We present a novel approach to study the sustainability of ancient Mediterranean agriculture that combines the measurement of carbon isotope discrimination (D 13 C) and nitrogen isotope composition (d 15 N) along with the assessment of quality traits in fossil cereal grains. Charred grains of naked wheat and barley were recovered in Los Castillejos, an archaeological site in SE Spain, with a continuous occupation of ca. 1500 years starting soon after the origin of agriculture (ca. 4000 BCE) in the region. Crop water status and yield were estimated from D 13 C and soil fertility and management practices were assessed from the d 15 N and N content of grains. The original grain weight was inferred from grain dimensions and grain N content was assessed after correcting N concentration for the effect of carbonisation. Estimated water conditions (i.e. rainfall) during crop growth remained constant for the entire period. However, the grain size and grain yield decreased progressively during the first millennium after the onset of agriculture, regardless of the species, with only a slight recovery afterwards. Minimum d 15 N values and grain N content were also recorded in the later periods of site occupation. Our results indicate a progressive loss of soil fertility, even when the amount of precipitation remained steady, thereby indicating the unsustainable nature of early agriculture at this site in the Western Mediterranean Basin. In addition, several findings suggest that barley and wheat were cultivated separately, the former being restricted to marginal areas, coinciding with an increased focus on wheat cultivation.

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Carbon isotope discrimination (∆) was determined for kernels of six-row barley and durum wheat cultivated in the western Mediterranean basin during the last seven millennia. Samples came from different archaeological sites in Catalonia (north-east Spain) and in the south-east of Spain (mainly eastern Andalusia). Samples from the present were also analysed. Mean values of ∆ for barley and durum wheat grains decreased slightly from Neolithic (7000-5000 BP) to Chalcolithic-Bronze (5000-3000 BP) and Iron ages (3000-2200 BP) both in Catalonia and in south-east (SE) Spain. Values were consistently lower in SE Spain than in Catalonia throughout these five millennia, which suggests that Catalonia was less arid than SE Spain in this period. Within a given region, current discrimination values for kernels of the same cereal species cultivated under rainfed conditions were lower than those of archaeological grains, which implies more arid conditions at present. Furthermore, an empirical relationship between ∆ of mature kernels and total precipitation (plus irrigation where applicable) during grain filling (r 2 ϭ 0.73, N ϭ 25) was established for barley, currently cultivated at different locations in the western Mediterranean basin in Spain. The resulting relationship was applied to the ∆ data for barley kernels from 10 archaeological sites in Catalonia and 10 sites in SE Spain, to estimate the precipitation during grain filling at the time the kernels were produced. For both regions, current climatic conditions are consistently more arid than those inferred for the Neolithic, Bronze and Iron ages. In addition, although Catalonia was estimated to have had consistently wetter conditions (about 20% more precipitation) than SE Spain throughout these millennia, differences in precipitation between these two regions have recently increased, with 79% more precipitation in Catalonia. Results indicate a more rapid increase in aridity in SE Spain than in Catalonia, probably produced during the last few centuries, and due to anthropogenic causes.Abbreviations ∆, stable carbon isotope discrimination; δ 13 C, ratio of CO 2 ; WUE, water-use efficiency; BP, before present; NE Spain, north-east of Spain; SE Spain, south-east of Spain; 13 C/ 12 C relative to PeeDee belemnite standard; p i /p a, ratio of intercellular to atmospheric partial pressure of VPD, vapour pressure deficit.

Autoimmune rheumatic diseases (AIRD) are not uncommon in the general population and up to one third of hospitalized patients with AIRD may need admission to intensive care unit (ICU). This paper describes the causes of admission, the clinical features and outcome of 24 AIRD patients admitted to a medical ICU from a third level hospital. Thirteen patients had systemic lupus erythematosus (54.2%), three rheumatoid arthritis (12.5%), three pulmonary renal syndrome (12.5%), two dermatopolymyositis (8.3%), two scleroderma (8.3%) and one antiphospholipid syndrome (4.2%). The main causes for ICU admission were rheumatic disease flare-up (37.5%), infection (37.5%) and complications derived from rheumatic disease (29.1%). Mortality during ICU stay was 16.7% (four patients). Excluding shock requiring vasopressor support, no statistical difference was found between survivors and nonsurvivors; although there was a trend to higher test severity scores (APACHE II, ODIN) in nonsurvivors. Our results reveal a lower mortality rate in AIRD patients admitted to the ICU than reported previously. Severity scores such as APACHE II are predictors of mortality in patients with AIRD in the ICU.

Single-port video-assisted thoracoscopic lobectomy in nonintubated patients seems to be feasible and safe, and probably represents the least invasive approach to lobectomy. Further studies are necessary to evaluate the results with a series of patients.