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

The economic rationale for infection control in Australian hospitals

The objective of the present study was to predict the economic consequences of healthcare-acquired infections arising among admissions to Australian acute care hospitals. A quantitative algorithm informed by epidemiological and economic data was developed. All acute care hospitals in Australia were included in the study and the participants included all admissions to general medical and general surgical specialties. The main outcome measures were the numbers of cases of healthcare-acquired infection and bed days lost annually. It was estimated that there are 175 153 (95% credible interval 155 911 : 195 168) cases of healthcare-acquired infection among admissions to Australian hospitals annually, and the extra stay in hospital to treat symptoms accounts for 854 289 bed days (95% credible interval 645 091 : 1 096 244). If rates were reduced by 1%, then 150 158 bed days would be released for alternative uses. This would allow ~38 500 new admissions. Healthcare-acquired infections in patients cause bed blocks in Australian hospitals. The cost-effectiveness of hospital services might be improved by allocating more resources to infection control, releasing beds and allowing new admissions. There exists an opportunity to improve the efficiency of the Australian health care system.

The relationship between personality characteristics and postconcussion symptoms in a non-clinical sample

Postconcussion symptoms are relatively common in the acute recovery period following mild traumatic brain injury (MTBI). However, for a small subset of patients, self reported postconcussion symptoms continue long after injury. Many factors have been proposed to account for the presence of persistent postconcussion symptoms. The influence of personality traits has been proposed as one explanation. The purpose of this study was to examine the relation between postconcussion-like symptom reporting and personality traits in a sample of 96 healthy participants. Participants completed the British Columbia Postconcussion Symptom Inventory (BC-PSI) and the Millon Clinical Multiaxial Inventory III (MCMI-III). There was a strong positive relation between the majority of MCMI-III scales and postconcussion-like symptom reporting. Approximately half of the sample met the International Classification of Diseases-10 Criterion C symptoms for Postconcussional Syndrome (PCS). Compared with those participants who did not meet this criterion, the PCS group had significant elevations on the negativistic, depression, major depression, dysthymia, anxiety, dependent, sadistic, somatic, and borderline scales of the MCMI-III. These findings support the hypothesis that personality traits can play a contributing role in self reported postconcussion-like symptoms.

United Arab Emirates

The United Arab Emirates (UAE) is part of the geographic region known as the Middle East. With a land mass of 82,000 square kilometres, predominantly desert and mountains it is bordered by Oman, Saudi Arabia and the Arabian Gulf. The UAE is strategically located due to its proximity to other oil rich Middle Eastern countries such as Kuwait, Iraq, Iran, and Saudi Arabia. The UAE was formed from a federation of seven emirates (Abu Dhabi, Dubai, Sharjah, Ras Al Khaimah, Ajman, Fujuriah, and Um Al Quain) in December 1971 (Ras Al Khaimah did not join the federation until 1972) (Heard-bey, 2004, 370). Abu Dhabi is the political capital, and the richest emirate; while Dubai is the commercial centre. The majority of the population of the various Emirates live along the coast line as sources of fresh water often heavily influenced the site of different settlements. Unlike some near neighbours (Iran and Iraq) the UAE has not undergone any significant political instability since it was formed in 1971. Due to this early British influences the UAE has had very strong political and economic ties with first Britain, and, more recently, the United States of America (Rugh, 2007). Until the economic production of oil in the early 1960’s the different Emirates had survived on a mixture of primary industry (dates), farming (goats and camels), pearling and subsidies from Britain (Davidson 2005, 3; Hvit, 2007, 565) Along with near neighbours Kuwait, Bahrain, Oman, Qatar and Saudi Arabia, the UAE is part of the Gulf Cooperation Council (GCC), a trading bloc. (Hellyer, 2001, 166-168).

Digital media literacy : connecting young people’s identities, creative production and learning about video games

This chapter outlines examples of classroom activities that aim to make connections between young people’s everyday experiences with video games and the formal high school curriculum. These classroom activities were developed within the emerging field of digital media literacy. Digital media literacy combines elements of ‘traditional’ approaches to media education with elements of technology and information education (Buckingham, 2007; Warschauer, 2006). It is an educational field that has gained significant attention in recent years. For example, digital media literacy has become a significant objective for media policy makers in response to the increased social and cultural roles of new media technologies and controversies associated with young people’s largely unregulated online participation. Media regulators, educational institutions and independent organizations1 in the United States, Canada, the United Kingdom and Australia have developed digital media literacy initiatives that aim to provide advice to parents, teachers and young people.

Militarising the body politic : new media as weapons of mass instruction

As militarization of bodies politic continues apace the world over, as military organizations again reveal themselves as primary political, economic and cultural forces in many societies, we argue that the emergent and potentially dominant form of political economic organization is a species of neo-feudal corporatism. Drawing upon Bourdieu, we theorize bodies politic as living habitus. Bodies politic are prepared for war and peace through new mediations, powerful means of public pedagogy. The process of militarization requires the generation of new, antagonistic evaluations of other bodies politic. Such evaluations are inculcated via these mediations, the movement of meanings across time and space, between formerly disparate histories, places, and cultures. New mediations touch new and different aspects of the body politic: its eyes, its ears, its organs, but they are consistently targeted at the formation of dispositions, the prime movers of action.

Service staff attitudes, organisational practices and performance drivers

We provide conceptual and empirical insights elucidating how organizational practices influence service staff attitudes and behaviors and how the latter set affects organizational performance drivers. Our analyses suggest that service organizations can enhance their performance by putting in place strategies and practices that strengthen the service-oriented behaviors of their employees and reduce their intentions to leave the organization. Improved performance is accomplished through both the delivery of high quality services (enhancing organizational effectiveness) and the maintenance of frontline staff(increasing organizational efficiency). Specifically, service-oriented business strategies in the form of organizational-level service orientation and practices in the form of training directly influence the manifest service-oriented behaviors of staff. Training also indirectly affects the intention of frontline staff to leave the organization; it increases job satisfaction, which, in turn has an impact on affective commitment. Both affective and instrumental commitment were hypothesized to reduce the intentions of frontline staff to leave the organization, however only affective commitment had a significant effect.

Vision-based detection and tracking of aerial targets for UAV collision avoidance

Machine vision represents a particularly attractive solution for sensing and detecting potential collision-course targets due to the relatively low cost, size, weight, and power requirements of the sensors involved (as opposed to radar). This paper describes the development and evaluation of a vision-based collision detection algorithm suitable for fixed-wing aerial robotics. The system was evaluated using highly realistic vision data of the moments leading up to a collision. Based on the collected data, our detection approaches were able to detect targets at distances ranging from 400m to about 900m. These distances (with some assumptions about closing speeds and aircraft trajectories) translate to an advanced warning of between 8-10 seconds ahead of impact, which approaches the 12.5 second response time recommended for human pilots. We make use of the enormous potential of graphic processing units to achieve processing rates of 30Hz (for images of size 1024-by- 768). Currently, integration in the final platform is under way.

Airborne vision-based collision-detection system

Machine vision represents a particularly attractive solution for sensing and detecting potential collision-course targets due to the relatively low cost, size, weight, and power requirements of vision sensors (as opposed to radar and TCAS). This paper describes the development and evaluation of a real-time vision-based collision detection system suitable for fixed-wing aerial robotics. Using two fixed-wing UAVs to recreate various collision-course scenarios, we were able to capture highly realistic vision (from an onboard camera perspective) of the moments leading up to a collision. This type of image data is extremely scarce and was invaluable in evaluating the detection performance of two candidate target detection approaches. Based on the collected data, our detection approaches were able to detect targets at distances ranging from 400m to about 900m. These distances (with some assumptions about closing speeds and aircraft trajectories) translate to an advanced warning of between 8-10 seconds ahead of impact, which approaches the 12.5 second response time recommended for human pilots. We overcame the challenge of achieving real-time computational speeds by exploiting the parallel processing architectures of graphics processing units found on commercially-off-the-shelf graphics devices. Our chosen GPU device suitable for integration onto UAV platforms can be expected to handle real-time processing of 1024 by 768 pixel image frames at a rate of approximately 30Hz. Flight trials using manned Cessna aircraft where all processing is performed onboard will be conducted in the near future, followed by further experiments with fully autonomous UAV platforms.