Fourteen Years of Archaeological and Heritage Research in the Iringa Region, Tanzania.

The Iringa Region is famous among archaeologists for the Acheulean site of Isimila, and among historians as the stronghold where Chief Mkwawa led the Hehe resistance against German colonial forces. However, our research reveals that Iringa has a rich archaeological record that spans the period from the Stone Age into the recent past. This article summarizes the results of 14 years of research by our team, the Iringa Region Archaeological Project (IRAP). Since 2006, IRAP members have recorded 67 sites, and this only scratches the surface of the archaeological potential in the area. These sites, some of which were recorded in conjunction with local participants, have archaeological component characteristic of the Early, Middle, and Later Stone Age, the Iron Age, and the recent past. We consider the archaeological and historical value of Iringa to be high and hope that this work inspires future research, tourism, and conservation efforts in the area.

La région d'Iringa en Tanzanie est. reconnue par les archéologues pour le site acheuléen d'Isimila et parmi les historiens comme le fief où le chef Mkwawa a dirigé la résistance du Hehe contre les forces coloniales allemandes. Cependant, nos recherches révèlent qu'Iringa possède de riches archives archéologiques allant de l'âge de pierre au passé récent. Cet article résume les résultats de quatorze années de recherche de notre équipe, le projet archéologique de la région d'Iringa (PARI). Depuis 2006, les membres du PARI ont enregistré 67 sites, ce qui ne fait qu'effleurer la surface du potentiel archéologique de la région. Les sites identifiés présentent des éléments archéologiques caractéristiques de l'âge de pierre précoce, moyen et postérieur, de l'âge du fer, et du passé historique. En outre, un certain nombre de sites culturels importants ont été enregistrés en collaboration avec des participants locaux. Nous considérons que la valeur archéologique et historique d'Iringa est. élevée et espérons que ces travaux inspireront la recherche, le tourisme et la conservation dans cette région importante.

Excavations at Mlambalasi Rockshelter: a Terminal Pleistocene to Recent Iron Age Record in Southern Tanzania.

The Mlambalasi rockshelter in the Iringa Region of southern Tanzania has rich artifactual deposits spanning the Later Stone Age (LSA), Iron Age, and historic periods. Middle Stone Age (MSA) artifacts are also present on the slope in front of the rockshelter. Extensive, systematic excavations in 2006 and 2010 by members of the Iringa Region Archaeological Project (IRAP) illustrate a complex picture of repeated occupations and reuse of the rockshelter during an important time in human history. Direct dates on Achatina shell and ostrich eggshell (OES) beads suggest that the earliest occupation levels excavated at Mlambalasi, which are associated with human burials, are terminal Pleistocene in age. This is exceptional given the rarity of archaeological sites, particularly those with human remains and other preserved organic material, from subtropical Africa between 200,000 and 10,000 years before present. This paper reports on the excavations to date and analysis of artifactual finds from the site. The emerging picture is one of varied, ephemeral use over millennia as diverse human groups were repeatedly attracted to this fixed feature on the landscape.

L'abri sous roche Mlambalasi dans la région d'Iringa au sud de la Tanzanie est riche en artéfacts du Paléolithique supérieur jusqu'à l'âge du fer et la période historique. Des artéfacts du Paléolithique moyen sont présents sur le versant en face de l'abri. Des fouilles extensives et systématiques réalisées par l'équipe d'Iringa Region Archaeological Project (IRAP) révèlent une image complexe de l'utilisation et de la réutilisation de l'abri sous roche pendant un moment important dans l'histoire de l'humanité. Des datations directes de coquilles d'Achatina et de perles en coquilles d'autruches (OES) suggèrent que l'occupation la plus ancienne excavée à Mlambalasi, associée aux sépultures humaines, parvient d'une phase terminale du Pléistocène. Ceci est exceptionnel car les sites archéologiques, en particulier contenant des corps humains et d'autres matières organiques préservées, sont rares en Afrique subtropicale entre 200,000-10,000 années avant le présent. Cet article présente les fouilles effectuées jusqu'à ce jour ainsi que l'analyse des artéfacts trouvés sur le site. L'image qui ressort est celle d'une utilisation variée et éphémère à travers les millénaires au fur et à mesure que divers groupes ont été attirés à cet endroit permanent dans le paysage.

Guglielmi detachable coil: report of intraoperative complications.

The newest therapy for cerebral aneurysm is the Guglielmi detachable coil (GDC). The authors describe the anesthetic management of two patients with intraoperative subarachnoid hemorrhage during Guglielmi coil placement. Various treatments for intraoperative hemorrhage are discussed, as are other common complications that can occur during placement of intravascular, intracranial coils. The placement of a ventriculostomy was a major contributing factor in the good outcome of both patients. Consideration should be given to placement of a ventriculostomy before the GDC procedure. Although the GDC procedure offers much promise, it is not a benign procedure and has its own set of complications that will no doubt challenge the neuroanesthesiologist.

Ethnic differences in perceptions of body size in middle-aged European, Maori and Pacific people living in New Zealand.

OBJECTIVES: The aim of this study was to compare perceptions of body size in European, Maori and Pacific Islands people with measured body mass index (BMI), waist-to-hip ratio and change in BMI since age 21 y. Socio-demographic factors that influenced perceptions of body size were also investigated. DESIGN: Cross-sectional survey. METHODS: Participants were 5554 workers, aged > or =40 y, recruited from companies in New Zealand during 1988-1990. RESULTS: Prevalences of BMI>25 kg/m2 were: Europeans, 64.7% men, 47.2% women; Maori, 93.2% men, 80.6% women; and Pacific Islanders, 94.1% men, 92.9% women. Similarly, prevalences of BMI >30 kg/m2 were: Europeans, 14.4% men, 14.6% women; Maori, 55.0% men, 41.9% women; and Pacific Islanders, 55.1% men, 71.7% women. At each perception of body size category, Maori and Pacific Islands men and women had a higher BMI than European men and women, respectively. BMI increased with increasing perception of body size in all gender and ethnic groups. Since age 21, increases in BMI were highest in Pacific Islands people and increased with increasing perceptions of body size category in all ethnic and gender groups. BMI adjusted odds (95% CI) of being in a lower perception category for body size were 1.70 (1.38-2.12) in Maori and 8.99 (7.30-11.09) in Pacific people compared to Europeans, 1.27 (1.13-1.42) times higher for people with no tertiary education, 1.41 (1.25-1.59) times higher in people with low socioeconomic status, and 0.94 (0.92- 0.95) for change in BMI since age 21. CONCLUSION: Nutritional programs aimed at reducing levels of obesity should be ethnic-specific, addressing food and health in the context of their culture, and also take into account the socioeconomic status of the group. On the population level, obesity reduction programs may be more beneficial if they are aimed at the maintenance of weight at age 21.

Disconnection of the anterior cingulate cortex and nucleus accumbens core impairs Pavlovian approach behavior: further evidence for limbic cortical-ventral striatopallidal systems.

The nucleus accumbens (NAcc) has been implicated in a variety of forms of reward-related learning, reflecting its anatomical connections with limbic cortical structures. After confirming that excitotoxic lesions of the anterior cingulate cortex (Ant Cing) impaired the acquisition of appetitive Pavlovian conditioning in an autoshaping procedure, the effects of excitotoxic lesions to the NAcc core or shell on autoshaping were also assessed. Only selective core lesions impaired Pavlovian approach. A subsequent experiment studied the effects of a disconnection of the Ant Cing and NAcc core, using an asymmetric lesion procedure, to determine whether these structures interact sequentially as part of a limbic corticostriatal system. Such lesioned rats were also significantly impaired relative to controls at autoshaping. These results demonstrate that the NAcc core and Ant Cing are "nodes" of a corticostriatal circuit involved in stimulus-reward learning.

Statistical methodology: VII. Q-methodology, a structural analytic approach to medical subjectivity.

Q-methodology is a relatively unknown tool to medical researchers, that uses a mixed quantitative/qualitative statistical technique known as by-person factor analysis to study subjectivity. Q-methodology allows the grouping of individuals according to their subjective feelings about a topic, without requiring preconceived ideas regarding the structure of those subjective feelings. Q-methodology is demonstrated using a study in which attitudes of emergency medicine residents toward computer education are explored systematically and classified in terms of statistically distinct factor viewpoints. In this example, Q-methodology identifies 4 attitude groups, as related to computers and computer education: 1) interested, eager to learn; 2) frustrated and interested, but with reservations; 3) interested mainly in benefits, willing to expend minimal effort; and 4) knowledgeable, independent learner. Q-methodology can be used to determine the structure of attitudes on a subjective topic, often yielding new insights.

Resident perspectives of EMS as a subspecialty.

OBJECTIVE: Emergency medical services (EMS) is frequently considered to be a subspecialty of emergency medicine (EM) despite the unavailability of subspecialty certification. An assessment of future interest in EMS subspecialization and the perceived educational needs of potential EMS physicians was performed in order to provide data to leaders responsible for development of this subspecialty area. METHODS: A survey concerning EMS subspecialization issues was distributed to 2,464 members of the Emergency Medicine Residents Association (EMRA). Questions addressed demographic information, interest in EMS, educational issues, and desired credentials. The response rate was 30% (n = 737). All surveys were analyzed by the Pearson chi-square probability and Mantel-Haenszel tests for linear association. RESULTS: A moderate to very high interest in EMS medical direction was expressed by 84% of the respondents, with 14% interested in full-time EMS positions. This interest increased with years of training (p < 0.0001). Almost 89% believed that EMS physicians should have special preparations prior to practice beyond EM residency training. Fewer than half (44%) thought that an EM residency provided sufficient preparation for a significant role in EMS, and this perception increased in intensity with years of training (p < 0.0052). Interest in EMS fellowships (24%) would increase to 36% if subspecialty certification were available (p < 0.0001). Thirty-nine percent believed subcertification should be required of all EMS medical directors if available. CONCLUSIONS: Many EM residents have an interest in active participation in EMS on either a part-time or a full-time basis. Most respondents think EMS is a unique area requiring focused education beyond an EM residency. Interest in EMS fellowships would greatly increase if subspecialty certification were available.

International Health Fellowship: a proposed curriculum for emergency physicians.

There are a growing number of emergency physicians (EPs) working in health care abroad. There are, however, no formal training programs for EPs in international health. An International Health Fellowship has been developed to provide training for EPs in public health and international medicine. The fundamental competencies of a fellow completing the International Health Fellowship include assessment of medical need, program development, integration of programs into the existing health care framework, and evaluation of projects. This article outlines the philosophy of a training program in international health, provides an overview of the goals and objectives for such a program, and describes the development of an existing fellowship. The International Health Fellowship will develop leaders in the field of global health by combining clinical expertise, practical field experience, formal public health training, and research and education in international health. Physicians completing a fellowship will be prepared to work within foreign health systems to develop, integrate, and evaluate health care programs on an international scale.

Development of a unique decentralized rapid-response capability and contingency mass-casualty field hospital for the 1996 Democratic National Convention.

This article describes the planning, development, and execution of a unique, decentralized, and flexible medical response capability that was developed for the 1996 Democratic National Convention in Chicago. Concerns for coordinated acts of violence, terrorism, toxicologic exposures, and logistic problems posed by the United Center prompted the development of a decentralized and flexible rapid-response plan. Contingency planning for the remote possibility of a full-scale disaster led to the additional development of a contingency mass-casualty field hospital on site. The plans for this mass-gathering response are described in considerable detail. Forty-four patient encounters across the four days of the convention were recorded, with a combination of minor injuries and potentially serious medical presentations. The 1.46 EMS encounters per 1,000 attendees at the Democratic National Convention is comparable to other utilization rates for mass gatherings in the literature. Proactive attention to comprehensive contingency planning for equipment, supplies, personnel, and organizational needs, especially when multiagency response and cooperation are required, is essential.

Implementation of an out-of-hospital termination of resuscitation policy.

OBJECTIVE: To evaluate the implementation of an out-of-hospital termination of resuscitation policy in an urban EMS setting. METHODS: A descriptive study characterizing the implementation of an out-of-hospital termination of resuscitation policy in the Chicago EMS system. It includes a retrospective telemetry record review analyzing the utilization and compliance with the policy. The newly implemented policy involved field termination of resuscitation for all nontraumatic, adult cardiac arrest victims presenting in asystole who were not responsive to a standard trial of resuscitation. RESULTS: Over the three-month study period, 228 resuscitations of adult, nontraumatic cardiac arrest victims were identified and submitted for review. The group of 142 cardiac arrest victims who presented in asystole and received resuscitative efforts were categorized into four groups. Group I included 34 cardiac arrests for which resuscitation was terminated in the field following policy criteria. Group II included eight cardiac arrests for which resuscitation was terminated but the patients did not meet criteria for termination of resuscitation. Group III included 84 cardiac arrests for which resuscitation was not terminated because the patients did not meet criteria for out-of-hospital termination. Group IV included 16 cardiac arrests for which resuscitative efforts were continued, although the patients met indications for field termination. CONCLUSIONS: Field termination of resuscitation is practical in the setting of asystole unresponsive to aggressive resuscitative efforts. The implementation of such an out-of-hospital termination of resuscitation policy is complicated by many problems and is best accomplished by a gradual implementation process. Through this process all members of the EMS community can address practical and ethical issues and grow comfortable with the ongoing evolution of out-of-hospital therapy.

A comparison of EMS continuing education for paramedics in the United States.

OBJECTIVE: To determine characteristics of continuing education programs for paramedics in large metropolitan areas, and to make recommendations for changes in the Chicago Emergency Medical Services (EMS) system. DESIGN: A survey of 95 metropolitan areas from each state in the United States. PARTICIPANTS: EMS medical directors, coordinators, and administrators. RESULTS: The survey population included 56 respondents. Within this group, 23% were from areas of 1 million people or more, 61% in areas with populations of 100,000 to 1 million and 16% from areas populated by < 100,000 people. Several system types were represented in the survey. In the systems surveyed, 98% mandate didactic continuing education requirements. Clinical continuing education was required by 34% of the systems. Ten systems (18%) awarded continuing education hours for documented in-field experience. This method did not have a specific structure by the majority of users. Both written and skills testing were used by most EMS systems to evaluate paramedic competency. No statistically significant differences (p > 0.05) could be found among population subgroups or EMS system types when evaluating the use of these various methods. CONCLUSION: EMS systems primarily use didactic sessions to meet their continuing education requirements. Nearly half of the systems requiring clinical continuing education use in-field credit to fulfill these requirements. In-field credit systems are poorly developed to date. This mechanism may be an effective alternative to usual clinical experiences for paramedics and deserves further investigation.

The lymph node pathology of Omenn's syndrome.

Omenn's syndrome is a rare, usually fatal immunologic disorder of infancy characterized by recurrent infections, skin lesion, lymphadenopathy, peripheral blood lymphocytosis, and eosinophilia. Histologic evaluation of a lymph node revealed total effacement of the microscopic architecture resulting from a diffuse proliferation of interdigitating reticulum cells and a depletion of B lymphocytes. The lymph node lacked a distinct cortex and had no follicle formation. The most striking feature was a diffuse hyperplasia of S-100-protein-positive nonphagocytic reticulum cells with large, pale Langerhans-like nuclei. Ultrastructural examination identified these cells to be interdigitating reticulum cells. The lymphocytes were small and predominantly of the CD8 cytotoxic/suppressor cell type.

Magnetic orotracheal intubation: a new technique.

We sought to determine the effectiveness of a magnet placed over the thyroid cartilage in the neck to guide an endotracheal tube into the trachea. Forty patients aged 18 to 60 yr with normal airway anatomy (ASA grade I) who required general anesthesia with an endotracheal tube and paralysis for their surgery were chosen and informed consents were obtained. The tip of the epiglottis was exposed with a No. 3 MacIntosh laryngoscope, and a magnet was held over the thyroid cartilage. A catheter with stylet was placed behind the epiglottis allowing the magnet to pull the stylet and catheter close to the glottic opening. The catheter was advanced into the trachea over the stylet and its position was confirmed by auscultating the lungs and by capnography. An extension tube was connected to the catheter, and the endotracheal tube was guided into the trachea over the catheter. The tracheas of 37 patients were intubated on the first attempt with the magnet. The tracheas of the remaining three patients could not be intubated on the first attempt but were successfully intubated without complications on the second attempt. An additional five patients with an anterior larynx whose tracheas could not be intubated with direct laryngoscopy also had tracheal intubation with a magnet. This magnet-guided technique can be used when it is difficult to expose a patient's larynx. It is noninvasive, simple, and can be used without any delay when expensive flexible fiberoptic endoscopes are not readily available. The procedure takes an average of 1 to 2 min.

Antibody specificity for human immunodeficiency virus type 1 in serum and cerebrospinal fluid from patients with AIDS and AIDS-related complex.

Since little information has been reported about the specificity of antibodies to human immunodeficiency virus type 1 (HIV-1) found in the cerebrospinal fluid (CSF), 21 CSF and serum specimens were examined from 19 patients with clinical AIDS, AIDS-related complex, or asymptomatic HIV-1 infection. The predominant specificity of antibodies using Western blot analysis in both serum (100%) and CSF (100%) was directed toward env gene products. The next most common antibody specificities were to the pol gene products (serum 95%; CSF 62%). Less commonly found was antibody to the gag-encoded proteins (serum 71%; CSF 38%). The level of antibody to HIV-1 in CSF could not be predicted from the level found in serum. Also, the spectrum of antibodies seen did not correlate with disease stage or with the quantity of antibody present. The serum/CSF pairs were also examined for the presence of HIV-1 antigen by commercial enzyme immunoassay. HIV-1 antigen was present in eight of 19 (43%) of the serum samples and five of 20 (25%) of the CSF samples tested.

Evaluation of three enzyme immunoassays for HIV-1 antigen detection.

Three enzyme immunoassay (EIA) methods for the detection of human immunodeficiency virus (HIV-1) were evaluated. Serum or plasma samples from 22 individuals seropositive for HIV-1 antibodies were tested with the Abbott, Coulter, and DuPont kits for presence of HIV-1 p24 antigen. Another 12 samples were tested with two kits only. Discordant results were obtained with 9 of 34 (26%) HIV-1-antibody-positive patient samples tested. Most of these discrepancies were found in samples containing less than 30 pg/ml of HIV-1 p24 core antigen. A sampling of sera from normal blood donors and patients with infectious or autoimmune diseases revealed a low level of false positive reactions, especially with sera containing antinuclear antibodies or rheumatoid factor. Noteworthy is the frequency of false positive reactions seen with the DuPont EIA for HIV-1 p24 antigen. 18/111 sera (16.2%) containing auto-antibodies tested positively with the DuPont HIV-1 p24 antigen EIA. The nonspecific nature of the test reactivity for 9/10 of these samples was confirmed using an HIV-1 p24 antigen inhibition assay. These findings are discussed in light of the need for HIV-1 antigen detection in the clinical laboratory and of other methods for HIV-1 detection: the polymerase chain reaction and measurements of reverse transcriptase activity.

Early commitment to neoplasia in murine B- and T-cell lymphomas arising late in life.

Lymphomas arise spontaneously in C57BL/10.H-2aH-4b (2a4b) mice greater than 1 year old. The purpose of this study was to determine when cells become committed to neoplasia and whether genes linked to H-2a or H-4b are a factor in predisposition to genesis of lymphoma. Following transplantation of a pool of spleen cells in large groups of mice, lymphoma incidence increased 1.8- to 2.1-fold and mean latent periods decreased, compared with those in controls. Lymphomas arising in mice that received the same pool of spleen cells often displayed identical rearrangements of genes for immunoglobulin and T-cell receptor. This finding indicates that the lymphomas were derived from expanding clones of cells present in the donor mice prior to transfer. The age of the donor mice determined the latency of lymphomas arising after spleen cell transfer. When donors were 3-4 months old at the time of spleen cell transfer, lymphomas were detected in the recipients 1 year later. When mice 1.5-2 years old were used as donors, tumors were observed 3 months after transfer. Almost all of these tumors were clonally related B-cell lymphomas. We conclude that the lymphomas seen late in life arise from premalignant clones of cells that have become committed to neoplasia in relatively young animals. These clones normally follow an indolent course and are manifested clinically only in old age. Neither H-2a nor H-4b alone appeared to alter susceptibility to the genesis of lymphoma in similar experiments with H-2a and H-4b congenic mice.

Analysis of a murine B cell lymphoma, CH44, with an associated non-neoplastic T cell population. I. Proliferation of normal T lymphocytes is induced by a secreted product of the malignant B cells.

A non-neoplastic T cell population associated with a murine monoclonal B cell malignancy, CH44, was analyzed. Immunofluorescence on cell suspensions and immunoperoxidase staining on tissue sections using monoclonal antibodies to the antigens Thy1.2, Ly-1, L3T4, and Lyt-2 confirmed the presence of both TH (Ly-1/L3T4+, Lyt-2-) and Tc/s (Ly-1/L3T4-, Lyt-2+) T cell subpopulations. The non-neoplastic T cells were present in both a 0.6 and 2.1 g CH44-bearing spleen. T cells, not normally in liver in significant numbers, were found in liver tissue when the CH44 tumor cells were present. These data implied an active proliferation of the T cell populations within tissues containing the malignant B cells. Supernatant from an in-vitro-adapted cell line of CH44 (CH44.LX) was tested for its ability to induce proliferation of normal murine splenocytes and thymocytes. As assayed by tritiated thymidine incorporation, both spleen and thymus cells proliferated in the presence of CH44.LX supernatant. Although supernatant from two of nine other B cell lines was able to stimulate the proliferation of spleen cells, only CH44.LX could induce proliferation of thymus cells. Supernatant from the seven other B cell lines and three hybridomas had no measurable effect on either splenocytes or thymocytes in this assay. It is hypothesized that the presence of a non-neoplastic proliferating T cell population associated with a neoplastic B cell lymphoma during in vivo passaging of the tumor is the result of effects derived from a secreted product of the malignant B cells. Whether the T cells have any effect on the growth of the malignant B cells is not known.