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

Exploring the influence of a science content course incorporating explicit nature of science and argumentation instruction on preservice primary teachers' views of nature of science

There exists a general consensus in the science education literature around the goal of enhancing students. and teachers. views of nature of science (NOS). An emerging area of research in science education explores NOS and argumentation, and the aim of this study was to explore the effectiveness of a science content course incorporating explicit NOS and argumentation instruction on preservice primary teachers. views of NOS. A constructivist perspective guided the study, and the research strategy employed was case study research. Five preservice primary teachers were selected for intensive investigation in the study, which incorporated explicit NOS and argumentation instruction, and utilised scientific and socioscientific contexts for argumentation to provide opportunities for participants to apply their NOS understandings to their arguments. Four primary sources of data were used to provide evidence for the interpretations, recommendations, and implications that emerged from the study. These data sources included questionnaires and surveys, interviews, audio- and video-taped class sessions, and written artefacts. Data analysis involved the formation of various assertions that informed the major findings of the study, and a variety of validity and ethical protocols were considered during the analysis to ensure the findings and interpretations emerging from the data were valid. Results indicated that the science content course was effective in enabling four of the five participants. views of NOS to be changed. All of the participants expressed predominantly limited views of the majority of the examined NOS aspects at the commencement of the study. Many positive changes were evident at the end of the study with four of the five participants expressing partially informed and/or informed views of the majority of the examined NOS aspects. A critical analysis of the effectiveness of the various course components designed to facilitate the development of participants‟ views of NOS in the study, led to the identification of three factors that mediated the development of participants‟ NOS views: (a) contextual factors (including context of argumentation, and mode of argumentation), (b) task-specific factors (including argumentation scaffolds, epistemological probes, and consideration of alternative data and explanations), and (c) personal factors (including perceived previous knowledge about NOS, appreciation of the importance and utility value of NOS, and durability and persistence of pre-existing beliefs). A consideration of the above factors informs recommendations for future studies that seek to incorporate explicit NOS and argumentation instruction as a context for learning about NOS.

Context and models for the analysis of individual and group needs

This paper summarizes the papers presented in the thematic stream Models for the Analysis of Individual and Group Needs, at the 2007 IAEVG-SVP-NCDA Symposium: Vocational Psychology and Career Guidance Practice: An International Partnership. The predominant theme which emerged from the papers was that theory and practice need to be positioned within their contexts. For this paper, context has been formulated as a dimension ranging from the individual’s experience of himself or herself in conversations, including interpersonal transactions and body culture, through to broad higher levels of education, work, nation, and economy.

Middle years teacher education : new programs and research directions

Teacher education programs focussing on the development of specialist teachers for 'the middle years' have proliferated in Australian universities in recent years. This paper provides some insights into middle years' teacher education programs at the University of Queensland, Edith Cowan and Flinders Universities with regard to their: philosophical underpinnings; specific educational context; scope and nature of the program. In addition, some of the research directions and efficacy strategies utilised in conjunction with the programs will be shared, along with some early findings from a longitudinal study in one of the programs. We propose that the pattern of programmatic growth heralds a new time for teacher education, and we speculate about the production of new kinds of teacher identities as graduates take their place in the profession.

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.

Secondary teachers’ conceptions of teaching and learning

This paper presents a phenomenographic analysis of the conceptions of teaching and learning held by a sample of 16 secondary school teachers in two Australian schools. It provides descriptions of four categories, derived from pooled data, of the ways in which these teachers thought about teaching and about learning, their teaching strategies, and their focus on student or content. The categories for teaching and learning are described with each teacher allocated to the category most typical of their conceptions of teaching and of learning. The lack of congruence, in some cases, between the conceptions of teaching and of learning held by these teachers is discussed.

Students’ perceptions of teaching and learning: the influence of students’ approaches to learning and teachers’ approaches to teaching

Nearly 500 secondary students in 24 classes were surveyed and four students in each class interviewed concerning their approaches to learning and perceptions of their classroom environment. While interviewed students with deep approaches to learning generally demonstrated a more sophisticated understanding of the learning opportunities offered to them than did students with surface approaches, teaching strategies also influenced students' perceptions. When teachers focused strongly on actively engaging students and creating a supportive environment, students with both deep and surface approaches focused on student-centred aspects of the class. In contrast, when traditional expository teaching methods were used exclusively, students with deep and surface approaches both focused on transmission and reproduction.

Of tails and Tempests : Feminine sexuality and Shakespearean children's texts

This paper reads a range of nineteenth-century texts for children that retell either Shakespeare's The Tempest or mermaid narratives, considering the models of feminine subjectivity and sexuality that they construct. It then moves on to two key contemporary texts — Disney's film adaptation of The Little Mermaid (Clements and Musker 1989) and Penni Russon's Undine (2004) — that combine the Shakespearean heroine with the mermaid, and reads them against the nineteenth-century models. Ultimately, the essay determines that, while these texts seem to perform a progressive appropriation of the two traditions, they actually combine the most conservative aspects of both The Tempest and mermaid stories to produce authoritative (and dangerously persuasive) ideals of passive feminine sexuality that confine girls within patriarchally-dictated familial positions. The new figure for adolescent female subjectivity, the mermaid-Miranda, becomes in turn a model of identification and aspiration for the implied juvenile consumer.

At-risk students and classroom engagement : listening to “voices of possibility and hope"

In my work with secondary school students who have disengaged from mainstream classrooms, I have often been surprised at the ways they enthusiastically engage with the projects on offer. They have demonstrated that, in apparent contradiction of their classroom behaviour, they still maintain hope in achieving a positive outcome from education. In a long-running schools-university project employing a “students-as-researchers” approach to investigating educational disadvantage, “at-risk” students have produced high quality results. Naturally, I wanted to know what it was about this sort of pedagogy that seemed to work for them. In this chapter, then, I outline the project and discuss some reasons for disengagement. I then address the features of the project that the participants themselves have identified as being instrumental in their re-engagement with formal education. Finally, I consider how these features may be transposed to maintaining the educational engagement of at-risk students in mainstream classrooms.