Lessons from history of socioeconomic improvements: a new approach to treating multi-drug-resistant tuberculosis.

This study investigated the trends in tuberculosis mortality through time in Switzerland. Information on the decline in mortality before chemotherapies were introduced may be useful in developing countries where drug-resistant tuberculosis is now becoming a major problem. Swiss data were collected from historical records and comparative data were obtained from the literature for England and Wales, New York, Japan, Brazil and Sierra Leone. Logistic curves were fitted to examine the rate of decline before introduction of pharmacotherapies and these show that the decline would have continued without the introduction of chemical therapies, including antibiotics. In Switzerland, England and Wales and New York, the decline had occurred long before the introduction of specific anti-tuberculosis agents. In Brazil and Japan, chemical therapy was co-incident with the decline in tuberculosis mortality rates. Overall, it is suggested that the effective control of tuberculosis can be achieved through a combination of chemical interventions, conservative therapy (rest, good nutrition, ventilation, etc.) as well as public health interventions addressing hygiene, nutrition, reducing exposure to infections and educating the population about tuberculosis.

Dynamics of tuberculosis infection in various populations during the 19th and 20th century: The impact of conservative and pharmaceutical treatments.

Humans and Mycobacterium tuberculosis have co-evolved together for thousands of years. Many individuals are infected with the bacterium, but few show signs and symptoms of tuberculosis (TB). Pharmacotherapy to treat those who develop disease is useful, but drug resistance and non-adherence significantly impact the efficacy of these treatments. Prior to the introduction of antibiotic therapies, public health strategies were used to reduce TB mortality. This work shows how these strategies were able to reduce TB mortality in 19th and 20th century populations, compared with antibiotic treatments. Previously published mortality data from historical records for several populations (Switzerland, Germany, England and Wales, Scotland, USA, Japan, Brazil and South Africa) were used. Curvilinear regression was used to examine the reduction in mortality before and after the introduction of antibiotic treatments (1946). A strong decline in TB mortality was already occurring in Switzerland, Germany, England and Wales, Scotland and the USA prior to the introduction of antibiotic treatment. This occurred following many public health interventions including improved sanitation, compulsory reporting of TB cases, diagnostic techniques and sanatoria treatments. Following the introduction of antibiotics, mortality rates declined further, however, this had a smaller effect than the previously employed strategies. In Japan, Brazil and South Africa, reductions in mortality rates were largely driven by antibiotic treatments that caused rapid decline of mortality, with a smaller contribution from public health strategies. For the development of active disease, immune status is important. Individuals infected with the bacterium are more likely to develop signs and symptoms if their immune function is reduced. Effective strategies against TB can therefore include enhancing immune function of the population by improving nutrition, as well as reducing transmission by improving living conditions and public health. This has been effective in the past. Improving immunity may be an important strategy against drug resistant TB.

Surgical anatomy for pelvic external fixation.

Pelvic external fixators have a high rate of reported complications, most of which relate to pin placement. In this descriptive study, we analyzed the morphology of the ilium in cadaveric specimens and compared these with the measures obtained from normal human pelvic computer tomograph scans, and how these related to each of the three basic configurations of pin positioning for the external fixation of a pelvis: anterosuperior (Slätis type), anteroinferior (supra-acetabular), and subcristal. The irregular shape and size of the iliac wing and the abdominal wall overlying the pin's insertion site could hinder accurate placement of anterosuperior pins. Potential disadvantages of the use of anteroinferior pins was found related to the deep location of the anterior inferior iliac spine, interference with the hip flexion area, risk of hip joint penetration, and the variable obliquity of the ilium. As subcristal pins are positioned between two superficial bony landmarks of the iliac crest, our findings suggest that they are more likely to have a correct placement and avoid complications.

Non-osseous extra-articular anterolateral talocalcaneal coalition: a case report.

We report a case of an extra-articular talocalcaneal coalition located anterolateral to the sinus tarsi. As non-osseous coalitions can be difficult to diagnose, physicians should keep this variant in mind in cases of a symptomatic hind foot with apparently equivocal radiological findings.

Recognition by forensic facial approximation: case specific examples and empirical tests.

The skeletal remains of one individual found near Adelaide in 1994, although not known at the time, were the first evidence of what was to be a serial killing reported to have resulted in the highest casualty list to date in Australia (12 victims). Since the usual methods of identification could not be used or were unsuccessful on these remains, facial approximations were produced and advertised over the 4-year period following their discovery, in an attempt to help to identify them. However, no identification was made. In 1999, the remains were reported to be identified by radiographic comparison. Approximately 3 months before this identification was made, another facial approximation was produced by the first author (CNS), but this face was never advertised in the media. Although rarely reported in the literature, this paper provides an example where facial approximation methods were not successful in a forensic scenario. The paper also reports on empirical tests of the facial approximation created by the first author to determine if this facial approximation might have been useful had it been advertised. The results provide further evidence that high resemblance of a facial approximation to the target individual does not indicate recognizability, as the facial approximation was poorly recognized even though it bore good resemblance to the target individual. The usefulness of facial approximation techniques is discussed within the context of this case and more broadly. Methods used to assess the accuracy of facial approximations are also discussed and further evaluated.

Cranial Arterial Patterning in Greyhounds: Another Case of Internal Intraspecific Variation.

The greyhound is a dog breed highly specialized to run fast (17 m/s) over short distances (Usherwood and Wilson, 2005). As a result, there are many anatomical structures correlated with this sprinting function. The branching patterns of vasculature supplying blood to the head, forelimbs and thorax (subclavian arteries and its branches) were described in 34 adult greyhound cadavers (22 male, 12 female) (donated with owner consent and used under a memorandum of understanding with the University of Adelaide Animal Ethics Committee) from silicone casts of the arch of the aorta and the cranial arteries. Chi-squared analysis was used to test for pattern frequency differences, and t-tests were used to analyse the differences between sex and symmetry. All measurements were scaled to a fixed measure, the Open Thorax Length (OTL), to correct for size variation between individuals. Significant differences were found between the left and right subclavian arteries in the greyhound. The length to the first branch as a percentage of the OTL was greater in the right subclavian artery than the left subclavian artery (P < 0.001). The interval between the first and last branches (branching interval) as a percentage of the OTL was larger in the left subclavian artery than the right subclavian artery (P < 0.001). The reason for these differences remains unclear. Nonetheless, intraspecific variations of the branching patterns of the subclavian arteries have been described in the greyhound, thus suggesting that breed-specific variations in the cardiovascular system are likely to occur throughout domestic dogs.

A dissection and computer tomograph study of tarsal coalitions in 100 cadaver feet.

Most of the clinical studies report the incidence of tarsal coalitions (TC) as less than 1% but they disregard the asymptomatic coalitions. TC have been associated with degenerative arthritic changes. After X-rays, computer tomography (CT) is the most commonly used diagnostic test in the detection of TC. The aims of our study were to establish the incidence of TC; the association between TC and accessory tarsal bones and between TC and tarsal arthritis; and to assess the sensitivity of CT as a diagnostic tool in TC. We performed spiral CT scans of 100 cadaver feet (mean age at death 77.7+/-10.4), which were subsequently dissected. The dissections identified nine non-osseous TC: two talocalcaneal and seven calcaneonavicular. There was no osseous coalition. Tarsal arthritis was identified in 31 cases. Both talocalcaneal coalitions were associated with arthritis while none of the calcaneonavicular coalitions were associated with tarsal arthritis. The CT diagnosed an osseous talocalcaneal coalition and was suspicious of fibrocartilaginous coalitions in eight cases. There was correlation between dissection and CT in two talocalcaneal coalitions and three calcaneonavicular coalitions thus CT identifying 55.5% of the coalitions. CT did not diagnose four non-osseous coalitions and diagnosed errouresly four possible coalitions. In conclusion our study demonstrated that the incidence of non-osseous TC is higher than previously thought (12.72%). The calcaneonavicular coalitions are the most common single type (9.09%) and they do not seem to be associated with arthritic changes in the tarsal bones. Our CT results suggest that spiral CT has a low sensitivity in the detection of non-osseous coalitions and questions if multislice CT should be used routinely when TC are suspected.

The small child: anthropometric and physical performance characteristics of short-for-age children growing in good and in poor socio-economic conditions.

OBJECTIVE: To ascertain whether individuals whose short stature is caused by poor living conditions differ in their other biological characteristics from those individuals who grow short, supposedly due to their genetic endowment, under favourable environmental conditions. DESIGN: From the growth survey of nearly 4000 children of the 'Cape Coloured' community aged 6-18 y half of whom lived in the middle-class suburbs of Cape Town [high socio-economic status (SES)], the other half who lived in poor rural settlements (low SES), boys and girls of similarly short stature were selected. Average body height by sex and age in each selected sample was close to the 5th percentile of height distribution among all high SES individuals surveyed. SETTING: Cape Town and neighbouring rural settlements in South Africa. SUBJECTS: Four thousand children of the Cape Coloured community aged 6-18 y. Among these were 109 high SES boys, 123 high SES girls, 302 low SES boys and 344 low SES girls selected for short stature study. INTERVENTIONS: Anthropometric measurements in public schools with appropriate permissions. RESULTS: Both short stature males and females from the low SES group tended to be significantly (P < 0.05) different from the high SES group of comparable stature in having lower body weights, shorter limbs, longer trunks, narrower shoulders, hips and chests, thinner skinfolds, smaller arm circumferences, and were very notably weaker and had poorer neuromuscular reaction times. Biepicondylar widths and pulse rates were little different between groups. Genetically short children do differ in various anthropometric and functional traits from those who are small from environmental causes.

Trends in cranial capacity and cranial index in Subsaharan Africa during the Holocene.

Craniometric data have been collected from published and unpublished reports of numerous authors on 961 male and 439 female crania from various sites in Subsaharan Africa spanning the last 100 ka. All data available in the literature, irrespective of their "racial" affinities, were used to cover the prehistoric and early historic times (up to 400 a BP). Samples covering the last 400 years do not include European colonists and consist of skeletons exavated at archeological sites, collected by early European travelers and derived from anatomical collections. Cranial capacity, depending on the mode of its calculation, has decreased by 95-165 cm3 among males and by 74-106 cm3 among females between the Late Stone Age (30-2 ka BP) and modern times (last 200 years). Values of the cranial index did not show any trend over time and their averages remained in the dolichocephalic category. The decrease in cranial capacity in Subsaharan Africa is similar to that previously found in Europe, West Asia, and North Africa, but, unlike the latter, it is not accompanied by brachycephalization. © 1993 Wiley-Liss, Inc.

Cross-sectional survey of growth of urban and rural "cape coloured" schoolchildren: anthropometry and functional tests.

The patterns of physical growth (height, weight, length of body segments, circumferences, and widths) and function (grip strength, reflexes, and pulse rates) of "Cape Coloured" schoolchildren were studied. Urban and rural groups were selected with maximum contrasting socioeconomic status (SES). Data were collected between 1986 and 1988 and included 906 males and 1,068 females of high SES between 5 and 20 years in the Cape Town urban area and 834 males and 940 females of low SES between 5 and 19 years in the Little Karoo region. Means and standard deviations of 20 characteristics by age are presented separately for males and females and urban and rural groups. The heights and weights of prepubertal urban children match American reference data, but postpubertally they decline somewhat, whereas these measurements of the rural children consistently lie ∼1 standard deviation below the urban group. Skinfold thicknesses of urban children match or exceed the American reference, implying that their nutritional needs are being met well. Functional indicators of rural children are much poorer than those of urban children. The results of the urban children may provide a target for the improvement in growth status of rural children. Am. J. Hum. Biol. 10:73-85, 1998. © 1998 Wiley-Liss, Inc.

Medicine may be reducing the human capacity to survive.

It appears that limited natural selection is taking place in populations of developed countries, since most individuals survive and have the full opportunity to reproduce. This paper addresses contemporary natural selection in a developed country (Australia) using the biological state index. Although the general context of this paper focuses on Australia it can be expected that most other first-world and/or developed countries follow a similar pattern. The findings of this study, that 98% of individuals survive through their reproductive period and have the full opportunity to reproduce, support predictions that natural selection has limited influence on the evolution of first-world populations. It appears that first-world populations may not be naturally well adapted to their environment but use medical treatments/technology to increase their survival capacity and maintain fitness. This has two apparent consequences. First, the fitness of individuals will decrease, since less favorable genes can accumulate in the population, and secondly, disease processes will remain fit as they adapt to the selective pressures exerted by medicine. If medical treatment becomes ineffective, extensive mortality is expected since fit disease processes will be unleashed on unfit human populations. It appears that a possible answer to these problems may be found in gene therapy.

Are hyperostosis frontalis interna and leptin linked? a hypothetical approach about hormonal influence on human microevolution.

It is striking that evidence for hyperostosis frontalis interna - a phenomenon of exclusive bilateral thickening of frontal endocranial surface - in archaeological samples is very rare in contrast to its modern prevalence. Because microevolutionary changes have been shown for various human characteristics any alteration of hormonal levels is very likely. Selection pressure was definitively higher in earlier times. This favoured prolonged alertness in order to access sufficient food, shorter feeling of satiety, lower level of fat metabolism, lower metabolic rates and, therefore, lower level of leptin - a 167 amino acid peptide mainly involved in human total body fat regulation. Its effects on bone metabolism are still debated. Nevertheless, we postulate the following hypothesis: In humans a decrease of selective pressure favoured an increased metabolic rate. This, being related to the higher level of leptin caused an increase of localized bony overgrowth like hyperostosis frontalis interna.

Building faces from dry skulls: are they recognized above chance rates?

Methods of facial approximation have successfully aided the identification of deceased individuals. Successes may be due to either accurate facial approximation techniques or chance. This study aims to determine if any of 16 facial approximations, built using standard techniques, are sufficiently accurate to produce correct identifications of target individuals above chance. Four skulls were approximated using four commonly used methods of facial approximation. The resulting 16 facial approximations were judged by 37 assessors of varying ages. Assessors attempted to identify the target individual of each facial approximation from a face pool of ten photographed faces. Only one facial approximation resulted in true positive identification rates above chance at statistically significant levels. It is concluded that it is rare for facial approximations to be sufficiently accurate to allow identification of a target individual above chance. Since 403 incorrect identifications were made out of 592 identification scenarios, facial approximation should be considered to be a highly inaccurate and unreliable forensic technique. These results suggest that facial approximations are not very useful in excluding individuals to whom skeletal remains may not belong. Evidence from this experiment supports suggestions by others that facial approximation should be used in forensic science when all other methods of identification have failed and only to provide tentative identification.

Variation in hominid brain size: how much is due to method?

Brain size represented by cranial capacity (CC) is one of the most frequently analysed characters of hominids. Accuracy of individual CC estimates depends on completeness of specimens and methods used for reconstruction and measurement. A file of published estimates of CC of hominids dated from 3.2 Ma (million years) to 10 Ka (thousand years) including 606 estimates for 243 specimens was compiled. In the file, 75 specimens are available with multiple values (3 to 15) obtained by various methods and/or by various authors. Using individuals as classes in ANOVA, intraclass variation, which represents "error" of estimates, was calculated. For the total sample of multiple estimates (N = 382) the error variance is 5315 ml2. The error standard deviation is 73 ml (coefficient of variation (CV = 7.3%), quite large in comparison to the actual variation in CC in modern humans, SD = 157 ml (CV = 11.6%). This large error makes us wonder whether any fossil can be reliably placed with respect to a particular "cerebral Rubicon" between palaeospecies. Recent discussions concerning cranial capacity of Stw505 are a case in point regarding errors in CC estimation. In actual repeated 30 time measurements on a research quality cast we obtained with various methods (water, seeds, plasticine) CC estimates ranging from 484 to 586 ml. The range of estimates in the literature is from 515 to 625 ml. When hominid CC by taxon with date as a covariate is subjected to ANOVA, taxon is responsible for 5% of the variance while date is responsible for the main portion, (89%). The relationship between CC and date is best characterised as a gradual time trend. It is proven by the ANOVA test for linearity, by gamma test for trend and by ASReml fitting of a linear function. The line of best fit to this time trend is a double exponential curve which explains 90% of the total variance in CC: CC = 306.63 (4.83(0.9995)DATE) Essentially the same curve fits subsamples of CC dated at less than 1 Ma and at 3.2-1.0 Ma. This has several implications for the nature of the Darwinian process to be reconstructed.

Hominins are a single lineage: brain and body size variability does not reflect postulated taxonomic diversity of hominins.

Fossil hominin taxonomy is still debated, chiefly due to the fragmentary nature of fossils and the use of qualitative (subjective) morphological traits. A quantitative analysis of a complete database of hominin cranial capacities (CC, n = 207) and body weight estimates (Wt, n = 285), covering a period from 5.1 ma (millions of years) to 10 ka (thousands of years) shows no discontinuities through time or geographic latitude. Distributions of residuals of CC and Wt around regressions on date and latitude are continuous and do not differ significantly from normal. Thus, with respect to these characteristics, all hominins appear to be a single gradually evolving lineage.

Hyperostosis frontalis interna: archaeological evidence of possible microevolution of human sex steroids?

Hyperostosis frontalis interna is a restricted bilateral thickening of the frontal endocranial surface, which is frequently found in postmenopausal females today. Surprisingly, this condition had a higher male prevalence in its rare archaeological records. This is again highlighted by the oldest known male European hyperostosis frontalis interna case in an adult Celtic from 100 BC presented here. This unique specimen supports earlier suggestions of the possible microevolution of human endocrine regulation, e.g. by sex steroids, and its pathoanatomical impact.

A possible cause of Alzheimer's dementia - industrial soy foods.

Alzheimer's data indicate that at present, approximately one new case of this form of dementia is identified in the USA every 68 s and that by 2050 the incidence will be about every 33 s, with projections from the Alzheimer Association (USA) indicating that nearly 25% of Americans will be affected by Alzheimer's dementia by 2031. Despite the numerous advances in medical science and neurological research, the causes are still unknown and the incidence is not decreasing or levelling out. Most research on the causes of Alzheimer's dementia indicates the possible roles of viruses, obesity, physical inactivity, diabetes, psychological depression, high blood pressure, frequent inflammation, environmental or domestic chemicals and toxins, or inescapable genetic factors. Alzheimer's, being the degeneration of parts of the neural pathways in the brain, may indeed involve neuro-toxic compounds that can bypass the blood-brain barrier. Therefore, it is necessary to examine what is prolific in the environment and, in particular, the food supply. One of the many suggestions in the literature is the ingestion of food items derived from unfermented soybean products; the anti-thyroid, anti-nutrient, and endocrine disruption properties of soy can have a deleterious effect in many individuals. Among the many theories and different factors that may be involved in dementiae, soy consumption may be a significant contributor to Alzheimer's dementia, and it cannot be excluded as a possible contributing cause. Our hypothesis argues that consumption of soy food products may contribute to the increasing incidence of Alzheimer's dementia and other dementiae.

Evolution of human tuberculosis: a systematic review and meta-analysis of paleopathological evidence.

Tuberculosis is a re-emerging disease and is a major problem in both developing and developed countries today. An estimated one third of the world's population is infected and almost two million people die from the disease each year. Bone lesions occur in 3-5% of active tuberculosis cases and can be used to diagnose the disease in ancient skeletal remains. A meta-analysis was conducted on 531 palaeopathological tuberculosis cases from 221 sites (7250 BCE to 1899) on all continents for the purpose of testing two hypotheses; (1) the frequency of bone lesions does not change through time and (2) the distribution of lesions throughout the skeleton does not change over time. The frequency of bone lesions was found to significantly decrease over time (P<0.05). The distribution of bone lesions was found to change from mainly spinal in earlier time periods to include more cases in other regions of the skeleton (long bones, joints, hands, feet) in later time periods. This difference in distribution was evaluated using a Chi-squared test and found to be significant (P<0.01). These findings are an important addition to the current knowledge of the evolution of the disease and the Mycobacterium tuberculosis.