JSTOR is a not-for-profit service that helps scholars, researchers, and students discover, use, and build upon a wide range of content in a trusted digital archive. We use information technology and tools to increase productivity and facilitate new forms of scholarship. For more information about JSTOR, please contact support@jstor.org.. Wiley-Blackwell is collaborating with JSTOR to digitize, preserve and extend access to Journal of Biogeography.Abstract. The Wisconsin glaciation divided North America into a number of ice-free refugia for flora and fauna. Patterns of variation of certain North American mammalian species have been interpreted as a product of biological differentiation arising from isolation in these refugia. Recently, a tripartite biological and linguistic division of human populations in North America has been proposed by a number of researchers. The tripartite division in biological and linguistic traits correlates with three ice-free refugia that existed during the Wisconsin. These refugia would have provided the necessary isolation for the development of biologically and linguistically divergent groups. The human data can be seen as part of a broader pattern of glacial influences on biological variation among North American mammals.

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At the request of the MedicaI Committee of the British Empire Leprosy Relief Association a subcommittee consisting of the three of us have carried out an inquiry into the number of leprosy cases seen during the last thirty years by de rni atologists in all parts of the country. The following is an analysis of replies received to a circular letter which enclosed forms ' to cover the required information. These were received from fifty specialists, only fourteen of whom had seen any cases of the disease. The great majority were reported by Dr. ]. M. H. MacLeod (to whom we are particularly indebted for his reports of 'càS�S) from the St. Giles Homes in Essex and private cases, and byi two of us (L.R. and E.M.). All but six cases had been seen i n Londón, dOlibtless due to so many patients from overseas visiting Lond o n for medicaI advice. The provinces therefore show very few cases, althbugh no doubt there are some regarding which n o info rnl ation has been received. i Càncealment is likely to be less ' common than it was two ' decades ago now that it is generaily kno w n •that treatment of value is available to those seeking it in good time. TABLE L-CO' u1titries in wh�ch t!te DiseuS le was Apparently Acquired (87 Cases) Europe: British isles 4. Malta I, Norway I, Russia I ...

Results: The median times for sham CT consent in phase 1 were 2 and 4 minutes. Of the 729 patients enrolled in phase 2, 647 (89%) underwent CT evaluation. Their median age was 52 years (IQR 32, 74); 54% were male; 95% had a blunt mechanism of trauma; 55% were admitted to the hospital; and 5% had a surgical procedure performed after CT. The median and mean TACCT were 11 min (IQR 7, 19) and 17 min (SD 20) respectively. The median GCS was 15 (IQR 14, 15). Of the 647 patients enrolled, 439 patients (67.9%; 95% confidence interval [CI] 64.2 -71.3%) met feasible consent criteria. Of the 208 patients who did not meet feasible consent criteria, 190 (91.4%; 95% CI 86.7 -94.5%) had a GCS less than 15 and 18 (8.7%; 95% CI 5.5 -13.3%) had a short TACCT.Conclusions: In this study of acute, adult trauma patients, consent for CT was feasible in over two-thirds of patients. When CT was not feasible, the primary reason was a GCS < 15. When considering efforts to increase shared decisionmaking between medical providers and acute trauma patients, informed consent for CT scans is a feasible option. Future studies may determine if providing such informed consent correlates with improvement in patient satisfaction and more efficient CT utilization.Acknowledgements: This work was made possible by R25MD006832 from the National Institute on Minority Health and Health Disparities. The viewpoints and opinions expressed here in no way reflect those held by this institution.

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