Maternal 25-Hydroxyvitamin D and parathyroid hormone concentrations and offspring birth size

Context: There is inconsistent evidence that maternal 25-hydroxyvitamin D [25-(OH)D] deficiency may impair fetal growth.

Objective: The objective of the study was to examine the relationship between maternal 25-(OH)D and PTH concentrations at less than 16 and 28 wk gestation and offspring birth size.

Design: This was an observational study.

Setting: The study was set at a hospital antenatal clinic.

Participants: Women with singleton pregnancies, before 16 wk gestation, participated.

Interventions: No interventions were used.

Main Outcome Measure: Knee-heel length at birth was the main outcome measure.

Results: Altogether 374 of 475 (79%) women completed this study. We found no evident relationship between birth size measures and maternal 25-(OH)D or PTH at recruitment (∼11 wk). Gestation length was 0.7 wk (95% confidence interval −1.3, −0.1) shorter and knee-heel length was 4.3 mm smaller (−7.3, −1.3) in infants of 27 mothers with low 25-(OH)D (<28 nmol/liter) at 28–32 wk vs. babies whose mothers had higher concentrations. This latter difference was reduced to −2.7 mm (−5.4, −0.1) after adjustment for gestation length, suggesting some of the apparent growth deficit is explained by shorter gestation. There was no evidence that other birth measures were affected. Maternal PTH concentration at 28–32 wk was positively related to knee-heel length, birth weight, and mid-upper arm and calf circumferences. These associations were independent of 25-(OH)D concentration.

Conclusions: Low maternal 25-(OH)D in late pregnancy is associated with reduced intrauterine long bone growth and slightly shorter gestation. The long-term consequences for linear growth and health require follow-up. The positive relationship between maternal PTH and measures of infant size may relate to increased mineral demands by larger babies, but warrants further investigation.

Maternal 25-hydroxyvitamin D concentration and offspring birth size : effect modification by infant VDR genotype

Background/Objectives: We tested the hypothesis that the relationship between maternal 25-hydroxyvitamin D (25-(OH)D) and offspring birth size differs according to offspring vitamin D receptor (VDR) genotype (Apa1, Bsm1, Fok1 or Taq1).

Subjects/Methods: Mothers of 354 singleton babies had serum 25-(OH)D concentration measured at 28–30 weeks of gestation and consented to measurement of their babies soon after birth. DNA was extracted from the babies’ Guthrie cards.

Results: There was evidence of effect modification by infant FokI genotype. Babies of deficient mothers had lower birth weight with FF or Ff, but not ff genotype (P-value for interaction after adjustment for potential confounding factors=0.02), but thicker subscapular and suprailiac skinfolds with ff, but not FF or Ff genotype (P=0.008 and 0.02, respectively). Sample size was insufficient to investigate effect modification by the other VDR polymorphisms.

Conclusions: These preliminary findings suggest that studies of maternal vitamin D status and birth size may need to take VDR genotype into account.

The traditional decision-making process of Berkaul in Tanjung Emas, West Sumatra : its nature and significance

Berkaul is a traditional practice associated with the rice cultivation cycle in West Sumatra, Indonesia, intended to seek consensus within the local community about agricultural practices and management of water for irrigation. Berkaul is deeply rooted in the adat and worldview of the region but is much less commonly practiced today than in the past and has disappeared in many parts of the region. This article describes the process of berkaul in Tanjung Emas, West Sumatra, places it within the context of Minangkabau adat and tradition, and considers its value in fostering participation, empowerment, and social inclusion in the context of rural development.

Inequalities in cardiovascular disease mortality : the role of behavioural, physiological and social risk factors

Background While the relationship between socio-economic disadvantage and cardiovascular disease (CVD) is well established, the role that traditional cardiovascular risk factors play in this association remains unclear. The authors examined the association between education attainment and CVD mortality and the extent to which behavioural, social and physiological factors explained this relationship.

Methods Adults (n=38 355) aged 40–69 years living in Melbourne, Australia were recruited in 1990–1994. Subjects with baseline CVD risk factor data ascertained through questionnaire and physical measurement were followed for an average of 9.4 years with CVD deaths verified by review of medical records and autopsy reports.

Results CVD mortality was higher for those with primary education only, compared with those who had completed tertiary education, with an HR of 1.66 (95% CI 1.10 to 2.49) after adjustment for age, country of birth and gender. Those from the lowest educated group had a more adverse cardiovascular risk factor profile compared with the highest educated group, and adjustment for these risk factors reduced the HR to 1.18 (95% CI 0.78 to 1.77). In analysis of individual risk factors, smoking and waist circumference explained most of the difference in CVD mortality between the highest and lowest education groups.

Conclusions Most of the excess CVD mortality in lower socio-economic groups can be explained by known risk factors, particularly smoking and overweight. While targeting cardiovascular risk factors should not divert efforts from addressing the underlying determinants of health inequalities, it is essential that known risk factors are addressed effectively among lower socio-economic groups.

Study on the visual performance of a traditional residential neighborhood in Old Cairo

Traditional dwellings located in the hot arid zone in Egypt are well known for their sensitive architectural response to the region's climatic conditions and socio-cultural norms. The majority of these dwellings are well recognized for their courtyard arrangement and perforated fenestration systems that evolved to control the harsh solar, climatic conditions without compromising the aesthetic quality of the space and the occupants' well-being. The unique visual characteristics of these structures cannot be fully appreciated by assessing the visual performance of buildings in isolation from their urban context. Much of the character of the traditional urban fabric of this region came from the collective visual perception of its architectural components as well as urban patterns. This paper examines daylight behavior of a well-known historic alleyway and of a courtyard house in the Old City of Cairo. Using the Radiance IES simulation modeling tool and a scaled model under an artificial sky dome, the paper investigates the visual comfort in a typical pedestrian street and a selected house. A comparative analysis between simulated results and measured values at target points was conducted. The results indicate a reasonable agreement with the simulation results. The paper gives an insight into the overall visual experience in the traditional settlements in the Old City of Cairo in relation to daylight components and hence their contribution to the unique sense of identity of the place.

A comparative study of the constant observation model of care

This study investigated two different nursing models of care for ‘at-risk’ patients requiring constant observation. One patient group was managed with a specialised nursing team and the other with a traditional custodial model utilising attendants and agency nurses. Patients cared for with the specialist team had fewer adverse events and a shorter period under constant observation.

Comparison of the traditional problem-based learning format and larger, directed, independent study groups

 Problem based learning has been implemented as a pedagogical tool world-wide across a range of health professions since its inception at McMaster University, Canada, in 1969 (Neville & Norman, 2007). In addition to enhancing knowledge and understanding it is also claimed that PBL develops communication skills, encourages teamwork, sharing of information and respect for others, furthers problem solving skills, and allows students to assume responsibility for their own learning (Wood, 2003). However, the cognitive outcomes of PBL and traditional pedagogy (based on didactic teaching) are similar and hence widespread adoption of PBL has been questioned (see Colliver, 2000). Criticisms of PBL include its resource hungry nature, requiring, as it does, experienced tutors to facilitate .learning across several clusters of students dealing with the same problem. Given the actual and anticipated increase in numbers of medical students in Australia other strategies that retain the advantages of PBL, while minimising the demands on faculty, should now be explored. This paper reports our experience with a modification of the traditional PBL approach, termed PBLplus. This innovation was trialled in a regional clinical school, attached to a hospital, with a group of 19 graduate entry students, who had completed an integrated Year 1 / 2 of the MBBS. PBLplus involved allocating students from the whole class to three task directed groups. Groups had specified assignments to complete to facilitate learning across the whole class. A tutor listened to student presentations and provided an interactive presentation. Hence use of tutors was made more efficient, and faculty input was more specialised.

Plant variety protection and traditional agricultural knowledge in Southeast Asia

This article provides an overview of the emerging plant variety protection (PVP) systems in Southeast Asia. The case studies are from countries that form part of the regional Association of Southeast Asian Nations (ASEAN), mainly Indonesia, Malaysia, Philippines and Thailand. The focus will be on the intersection between intellectual property rights (IPRs) and popular demands for the protection of the traditional knowledge (TK) of local communities. Factors that fuelled the emergence and shaped the content of the PVP laws were the obligation to comply with art 27(3)(b) of the Agreement on Trade Related Aspects of Intellectual Property Rights (TRIPS Agreement), aspirations for the development of the biotechnology industry, avoidance of possible sanction under the US ‘Special 301’ procedure, Free Trade Agreements (FTAs), the role played by the International Union for the Protection of New Plant Varieties (UPOV), technical assistance from UPOV member countries, membership of international biodiversity treaties and demands from civil society organisations for protection of TK. The PVP laws that resulted present an uneasy amalgam of conventional property rights with some aspects of protection of TK. It is very likely that the local communities claiming TK rights will face legal hurdles, in as much as government agencies implementing the law will face administrative and technical complications.

Creative conservation and Balinese traditional landscape : scenarios for eco city concepts and culturally sensitive tourism development

Bali is internationally recognized as an island possessing a beautiful natural landscape as well as a unique culture. The natural qualities of its mountains, lakes, rivers, rice terrace fields with subak irrigation make Bali an important tourism destination. Cultural Tourism is integral in Bali’s tourism industry providing the basic capital for development1. The social condition of this society that is strongly characterized by religious beliefs, and its nature and ecology also supports this. The conservation and maintenance of this traditional landscape is often forgotten because of government agendas to implement cultural city programs aimed at encouraging tourism development. Despite this, the government is now supporting the program of ‘Bali toward Garden Island’, which aims to sustain the physical and cultural environment of the island towards conservation of its landscape. The implementation of this program includes attention to universal, societal and cultural values as unity indicators, of which the landscape planning of the Balinese characteristics and traditions cannot be separated. Landscape planning is integral in this initiative of character defining the region.

Globalisation is increasingly becoming one of the most important discussions amongst the Balinese people. It has become a national concern about the changes implicating Bali’s environment. Urbanisation, population growth, ribbon development, migration and consumption of energy are important imperatives and necessary evils for growing cities. These imperatives are creating the sprawl of building planning, development information, loss of open spaces, as well as the decline of the identity of cities. Places such as Denpasar City are struggling with increasing population at a rate of 1.94% per year that is causing increase in housing and public facilities demanded by both residents and ex-patriates. Thus land associated with the city has been lost to the rapid development of this cultural landscape.

This paper examines the Balinese traditional landscape and its role in encouraging tourism development that based on the Balinese culture and its ecology. The paper focuses on the planning of city landscape appearance characteristics and seeks to test and adopt the terms ‘creative conservation’ and ‘eco city concept’. By conserving the most important philosophy of the Balinese Tri Hita Karana Concept will better inform all aspects of city development in Bali. This study seeks to offer guidance for the legitimate use of landscape planning especially for city development in Bali.

Does traditional security risk assessment have a future in information security?

The current information security standards still advocate the use of risk assessment in the prioritisation of security investments. However, prior research on the use of risk assessment methodologies in organisational security has shown that the use of the traditional monolithic risk assessment process described in the current risk management standard is simply not practical at the organisational level. This paper first examines the problems in performing a systematic risk assessment and then discusses the limitations of a traditional risk assessment. To address these limitations, this paper proposes splitting up the current monolithic risk assessment process. The result is an information security assessment framework that puts greater emphasis on situational awareness and allows for better decision making on the prioritization of security investments.