Associations of height, leg length, and lung function with cardiovascular risk factors in the Midspan Family Study

<b>Background</b>: Taller people and those with better lung function are at reduced risk of coronary heart disease (CHD). Biological mechanisms for these associations are not well understood, but both measures may be markers for early life exposures. Some studies have shown that leg length, an indicator of pre-pubertal nutritional status, is the component of height most strongly associated with CHD risk. Other studies show that height-CHD associations are greatly attenuated when lung function is controlled for. This study examines (1) the association of height and the components of height (leg length and trunk length) with CHD risk factors and (2) the relative strength of the association of height and forced expiratory volume in one second (FEV1) with risk factors for CHD. <b>Subjects and methods</b>: Cross sectional analysis of data collected at detailed cardiovascular screening examinations of 1040 men and 1298 women aged 30–59 whose parents were screened in 1972–76. Subjects come from 1477 families and are members of the Midspan Family Study. <b>Setting</b>: The towns of Renfrew and Paisley in the West of Scotland. <b>Results</b>: Taller subjects and those with better lung function had more favourable cardiovascular risk factor profiles, associations were strongest in relation to FEV1. Higher FEV1 was associated with lower blood pressure, cholesterol, glucose, fibrinogen, white blood cell count, and body mass index. Similar, but generally weaker, associations were seen with height. These associations were not attenuated in models controlling for parental height. Longer leg length, but not trunk length, was associated with lower systolic and diastolic blood pressure. Longer leg length was also associated with more favourable levels of cholesterol and body mass index than trunk length. <b>Conclusions</b>:These findings provide indirect evidence that measures of lung development and pre-pubertal growth act as biomarkers for childhood exposures that may modify an individual's risk of developing CHD. Genetic influences do not seem to underlie height-CHD associations

Intensive care in labour: a preliminary appraisal

This is a preliminary investigation into the value, function and practicability of an intensive care labour unit for highrisk cases. All the equipment necessary can be mounted on two standard theatre trolleys which can be moved to the patient's bedside, but there is no place at present for this equipment outside a teaching unit. The investigation reports on continuous foetal heart monitoring of 36 patients and simultaneous foetal scalp pH estimations on 16 of them. A high proportion of babies with low Apgar scores showed one of two (or both) characteristic foetal heart patterns during labour: (a) the well-known type 2 dip, (b) a steppe pattern not previously described as such. The latter is of importance because it is impossible to detect using only clinical methods.There was poor correlation between foetal pH values and Apgar rating, and between foetal pH values and monitor patterns. Moreover, the pH values of foetal scalp blood and foetal umbilical arterial and venous blood samples bore varying relations to one another. However, for practical purposes, a foetal scalp blood of pH less than 7·20 when associated with a maternofoetal pH difference of 0·250 or more should be regarded with anxiety. The place and value of intensive care are discussed

Dynamic Load and Storage Integration

Modern technology combined with the desire to minimize the size and weight of a ship’s power system are leading to renewed interest in more electric or all electric ships. An important characteristic of the emerging ship power system is an increasing level of load variability, with some future pulsed loads requiring peak power in excess of the available steady– state power. This inevitably leads to the need for some additional energy storage beyond that inherent in the fuel. With the current and evolving technology, it appears that storage will be in the form of batteries, rotating machines, and capacitors. All of these are in use on ships today and all have enjoyed significant technological improvements over the last decade. Moreover all are expected to be further enhanced by today’s materials research. A key benefit of storage is that, when it can be justified for a given load, it can have additional beneficial uses such as ride-through capability to restart a gas turbine if there is an unanticipated power loss; alternatively, storage can be used to stabilize the power grid when switching large loads. Knowing when to stage gas turbine utilization versus energy storage is a key subject in this paper. The clear need for storage has raised the opportunity to design a comprehensive storage system, sometimes called an energy magazine, that can combine intermittent generation as well as any or all of the other storage technologies to provide a smaller, lighter and better performing system than would individual storage solutions for each potential application.Center for Electromechanic

Platelet count and liver function tests in proteinuric and chronic hypertension in pregnancy

Platelet counts and plasma enzyme estimations were performed in 207 pregnant patients with proteinuric hypertension and in 60 patients with chronic hypertension. Patients with abruptio placentae were excluded. In the proteinuric hypertensive patients a low platelet count « 150000/mm3 ) was found in 63 (30%) and elevated transaminase levels in 50 (24%) and both abnormalities were present in 47 patients (23%). The serum lactate dehydrogenase (LDH) value was mildly elevated in most proteinuric hypertensive women, but a markedly elevated LDH level ( > 400 IU/I) was usually associated with other evidence of liver necrosis. Raised plasma alkaline phosphatase and -y-glutamyhransferase levels were not related to the occurrence or severity of liver necrosis. In proteinuric hypertensive patients a low platelet count or elevated transaminase level was associated with deteriorating renal function, increased maternal morbidity, increased incidence of low-birth-weight babies and a raised perinatal mortality rate (149/1 000). In patients with chronic hypertension, 1 had a low platelet count but none had elevated transaminase, LDH or other enzyme levels and there was no recorded perinatal mortality

Tsunami Evacuation Planning as a tool for Tsunami Risk Reduction: A case study in Palu Bay, Central Sulawesi

Situated in one of the most complicated tectonic zones of the world, Palu is classified as one of the most susceptible places to earthquake and tsunami in Indonesia. This study aim to develop near-field tsunami evacuation simulation, as the primary strategy to reduce casualties in disaster risk reduction, based on daytime and night-time population scenarios in a tsunami-prone area in Palu Bay, Central Sulawesi. Least Cost Distance, a geospatial evacuation analysis approach in ArcGIS, is applied involving three main variables, namely population exposure, the arrival time of tsunami and walking speed of evacuees. These variables were analysed to calculate distribution of populations in daytime and night-time scenario; to identify and calculate the capacity of potential existing evacuation shelter buildings (ESB); and to analyse suitable locations, and to calculate the number and capacity of additional ESBs based on the most effective evacuation route. This study found that of the population in the study area, about 62.60 % cannot be sheltered in the seven existing ESB in the daytime as well as 63.98% of total population in the night-time scenario. Meanwhile,only 60.13% and 61.83% of the population in the service area of existing ESBs, can be evacuated in daytime and night-time scenarios, respectively. Therefore, eleven and twelve additional ESBs are proposed to be established for daytime and night-time scenarios, respectively, to accommodate people who currently cannot be sheltered

Exponential increase in postprandial blood-glucose exposure with increasing carbohydrate loads using a linear carbohydrate-to-insulin ratio

Background. Postprandial glucose excursions contribute significantly to average blood glucose, glycaemic variability and cardiovascular risk. Carbohydrate counting is a method of insulin dosing that balances carbohydrate load to insulin dose using a fixed ratio. Many patients and current insulin pumps calculate insulin delivery for meals based on a linear carbohydrate-to-insulin relationship. It is our hypothesis that a non-linear relationship exists between the amounts of carbohydrate consumed and the insulin required to cover it.Aim. To document blood glucose exposure in response to increasing carbohydrate loads on fixed carbohydrate-to-insulin ratios.Methods. Five type 1 diabetic subjects receiving insulin pump therapy with good control were recruited. Morning basal rates and carbohydrateto-insulin ratios were optimised. A Medtronic glucose sensor was used for 5 days to collect data for area-under-the-curve (AUC) analysis, during which standardised meals of increasing carbohydrate loads were consumed.Results. Increasing carbohydrate loads using a fixed carbohydrate-to-insulin ratio resulted in increasing glucose AUC. The relationship was found to be exponential rather than linear. Late postprandial hypoglycaemia followed carbohydrate loads of >60 g and this was often followed by rebound hyperglycaemia that lasted >6 hours.Conclusion. A non-linear relationship exists between carbohydrates consumed and the insulin required to cover them. This has implications for control of postprandial blood sugars, especially when consuming large carbohydrate loads. Further studies are required to look at the optimal ratios, duration and type of insulin boluses required to cover increasing carbohydrate loads

The Midspan studies

No abstract available

Factors related to discontinued clinic attendance by patients with podoconiosis in southern Ethiopia: a qualitative study

Background Podoconiosis is a lymphoedema of non-infectious cause which results in long-term ill health in affected individuals. Simple, effective treatment is available in certain parts of Ethiopia, but evidence indicates that not all patients continue collecting treatment supplies from clinic sites once started. We used qualitative techniques to explore factors related to discontinued attendance at outreach clinics of a non-government organization in southern Ethiopia. Methods A cross-sectional qualitative study was conducted in four clinic sites through unstructured in-depth interviews, key informant interviews and focus group discussions with the involvement of 88 study subjects. Results Discontinuation of clinic visits is common among podoconiosis patients. The reasons were: remoteness from the clinic sites, unrealistic expectation of ‘special’ aid, worry about increasing stigma, illness and misconceptions about treatment. Conclusions Several of these factors are remediable through community and individual information and education. Appropriate routes to deliver this information must be identified. Certain factors (such as distance to clinic sites and stigma) require substantial expansion of services or liaison with village-level government health services