Multi-isotope evidence for the emergence of cultural alterity in Late Neolithic Europe.

The coexistence of cultural identities and their interaction is a fundamental topic of social sciences that is not easily addressed in prehistory. Differences in mortuary treatment can help approach this issue. Here, we present a multi-isotope study to track both diet and mobility through the life histories of 32 broadly coeval Late Neolithic individuals interred in caves and in megalithic graves of a restricted region of northern Iberia. The results show significant differences in infant- and child-rearing practices, in subsistence strategies, and in landscape use between burial locations. From this, we posit that the presence of communities with distinct lifestyles and cultural backgrounds is a primary reason for Late Neolithic variability in burial location in Western Europe and provides evidence of an early "them and us" scenario. We argue that this differentiation could have played a role in the building of lasting structures of socioeconomic inequality and, occasionally, violent conflict.

Technical note: some observations on the conversion of dental enamel δ18O(p) values to δ18O(w) to determine human mobility.

It has become a widespread practice to convert δ(18)O(p) values measured in human and animal dental enamel to a corresponding value of δ(18)O(w) and compare these data with mapped δ(18)O(w) groundwater or meteoric water values to locate the region where the owner of the tooth lived during the formation of the enamel. Because this is a regression procedure, the errors associated with the predicted δ(18)O(w) values will depend critically on the correlation between the comparative data used to perform the regression. By comparing four widely used regression equations we demonstrate that the smallest 95% error is likely to be greater than ±1% in δ(18)O(w) , and could be as large as ±3.5%. These values are significantly higher than those quoted in some of the recent literature, and measurements with errors at the higher end of this range would render many of the published geographical attributions statistically unsupportable. We suggest that the simplest solution to this situation is to make geographical attributions based on the direct comparison of measured values of δ(18)O(p) rather than on predicted values of δ(18)O(w).

Do "savanna" chimpanzees consume C4 resources?

Several stable carbon isotopic studies have shown that South African australopiths consumed significant quantities of C(4) resources (tropical grasses, sedges, or animals that eat those foods), but relatively little is known about the consumption of such resources by chimpanzees. Here, we present stable carbon isotopic data for 36 chimpanzee hair samples from Fongoli, one of the driest and most open areas inhabited by chimpanzees. These data suggest that the Fongoli chimpanzees consume little in the way of C(4) vegetation or animals that eat such vegetation, even though these resources are locally abundant and preferred fruits are more widely scattered than at most chimpanzee study sites. The homogeneity of the Fongoli results is especially striking and recalls the narrow isotopic distribution of stenotopic savanna mammals. This is in stark contrast to what has been observed for australopiths, which had highly variable diets and consumed about 35% C(4) vegetation on average. Carbon isotope data for modern and fossil Papio depict a dietarily variable genus with a tendency to consume C(4) vegetation. This trophic flexibility, or willingness to consume C(4) savanna resources, may make Papio a more profitable ecological analog for australopiths than chimpanzees.

Perinatal factors associated with severe intracranial hemorrhage.

OBJECTIVE: The purpose of this study was to assess the incidence of perinatal factors that are associated with severe intracranial hemorrhage in a large and recent multicenter experience. STUDY DESIGN: Retrospective analyses of nonanomalous newborns who were admitted to 100 neonatal intensive care units from 23 to 34 6/7 weeks' gestation were analyzed by multiple regression. RESULTS: There were 12,578 premature newborns with a mean (+/- SD) gestational age of 31.3 +/- 2.9 weeks and a birth weight of 1685 +/- 571 g, respectively. The overall incidence of severe intracranial hemorrhage was 2.9%; in 4575 newborns who weighed < or = 1500 g the incidences of intracranial hemorrhage was 7.1%. Factors with positive and negative associations with severe intracranial hemorrhage are listed in order of decreasing statistical significance: gestational age (negative), surfactant (positive), antenatal indomethacin (positive), neonatal transport (positive), cesarean birth (negative), poor prenatal care (positive), 5-minute Apgar score of < 7 (positive), chorioamnionitis (positive), antenatal terbutaline (negative), preterm premature rupture of fetal membranes (negative), and abruption (positive). CONCLUSION: The incidence of severe intracranial hemorrhage has dramatically declined over the past 2 decades. Antenatal steroids were not associated with reductions in severe intracranial hemorrhage.

Antenatal magnesium exposure and neonatal demise.

OBJECTIVE: To assess the effect of antenatal magnesium sulfate exposure on neonatal demise. STUDY DESIGN: A retrospective analysis of prospectively captured data from 100 tertiary centers between May 1997 and January 2000 was performed. Included were nonanomalous newborns who were admitted to the neonatal intensive care unit between 23 and 34 completed weeks' gestation. Predictors of neonatal demise were determined from a pool of 24 candidate variables in a univariate analysis. A multivariate predictive model for mortality was constructed by using the variables that had significant interactions with the rate of demise (P < or = .1). RESULTS: A total of 12,876 cases were available for analysis. When these cases were stratified according to gestational age, magnesium was associated with a significant reduction in neonatal demise (OR, 0.67; 95% CI, 0.54 to 0.84; P =.0005). The effect remained when controlling for both gestational age and indication for therapy (adjusted OR, 0.70; 95% CI, 0.56 to 0.89; P =.003). The effect was similar in direction and magnitude in the final model after controlling for additional antenatal factors (OR, 0.82; 95% CI, 0.65 to 1.04; P =.108). CONCLUSION: Antenatal magnesium exposure is not associated with neonatal death, regardless of indication for therapy.

The effect of multidose antenatal betamethasone on maternal and infant outcomes.

OBJECTIVE: This study was undertaken to determine whether prolonged betamethasone therapy is, as has been suggested, associated with adverse maternal or neonatal outcomes. STUDY DESIGN: A secondary multivariate analysis of a randomized controlled trial was performed to determine whether duration of betamethasone therapy was associated with adverse maternal or neonatal outcomes. RESULTS: There were 414 fetuses whose mothers were randomly assigned to trial groups. Final models included only valid cases without missing or averaged data (N = 367 to N = 412, depending on the model). Three or more sets of weekly betamethasone injections were given in 21.3% of cases and > or =4 sets were given in 12.3% of cases. Prolonged antenatal betamethasone therapy was not associated with increases in incidences of antenatal fever, chorioamnionitis, reduced birth weight, suppressed neonatal adrenal function, neonatal sepsis, or neonatal death. It was associated with larger birth weights (P <.05). CONCLUSION: Prolonged antenatal betamethasone therapy was not associated with higher risks of antenatal maternal fever, chorioamnionitis, reduced birth weight, neonatal adrenal suppression, neonatal sepsis, and neonatal death.

Decompression of fetal cardiac tamponade caused by congenital capillary hemangioma of the pericardium.

BACKGROUND: Isolated fetal pericardial effusion is rare but has been associated with various cardiac masses. Decompression in utero might prolong the pregnancy. CASE: In a 34-year-old white woman, gravida 3, para 0-1-1-1, at 34 5/7 weeks' gestation, ultrasound detected massive fetal pericardial effusion that progressed rapidly to hydrops. The fetal heart was structurally normal. We decompressed the fetal cardiac tamponade by pericardiocentesis, removing 52 mL of straw-colored fluid, which improved fetal movement and hydrops. We did pericardiocentesis at 6 weeks postpartum for a large pericardial effusion. Two weeks later the effusion recurred and we did thoracotomy with pericardial window placement. Pathologic diagnosis of pericardial biopsy was congenital capillary hemangioma of the pericardium. CONCLUSION: Isolated fetal pericardial effusion can be caused by capillary hemangioma of the pericardium despite lack of any mass on ultrasound. Decompression of pericardial effusion in utero might relieve fetal cardiac tamponade and extend pregnancy.

Umbilical cord blood gas analysis.

Umbilical cord blood gas and pH values should always be obtained in the high-risk delivery and whenever newborn depression occurs. This practice is important because umbilical cord blood gas analysis may assist with clinical management and excludes the diagnosis of birth asphyxia in approximately 80% of depressed newborns at term. The most useful umbilical cord blood parameter is arterial pH. Sampling umbilical venous blood alone is not recommended because arterial blood is more representative of the fetal metabolic condition and because arterial acidemia may occur with a normal venous pH. A complete blood gas analysis may provide important information regarding the type and cause of acidemia and sampling the artery and vein may provide a more clear assessment. The sampling technique is simple and easily mastered by any treatment person in the delivery room. Preheparinized syringes ensure a consistent dose and amount of heparin. Depending on how normality is defined and on the population studied, normal ranges for umbilical cord blood gas values vary (see Table 1). In general, the lower range for normal arterial pH extends to at least 7.10 and that for venous pH to at least 7.20. Many different factors during pregnancy, labor, and delivery can affect cord blood gases. Umbilical blood sampling for acid-base status at all deliveries cannot be universally recommended because many facilities do not have the capabilities to support such a practice and in doing so may impose an excessive financial burden. Considering the costs, the accumulated published data, and the nonspecificity of electronic fetal monitoring in the evaluation of fetal oxygenation, it may be more rational to implement universal cord blood gas analysis. Care providers and institutions with the logistical capabilities in place should consider the cost efficacy of routine cord blood gas analysis because it is the gold standard assessment of uteroplacental function and fetal oxygenation/acid-base status at birth.

Severe early onset preeclampsia secondary to bilateral ureteral obstruction reversed by stenting.

BACKGROUND: Severe early onset preeclampsia might be reversed by correction of an underlying pathophysiologic condition. CASE: A 22-year-old nullipara with a history of antivesicoureteral reflux surgery in childhood presented at 23 weeks' gestation with severe headaches, hypertension, proteinuria, edema, and acute renal failure. Severe preeclampsia was diagnosed, and bilateral distal ureteral obstruction was documented by cystoscopy, fluoroscopy, and retrograde pyelography. Bilateral ureteral stent placement completely resolved the preeclampsia and prolonged pregnancy until term. CONCLUSION: Pregnant women with a history of antireflux surgery in childhood might be at risk for acute renal failure and severe preeclampsia caused by bilateral ureteral obstruction. Ureteral stent placement might reverse obstruction, renal failure, and preeclampsia.

Does perinatal phenobarbital exposure affect developmental outcome at age 2?

The objective of this paper is to determine if phenobarbital exposure during pregnancy affects developmental outcome at age 2 years. Between 1991 and 1994, 401 pregnant patients at risk for delivery prior to 34 weeks' gestation were invited to participate; 48 mothers declined entry. Before delivery, pharmacy randomized the pregnant women to receive phenobarbital and vitamin K or identically appearing placebo in a blinded fashion. Developmental follow-up at age 2 years was performed. Children from the treatment group scored significantly lower on the Bayley Mental Developmental Index (mean MDI +/- 1 SD) than children whose mothers were randomized to the placebo group [104 +/- 21 (n = 59) vs. 113 +/- 22 (n = 62), p = 0.023]. Of 36 independent variables, randomization group was one of five that individually contributed to the prediction of the Bayley MDI score (p < 0.05). It was concluded that perinatal phenobarbital therapy may impair developmental outcome.

Combining isotopic and ecomorphological data to refine bovid paleodietary reconstruction: a case study from the Makapansgat Limeworks hominin locality.

The relationship between environmental change and hominin evolution remains obscure. For the most part, this stems from the difficulty of reconstructing ancient hominin habitats. Bovids are among the most frequently utilized paleoenvironmental indicators, but little is known about the habitat preferences of extinct taxa. It is generally assumed that fossil bovids both ate the same things and occupied the same habitats as their closest extant relatives. We test the first part of this assumption by reconstructing the diets of seven bovids from Makapansgat Limeworks, South Africa. Since diet and habitat are linked, these reconstructions have implications for our understanding of fossil bovid habitat tolerances. Ecomorphological and stable carbon isotope analyses are employed, allowing us to take advantage of the strengths and overcome the weaknesses of both. In most cases, fossil bovids did have similar diets to their extant relatives, and probably occupied similar habitats. Gazella vanhoepeni and Aepyceros sp., however, were almost exclusive browsers, and not mixed feeders like their living counterparts.

Isotopic evidence for the diet of an early hominid, Australopithecus africanus.

Current consensus holds that the 3-million-year-old hominid Australopithecus africanus subsisted on fruits and leaves, much as the modern chimpanzee does. Stable carbon isotope analysis of A. africanus from Makapansgat Limeworks, South Africa, demonstrates that this early hominid ate not only fruits and leaves but also large quantities of carbon-13-enriched foods such as grasses and sedges or animals that ate these plants, or both. The results suggest that early hominids regularly exploited relatively open environments such as woodlands or grasslands for food. They may also suggest that hominids consumed high-quality animal foods before the development of stone tools and the origin of the genus Homo.

Epidural and other labor analgesic methods.

This article focuses on methods of pain relief during labor, reviewing the current state of the art including risks and benefits. Regional techniques such as epidural or combined spinal/epidural techniques are discussed. A limited review of the effects of epidural analgesia on labor and delivery is presented. Other pharmacologic methods for labor pain relief are discussed including intravenous narcotics, paracervical block and inhalational analgesia. The following nonpharmacologic methods are also discussed: hypnosis, supportive care, transcutaneous electronic nerve stimulation (TENS), acupuncture/acupressure, subcutaneous water blocks and hydrotherapy.

Maternal oxygen desaturation with intravenous magnesium therapy.

OBJECTIVE: To describe the occurrence, treatment, and outcome of maternal oxygen desaturation during magnesium sulfate therapy. METHODS: A post hoc analysis of a randomized double-blind trial, designed to determine if mothers at risk for premature delivery treated with phenobarbital and vitamin K had less frequent intracranial hemorrhage in their newborns, was done. A subset of these patients at imminent risk for delivery received both intravenous magnesium sulfate and intravenous study drug (phenobarbital or placebo) and was monitored with maternal oxygen saturation monitoring. RESULTS: One hundred one women (29%) in the trial had pulse oximetry; 47 were assigned to placebo and 54 to the treatment group. The placebo and treatment groups had the following similarities: mean lowest oxygen saturation by pulse oximeter (93.4% +/- 3.0 compared with 93.1% +/- 3.3). mean highest magnesium levels (6.3 mEq/L +/- 1.5 compared with 6.2 mEq/L +/- 0.9), frequencies of desaturation events defined as oxygen saturation below 90% (11% compared with 11%), gestational age at delivery, birth weight, Apgar scores, and cord arterial pH. Using regression analysis, multiple gestation was the only one of 14 independent variables associated with low maternal oxygen saturation. Preeclampsia was not associated with a greater risk of desaturation. The statistical power of this study is limited by its small sample sizes. CONCLUSION: Maternal oxygen desaturation occurs commonly with intravenous magnesium therapy, does not occur more frequently with simultaneous administration of intravenous phenobarbital, and does not cause decompensation in maternal or fetal status. Multiple gestation may be associated with lower maternal oxygen saturation.

Perinatal factors predicting severe intracranial hemorrhage.

The objective of this paper is to determine the importance of perinatal factors predicting occurrence of severe intracranial hemorrhage (ICH) in premature newborns. A post-hoc analysis of a previously published randomized, double-blinded, prospective trial was performed. Logistic regression analysis was used to assess the importance of obstetrical variables and umbilical cord blood coagulation studies and acid-base status in predicting severe ICH (grades 3 and 4). The trial lasted 42 months; 401 pregnant women were invited to participate and 48 declined. The most important predictors of severe ICH in order of decreasing significance were: gestational age at delivery (p=0.0001), duration of painful labor (p=0.0077), duration of antenatal antibiotic therapy (p=0.0203), maternal age (p=0.0247), and factor X activity in umbilical cord blood (p=0.0302). Mode of delivery, cord blood acid-base, and coagulation status did not correlate with severe ICH. The majority of severe ICHs were late in onset; only two of 31 were known to have occurred in the first 24 hr of life. Gestational age, duration of painful labor, duration of antibiotic therapy, and maternal age were the most important predictors of severe ICH.