MEASUREMENT OF CONTROLLED ATTENUATION PARAMETER: A SURROGATE MARKER OF HEPATIC STEATOSIS IN PATIENTS OF NONALCOHOLIC FATTY LIVER DISEASE ON LIFESTYLE MODIFICATION - A PROSPECTIVE FOLLOW-UP STUDY

ABSTRACT BACKGROUND: Liver biopsy is a gold standard method for hepatic steatosis assessment. However, liver biopsy is an invasive and painful procedure and can cause severe complications therefore it cannot be frequently used in case of follow-up of patients. Non-invasive assessment of steatosis and fibrosis is of growing relevance in non-alcoholic fatty liver disease (NAFLD). To evaluate hepatic steatosis, transient elastography with controlled attenuation parameter (CAP) measurement is an option now days. OBJECTIVE: Aim of this study is to evaluate role of measurement of controlled attenuation parameter, a surrogate marker of hepatic steatosis in patients of nonalcoholic fatty liver disease on lifestyle modification. METHODS: In this study, initially 37 participants were included who were followed up after 6 months with transient elastography, blood biochemical tests and anthropometric measurements. The results were analyzed by Multivariate linear regression analysis and paired samples t-test (Dependent t-test) with 95% confidence interval. Correlation is calculated by Pearson correlation coefficients. RESULTS: Mean CAP value for assessing hepatic steatosis during 1st consultation (278.57±49.13 dB/m) was significantly improved (P=0.03) after 6 months of lifestyle modification (252.91±62.02 dB/m). Only fasting blood sugar (P=0.008), weight (P=0.000), body mass index (BMI) (P=0.000) showed significant positive correlation with CAP. Only BMI (P=0.034) and weight (P=0.035) were the independent predictor of CAP value in NAFLD patients. CONCLUSION: Lifestyle modification improves the hepatic steatosis, and CAP can be used to detect the improvement of hepatic steatosis during follow-up in patients with NAFLD on lifestyle modification. There is no relation between CAP and Fibroscan score in NAFLD patients. Only BMI and weight can predict CAP value independently

Statistical characteristics of cost contingency in water infrastructure projects

Cost contingency is one component of a project’s budget to cater for cost growth. The determination of a project’s cost contingency is a pervasive problem because the amount that is incorporated into an estimate is invariably insufficient to accommodate the cost growth of a project. This study analyzed the statistical characteristics of cost contingency and cost growth experienced in 228 similar Australian water infrastructure projects that were procured by using traditional lump contracts. It was revealed that mean project final costs exceeded the approved budgets that contained contingency. The mean contingency percentage addition was 8.46%, yet the mean contingency required for the final cost was 13.58% for the sampled projects. Thus, the deterministic percentage addition, used by the sponsor to accommodate for cost growth beyond their baseline budget, was inaccurate. To improve the accuracy of a contingency estimate, the empirical distributions of cost contingency and cost performance were examined to determine their best-fit probability distribution. The research presented in this paper demonstrates that determining the best fit probability distribution provides a more robust and defendable basis for selecting a cost contingency than the traditional deterministic percentage approach

Does Presence of a Mid-Ocean Ridge Enhance Biomass and Biodiversity?

In contrast to generally sparse biological communities in open-ocean settings, seamounts and ridges are perceived as areas of elevated productivity and biodiversity capable of supporting commercial fisheries. We investigated the origin of this apparent biological enhancement over a segment of the North Mid-Atlantic Ridge (MAR) using sonar, corers, trawls, traps, and a remotely operated vehicle to survey habitat, biomass, and biodiversity. Satellite remote sensing provided information on flow patterns, thermal fronts, and primary production, while sediment traps measured export flux during 2007–2010. The MAR, 3,704,404 km2 in area, accounts for 44.7% lower bathyal habitat (800–3500 m depth) in the North Atlantic and is dominated by fine soft sediment substrate (95% of area) on a series of flat terraces with intervening slopes either side of the ridge axis contributing to habitat heterogeneity. The MAR fauna comprises mainly species known from continental margins with no evidence of greater biodiversity. Primary production and export flux over the MAR were not enhanced compared with a nearby reference station over the Porcupine Abyssal Plain. Biomasses of benthic macrofauna and megafauna were similar to global averages at the same depths totalling an estimated 258.9 kt C over the entire lower bathyal north MAR. A hypothetical flat plain at 3500 m depth in place of the MAR would contain 85.6 kt C, implying an increase of 173.3 kt C attributable to the presence of the Ridge. This is approximately equal to 167 kt C of estimated pelagic biomass displaced by the volume of the MAR. There is no enhancement of biological productivity over the MAR; oceanic bathypelagic species are replaced by benthic fauna otherwise unable to survive in the mid ocean. We propose that globally sea floor elevation has no effect on deep sea biomass; pelagic plus benthic biomass is constant within a given surface productivity regime

Areas of Lower Bathyal Habitat in the North Atlantic Ocean.

<p>Areas of Lower Bathyal Habitat in the North Atlantic Ocean.</p

Spatial distribution of area backscatter.

<p>Area backscattering coefficient (m² nautical mile⁻²), from the mesopelagic deep scattering layer. Recordings from multi-ship surveys using calibrated SIMRAD 38 kHz echosounders integrating down to 750 m depth (1000 m after 1999). Composite image of data from 1996–2009 during June–July.</p

Effect of a ridge on mid-ocean biomass.

<p>Comparison of sections of a hypothetical ocean with the MAR truncated at the 3500 m depth horizon (upper panel) with the real ocean with a ridge present (lower panel). The thickness of the red section indicates the benthic biomass that decreases with depth. V_ridge is the volume of water, including pelagic biomass displaced by the ridge.</p

Remote sensing imagery of distribution of fronts.

<p>Seasonal oceanic front frequency map indicating the percentage of time a strong front was observed at each location during spring (Mar-May), derived from merged microwave and infrared SST (Sea Surface Temperature) data, 2007–2009. Blue arrows are inferred paths of branches of the North Atlantic Current (NAC) delineating the sub-polar front. Frontal features related to bathymetry are labelled: B - Rockall Bank, C - Iceland-Greenland branch of NAC, H - deeper hollow in sea bed, M - recurring meander, N - near to MAR, PAP – Porcupine Abyssal Plain, PSB – Porcupine Seabight, R – Reykjanes Ridge.</p