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 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.

An interpretative phenomenological analysis of adult clients’ experience of My Career Chapter

This paper presents an investigation into the properties of a new narrative technique for career assessment and counselling, My Career Chapter: A Dialogical Autobiography. This technique is used to facilitate clients’ construction of a meaningful career-related autobiography. Previous research indicates the usefulness of My Career Chapter for adult clients and its alignment with recommendations for the development and application of qualitative assessment and counselling techniques. This study specifically commences research into the technique’s applicability for adolescents. A focus group, comprised of guidance counselling professionals whose work primarily pertained to the needs of adolescents, found that there is potential to develop a version of My Career Chapter that is suitable for adolescents.

The need for dialogue between the vocational psychological and organisational perspectives on career

As editors of the recently published Vocational psychological and organisational perspectives on career: Towards a multidisciplinary dialogue (Collin & Patton, 2009), we have considerable interest in this particular issue of the Australian Journal of Career Development. This short piece will first present the purpose and thesis of that book and, in the light of them, will then comment on the four papers. The book suggests that to understand the multidimensional and multilayered nature of career, “it has to be studied in a similarly multilayered and multi-perspectival way, and, indeed, it has been” (p. 3). Scholars have pointed out that there is a wide array of disciplines including economics, sociology, anthropology, geography, political science, various branches of psychology (e.g. industrial/organisational (I/O), vocational, counselling), psychiatry, education, organisation studies, organisational behaviour, personnel/human resource management, industrial relations, and more, all of which have something to say about career. Of these, the most influential, according to Peiperl and Arthur (2000), have been psychology, sociology, education and management. These many disciplinary perspectives on career constitute the rich field of career studies.

Annual Review : practice and research in career counseling and development – 2008

The career development literature published in 2008 is summarized and presented thematically: (a) professional issues, (b) career assessment, (c) career development, (d) career theory and concepts, (e) career interventions, (f) advances in technology, (g) employment, (h) international perspectives, and (i) research design and methodology. Traditional and emerging theories and practices are robust and vibrant.

Reviewing psychologists’ qualifications for career development practice in Australia

Vocational psychology and the practice of career development are important dimensions of the psychology discipline. This paper contains an overview of the Australian career development industry in light of recent trends, particularly the formalisation of professional career development practice. Given the advent of the Professional Standards for Career Development Practitioners, an audit of postgraduate degrees in organisational, developmental and educational, and counselling psychology was conducted to determine their alliance with the competencies of the Standards. The audit revealed significant areas of consistency on generic competencies, however there was a serious lack of training specific to career development. The implications of the audit results are discussed in light of the evolution of the career development industry and the threat to psychologists’ standing in this field.

Maintaining your career “edge” in a global world of work

The world of work in the 21st century has been described by many as globalised (Peiperl & Jonsen, 2007; Levy, 2007; Bhagat, 2006; Czinkota & Ronkainen, 2005). Globalisation is generally understood as a greater awareness of the world as a whole; an integrated stage where the countries of the world are seen to be players on the one playing field. This notion is driven by a perception of the world as being occupied by global citizens who are affiliated not with the country in which they are born but whose loyalties lie with planet Earth. They strive to live and work with this focus foremost in their consciousness. Indeed, many of these global citizens will enjoy global careers during their lifetime whereby they work in more than one region of the world during the course of their employment. The present chapter will present a discussion on globalisation and its impact on the world of work, in particular the changes on particular demographic groups in both developed and developing economies. It will then discuss implications for workers and their careers, specifically focusing on changing relationships between workers and organisations and the need for individuals to maintain their competitive edge in the market place through an ongoing focus on relevant career management competencies.

Career development and personal functioning differences between work-bound and non-work bound students

We surveyed 506 Australian high school students on career development (exploration, planning, job-knowledge, decision-making, indecision), personal functioning (well-being, self-esteem, life satisfaction, school satisfaction) and control variables (parents’ education, school achievement), and tested differences among work-bound, college-bound and university-bound students. The work-bound students had the poorest career development and personal functioning, the university-bound students the highest, with the college-bound students falling in-between the other two groups. Work-bound students did poorest, even after controlling for parental education and school achievement. The results suggest a relationship between career development and personal functioning in high school students.

User-designer collaboration during the early stage of the product development process

As an understanding of users' tacit knowledge and latent needs embedded in user experience has played a critical role in product development, users’ direct involvement in design has become a necessary part of the design process. Various ways of accessing users' tacit knowledge and latent needs have been explored in the field of user-centred design, participatory design, and design for experiencing. User-designer collaboration has been used unconsciously by traditional designers to facilitate the transfer of users' tacit knowledge and to elicit new knowledge. However, what makes user-designer collaboration an effective strategy has rarely been reported on or explored. Therefore, interaction patterns between the users and the designers in three industry-supported user involvement cases were studied. In order to develop a coding system, collaboration was defined as a set of coordinated and joint problem solving activities, measured by the elicitation of new knowledge from collaboration. The analysis of interaction patterns in the user involvement cases revealed that allowing users to challenge or modify their contextual experiences facilitates the transfer of knowledge and new knowledge generation. It was concluded that users can be more effectively integrated into the product development process by employing collaboration strategies to intensify the depth of user involvement.