Fibrosis Progression Rate in Biopsy-Proven Nonalcoholic Fatty Liver Disease Among People With Diabetes Versus People Without Diabetes: A Multicenter Study

Background & aimsThere are limited data regarding fibrosis progression in biopsy-proven nonalcoholic fatty liver disease (NAFLD) in people with type 2 diabetes mellitus (T2DM) compared with people without T2DM. We assessed the time to fibrosis progression in people with T2DM compared with people without T2DM in a large, multicenter, study of people with NAFLD who had paired liver biopsies.MethodsThis study included 447 adult participants (64% were female) with NAFLD who had paired liver biopsies more than 1 year apart. Liver histology was systematically assessed by a central pathology committee blinded to clinical data. The primary outcome was the cumulative incidence of a ≥1-stage increase in fibrosis in participants with T2DM compared with participants without T2DM.ResultsThe mean (SD) age and body mass index (calculated as weight in kilograms divided by the square of the height in meters) were 50.9 (11.5) years and 34.7 (6.3), respectively. The median time between biopsies was 3.3 years (interquartile range, 1.8-6.1 years). Participants with T2DM had a significantly higher cumulative incidence of fibrosis progression at 4 years (24% vs 20%), 8 years (60% vs 50%), and 12 years (93% vs 76%) (P = .005). Using a multivariable Cox proportional hazards model adjusted for multiple confounders, T2DM remained an independent predictor of fibrosis progression (adjusted hazard ratio, 1.69; 95% CI, 1.17-2.43; P = .005). The cumulative incidence of fibrosis regression by ≥1 stage was similar in participants with T2DM compared with participants without T2DM (P = .24).ConclusionsIn this large, multicenter cohort study of well-characterized participants with NAFLD and paired liver biopsies, we found that fibrosis progressed faster in participants with T2DM compared with participants without T2DM. These data have important implications for clinical practice and trial design

Evaluating your train simulator. Part II, the task environment

This chapter will expand on this idea, but while the focus of the previous discussion was on the design and classification of the simulator environment, this chapter will focus on the data that are recorded by simulators and how they may be used in view of the simulator’s objectives. In broad terms, train simulators are typically designed for three key purposes, as follows:• Driver training • Competency assessment • Research Using simulators to deliver training allows familiarisation with routes, certain track features and responses to emergency situations in a relatively consequence free setting. Using them to assess competency enables the ongoing measurement of performance. Finally, using them for research enables the systematic investigation of the effects of differences at the driver (e.g. mood, experience, memory, fatigue), train (e.g. type, length, loading, locos, mechanical malfunctions), track (e.g. curvature, length, grade, defects, works, crossings) and environmental (e.g. light, noise, visibility, ice, rain, snow) levels on driving performance. As shown in Figure 9.1, a wide range of factors influence the ability to drive a train, highlighting an information-rich environment. However, simulation requirements, particularly the type and detail of the data required for training, competency and research, are often at odds with one another. The previous chapter made the point that simulators can be used to evaluate more than just technology, and that the fabric of the simulator must also be evaluated if meaningful data are to be derived from the evaluations of humans, systems and the processes placed inside. This chapter will extend this notion but focus more overtly on how these evaluations may be performed for research and review, with a focus on data format, choice of measurement, and interpretation and analysis of data

Partnering for workplace health and safety

Worker involvement in decision-making about the workplace can improve safety, health, productivity and the quality of organizational outputs. Australian work health and safety (WHS) legislation mandates worker involvement and gives elected Health and Safety Representatives (HSRs) specific powers, but there has been limited research about the impact of that regulatory framework on the nature, quality and outcomes of worker involvement. As part of a wider review of worker representation in WHS, we investigated the role and impact (positive and negative) of elected HSRs on WHS] in South Australia using a newly-constructed survey instrument. This paper reports on the development of the instrument and the initial findings of the research. The initial survey dimensions and items were developed from earlier research on consultation in South Australia and were refined and validated through this research. The survey has 9 constructs and 61 items and has both face validity and high internal consistency. This research is a step forward for researchers and policy makers seeking a means of determining the effectiveness of worker participation in WHS. It provides an instrument, pilot baseline data and a method that could be used internationally to enable this assessment

Strategies used by healthcare practitioners to manage fatigue-related risk beyond work hours /

Objectives: Fatigue in healthcare practitioners presents a risk to both patient safety and the safety and well-being of doctors and nurses. Management of fatigue-related risk is largely focused on hours of work limits, but these limits are fallible. The aim was to investigate the ways in which healthcare professionals manage fatigue-related risk beyond the hours. Methods: Qualitative data extracted from semi-structured interviews and focus groups with 189 healthcare practitioners from nursing and medical disciplines were subjected to thematic analysis to identify key themes of causes and consequences of fatigue, as well as strategies deployed within teams and by individuals. Results: The majority of fatigue risk management beyond hours of work limits occurs as informal processes that have evolved within teams. These processes can be characterised as non-technical skills and include error protection practices and fatigue-proofing strategies. Conclusions: The informal practices we identified represent a key layer of defence in a fatigue risk management system – that of recognising and responding to fatigue. A process to assess and formalise the error protection practices and fatigue-proofing strategies is required and any formal implementation should be supported by effective and fair incident reporting systems

Evaluating your train simulator. Part I, The physical environment

The aim of this chapter is to stray a little closer towards the region straddling the academic–industry plane, and explore the topic of train simulation. Train simulation has rapidly gained momentum in recent years, and in doing so, cultivated a number of different approaches and definitions in the treatment and practice of simulating reality. This chapter contains information that will be very useful for academic researchers, but is primarily aimed at rail industry subject matter experts, particularly senior train drivers, train crew training managers and general managers of train service delivery who are interested in evaluating train simulator technology. It will discuss the most pertinent issues, and clarify simulator design, use and management, towards defining classes of simulator that may be used for various goals

Subjective and objective sleep in children and adolescents measurement, age, and gender differences /

It is important to ascertain the accuracy of children’s and adolescents’ self-reported sleep estimates as they are usually the first (and sometimes only) measure of sleep taken by parents, clinicians, or researchers. In this study, sleep diaries were compared with actigraphy monitoring to investigate the correspondence between measures of sleep in children and adolescents and provide normative data. Differences in age, gender, and school day/weekend were investigated. Sixty-six (21 boys, 45 girls) children and adolescents (11–17 years) wore a wrist actigraphy monitor and completed a 7-day sleep diary. Measures of sleep onset, wake time, wake after sleep onset, and total sleep time were obtained. Less than recommended (9–11 h) amounts of sleep were obtained throughout the week and all participants underestimated the duration of their night wake. Children went to sleep significantly earlier and obtained more sleep than adolescents. Sleep onset and wake time were significantly later on weekends than school days for both age groups. No significant gender differences were found for any objectively measured sleep parameter. Correlations between diary and actigraphy were moderate to high and significant for sleep onset, wake time, and total sleep time. Paired samples t-tests indicated a significant difference between diary and actigraphy scores for all variables except children’s sleep onset. Overall, children and adolescents overestimated their total sleep time by approximately an hour, primarily through an under appreciation of night awakenings

Recycling 115,369 mobile phones for gorilla conservation over a six-year period (2009-2014) at Zoos Victoria: A case study of 'points of influence' and mobile phone donations.

More than seven billion mobile phones are estimated to be in service globally, with more than a billion older phones likely to be retired. A major barrier to a sustainable circular economy for mobile phones is people's hoarding of their retired phones. Old mobile phones may be refurbished for re-use or ultimately dismantled for possible extraction of elements, including 'conflict' metals such as coltan (containing elements tantalum and niobium), mined in eastern Democratic Republic of Congo and threatening wild populations of eastern Grauer's gorillas (Gorilla beringei graueri). Zoos Victoria cares for western gorillas (Gorilla gorilla gorilla) who served as ambassadors for their Grauer's gorilla counterparts in this community-based social marketing initiative. Through tracking of barcodes on satchels of recycled mobile phones, efficiency of ten different points of influence could be calculated for the 'They're Calling on You' mobile phone recycling community campaign at Zoos Victoria in Australia. Over a six-year period (2009-2014), a total of 115,369 mobile phones were donated. The Courier Collect initiative resulted in 50,883 mobile phone donations (44% of total), followed by the Static Display at Melbourne Zoo, resulting in 29,778 mobile phone donations (26% of total). The number of phones collected for Keeper Talks (at Melbourne Zoo and Werribee Open Range Zoo) was 12,684 (11% of total), and in terms of fostering close connections between visitors and the conservation campaign, keeper talks were effective as one phone was donated for every four people attending a keeper talk at Werribee Open Range Zoo and one phone was donated for every 28 people who attended a keeper talk at Melbourne Zoo. We provide suggestions for future campaigns, so that accurate data capture can allow cost-benefit analyses to be conducted. Our results demonstrate that a conservation-based organisation, in partnership with corporate sponsors and community groups can effectively influenced people's mobile phone recycling behavior, paving the way for international collaborations to maximize scale and impact

The deterrent effects of OHS enforcement: a review of the literature

Work-related injury and death in Australia, as elsewhere, remains a perennial issue of public concern, especially in view of the high toll it exacts on the nation’s social and economic wellbeing. Systemic failure persists even though OHS laws enacted to protect people at work from hazards associated with their employment have been in place for more than a century. In examining the role of enforcement in OHS regulation, this review briefly outlines the main significance of OHS as a public policy issue; and provides an overview of the evolution of the legal architecture and inspectorial practices that have historically underpinned OHS laws in Australia, along with more recent changes in these areas. This is followed by an evaluation of quantitative and qualitative studies that have sought to determine the deterrent effect of OHS enforcement. The main findings are that deterrence operates in a more mediated manner than presumed by traditional deterrence theory; that the certainty of inspection appears to be the most important component of deterrence and that specific deterrence is greater than general deterrence. It is also apparent that there are many gaps in our understanding of the role of enforcement in Australia in promoting improvements in OHS performance. A number of implications arising from the research findings are drawn that may assist in enhancing enforcement activity