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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]

Ground source heat pumps (GSHP) are attractive alternatives to conventional heating and cooling systems owing to their higher energy utilization efficiency. In this paper, the effect of various system parameters on GSHP performance is studied using a computer model. Also, a comparative economic evaluation is carried out to assess the feasibility of using a GSHP in place of conventional heating/cooling systems and an air source heat pump. The results indicate that system parameters can have a significant effect on performance, and that GSHP is economically preferable to conventional systems. ) 1997 by John Wiley &Sons, Ltd. [ABSTRACT FROM AUTHOR]

ABSTRACT New fumigants are needed to control grain insects because methyl bromide is being phased out as an ozone-depleting substance under the Montreal Protocol and because resistance to phosphine is increasing. Alternative fumigants also provide one strategy to manage resistance. To assess the effect of candidate fumigants on barley quality, malting and brewing trials were conducted with malting barley ( Schooner), 9.4% moisture content, fumigated with carbonyl sulphide (COS), ethyl formate (EF) and carbon disulphide (CS2) at concentrations of 20, 90 and 36 mg/L respectively for 7 days at 20°C in riveted steel silos containing 33 t of barley. The appropriate industry body, the Malting and Brewing Industry Barley Technical Committee (MBIBTC) set the quality parameters to be evaluated and allocated work to the appropriate quality laboratories. Germination of fumigated barley was not affected by the fumigants. Residues of COS, EF and CS2 in outloading barley samples were 0.085 ± 0.0052, 0.4 ± 0.1 and 2.22 ± 0.07 mg/kg respectively, which were below the experimental permits of maximum residue levels (MRL). Residues of COS, EF and CS2 in malt, wort and beer were indistinguishable from those in unfumigated (or non-fumigated) barley. Ethyl formate and CS2 affected wort in increasing the apparent attenuation limit (AAL) and CS2 affected barley colour. Sulphur volatiles in the trial beer made from EF and CS2 (unlike COS) fumigated barley decreased significantly. Beer from COS, EF and CS2 fumigated barley had a somewhat higher 24-hour chill haze level (0.62-0.84) than beer from the untreated barley (0.53). The total alcohols and isoamyl acetate increased in beer made from EF fumigated barley. Carbonyl sulphide, EF and CS2, however, had no effect on beer flavour or quality. [ABSTRACT FROM AUTHOR]

Guinea pigs (Cavia spp.) have a long association with humans. From as early as 10,000 years ago they were a wild food source. Later, domesticated Cavia porcellus were dispersed well beyond their native range through pre-Columbian exchange networks and, more recently, widely across the globe. Here we present 46 complete mitogenomes of archaeological guinea pigs from sites in Peru, Bolivia, Colombia, the Caribbean, Belgium and the United States to elucidate their evolutionary history, origins and paths of dispersal. Our results indicate an independent centre of domestication of Cavia in the eastern Colombian Highlands. We identify a Peruvian origin for the initial introduction of domesticated guinea pigs (Cavia porcellus) beyond South America into the Caribbean. We also demonstrate that Peru was the probable source of the earliest known guinea pigs transported, as part of the exotic pet trade, to both Europe and the southeastern United States. Finally, we identify a modern reintroduction of guinea pigs to Puerto Rico, where local inhabitants use them for food. This research demonstrates that the natural and cultural history of guinea pigs is more complex than previously known and has implications for other studies regarding regional to global-scale studies of mammal domestication, translocation, and distribution. [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]

Intraoperative frozen section (FS) margin evaluation is not common practice for patients undergoing breast conservation therapy (BCT), but offers a significant reduction in reoperation. In this study, a technique to allow for more effective freezing of breast tissue was developed to perform FS evaluation of lumpectomy margins (FSM) for all patients undergoing BCT at an ambulatory surgery center. FS evaluation of sentinel lymph node biopsy specimens was performed concurrently. One hundred eighty-one study and 188 control patients, with and without FS evaluation, were compared. Reexcision was reduced 34% (from 48.9% to 14.9%) and reoperation was reduced 36% (from 55.3% to 19.3%) with FS evaluation. Most of the decrease in reoperative rate was because of a decrease in the need for margin reexcision. The number of patients requiring 1, 2, or 3 operations to complete therapy was 84, 92, and 12, respectively, in the control group, and 146, 33, and 2, respectively, in the study group. Lobular subtype, multifocal disease, and larger tumor size (≥2 cm) were significantly associated with failure of FSM to prevent reoperation, but reoperation rates were still significantly decreased in this subgroup of patients (from 75.5% to 43.8%) with FSM. This study highlights an innovative yet simple and adaptable FS approach that resulted in a nearly 3-fold reduction in reoperation for patients undergoing BCT. [ABSTRACT FROM AUTHOR]

Objective. To compare scores for the Leeds enthesitis index in psoriatic arthritis and rheumatoid arthritis using clinical assessment and ultrasonography (US). Design. Swelling and tenderness of the enthesis was assessed at six sites: lateral epicondyles of humerus (LE), medial condyles of femur (MC), and the insertion of the Achilles tendon (AT). US assessed "inflammatory activity" (power Doppler signal, oedema, tendon thickening, and bursal swelling) and "damage" (erosions and enthesophytes). Results. 94 patients were included, 71 with PsA and 23 with RA. The patients with RA were significantly older (PsA 47.6 years; RA 62.6 years; (mean difference in ages =15.0 years, 95% CI 9.3-20.7 years)). US scores were higher in RA at the LE, significantly so for the "damage" scores. No differences between RA and PsA were seen at the other sites. As a result, the odds ratio for PsA, given an US score above the median, was 0.41 (0.13-1.03). However, using the clinical score, the odds ratio for PsA was 2.16 (0.81-5.70). Conclusions. Although clinical scores of enthesitis are greater in PsA compared to RA, US enthesitis scores did not distinguish between RA and PsA. This may in part be due to more frequent juxta-articular involvement in RA and in part due to the older age of the subjects with RA. [ABSTRACT FROM AUTHOR]

Presents a study which undertook a genomewide screen of 11 families segregating multiple leiomyomatosis (ML) to detect the localization of the ML gene. Subjects and methods; Results; Discussion.