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

Delay distribution based robust H∞ control of networked control systems with uncertainties

Network induced delay in networked control systems (NCS) is inherently non-uniformly distributed and behaves with multifractal nature. However, such network characteristics have not been well considered in NCS analysis and synthesis. Making use of the information of the statistical distribution of NCS network induced delay, a delay distribution based stochastic model is adopted to link Quality-of-Control and network Quality-of-Service for NCS with uncertainties. From this model together with a tighter bounding technology for cross terms, H∞ NCS analysis is carried out with significantly improved stability results. Furthermore, a memoryless H∞ controller is designed to stabilize the NCS and to achieve the prescribed disturbance attenuation level. Numerical examples are given to demonstrate the effectiveness of the proposed method.

FPGA implementation of dual-microphone delay-and-sum beamforming for in-car speech enhancement and recognition

In an automotive environment, the performance of a speech recognition system is affected by environmental noise if the speech signal is acquired directly from a microphone. Speech enhancement techniques are therefore necessary to improve the speech recognition performance. In this paper, a field-programmable gate array (FPGA) implementation of dual-microphone delay-and-sum beamforming (DASB) for speech enhancement is presented. As the first step towards a cost-effective solution, the implementation described in this paper uses a relatively high-end FPGA device to facilitate the verification of various design strategies and parameters. Experimental results show that the proposed design can produce output waveforms close to those generated by a theoretical (floating-point) model with modest usage of FPGA resources. Speech recognition experiments are also conducted on enhanced in-car speech waveforms produced by the FPGA in order to compare recognition performance with the floating-point representation running on a PC.

Oscillatory regulation of Hes1: Discrete stochastic delay modelling and simulation

Discrete stochastic simulations are a powerful tool for understanding the dynamics of chemical kinetics when there are small-to-moderate numbers of certain molecular species. In this paper we introduce delays into the stochastic simulation algorithm, thus mimicking delays associated with transcription and translation. We then show that this process may well explain more faithfully than continuous deterministic models the observed sustained oscillations in expression levels of hes1 mRNA and Hes1 protein.

A Bayesian approach to the determination of ignition delay

A novel in-cylinder pressure method for determining ignition delay has been proposed and demonstrated. This method proposes a new Bayesian statistical model to resolve the start of combustion, defined as being the point at which the band-pass in-cylinder pressure deviates from background noise and the combustion resonance begins. Further, it is demonstrated that this method is still accurate in situations where there is noise present. The start of combustion can be resolved for each cycle without the need for ad hoc methods such as cycle averaging. Therefore, this method allows for analysis of consecutive cycles and inter-cycle variability studies. Ignition delay obtained by this method and by the net rate of heat release have been shown to give good agreement. However, the use of combustion resonance to determine the start of combustion is preferable over the net rate of heat release method because it does not rely on knowledge of heat losses and will still function accurately in the presence of noise. Results for a six-cylinder turbo-charged common-rail diesel engine run with neat diesel fuel at full, three quarters and half load have been presented. Under these conditions the ignition delay was shown to increase as the load was decreased with a significant increase in ignition delay at half load, when compared with three quarter and full loads.

Impact of mobility constraints on epidemic broadcast mechanisms in delay-tolerant networks

In this paper, we investigate the effect of mobility constraints on epidemic broadcast mechanisms in DTNs (Delay-Tolerant Networks). Major factors affecting epidemic broadcast performances are its forwarding algorithm and node mobility. The impact of forwarding algorithm and node mobility on epidemic broadcast mechanisms has been actively studied in the literature, but those studies generally use unconstrained mobility models. The objective of this paper is therefore to quantitatively investigate the effect of mobility constraints on epidemic broadcast mechanisms. We evaluate the performances of three classes of epidemic broadcast mechanisms - P-BCAST (PUSH-based BroadCast), SA-BCAST (Self-Adaptive BroadCast), and HP-BCAST (History-based P-BCAST) - with a random waypoint mobility model with mobility constraints. Our finding includes that the existence of mobility constraints significantly improves the reach ability and dissemination speed of epidemic broadcast mechanisms while degrading their efficiency.

Somewhere between haste and delay... Investigating the interactions of road users and pedestrians in a dynamic rail level crossing environment

There are currently 23,500 level crossings in Australia, broadly divided into one of two categories: active level crossings which are fully automatic and have boom barriers, alarm bells, flashing lights, and pedestrian gates; and passive level crossings, which are not automatic and aim to control road and pedestrianised walkways solely with stop and give way signs. Active level crossings are considered to be the gold standard for transport ergonomics when grade separation (i.e. constructing an over- or underpass) is not viable. In Australia, the current strategy is to annually upgrade passive level crossings with active controls but active crossings are also associated with traffic congestion, largely as a result of extended closure times. The percentage of time level crossings are closed to road vehicles during peak periods increases with the rise in the frequency of train services. The popular perception appears to be that once a level crossing is upgraded, one is free to wipe their hands and consider the job done. However, there may also be environments where active protection is not enough, but where the setting may not justify the capital costs of grade separation. Indeed, the associated congestion and traffic delay could compromise safety by contributing to the risk taking behaviour by motorists and pedestrians. In these environments it is important to understand what human factor issues are present and ask the question of whether a one size fits all solution is indeed the most ergonomically sound solution for today’s transport needs.

Revocation and update of trust in autonomous delay tolerant networks

A Delay Tolerant Network (DTN) is a dynamic, fragmented, and ephemeral network formed by a large number of highly mobile nodes. DTNs are ephemeral networks with highly mobile autonomous nodes. This requires distributed and self-organised approaches to trust management. Revocation and replacement of security credentials under adversarial influence by preserving the trust on the entity is still an open problem. Existing methods are mostly limited to detection and removal of malicious nodes. This paper makes use of the mobility property to provide a distributed, self-organising, and scalable revocation and replacement scheme. The proposed scheme effectively utilises the Leverage of Common Friends (LCF) trust system concepts to revoke compromised security credentials, replace them with new ones, whilst preserving the trust on them. The level of achieved entity confidence is thereby preserved. Security and performance of the proposed scheme is evaluated using an experimental data set in comparison with other schemes based around the LCF concept. Our extensive experimental results show that the proposed scheme distributes replacement credentials up to 35% faster and spreads spoofed credentials of strong collaborating adversaries up to 50% slower without causing any significant increase on the communication and storage overheads, when compared to other LCF based schemes.