The foot of Homo naledi.

Modern humans are characterized by a highly specialized foot that reflects our obligate bipedalism. Our understanding of hominin foot evolution is, although, hindered by a paucity of well-associated remains. Here we describe the foot of Homo naledi from Dinaledi Chamber, South Africa, using 107 pedal elements, including one nearly-complete adult foot. The H. naledi foot is predominantly modern human-like in morphology and inferred function, with an adducted hallux, an elongated tarsus, and derived ankle and calcaneocuboid joints. In combination, these features indicate a foot well adapted for striding bipedalism. However, the H. naledi foot differs from modern humans in having more curved proximal pedal phalanges, and features suggestive of a reduced medial longitudinal arch. Within the context of primitive features found elsewhere in the skeleton, these findings suggest a unique locomotor repertoire for H. naledi, thus providing further evidence of locomotor diversity within both the hominin clade and the genus Homo.

Ecological level analysis of the relationship between smoking and residential-fire mortality.

OBJECTIVES: To examine the association between tobacco smoking and residential-fire mortality and to investigate whether this association is explained by the confounding effects of selected socioeconomic factors (ie, educational attainment and median household income). DESIGN: An ecological analysis relating state-level residential-fire mortality to state-level percentages of adults who smoke was conducted. Negative binomial rate regression was used to model this relationship, simultaneously controlling for the selected socioeconomic factors. RESULTS: After educational attainment and median household income had been controlled for, smoking percentages among adults correlated significantly with state-level, population-based residential-fire mortality (estimated relative rate for a 1% decrease in smoking = 0.93; 95% CI 0.89 to 0.97). CONCLUSIONS: Mortality from residential fires is high in states with high smoking rates. This relationship cannot be explained solely by the socioeconomic factors examined in this study.

Community based program to improve firearm storage practices in rural Alaska.

OBJECTIVE: To develop and evaluate a pilot program to reduce unauthorized access to firearms by youth by distributing gun safes and trigger locks to households. DESIGN: Pilot intervention with pre/post-evaluation design. SETTING: Two Alaska Native villages in the Bristol Bay Health Corporation region of southwest Alaska. SUBJECTS: Forty randomly selected households with two or more guns in the home. INTERVENTION: Initially, a focus group of community members who owned guns was convened to receive input regarding the acceptability of the distribution procedure for the gun storage devices. One gun safe and one trigger lock were distributed to each of the selected households during December 2000. Village public safety officers assisted with the distribution of the safes and provided gun storage education to participants. MAIN OUTCOME MEASURES: Baseline data were collected regarding household gun storage conditions at the time of device distribution. Three months after distribution, unannounced onsite home visits were conducted to identify if residents were using the gun safes and/or trigger locks. RESULTS: All selected households had at least two guns and 28 (70%) of the 40 households owned more than two guns. At baseline, 85% of homes were found to have unlocked guns in the home and were most often found in the breezeway, bedroom, storage room, or throughout the residence. During the follow up visits, 32 (86%) of the 37 gun safes were found locked with guns inside. In contrast, only 11 (30%) of the 37 trigger locks were found to be in use. CONCLUSIONS: This community based program demonstrated that Alaska Native gun owners accepted and used gun safes when they were installed in their homes, leading to substantial improvements in gun storage practices. Trigger locks were much less likely to be used.

Assessing community child passenger safety efforts in three Northwest Tribes.

OBJECTIVE: To identify strengths and weaknesses in community based child passenger safety programs by developing a scoring instrument and conducting observations of child restraint use in three Native American communities. SETTING: The three communities are autonomous Tribal reservations in the Pacific Northwest. Their per capita incomes and rates of unemployment are comparable. METHODS: In each community, 100 children under 5 years old were observed for car seat use. A six item community assessment tool (100 points maximum) awarded points for such items as the type (primary or secondary) and enforcement of child restraint laws; availability of car seats from distribution programs; extent of educational programs; and access to data on vehicle injuries. RESULTS: For children from birth to 4 years, the car seat use rate ranged from 12%-21%. Rates for infants (71%-80%) far exceeded rates for 1-4 year old children (5%-14%). Community scores ranged from 0 to 31.5 points. There was no correlation between scores and observed car seat use. One reason was the total lack of enforcement of restraint laws. CONCLUSIONS: A community assessment tool can highlight weaknesses in child passenger efforts. Linking such a tool with an objective measure of impact can be applied to other injury problems, such as fire safety or domestic violence. The very process of creating and implementing a community assessment can enhance agency collaboration and publicize evidence based "best practices" for injury prevention. Further study is needed to address methodologic issues and to examine crash and medical data in relation to community child passenger safety scores.

Human mandibular incisors from the late Middle Pleistocene locality of Hoedjiespunt 1, South Africa.

The Hoedjiespunt 1 locality is an archaeological and palaeontological site located on the Hoedjiespunt Peninsula at Saldanha Bay, South Africa. In 1996 two human teeth, a left central mandibular incisor and a left lateral mandibular incisor, were discovered during excavations in the late Middle Pleistocene palaeontological layers. These teeth are described and are found to belong to a single subadult individual. Despite their developmental stage, these incisors already display early signs of wear. Their crown diameters are larger than modern and archaeological African comparative material and are most closely comparable with crown diameters of an early Middle Pleistocene and late Middle Pleistocene dental sample from Africa, Europe and Asia. In the light of this metrical evidence, data on two previously excavated maxillary molars, most probably belonging to the same individual, were re-examined. It was found that the Hoedjiespunt 1 hominid possessed dental metrical features (large anterior teeth and small molars) comparable with other African and European hominids referred to the Middle Pleistocene.

Training injury control practitioners: the Indian Health Service model.

Many individuals practicing injury control have not received specific training for their work, in large part because of a scarcity of training opportunities. Consistent with its mission of "raising the health status of American Indian and Alaska Native people to the highest possible level," the Indian Health Service (IHS) created an innovative training program for federal and tribal employees. The model emphasizes training that is practical and can be applied immediately to community interventions. Many features of the IHS training model have broad applicability to other settings. These features include the use of experiential instruction, preceptors, and community case studies to train individuals from diverse cultural and educational backgrounds; educational strategies for employed adults; and courses that promote community empowerment. The development of IHS training courses are guided by community input, epidemiological data, advances in knowledge, and program evaluations. Courses range from a half-day "minicourse" to a full-year fellowship program. The success of the training model is evident in programs instituted by IHS Injury Prevention Specialist Fellowship graduates, whose projects have ranged from drowning prevention in Alaska to fire safety in North Dakota. The IHS training model could be applied in a variety of other community-based settings, but it is most relevant to programs that train individuals from diverse backgrounds who are not full-time students and programs that make community needs an organizational priority.

Assessing primary care content: four conditions common in community health center practice.

Under managed care, community health center (CHC) care patterns will be increasingly subject to outside scrutiny. This article discusses results of medical records reviews assessing quality of care at CHCs for acute otitis media, diabetes, asthma, and hypertension. As a group, these safety net providers meet or exceed prevailing practice across other health care settings; however, there is substantial variation among sites. Regression analyses indicate that the individual CHC used by a patient is the most consistent determinant of whether a patient receives recommended care. Drawing on these results, the article explores approaches for improving care and discusses the implications for performance measurement among CHCs and other safety net providers.

Body proportions of Australopithecus afarensis and A. africanus and the origin of the genus Homo.

New discoveries of A. africanus fossils from Member 4 Sterkfontein reveal a body form quite unlike earlier Australopithecus species. The new adult material consists of over 48 fore- and hindlimb specimens and includes an associated partial skeleton, Stw 431. The forelimbs and relatively large: the average size of their joints corresponds to a modern human with body mass of 53 kg. The hindlimbs are much smaller with an average size matching a modern human of only 33 kg. Analyses of the Stw 431 partial skeleton confirm these results. In contrast, A. afarensis and anamensis more closely approximate a human pattern of forelimb joint size. This is an unanticipated complication in our understanding of early human evolution. In general, craniodental morphology tracks time in species of Australopithecus: A. anamensis (3.5-4.1 Ma) is the the most primitive with a strongly sloping symphysis, large canine roots, etc., A. afarensis (3.0-3.6 Ma) is less primitive, and A. africanus (2.6-3.0 Ma) shares many derived characteristics with early Homo (e.g., expanded brain, reduced canine, bicuspid lower third premolar, reduced prognathism, greater flexion of the cranial base, deeper TMJ). the new postcranial material, however, reveals an apparently primitive morphology of relatively large forelimb and small hindlimb joints resembling more the pongid than the human pattern. More pongid-like proportions are also present in the two known associated partial skeletons of H. habilis (OH 62 KNM-ER 3735). This may imply either (1) that A. africanus and H. habilis evolved craniodental characters in parallel with the lineage leading to later Homo, or (2) that fore- to hindlimb proportions of A. afarensis (and perhaps A. anamensis) evolved independent of the lineage leading to Homo and does not imply a close phylogenetic link with Homo. Both of these explanations or any other phylogeny imply homoplasy.

Carbon monoxide hazards in rural Alaskan homes.

Alaska has the highest age-adjusted death rate from unintentional carbon monoxide poisoning in the nation. We conducted a study in five villages to determine carbon monoxide levels and sources. Nearly 10% (10/105) of the homes had elevated levels. Improperly vented propane Paloma water heaters were most commonly responsible and produced the highest levels of carbon monoxide. Other sources were leaking pipes from wood stoves and stoves that had been left on for several hours. We recommend that Paloma water heaters not be used where freezing temperatures create a risk for carbon monoxide poisoning, fires, and explosion. Safety education campaigns should note the risks of Paloma water heaters and defective stove pipes, and the need for increased kitchen ventilation during prolonged cooking. Medical workers need to be informed of the prevalence of carbon monoxide exposures. Homeowners can install carbon monoxide detectors, although expense and false alarms remain barriers to their use.

Violence to health care workers in rural Alaska hospitals.

The authors selected five rural Alaska hospitals for a survey of ED workers. The goal was to identify risk factors and preventive strategies to protect workers in these environments.

Brief communication: a new Pleistocene hominid-bearing locality at Hoedjiespunt, South Africa.

HDP1 is an archaeological and faunal site located on the Hoedjiespunt peninsula at Saldanha Bay, South Africa, that has recently yielded fossil human remains. Artefacts from the associated archaeological deposits are identified as being Middle Stone Age. U series analysis of capping calcretes and analysis of the foraminifera and fauna associated with the human fossils indicate an age for the deposit in excess of 74,000 years before present, and it most probably dates to around 300,000 years before present. The fossil human teeth from in situ deposits at Hoedjiespunt are described and found to be large by comparison with modern humans but smaller than the known upper dentitions of southern African "archaic" Homo sapiens. The Hoedjiespunt molars are found to be morphologically within the range of variation observed in the teeth of modern Homo sapiens.

Faunal assemblage seriation of southern African Pliocene and Pleistocene fossil deposits.

Fossil assemblages from the Pliocene and Pleistocene of southern Africa were seriated in order to give a better idea of their relative chronology. Time-sensitive mammals were selected for calculation of the Faunal Resemblance Index among 17 site units. On the basis of a logistical seriation and subsequent site analysis, the following sequence of sites was deemed most probable: Makapansgat Member 3, Makapansgat Member 4, Taung Dart deposits, Sterkfontein Member 4 and Taung Hrdlicka deposits, Sterkfontein Member 5 (in part) and Kromdraai B, Kromdraai A and Swartkrans Member 1, Swartkrans Member 2, Swartkrans Member 3, Plovers Lake, Cornelia, Elandsfontein Main Site, Cave of Hearths Acheulian levels, Florisbad and Equus Cave and Klasies River Mouth.

Brief communication: Gladysvale: first early hominid site discovered in South Africa since 1948.

We report here the discovery of fossil hominid teeth at Gladysvale, near Johannesburg in the southern Transvaal. This find makes the site the seventh in South Africa to yield australopithecine remains and the first new early hominid-bearing locality to be found in this region since 1948. Apart from the hominid specimens, our excavations at Gladysvale have added appreciably to the abundant Plio-Pleistocene fauna previously recorded from the cave deposit. The fauna indicates that savanna conditions prevailed during deposition of at least part of the fill. Preliminary faunal dating gives an age of deposition of between c1.7 and c2.5 mya.

Pedestrian and hypothermia deaths among Native Americans in New Mexico. Between bar and home.

OBJECTIVE: To determine the nature of excess injury mortality among Native Americans in New Mexico. DESIGN: Retrospective review of death certificates for deaths from unintentional injuries. SETTING: The state of New Mexico. SUBJECTS: New Mexico residents who died of unintentional injuries between January 1, 1980, and December 31, 1989. MAIN OUTCOME MEASURE: Cause-specific mortality rates. RESULTS: Over half of the excess mortality from all unintentional injuries among Native Americans resulted from hypothermia and from pedestrian-motor vehicle crashes. New Mexico Native Americans were nearly eight times more likely to die in pedestrian--motor vehicle crashes and were 30 times more likely to die of hypothermia compared with other New Mexico residents. At death, 90% of those Native Americans tested were highly intoxicated (median blood alcohol concentrations of 0.24 and 0.18 g/dL [corrected] for pedestrian and hypothermia deaths, respectively). Despite the fact that most Native Americans in New Mexico live on reservations, most deaths occurred at off-reservation sites in border towns and on roads leading back to the reservation. CONCLUSIONS: The possession and sale of alcohol is illegal on many Native American reservations. This policy forces Native Americans who want to drink to travel long distances to obtain alcohol. These data suggest that this policy is also the likely explanation for the markedly increased risk of death from hypothermia and pedestrian-motor vehicle crashes in this population.