlines a methodological tool to assist in the application of micro sociology to Web 2.0 environments that accounts for the multiple dimensions of participation within the digital field.

Should mental health issues be addressed in primary care, and can it be done? Views of rural general practitioners in Queensland

Objective: The aim of this paper was to examine self-efficacy and perceived appropriateness among rural general practitioners (GPs) in regards to screening and intervention for physical, lifestyle and mental health issues. ----- Method: Fifty GPs from 25 practices in eight rural Queensland towns completed a written survey designed for the study. ----- Results: General practitioners rated opportunistic screening or assessment for smoking and for detection of relapse of mental disorders as the most appropriate, with even cardiovascular and diabetes risk falling behind these. Self-efficacy was highest for medical disorders for smoking assessment. It was significantly lower for alcohol, mental health issues, and addressing risks of physical disorder in people with mental disorders. ----- Conclusions: High appropriateness ratings suggest that current strategies to boost self-efficacy of GPs in addressing mental health issues are timely.

Can Risk Management boost the supply of Affordable Housing Development and Management?

A shortage of affordable housing is a major problem in Australia today. This is mainly due to the limited supply of affordable housing that is provided by the non-government housing sector. Some private housing developers see the provision of affordable housing for lower income people as a high risk investment which offers a lower return than broader market-based housing. The scarcity of suitable land, a limited government ‘subsidy’, and increasing housing costs have not provided sufficient development incentives to encourage their investment despite the existing high demand for affordable housing. This study analyses the risk management process conducted by some private and not-for-profit housing providers in South East Queensland, and draws conclusions about the relationship between risk assessments/responses and past experiences. In-depth interviews of selected non-government housing providers have been conducted to facilitate an understanding of their approach to risk assessment/response in developing and in managing affordable housing projects. These developers use an informal risk management process as part of their normal business process in accordance with industry standards. A simple qualitative matrix has been used to analyse probability and impacts using a qualitative scale - low, medium and high. For housing providers who have considered investing in affordable housing but have not yet implemented any such projects, affordable housing development is seen as an opportunity that needs to be approached with caution. The risks associated with such projects and the levels of acceptance of these are not consistently identified by current housing providers. Many interviewees agree that the recognition of financial risk and the fear of community rejection of such housing projects have restrained them from committing to such investment projects. This study suggests that implementing improvements to the risk mitigation and management framework may assist in promoting the supply of affordable housing by non-government providers.

Enhancing road safety for young drivers : how Graduate Driver Licensing initiatives can complement "anti-hooning" legislation

Street racing and associated (hooning) behaviours have attracted increasing concern in recent years. While New Zealand and all Australian jurisdictions have introduced “antihooning” legislation and allocated significant police resources to managing the problem, there is limited evidence of the road safety implications of hooning. However, international and Australian data suggests that drivers charged with a hooning offence tend to be young males who are accompanied by one or more peers, and hooning-related crashes tend to occur at night. In this regard, there is considerable evidence that drivers under the age of 25 are over-represented in crash statistics, and are particularly vulnerable soon after obtaining a Provisional licence, when driving at night, and when carrying peer-aged passengers. The similarity between the nature of hooning offenders, offences and crashes, and road safety risks for young drivers in general, suggests that hooning is an issue that may be viewed as part of the broader young driver problem. Many jurisdictions have recently implemented a range of evidence-based strategies to address young driver road safety, and this paper will present Queensland crash and offence data to highlight the potential benefit of Graduated Driver Licensing initiatives, such as night driving restrictions and peer-aged passenger restrictions, to related road safety issues, including hooning. An understanding of potential flow-on effects is important for evaluations of anti-hooning legislation and Graduated Driver Licensing programs, and may have implications for future law enforcement resource allocation and policy development.