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

Regioregular poly(3-hexyl-thiophene) helical self-organization on carbon nanotubes

Mixtures of Regioregular Poly(3-hexyl-thiophene) (rrP3HT) and multi wall carbon nanotubes have been investigated by Scanning Tunneling Microscopy in Ultra High Vacuum. Carbon nanotubes covered by rrP3HT have been imaged and analyzed, providing a clear evidence that this polymer self assembles on the nanotube surface following geometrical constraints and adapting its equilibrium chain-to-chain distance. Largely spaced covered nanotubes have been analyzed to investigate the role played by nanotube chirality in the polymer wrapping, evidencing strong rrP3HT interactions along well defined directions.

The Euro-American psyche and the imaging of Samoa in the early 20th century

Drawing on English language sources and material from Western Samoa (now Samoa), this examination of photographically illustrated serial encyclopaedia and magazines proposes an alternative historical analysis of the colonial photographs of Samoa, the most extensively covered field in Oceanic photographic studies. Photographs published between the 1890s and World War II were not necessarily from that era, and despite claims in the text of illustrated publications of an unchanged, enduring, archaic tradition in Samoa, the amazing variety of content and subject matter often offered contradictory evidence, depicting a modern, adaptive and progressive Samoa. Contrary to orthodox historical analysis, the images of Samoa in illustrated magazines and encyclopaedia were not limited to a small, repetitive gallery of partially clothed women and costumed chiefs.

The city, self, and connections : transyouth and urban social networking in Seoul

The end of the Korean War in 1953 marked the beginning of Seoul’s transformation from the shattered capital city of South Korea to one of the most connected, populous, and fast-changing hubs of global economy. Seoul’s technosocial development has been celebrated nationally and internationally. To the outside, young Koreans’ swift and extensive adoption and adaptation to digital technologies has been a subject of exotification; to adults in Korea, it has been a subject of criticism (see Yoon in this volume). With the understanding that ‘the city is connections,’ it is crucial to study not only the macro-level design of the city as a network (through policy, for example), but also its micro-level construction at the intersection of people, place, and technology. Accordingly, this chapter explores this exact intersection to comprehensively portray the constant renewal of the city as imagined and experienced by young Koreans. The chapter is based on fieldwork conducted in Seoul, South Korea, from 2007 to 2008 as part of a research project on the mobile play culture of Seoul transyouth, the transitional demographic situated between youth and adulthood, and the pioneers of the Korean ‘broadband miracle’ (Hazlett, 2004). The study draws upon transdisciplinary research data including interviews, questionnaires, diaries, and Shared Visual Ethnography (SVE) to render the everyday urban social networking of young Seoulites with and through which they interact to constantly (re)create the city and the self.

The influences of conceptions of learning and learner self-concept on high school students' approaches to learning

This study investigated the mediating effect of learner selfconcept between conceptions of learning and students' approaches to learning using structural equation modelling. Data were collected using a modified version of Biggs' Learning Process Questionnaire, together with the recently developed 'What is Learning Survey' and 'Learner Self-Concept Scale'. A sample of 355 high school students participated in the study. Results indicate that learner self-concept does mediate between conceptions of meaning and approaches to learning. Students who adopted a deep approach liked learning new things and indirectly viewed learning as experiential, involving social interaction and directly viewed learning as personal development. Implications for teachers are discussed, with consideration given to appropriate classroom practice.

Discriminating between primary school students with high and low self-esteem.

From an initial sample of 747 primary school students, the top 16 percent (n =116) with high self-esteem (HSE) and the bottom 15 percent (n = I1 I) with low selfesteem (LSE) were se/eeted. These two groups were then compared on personal and classroom variables. Significant differences were found for all personal (self-talk, selfconcepts) and classroom (teacher feedback, praise, teacher-student relationship, and classroom environment) variables. Students with HSE scored more highly on all variables. Discriminant Function Analysis (DFA) was then used to determine which variables discriminated between these two groups of students. Learner self-concept, positive and negative self-talk, classroom environment, and effort feedback were the best discriminators of students with high and low self-esteem. Implications for educational psychologists and teachers are discussed.

Elementary school students’ learner self-concept, academic self-concepts and approaches to learning

The present study investigated the relationships between academic selfconcepts, learner self-concept, and approaches to learning in elementary school students. A sample of 580 Australian Grade 6 and 7 school students with a mean age of 10.7 years participated in the study. Weak negative correlations between learner self-concepts and surface approaches to learning were identiŽ ed. In contrast, deep approaches for both boys and girls showed the highest positive correlations with school self-concept and learning self-concept. Only slight variations in these Ž gures were found between boys and girls.