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

National numeracy tests : a graphic tells a thousand words

Mandatory numeracy tests have become commonplace in many countries, heralding a new era in school assessment. New forms of accountability and an increased emphasis on national and international standards (and benchmarks) have the potential to reshape mathematics curricula. It is noteworthy that the mathematics items used in these tests are rich in graphics. Many of the items, for example, require students to have an understanding of information graphics (e.g., maps, charts and graphs) in order to solve the tasks. This investigation classifies mathematics items in Australia’s inaugural national numeracy tests and considers the effect such standardised testing will have on practice. It is argued that the design of mathematics items are more likely to be a reliable indication of student performance if graphical, linguistic and contextual components are considered both in isolation and in integrated ways as essential elements of task design.

Measuring the quality of teaching in elementary school classrooms

This paper reviews the means by which teacher quality has been measured. It considers data sources such as students, peers, experts, and examines the psychometrics and scaleproperties of teacher quality assessment instruments with respect to reliability and validity. A list of items for possible inclusion in an elementary student focussed instrument is considered, together with the potential use of such an instrument in measuring teacher quality.

Entrepreneurship and family firms : a case study in growth and survival

Entrepreneurial marketing has gained popularity in both the entrepreneurship and marketing disciplines in recent times. The success of ventures that have pursued what are considered non-traditional marketing approaches has been attributed to entrepreneurial marketing practices. Despite the multitude of marketing concepts and models, there are prominent venture successes that do not conform to these and have thus been put in the ''entrepreneurial'' box. One only has to look to the ''Virgin'' model to put this in context. Branson has proven for example that not ''sticking to the knitting'' can work with the ways the Virgin portfolio has been diversified. Consequently, an entrepreneurial orientation is considered a desirable philosophy and has become prominent in such industries as airlines and information technology. Miles and Arnold (1991) found that entrepreneurial orientation is positively correlated to marketing orientation. They propose that entrepreneurial orientation is a strategic response by firms to turbulence in the environment. While many marketing successes are analysed in hindsight using traditional marketing concepts and strategies, there are those that challenge standard marketing textbook recommendations. Marketing strategy is often viewed as a process of targeting, segmenting and positioning (STP). Academics and consultants advocate this approach along with the marketing and business plans. The reality however is that a number of businesses do not practice these and pursue alternative approaches. Other schools of thought and business models have been developing to explain differences in orientation such as branding (Keller 2001), the service-dominant logic (Vargo and Lusch 2004) and effectuation logic (Sarasvathy 2001). This indicates that scholars are now looking to cognate fields to explain a given phenomenon beyond their own disciplines. Bucking this trend is a growing number of researchers working at the interface between entrepreneurship and marketing. There is now an emerging body of work dedicated to this interface, hence the development of entrepreneurial marketing as an alternative to the traditional approaches. Hills and Hultman (2008:3) define entrepreneurial marketing as ''a spirit, an orientation as well as a process of passionately pursuing opportunities and launching and growing ventures that create perceived customer value through relationships by employing innovativeness, creativity, selling, market immersion, networking and flexibility.'' Although it started as a special interest group, entrepreneurial marketing is now gaining recognition in mainstream entrepreneurship and marketing literature. For example new marketing textbooks now incorporate an entrepreneurial marketing focus (Grewal and Levy 2008). The purpose of this paper is to explore what entrepreneurial approaches are used by entrepreneurs and their impact on the success of marketing activities. Methodology/Key Propositions In order to investigate this, we employ two cases: 42Below, vodka producers from New Zealand and Penderyn Distillery, whisky distillers from Wales. The cases were chosen based on the following criteria. Firstly, both companies originate from small economies. Secondly, both make products (spirits) from locations that are not traditionally regarded as producers of their flagship products and thirdly, the two companies are different from each other in terms of their age. Penderyn is an old company established in 1882, whereas 42Below was founded only in 1999. Vodka has never been associated with New Zealand. By the same token, whisky has always been associated with Scotland and Ireland but never been with Wales. Both companies defied traditional stereotypes in marketing their flagship products and found international success. Using a comparative a case study approach, we use Covin and Slevin's (1989) set of items that purport to measure entrepreneurial orientation and apply a qualitative lens on the approaches of both companies. These are: 1. cultural emphases on innovation and R&D 2. high rate of new product introduction 3. bold, innovative product development 4. initiator proactive posture 5. first to introduce new technologies and products 6. competitive posture toward competitor 7. strong prolictivity for high risk, high return projects 8. environment requires boldness to achieve objectives 9. when faced with risk, adopts aggressive, bold posture. Results and Implications We find that both companies have employed entrepreneurial marketing approaches but with different intensities. While acknowledging that they are different from the norm, the specifics of their individual approaches are dissimilar. Both companies have positioned their products at the premium end of their product categories and have emphasised quality and awards in their communication strategies. 42Below has carved an image of irreverence and being non-conformist. They have unashamedly utilised viral marketing and entered international markets by training bartenders and hosting unconventional events. They use edgy language such as vodka university, vodka professors and vodka ambassadors. Penderyn Distillery has taken a more traditional approach to marketing its products and portraying romantic images of age-old tradition of distilling as key to their positioning. Both companies enjoy success as evidenced by industry awards and international acclaim.

Virtual reality or virtually real : blended teaching and learning in a Master's level research methods class

This paper examines the enabling effect of using blended learning and synchronous internet mediated communication technologies to improve learning and develop a Sense of Community (SOC) in a group of post-graduate students consisting of a mix of on-campus and off-campus students. Both quantitative and qualitative data collected over a number of years supports the assertion that the blended learning environment enhanced both teaching and learning. The development of a SOC was pivotal to the success of the blended approach when working with geographically isolated groups within a single learning environment.

Effective employment-based training models for childcare workers

Childcare workers play a significant role in the learning and development of children in their care. This has major implications for the training of workers. Under new reforms of the childcare industry the Australian government now requires all workers to obtain qualifications from a vocational education and training provider (eg. Technical and Further Education) or university. Effective models of employment-based training are critical to provide training to highly competent workers. This paper presents findings from a study that examined current and emerging models of employment-based training in the childcare sector, particularly at the Diploma level. Semi-structured interviews were conducted with a sample of 16 participants who represented childcare directors, employers, and workers located in childcare services in urban, regional and remote locations in the State of Queensland. The study proposes a ‘best-fit’ employment-based training approach that is characterised by a compendium of five models instead of a ‘one size fits all’. Issues with successful implementation of the EBT models are also discussed

The importance of ecological scale for wildlife conservation in naturally fragmented environments: A case study of the Brush-Tailed Rock-Wallaby (Petrogale Penicillata)

Determining the ecologically relevant spatial scales for predicting species occurrences is an important concept when determining species–environment relationships. Therefore species distribution modelling should consider all ecologically relevant spatial scales. While several recent studies have addressed this problem in artificially fragmented landscapes, few studies have researched relevant ecological scales for organisms that also live in naturally fragmented landscapes. This situation is exemplified by the Australian rock-wallabies’ preference for rugged terrain and we addressed the issue of scale using the threatened brush-tailed rock-wallaby (Petrogale penicillata) in eastern Australia. We surveyed for brush-tailed rock-wallabies at 200 sites in southeast Queensland, collecting potentially influential site level and landscape level variables. We applied classification trees at either scale to capture a hierarchy of relationships between the explanatory variables and brush-tailed rock-wallaby presence/absence. Habitat complexity at the site level and geology at the landscape level were the best predictors of where we observed brush-tailed rock-wallabies. Our study showed that the distribution of the species is affected by both site scale and landscape scale factors, reinforcing the need for a multi-scale approach to understanding the relationship between a species and its environment. We demonstrate that careful design of data collection, using coarse scale spatial datasets and finer scale field data, can provide useful information for identifying the ecologically relevant scales for studying species–environment relationships. Our study highlights the need to determine patterns of environmental influence at multiple scales to conserve specialist species such as the brush-tailed rock-wallaby in naturally fragmented landscapes.

Diagramming the interior

Mark Taylor's new essay assesses the impact of the diagram on interior design from the late 19th century to the present. Taylor identifies the pop-cultural discourse of advice writing in both books and magazines as a starting point for his analysis. Drawing on diverse sources, his analysis focuses on texts relating to the dynamics of use and flexibility by Catherine Beecher, Harriet Beecher Stowe, Melusina Fay Peirce, Mary Haweis and Christine Frederick among others. The examples in these texts use the home, domestic housekeeping and kitchens as the sites and practices of intervention through which interior design innovations can be enacted. Taylor's analysis identified the innovations in both the social and the political aspects of space and the critique of static space behind these seemingly amateurish and innocuous texts. Identifying these contributions as early precursors of Modernism's open-plan and flexible, dynamic spaces, Taylor also interprets them with a critical concern for the oppositions and hierarchies that can exist in spatial design, and which are the hallmarks of recent Postmodern, phenomenological approaches to interior design and its theorisations. The progressive and subversive "paradigms for living" implicit in these diagrams can be argued to present a model of greater economic, social and political equality as well as representing a more balanced set of power relations in the home. Progressing through the 20th century to the present, Taylor's analysis shifts byond the dressed body and on to the more intimate rituals of the revealed body to further examine how diagrams of the interior, and the interior as a set of diagrams, are also mediators, sites and grounds for the design of social and sexual intimacy. Through a consideration of the link between design, indentity and intimacy (whether of the invisible, fashioned or sexualised body), the diagrms of interiors are reconfigured as radical and critical tools for an animate, material and emancipatory "redressing" of the balance between the body, identity, sexuality, gender, function, mis(use), aesthetics and the interior.

Thermal analysis and hot stage Raman spectroscopy of the basic copper arsenate mineral : euchroite

The thermal analysis of euchroite shows two mass loss steps in the temperature range 100 to 105°C and 185 to 205°C. These mass loss steps are attributed to dehydration and dehydroxylation of the mineral. Hot stage Raman spectroscopy (HSRS) has been used to study the thermal stability of the mineral euchroite, a mineral involved in a complex set of equilibria between the copper hydroxy arsenates: euchroite Cu2(AsO4)(OH).3H2O → olivenite Cu2(AsO4)(OH) → strashimirite Cu8(AsO4)4(OH)4.5H2O → arhbarite Cu2Mg(AsO4)(OH)3. Hot stage Raman spectroscopy inolves the collection of Raman spectra as a function of the temperature. HSRS shows that the mineral euchroite decomposes between 125 and 175 °C with the loss of water. At 125 °C, Raman bands are observed at 858 cm-1 assigned to the ν1 AsO43- symmetric stretching vibration and 801, 822 and 871 cm-1 assigned to the ν3 AsO43- (A1) antisymmetric stretching vibration. A distinct band shift is observed upon heating to 275 °C. At 275 °C the four Raman bands are resolved at 762, 810, 837 and 862 cm-1. Further heating results in the diminution of the intensity in the Raman spectra and this is attributed to sublimation of the arsenate mineral. Hot stage Raman spectroscopy is most useful technique for studying the thermal stability of minerals especially when only very small amounts of mineral are available.