A probable case of leprosy from colonial period St. Vincent and the Grenadines, Southeastern Caribbean.

OBJECTIVE: To document and differentially diagnose facial pathology found in an isolated skull from St. Vincent and the Grenadines, southeastern Caribbean. To directly date this individual using radiocarbon dating. MATERIALS: Isolated skull recovered from Petite Mustique Island. METHODS: Describe facial pathology occurring in this individual and compare with known diseases or disease processes that impact the craniofacial complex. RESULTS: Features of the rhinomaxillary syndrome are present, indicating a diagnosis of leprosy. Dating places the time of death to the late 18th or early 19th centuries. CONCLUSIONS: Analysis of the rhinomaxillary syndrome produces a diagnosis of early-stage leprosy in an individual that correlates with the apparent attempt to locate a leprosarium on Petite Mustique Island in the first decade of the 19th century. SIGNIFICANCE: Location and time corroborate historical records of at least one attempt to locate a leprosarium on Petite Mustique Island. Only directly dated individual with leprosy in the western hemisphere and possibly the earliest yet recorded. LIMITATIONS: This is an isolated find that is archaeologically unprovenienced. SUGGESTIONS FOR FURTHER RESEARCH: Professional archaeological survey of Petite Mustique.

Temporomandibular joint osteoarthritis at Chelechol ra Orrak, Palau.

OBJECTIVE: To explore the frequency and severity of temporomandibular joint osteoarthritis (TMJ-OA) and its causative factors in a skeletal assemblage from the prehistoric site of Chelechol ra Orrak, Palau, western Micronesia. MATERIALS: 50 temporomandibular joint surfaces (mandibular condyles and articular eminences), representing a minimum of 22 adult individuals, 17 of which retain teeth. METHODS: Joint surfaces were macroscopically evaluated for characteristics associated with TMJ-OA and joint morphology. Dental remains were scored for tooth wear and staining. RESULTS: Nine individuals (40.1 %) displayed lesions typical of TMJ-OA. The strongest associations were between tooth wear and TMJ-OA. CONCLUSIONS: Indirect effects of parafunctional dental activity appear to be a factor in TMJ-OA frequency at Chelechol ra Orrak. While betel nut chewing may be one of those activities, it does not appear to be solely driving the presence of TMJ-OA. SIGNIFICANCE: This study highlights the association between a specific parafunctional use of the temporomandibular joint and the potential pathological consequences. It also reinforces the need to carefully evaluate the archaeological context of skeletal remains in order to evaluate specific etiological factors in the presence of TMJ-OA in present and past populations. LIMITATIONS: Sample sizes are limited in this study. This will increase as excavations continue. SUGGESTIONS FOR FURTHER RESEARCH: Because dental occlusion appears to be associated with TMJ-OA, focus on dental conditions affecting occlusal patterns, such as third molar agenesis, antemortem tooth loss, and malocclusion, and their relationship to TMJ-OA frequency, are recommended.

Stature in Holocene foragers of North India.

The Ganga Plain of North India provides an archaeological and skeletal record of semi-nomadic Holocene foragers in association with an aceramic Mesolithic culture. Prior estimates of stature for Mesolithic Lake Cultures (MLC) used inappropriate equations from an American White reference group and need revision. Attention is given to intralimb body proportions and geo-climatic provenance of MLC series in considering the most suitable reference population. Regression equations from ancient Egyptians are used in reconstructing stature for MLC skeletal series from Damdama (DDM), Mahadaha (MDH), and Sarai Nahar Rai (SNR). Mean stature is estimated at between 174 (MDH) and 178 cm (DDM and SNR) for males, and between 163 cm (MDH) and 179 cm (SNR) for females. Stature estimates based on ancient Egyptian equations are significantly shorter (from 3.5 to 7.1 cm shorter in males; from 3.2 to 7.5 cm shorter in females) than estimates using the American White reference group. Revised stature estimates from tibia length and from femur + tibia more accurately estimate MLC stature for two reasons: a) these elements are highly correlated with stature and have lower standard estimates of error, and b) uncertainty regarding methods of measuring tibia length is avoided. When compared with Holocene samples of native Americans and Mesolithic Europeans, MLC series from North India are tall. This aspect of their biological variation confirms earlier assessments and results from the synergistic influence of balanced nutrition from broad-spectrum foraging, body-proportions adapted to a seasonally hot and arid climate, and the functional demands of a mobile, semi-nomadic life-style.

Obelionic cranial deformation in the Puebloan Southwest.

As a form of cranial deformation, obelionic flattening is rare. Originally named and described by Stewart (J Wash Acad Sci 29 (1939) 460-465), based on a small sample from Florida, it has been little noted since. Previously [Nelson and Madimenos, Paper presented at the Paleopathology Association annual meeting (2007)], we reported the discovery of two individuals from the Pueblo III Gallina site of Cañada Simon I who exhibit flattening of this type. Although technically undescribed in the Southwest before now, there are tantalizing clues in the literature that it occurred in low frequencies throughout the Ancestral Pueblo world. To determine whether the obelionic flattening found at Cañada Simon I was isolated or an indication of a more widespread phenomenon, we undertook a survey of crania from other Gallina sites, Chaco Canyon, and the literature (type of deformation can be determined on lateral photographs of crania properly positioned along the Frankfort Horizontal). We examined 146 crania (78 firsthand) of which seven exhibit obelionic flattening. Our results indicate that obelionic flattening should be added to the suite of cranial deformations that occur in the Southwest. Here, we propose parameters by which obelionic flattening can be described and differentiated from the more common lambdoidal and occipital forms and suggest that the three types of flattening form a continuum of cradleboard induced deformation, although the exact mechanism for obelionic flattening remains elusive. Am J Phys Anthropol, 2010. © 2010 Wiley-Liss, Inc.

Effect of prehospital triage on revascularization times, left ventricular function, and survival in patients with ST-elevation myocardial infarction.

Shorter reperfusion times lead to better outcomes in patients with ST-elevation myocardial infarction (STEMI). We assessed the efficacy of prehospital triage with bypass of community hospitals and early activation of the cardiac catheterization team on revascularization times, left ventricular (LV) ejection fraction, and survival. Patients with STEMI (624) were divided into 3 groups determined by site of triage: ambulance field triage (163), interventional center emergency department (202), and 3 community hospital emergency departments (259). Compared with community hospital and interventional center triages, ambulance field triage resulted in a significant median decrease in door-to-balloon times of 68 and 27 minutes, respectively (p <0.001). LV ejection fraction was highest in the field triage group (52 +/- 13%) compared with the interventional center (49 +/- 12%) and community hospital (48 +/- 12%, p = 0.017) groups. Thirty-day mortality was lowest in the ambulance field group (3%) compared with the interventional facility (11%) and community hospital (4%, p = 0.007) groups. There was a significant difference in long-term survival with up to 30-month follow-up among the 3 triage groups (p = 0.041). With time-dependent Cox regression modeling the difference in survival was significant only during the first week after STEMI (p = 0.020). Every extra minute of symptom onset to reperfusion time was associated with a relative risk of long-term mortality of 1.003 (95% confidence interval 1.000 to 1.006, p = 0.027). In conclusion, field triage of patient with STEMI decreased revascularization times, which preserved LV function, and improved early survival.

Small scattered fragments do not a dwarf make: biological and archaeological data indicate that prehistoric inhabitants of Palau were normal sized.

UNLABELLED: Current archaeological evidence from Palau in western Micronesia indicates that the archipelago was settled around 3000-3300 BP by normal sized populations; contrary to recent claims, they did not succumb to insular dwarfism. BACKGROUND: Previous and ongoing archaeological research of both human burial and occupation sites throughout the Palauan archipelago during the last 50 years has produced a robust data set to test hypotheses regarding initial colonization and subsequent adaptations over the past three millennia. PRINCIPAL FINDINGS: Close examination of human burials at the early (ca. 3000 BP) and stratified site of Chelechol ra Orrak indicates that these were normal sized individuals. This is contrary to the recent claim of contemporaneous "small-bodied" individuals found at two cave sites by Berger et al. (2008). As we argue, their analyses are flawed on a number of different analytical levels. First, their sample size is too small and fragmentary to adequately address the variation inherent in modern humans within and outside of Palau. Second, the size and stature of all other prehistoric (both older and contemporaneous) skeletal assemblages found in Palau fall within the normal parameters of modern human variation in the region, indicating this was not a case of insular dwarfism or a separate migratory group. Third, measurements taken on several skeletal elements by Berger et al. may appear to be from smaller-bodied individuals, but the sizes of these people compares well with samples from Chelechol ra Orrak. Last, archaeological, linguistic, and historical evidence demonstrates a great deal of cultural continuity in Palau through time as expected if the same population was inhabiting the archipelago. CONCLUSIONS: Prehistoric Palauan populations were normal sized and exhibit traits that fall within the normal variation for Homo sapiens-they do not support the claims by Berger et al. (2008) that there were smaller-bodied populations living in Palau or that insular dwarfism took place such as may be the case for Homo floresiensis.

Field triage to primary angioplasty combined with emergency department bypass reduces treatment delays and is associated with improved outcome.

AIMS: We investigated the net benefit in the outcome of reducing treatment delay through field triage and emergency department (ED) bypass in patients with ST-elevation myocardial infarction (STEMI) treated with primary angioplasty. METHODS AND RESULTS: In a prospective registry study, consecutive patients with suspected STEMI were assigned to: (i) pre-hospital ECG and triage or (ii) ECG and triage at the closest ED, solely based on ambulance availability. Four district hospitals and one regional heart centre serviced the 890,000 population metropolitan area and primary angioplasty was the only reperfusion strategy employed. Baseline characteristics were similar in STEMI patients triaged in the field (108) and the EDs (193). Symptom onset to balloon times: 154 [inter-quartile range (IQR) 120-233) vs. 249 (IQR 184-405) min (P<0.001) and peak creatine kinase in early presenters (<2 h): 1435 (95 %CI: 904-1966) U/L vs. 2320 (95% CI: 1881-2762) U/L (P=0.009) were lower in field- than in ED-triaged patients. Mortality in the PCI treated were 1.1 and 8.2% [P=0.025, RR 0.14 (95% CI: 0.01-1.08)] and overall mortality were 1.9 and 7.3% [P=0.046, RR 0.26 (95% CI: 0.05-1.11)]. CONCLUSION: Field-triage and ED bypass were feasible means of reducing treatment delay in patients with suspected STEMI and resulted in smaller infarct size in early presenters and a trend towards a reduction in mortality.