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The skeletal remains of 18 individuals interred at the ancient Maya site of Caledonia (100 to 1000 C.E.), located in the Cayo District of Belize, w ere sampled for stable carbon and nitrogen isotope analysis in order to reconstruct their diet. Stable carbon and nitrogen isotope ratios in 18 bone collagen samples and stable carbon isotope ratios in bioapatite from 15 bone and 6 tooth enamel samples were assessed. Small sample sizes precluded the assessment of dietary variation with respect to age, sex, social status or time period among the Caledonia Maya. However, the sampled individuals consumed a varied diet consisting of maize, supplemented with some C3 plants, terrestrial herbivores and/or lower order freshwater resources such as snails and molluscs and possibly maize-fed animals. This dietary variability with an emphasis on maize is unsurprising given the biological diversity surrounding the site and the known importance of this crop to the ancient Maya. As expected, the isotopic values from Caledonia are similar to those from nearby sites from similar time periods. However, four individuals exhibit a marine dietary signature, possibly indicating inland trade of marine resources from coastal sites, or the migration of coastal people to Caledonia. This study demonstrates the validity of sampling small, fragmented collections from minor Maya centres in order to gain valuable insight into ancient Maya dietary practices. Copyright © 2013 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Objective: To perform a health economic analysis of an intervention designed to increase rates of vaginal birth after caesarean, compared with usual care.Design: Economic analysis alongside the cluster-randomised OptiBIRTH trial (Optimising childbirth by increasing vaginal birth after caesarean section (VBAC) through enhanced women-centred care).Setting: Fifteen maternity units in three European countries - Germany (five), Ireland (five), and Italy (five) - with relatively low VBAC rates.Population: Pregnant women with a history of one previous lower-segment caesarean section; sites were randomised (3:2) to intervention or control.Methods: A cost-utility analysis from both societal and health-services perspectives, using a decision tree.Main Outcome Measures: Costs and resource use per woman and infant were compared between the control and intervention group by country, from pregnancy recognition until 3 months postpartum. Based on the caesarean section rates, and maternal and neonatal morbidities and mortality, the incremental cost-utility ratios were calculated per country.Results: The mean difference in costs per quality-adjusted life years (QALYs) gained from a societal perspective between the intervention and the control group, using a probabilistic sensitivity analysis, was: €263 (95% CI €258-268) and 0.008 QALYs (95% CI 0.008-0.009 QALYs) for Germany, €456 (95% CI €448-464) and 0.052 QALYs (95% CI 0.051-0.053 QALYs) for Ireland, and €1174 (95% CI €1170-1178) and 0.006 QALYs (95% CI 0.005-0.007 QALYs) for Italy. The incremental cost-utility ratios were €33,741/QALY for Germany, €8785/QALY for Ireland, and €214,318/QALY for Italy, with a 51% probability of being cost-effective for Germany, 92% for Ireland, and 15% for Italy.Conclusion: The OptiBIRTH intervention was likely to be cost-effective in Ireland and Germany.Tweetable Abstract: The OptiBIRTH intervention (to increase VBAC rates) is likely to be cost-effective in Germany and Ireland. [ABSTRACT FROM AUTHOR]

Objective: Although fetal growth restriction (FGR) is well known to be associated with adverse outcomes for the mother and offspring, effective interventions for the management of FGR are yet to be established. Trials reporting interventions for the prevention and treatment of FGR may be limited by heterogeneity in the underlying pathophysiology. The aim of this study was to conduct a systematic review of outcomes reported in randomized controlled trials (RCTs) assessing interventions for the prevention or treatment of FGR, in order to identify and categorize the variation in outcome reporting.Methods: MEDLINE, EMBASE and The Cochrane Library were searched from inception until August 2018 for RCTs investigating therapies for the prevention and treatment of FGR. Studies were assessed systematically and data on outcomes that were reported in the included studies were extracted and categorized. The methodological quality of the included studies was assessed using the Jadad score.Results: The search identified 2609 citations, of which 153 were selected for full-text review and 72 studies (68 trials) were included in the final analysis. There were 44 trials relating to the prevention of FGR and 24 trials investigating interventions for the treatment of FGR. The mean Jadad score of all studies was 3.07, and only nine of them received a score of 5. We identified 238 outcomes across the included studies. The most commonly reported were birth weight (88.2%), gestational age at birth (72.1%) and small-for-gestational age (67.6%). Few studies reported on any measure of neonatal morbidity (27.9%), while adverse effects of the interventions were reported in only 17.6% of trials.Conclusions: There is significant variation in outcome reporting across RCTs of therapies for the prevention and treatment of FGR. The clinical applicability of future research would be enhanced by the development of a core outcome set for use in future trials. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]