New insights into appetite, inflammation and the use of fish oil in hemodialysis patients

Protein-energy wasting (PEW) is commonly seen in patients with chronic kidney disease (CKD). The condition is characterised by chronic, systemic low-grade inflammation which affects nutritional status by a variety of mechanisms including reducing appetite and food intake and increasing muscle catabolism. PEW is linked with co-morbidities such as cardiovascular disease, and is associated with lower quality of life, increased hospitalisations and a 6-fold increase in risk of death1. Significant gender differences have been found in the severity and effects of several markers of PEW. There have been limited studies testing the ability of anti-inflammatory agents or nutritional interventions to reduce the effects of PEW in dialysis patients. This thesis makes a significant contribution to the understanding of PEW in dialysis patients. It advances understanding of measurement techniques for two of the key components, appetite and inflammation, and explores the effect of fish oil, an anti-inflammatory agent, on markers of PEW in dialysis patients. The first part of the thesis consists of two methodological studies conducted using baseline data. The first study aims to validate retrospective ratings of hunger, desire to eat and fullness on visual analog scales (VAS) (paper and pen and electronic) as a new method of measuring appetite in dialysis patients. The second methodological study aims to assess the ability of a variety of methods available in routine practice to detect the presence of inflammation. The second part of the thesis aims to explore the effect of 12 weeks supplementation with 2g per day of Eicosapentaenoic Acid (EPA), a longchain fatty acid found in fish oil, on markers of PEW. A combination of biomarkers and psychomarkers of appetite and inflammation are the main outcomes being explored, with nutritional status, dietary intake and quality of life included as secondary outcomes. A lead in phase of 3 months prior to baseline was used so that each person acts as their own historical control. The study also examines whether there are gender differences in response to the treatment. Being an exploratory study, an important part of the work is to test the feasibility of the intervention, thus the level of adherence and factors associated with adherence are also presented. The studies were conducted at the hemodialysis unit of the Wesley Hospital. Participants met the following criteria: adult, stage 5 CKD on hemodialysis for at least 3 months, not expected to receive a transplant or switch to another dialysis modality during the study, absence of intellectual impairment or mental illness impairing ability to follow instructions or complete the intervention. A range of intermediate, clinical and patient-centred outcome measures were collected at baseline and 12 weeks. Inflammation was measured using five biomarkers: c-reactive protein (CRP), interleukin-6 (IL6), intercellular adhesion molecule (sICAM-1), vascular cell adhesion molecule (sVCAM-1) and white cell count (WCC). Subjective appetite was measured using the first question from the Appetite and Dietary Assessment (ADAT) tool and VAS for measurements of hunger, desire to eat and fullness. A novel feature of the study was the assessment of the appetite peptides leptin, ghrelin and peptide YY as biomarkers of appetite. Nutritional status/inflammation was assessed using the Malnutrition-Inflammation Score (MIS) and the Patient-Generated Subjective Global Assessment (PG-SGA). Dietary intake was measured using 3-day records. Quality of life was measured using the Kidney Disease Quality of Life Short Form version 1.3 (KDQOL-SF™ v1.3 © RAND University), which combines the Short-Form 36 (SF36) with a kidney-disease specific module2. A smaller range of these variables was available for analysis during the control phase (CRP, ADAT, dietary intake and nutritional status). Statistical analysis was carried out using SPSS version 14 (SPSS Inc, Chicago IL, USA). Analysis of the first part of the thesis involved descriptive and bivariate statistics, as well as Bland-Altman plots to assess agreement between methods, and sensitivity analysis/ROC curves to test the ability of methods to predict the presence of inflammation. The unadjusted (paired ttests) and adjusted (linear mixed model) change over time is presented for the main outcome variables of inflammation and appetite. Results are shown for the whole group followed by analyses according to gender and adherence to treatment. Due to the exploratory nature of the study, trends and clinical significance were considered as important as statistical significance. Twenty-eight patients (mean age 61±17y, 50% male, dialysis vintage 19.5 (4- 101) months) underwent baseline assessment. Seven out of 28 patients (25%) reported sub-optimal appetite (self-reported as fair, poor or very poor) despite all being well nourished (100% SGA A). Using the VAS, ratings of hunger, but not desire to eat or fullness, were significantly (p<0.05) associated with a range of relevant clinical variables including age (r=-0.376), comorbidities (r=-0.380) nutritional status (PG-SGA score, r=-0.451), inflammatory markers (CRP r=-0.383; sICAM-1 r=-0.387) and seven domains of quality of life. Patients expressed a preference for the paper and pen method of administering VAS. None of the tools (appetite, MIS, PG-SGA, albumin or iron) showed an acceptable ability to detect patients who are inflamed. It is recommended that CRP should be tested more frequently as a matter of course rather than seeking alternative methods of measuring inflammation. 27 patients completed the 12 week intervention. 20 patients were considered adherent based on changes in % plasma EPA, which rose from 1.3 (0.94)% to 5.2 (1.1)%, p<0.001, in this group. The major barriers to adherence were forgetting to take the tablets as well as their size. At 12 weeks, inflammatory markers remained steady apart from the white cell count which decreased (7.6(2.5) vs 7.0(2.2) x109/L, p=0.058) and sVCAM-1 which increased (1685(654) vs 2249(925) ng/mL, p=0.001). Subjective appetite using VAS increased (51mm to 57mm, +12%) and there was a trend towards reduction in peptide YY (660(31) vs 600(30) pg/mL, p=0.078). There were some gender differences apparent, with the following adjusted change between baseline and week 12: CRP (males -3% vs females +17%, p=0.19), IL6 (males +17% vs females +48%, p=0.77), sICAM-1 (males -5% vs females +11%, p=0.07), sVCAM-1 (males +54% vs females +19%, p=0.08) and hunger ratings (males 20% vs females -5%, p=0.18). On balance, males experienced a maintainence or reduction in three inflammatory markers and an improvement in hunger ratings, and therefore appeared to have responded better to the intervention. Compared to those who didn’t adhere, adherent patients maintained weight (mean(SE) change: +0.5(1.6) vs - 0.8(1.2) kg, p=0.052) and fat-free mass (-0.1 (1.6) vs -1.8 (1.8) kg, p=0.045). There was no difference in change between the intervention and control phase for CRP, appetite, nutritional status or dietary intake. The thesis makes a significant contribution to the evidence base for understanding of PEW in dialysis patients. It has advanced knowledge of methods of assessing inflammation and appetite. Retrospective ratings of hunger on a VAS appear to be a valid method of assessing appetite although samples which include patients with very poor appetite are required to confirm this. Supplementation with fish oil appeared to improve subjective appetite and dampen the inflammatory response. The effectiveness of the intervention is influenced by gender and adherence. Males appear to be more responsive to the primary outcome variables than females, and the quality of response is improved with better adherence. These results provide evidence to support future interventions aimed at reducing the effects of PEW in dialysis patients.

The use of high dynamic range luminance mapping in the assessment, understanding and defining of visual issues in post occupancy building assessment

The international focus on embracing daylighting for energy efficient lighting purposes and the corporate sector’s indulgence in the perception of workplace and work practice “transparency” has spurned an increase in highly glazed commercial buildings. This in turn has renewed issues of visual comfort and daylight-derived glare for occupants. In order to ascertain evidence, or predict risk, of these events; appraisals of these complex visual environments require detailed information on the luminances present in an occupant’s field of view. Conventional luminance meters are an expensive and time consuming method of achieving these results. To create a luminance map of an occupant’s visual field using such a meter requires too many individual measurements to be a practical measurement technique. The application of digital cameras as luminance measurement devices has solved this problem. With high dynamic range imaging, a single digital image can be created to provide luminances on a pixel-by-pixel level within the broad field of view afforded by a fish-eye lens: virtually replicating an occupant’s visual field and providing rapid yet detailed luminance information for the entire scene. With proper calibration, relatively inexpensive digital cameras can be successfully applied to the task of luminance measurements, placing them in the realm of tools that any lighting professional should own. This paper discusses how a digital camera can become a luminance measurement device and then presents an analysis of results obtained from post occupancy measurements from building assessments conducted by the Mobile Architecture Built Environment Laboratory (MABEL) project. This discussion leads to the important realisation that the placement of such tools in the hands of lighting professionals internationally will provide new opportunities for the lighting community in terms of research on critical issues in lighting such as daylight glare and visual quality and comfort.

Psychological predictors of young adults' use of social networking sites

Young people are increasingly using social networking sites (SNSs), like Myspace and Facebook, to engage with others. The use of SNSs can have both positive and negative effects on the individual; however, few research studies identify the types of people who frequent these Internet sites. This study sought to predict young adults’ use of SNSs and addictive tendency towards the use of SNSs from their personality characteristics and levels of self-esteem. University students (N = 201), aged 17 to 24 years, reported their use of SNSs and addictive tendencies for SNSs use, and completed the NEO Five-Factor Personality Inventory 1 and the Coopersmith Self-Esteem Inventory.2 Multiple regression analyses revealed that, as a group, the personality and self-esteem factors significantly predicted both level of SNS use and addictive tendency but did not explain a large amount of variance in either outcome measure. The findings indicated that extraverted and unconscientious individuals reported higher levels of both SNS use and addictive tendencies. Future research should attempt to identify which other psychosocial characteristics explain young people’s level of use and propensity for addictive tendencies for these popular Internet sites.

Dating and intimacy in the 21st century : the use of online dating sites in Australia

This article examines the growing phenomenon of online dating and intimacy in the 21st century. The exponential rise of communications technologies, which is both reflective and constitutive of an increasingly networked and globalized society, has the potential to significantly influence the nature of intimacy in everyday life. Yet, to date, there has been a minimal response by sociologists to seek, describe and understand this influence. In this article, we present some of the key findings of our research on online dating in Australia, in order to foster a debate about the sociological impacts on intimacy in the postmodern world. Based on a web audit of more than 60 online dating sites and in-depth interviews with 23 users of online dating services, we argue that recent global trends are influencing the uptake of online technologies for the purposes of forming intimate relations. Further, some of the mediating effects of these technologies – in particular, the hypercommunication – may have specific implications for the nature of intimacy in the global era.

Gifted young adolescents and email : developing a personal language of self

This paper reports on the use of email as a means to access the self-constructions of gifted young adolescents. Australian research shows that gifted young adolescents may feel more lonely and misunderstood than their same-age counterparts, yet they are seldom asked about their lives. Emerging use of online methods as a means of access to individual lives and perceptions has demonstrated the potential offered by the creation of digital texts as narrative data. Details are given of a qualitative study that engaged twelve children aged between 10 and 14 years, who were screened for giftedness, in a project involving the generation of emailed journal entries sent over a period of 6 months. With emphasis on participatory principles, individual young adolescents produced self-managed journal entries that were written and sent to the researcher from personal computers outside the school setting. Drawing from a theoretical understanding of self as constructed within dialogic relationships, the digital setting of email is proposed as a narrative space that fosters healthy self-disclosure. This paper outlines the benefits of using email as a means to explore emotions, promote reflective accounts of self and support the development of a personal language for self-expression. Individual excerpts will be presented to show that the harnessing of personal narratives within an email context has potential to yield valuable insights into the emotions, personal realities and experiences of gifted young adolescents. Findings will be presented to show that the co-construction of self-expressive and explanatory narratives supported by a facilitative adult listener promoted healthy self-awareness amongst participants. This paper contributes to appreciative conversations about using online methods as a flexible and practical avenue for conducting educational research. Furthermore, digital writing in email form will be presented as having distinct advantages over face-to-face methods when utilised with gifted young adolescents who may be unwilling to disclose information within school-based settings.

Predicting adolescents’ use of social networking sites from an extended theory of planned behaviour perspective

The popularity of social networking sites (SNSs) among adolescents has grown exponentially, with little accompanying research to understand the influences on adolescent engagement with this technology. The current study tested the validity of an extended theory of planned behaviour model (TPB), incorporating the additions of group norm and self-esteem influences, to predict frequent SNS use. Adolescents (N = 160) completed measures assessing the standard TPB constructs of attitude, subjective norm, perceived behavioural control (PBC), and intention, as well as group norm and self-esteem. One week later, participants reported their SNS use during the previous week. Support was found for the standard TPB variables of attitude and PBC, as well as group norm, in predicting intentions to use SNS frequently, with intention, in turn, predicting behaviour. These findings provide an understanding of the factors influencing frequent engagement in what is emerging as a primary tool for adolescent socialisation.

Use of IP addresses for high rate flooding attack detection

High-rate flooding attacks (aka Distributed Denial of Service or DDoS attacks) continue to constitute a pernicious threat within the Internet domain. In this work we demonstrate how using packet source IP addresses coupled with a change-point analysis of the rate of arrival of new IP addresses may be sufficient to detect the onset of a high-rate flooding attack. Importantly, minimizing the number of features to be examined, directly addresses the issue of scalability of the detection process to higher network speeds. Using a proof of concept implementation we have shown how pre-onset IP addresses can be efficiently represented using a bit vector and used to modify a “white list” filter in a firewall as part of the mitigation strategy.

Visual arts, technology and education : how can teaching and learning in high school visual arts classrooms be enriched by the use of computer technology?

Whilst a variety of studies has appeared over the last decade addressing the gap between the potential promised by computers and the reality experienced in the classroom by teachers and students, few have specifically addressed the situation as it pertains to the visual arts classroom. The aim of this study was to explore the reality of the classroom use of computers for three visual arts highschool teachers and determine how computer technology might enrich visual arts teaching and learning. An action research approach was employed to enable the researcher to understand the situation from the teachers' points of view while contributing to their professional practice. The wider social context surrounding this study is characterised by an increase in visual communications brought about by rapid advances in computer technology. The powerful combination of visual imagery and computer technology is illustrated by continuing developments in the print, film and television industries. In particular, the recent growth of interactive multimedia epitomises this combination and is significant to this study as it represents a new form of publishing of great interest to educators and artists alike. In this social context, visual arts education has a significant role to play. By cultivating a critical awareness of the implications of technology use and promoting a creative approach to the application of computer technology within the visual arts, visual arts education is in a position to provide an essential service to students who will leave high school to participate in a visual information age as both consumers and producers.

The use of economic evaluation in CAM : an introductory framework

Background For CAM to feature prominently in health care decision-making there is a need to expand the evidence-base and to further incorporate economic evaluation into research priorities. In a world of scarce health care resources and an emphasis on efficiency and clinical efficacy, CAM, as indeed do all other treatments, requires rigorous evaluation to be considered in budget decision-making. Methods Economic evaluation provides the tools to measure the costs and health consequences of CAM interventions and thereby inform decision making. This article offers CAM researchers an introductory framework for understanding, undertaking and disseminating economic evaluation. The types of economic evaluation available for the study of CAM are discussed, and decision modelling is introduced as a method for economic evaluation with much potential for use in CAM. Two types of decision models are introduced, decision trees and Markov models, along with a worked example of how each method is used to examine costs and health consequences. This is followed by a discussion of how this information is used by decision makers. Conclusions Undoubtedly, economic evaluation methods form an important part of health care decision making. Without formal training it can seem a daunting task to consider economic evaluation, however, multidisciplinary teams provide an opportunity for health economists, CAM practitioners and other interested researchers, to work together to further develop the economic evaluation of CAM.

The use of ZIP and CART to model cryptosporidiosis in relation to climatic variables

This research assesses the potential impact of weekly weather variability on the incidence of cryptosporidiosis disease using time series zero-inflated Poisson (ZIP) and classification and regression tree (CART) models. Data on weather variables, notified cryptosporidiosis cases and population size in Brisbane were supplied by the Australian Bureau of Meteorology, Queensland Department of Health, and Australian Bureau of Statistics, respectively. Both time series ZIP and CART models show a clear association between weather variables (maximum temperature, relative humidity, rainfall and wind speed) and cryptosporidiosis disease. The time series CART models indicated that, when weekly maximum temperature exceeded 31°C and relative humidity was less than 63%, the relative risk of cryptosporidiosis rose by 13.64 (expected morbidity: 39.4; 95% confidence interval: 30.9–47.9). These findings may have applications as a decision support tool in planning disease control and risk management programs for cryptosporidiosis disease.

My career chapter as a tool for reflective practice

This paper addresses reflective practice in research and practice and takes the issue of consciousness of social class in vocational psychology as a working example. It is argued that the discipline’s appreciation of social class can be advanced through application of the qualitative research method autoethnography. Excerpts from an autoethnographic study are used to explore the method’s potential. This reflexive research method is presented as a potential vehicle to improve vocational psychologists’ own class consciousness, and to concomitantly enhance their capacity to grasp social class within their own spheres of research and practice. It is recommended that autoethnography be used for research, training, and professional development for vocational psychologists.

Use of IEEE 1588-2008 for a sampled value process bus in transmission substations

IEC Technical Committee 57 (TC57) published a series of standards and technical reports for “Communication networks and systems for power utility automation” as the IEC 61850 series. Sampled value (SV) process buses allow for the removal of potentially lethal voltages and damaging currents inside substation control rooms and marshalling kiosks, reduce the amount of cabling required in substations, and facilitate the adoption of non-conventional instrument transformers. IEC 61850-9-2 provides an inter-operable solution to support multi-vendor process bus solutions. A time synchronisation system is required for a SV process bus, however the details are not defined in IEC 61850-9-2. IEEE Std 1588-2008, Precision Time Protocol version 2 (PTPv2), provides the greatest accuracy of network based time transfer systems, with timing errors of less than 100 ns achievable. PTPv2 is proposed by the IEC Smart Grid Strategy Group to synchronise IEC 61850 based substation automation systems. IEC 61850-9-2, PTPv2 and Ethernet are three complementary protocols that together define the future of sampled value digital process connections in substations. The suitability of PTPv2 for use with SV is evaluated, with preliminary results indicating that steady state performance is acceptable (jitter < 300 ns), and that extremely stable grandmaster oscillators are required to ensure SV timing requirements are met when recovering from loss of external synchronisation (such as GPS).

A survey of the use of grading scales for contact lens complications in optometric practice

Purpose:  The aim of this study was to investigate the extent and pattern of use of grading scales for contact lens complications (‘grading scales’) in optometric practice. Methods:  An anonymous postal survey was sent to all 756 members of the Queensland Division of Optometrists Association Australia. Information was elicited relating to level of experience, practice type and location, and mode of usage of grading scales. Results:  Survey forms were returned by 237 optometrists, representing a 31 per cent response rate. The majority of respondents (61 per cent) reported using grading scales frequently in practice, while 65 per cent of these preferred to use the Efron Grading Scales for Contact Lens Complications. Seventy-six per cent of optometrists use a method of incremental grading rather than simply grading with whole numbers. Grading scales are more likely to be used by optometrists who have recently graduated (p < 0.001), have a postgraduate certificate in ocular therapeutics (p = 0.018), see more contact lens patients (p = 0.027) and use other forms of grading scales (p < 0.001). The most frequently graded ocular conditions were corneal staining, papillary conjunctivitis and conjunctival redness. The main reasons for not using grading scales included a preference for sketches, photographs or descriptions (87 per cent) and unavailability of scales (29 per cent). Conclusion:  Grading scales for contact lens complications are used extensively in optometric practice for a variety of purposes. This tool can now be considered as an expected norm in contact lens practice. We advocate the incorporation of such grading scales into professional guidelines and standards for good optometric clinical practice.

The use of temporal speech and lip information for multi-modal speaker identification via multi-stream HMMs

Investigates the use of temporal lip information, in conjunction with speech information, for robust, text-dependent speaker identification. We propose that significant speaker-dependent information can be obtained from moving lips, enabling speaker recognition systems to be highly robust in the presence of noise. The fusion structure for the audio and visual information is based around the use of multi-stream hidden Markov models (MSHMM), with audio and visual features forming two independent data streams. Recent work with multi-modal MSHMMs has been performed successfully for the task of speech recognition. The use of temporal lip information for speaker identification has been performed previously (T.J. Wark et al., 1998), however this has been restricted to output fusion via single-stream HMMs. We present an extension to this previous work, and show that a MSHMM is a valid structure for multi-modal speaker identification