Mesolithic cemeteries have greater dimensionality and scale that reflect emerging social complexity following the Upper Paleolithic. The Zvejnieki cemetery dates between the Middle Mesolithic and Late Neolithic, is associated with a persistent hunter-fisher-gatherer economy, and includes burials with pendants fashioned from mammal teeth. Stable isotopic analyses indicate dietary differences between individuals with pendants and without pendants beginning early in life. This context provides an opportunity to explore questions relating to occupational specialization using long bone cross-sectional geometry. Femoral cross-sectional properties from Zvejnieki were compared to a European database from the Upper Paleolithic to Neolithic to explore mobility. Femoral and humeral cross-sectional properties were compared between individuals with and without pendants to understand differences in mobility and manual activity in relation to mortuary practices. Diminished femoral rigidity and circular femoral shape were found at Zvejnieki, but no differences were observed between burial groups. Expanded cortical area and diminished medullary area were observed in the right humeri of males with pendants. Right humeral shape was comparatively circular among males with pendants, while right and left humeral shape was anteroposteriorally reinforced among males without pendants. Females with pendants had elevated right and left humeral shape ratios compared to females without pendants. Femoral morphology reflects reduced mobility, interaction with flat terrain, and exploitation of abundant, local resources at Zvejnieki. Differences in humeral cross-sectional properties between burial groups are consistent with specialized manual activity. These patterns reflect the economic and ideological components of independent specialization and point toward expanding social dimensions in Mesolithic-Neolithic hunter-gatherers.
Depression is considered a psychological illness, and the effects of depression are persistent sadness, loss of interest, and severe depression, which, if untreated, can lead to suicidal thoughts and actions. Moreover, early intervention and detection of depression are essential for reducing the loss of life and avoiding adverse complications. Conventional methods of diagnosing depression rely largely on clinician's judgment and the patient's self-reporting, which can sometimes result in variability or reduced accuracy in diagnoses. Approaches that rely on a single type of data often miss important aspects of depression, as they cannot fully represent the wide range of characteristics linked to the condition. To address these shortcomings, a novel framework named Hunter Geese Migration Optimization-based LeNet (HGMO-LeNet) is established for depression detection from multimodalities, comprising Magnetic Resonance Imaging (MRI) and speech. Primarily, the input MRI images are forwarded to the image processing, in which an adaptive Wiener filter is utilized to perform the image processing. Then, ROI extraction is carried out, which involves segmenting the brain region from the overall scan by removing non-brain tissues. Subsequently, feature extraction is done, and the features, namely volumetric and textural features, are extracted. Further, depression detection is established by exploiting the LeNet, which is fine-tuned by the designed HGMO. At the same time, the Gaussian filter assists in performing speech signal pre-processing. Further, the preprocessed signal is fed into the feature extraction phase, and then depression detection is accomplished using HGMO-LeNet. Finally, the output obtained from both inputs are merged using a correlation coefficient to produce the result. The devised HGMO-LeNet measured the maximum specificity of 91.000%, the accuracy of 91.276%, and the sensitivity of 92.266%. This demonstrates the superior performance of the devised model over existing methods and provides a robust system for automated depression detection.
Bow hunter's syndrome (BHS) causes vertebrobasilar insufficiency when head rotation compresses the vertebral artery (VA).1,2 Although classically craniocervical, subaxial cases from osteophytic V2 compression lack standardized management with treatments ranging from decompression to stenting.3-5 During decompression, intraoperative VA patency confirmation is essential, as static postoperative imaging cannot reliably exclude residual dynamic compression, and delayed confirmation may necessitate reoperation.6,7 We present two cases of subaxial rotational occlusion syndrome (subaxial BHS) treated with anterior cervical decompression and intraoperative angiography in a hybrid operating suite. Case 1: an 80-year-old woman with neck pain, dizziness, tinnitus, near-syncope, and ocular symptoms on leftward head rotation; CT/dynamic angiography showed left VA narrowing at C4-C5 from spondylotic compression. Case 2: a 57-year-old woman with prior Eagle syndrome with vertigo, nausea, and blurred vision on left neck rotation; MRA demonstrated focal left V2 stenosis at C5-C6 from uncovertebral osteophytes and incidental distal VA fenestration. Both underwent anterior V2 exposure, ultrasonic drilling of osteophytes, Gore-Tex/fibrin glue reinforcement, and ACDF (C4-C5; C5-C6) to eliminate residual rotational motion at the decompressed segment. Intraoperative biplane angiography via left radial access (Isovue 300; 6 mL at 6 mL/sec per 2D run; 18 mL at 3 mL/sec for 3D acquisition) with simulated head turning, performed 10-15 minutes after hemostasis under general anesthesia, supplemented by 3D rotational angiography in Case 2 to characterize the VA fenestration, showed no head-turning compression and confirmed complete VA patency.8,9 Both were discharged on postoperative day three and complete symptom resolution was confirmed at 6 weeks.
A C-2 functionalized l-IdoA derivative was designed as a potential pharmacological chaperone for MPS II, and several routes to its synthesis were investigated. Successful synthesis proceeded via an oxidation/Horner-Wadsworth-Emmons sequence, overcoming significant challenges with competing elimination reactions to give alkene derivatives in good overall yields. Catalytic hydrogenation of the double bonds proceeded stereoselectively in high yield to give the desired L-ido-configured products, confirmed by x-ray crystallographic analysis. These were subsequently elaborated to the target dicarboxylate prodrug 1 in good overall yield. Molecular docking studies suggest the parent compound engages with the active site and makes several H-bonding interactions with key active site residues. Target prodrug 1 and known chaperone D2S0 were evaluated against two MPS II cell lines, but neither compound was able to reduce HS substrate levels at the doses tested.
This essay portrays a physician’s journey in rural health care from an outsider to a trusted part of the community.
Game meat supply chains create variable safety risks and economic benefits across traders, yet research often focuses on hunters or consumers while overlooking meat preparation and processing roles. This study examines how zoonotic disease exposure, precautionary behaviors, and economic returns vary across hunters, vendors, and restaurant workers within the game meat trade in Cross River State, Nigeria. Between January 2023 and April 2024, we conducted 91 annual and 760 monthly interviews with 91 actors, including hunters, vendors, and restaurant workers, documenting handling practices, hygienic precautions, risk perceptions, and income derived from the game meat trade. Hunters reported the highest levels of direct contact with high-risk meat states and the lowest use of hygienic precautions. Vendors generated higher income than other actors, while hunters reported lower economic dependence on game meat than either vendors or restaurants. These findings demonstrate that game meat safety risks and livelihood benefits are distributed unevenly across value chains. Recognizing these asymmetries is essential for designing food safety interventions and policies that protect public health and anticipate differential impacts on livelihoods.
The present report describes the first record of the tapeworm Taenia krabbei Moniez, 1879, represented by its larval stage, in roe deer (Capreolus capreolus) from two hunting districts in Carinthia, Austria. The cysticerci of T. krabbei were found during gross meat inspection and isolated from the muscle. The specific identification was based on molecular analysis of a partial sequence of the mitochondrial cytochrome c oxidase subunit I (COI) gene. The definitive host was not identified in this report. Grey wolves (Canis lupus lupus) are suspected to be the definitive host, as they are reported to be resettling in the area. The finding of muscle cysts of T. krabbei raises concerns for hunters and producers of venison, as affected carcasses are often rejected based on visual inspection criteria. Consequently, systematic assessment of the distribution of T. krabbei across both intermediate and definitive host populations is warranted. In parallel, targeted sanitary education initiatives for hunters are essential to discourage practices that may facilitate transmission and perpetuation of the parasite's life cycle.
Mucopolysaccharidosis type II (MPS II), also known as Hunter syndrome, is a rare, progressive X-linked lysosomal storage disorder that clinically manifests in children around 2-4 years of age. It affects nearly all organ systems, and in about two-thirds of patients, follows a severe neuronopathic course marked by developmental delay and cognitive decline. This study examined caregivers' perspectives on the most important symptoms and impacts of MPS II in young children. Caregivers of children aged 2-5 years with MPS II in the UK or USA were interviewed about the symptoms and impacts of MPS II in their child using a concept elicitation approach. A content analysis approach was used to analyze qualitative data collected. Sixteen caregivers (n = 13 USA, n = 3 UK; mean age 34.0 years) of 16 children with MPS II participated. All 15 children for whom sociodemographic data were available were male and neuronopathic (mean age 4.2 years). All 16 caregivers reported cognitive decline in their child and disruption of family life. Other areas where MPS II burdens their children included problems with verbal communication/speech (n = 15), walking/climbing stairs (n = 15), hand movement (n = 15), hearing loss (n = 15), infection (n = 15), frustration (n = 14), interaction with non-family members (n = 14), nonverbal communication (n = 13), endurance (n = 13), stiff joints or muscles (n = 13), incontinence (n = 12), and skin issues (n = 10). Caregivers considered communication, mobility, and joint and muscle issues the "most bothersome" impacts. Despite the availability of enzyme replacement therapy since 2006, MPS II substantially affects the lives of young children and their families.
The first 2000 days can profoundly influence long-term health. Healthy Beginnings for Hunter New England Kids (HB4HNEKids) is an SMS text messaging program delivered alongside routine Child and Family Health Nursing (CFHN) care, which provides families with evidence-based, age- and stage-related preventive health information across the first 2000 days. This pilot study aimed to explore the feasibility, engagement, and acceptability of the HB4HNEKids program. It also aimed to explore the potential effectiveness of the program at 6 and/or 12 months post partum on outcomes including breastfeeding, child diet, child movement, and parental mental well-being. During the pilot phase (October 2021 to July 2024), project records were used to assess the number of families enrolled, number of SMS text messages sent (feasibility), and the number of opt outs (engagement). Repeat cross-sectional surveys were conducted at 5-7 months post partum and again at 12-14 months post partum using validated survey instruments. Using convenience sampling methods, survey participants consisted of birthing parents who had received HB4HNEKids and a concurrent nonrandomized comparison group that did not receive the program. Surveys assessed parental self-reported engagement with the messages, program acceptability, breastfeeding status, child diet, child movement, and parental mental well-being. Mixed linear regression analyses were conducted to calculate mean differences and odds ratios. During the pilot phase, HB4HNEKids was delivered to 6243 families (73.4% of families contacted by CFHN). A total of 383 birthing parents completed the survey at 6 months (99/383, 26% receiving HB4HNEKids), and 283 completed the survey at 12 months (104/283, 37% receiving HB4HNEKids). Of the survey participants who received HB4HNEKids (n=200), between 76% and 83% reported that they always or very often read the SMS text messages, spending on average 5-7 minutes engaged with the content. At both survey time points, more than 90% of participants receiving HB4HNEKids agreed that the program was acceptable. Child daily intake of vegetables was significantly higher in the HB4HNEKids group (adjusted mean difference 0.23, 95% CI 0.07-0.40; P=.006) than in the comparison group at 12 months. Parents receiving HB4HNEKids also reported significantly better mental well-being scores (P=.005). While HB4HNEKids participants reported breastfeeding rates 5 percentage points greater than comparison participants at 6 and 12 months, this result was not statistically significant. There were no statistically significant differences between HB4HNEKids, and comparison participant responses related to child movement behaviors. The HB4HNEKids SMS text messaging program is feasible to deliver at scale alongside routine CFHN care and is highly acceptable and engaging to parents. This pragmatic evaluation of the pilot, embedded into usual care, indicates potential effectiveness of the program for improving child vegetable intakes and parental mental well-being. Further evaluation of this program using robust methodology is needed to determine the effectiveness of this innovative mHealth program across the first 2000 days.
Serotonin syndrome (SS) is a potentially life-threatening adverse drug reaction resulting from excessive serotonergic activity in the central and peripheral nervous systems. Tramadol produces analgesia through μ-opioid receptor agonism while also inhibiting the reuptake of serotonin and norepinephrine. Linezolid an oxazolidinone antibacterial agent, possesses reversible, non-selective monoamine oxidase inhibitory activity. Through distinct pharmacological mechanisms, both agents enhance serotonergic neurotransmission and may theoretically increase the risk of SS when used concomitantly. We report the case of an elderly woman who developed serotonin syndrome shortly after receiving tramadol and linezolid for ischemic lower-limb pain complicated by severe infection. The patient fulfilled the Hunter diagnostic criteria, presenting with hyperthermia, tremor, myoclonus, hyperreflexia, muscle rigidity, diaphoresis, and flushing. The symptoms resolved rapidly after discontinuation of the suspected medications and initiation of supportive treatment. Although several real-world studies have suggested that the overall incidence of SS associated with concomitant linezolid and serotonergic agents is relatively low, this report highlights that individualized risk assessment remains essential in elderly patients with multiple comorbidities and polypharmacy. Careful evaluation of potential drug interactions and close clinical monitoring are therefore warranted when anti-infective and analgesic therapies with serotonergic properties are administered concurrently.
DNA methylation (5mC) is an epigenetic mark that plays a critical role in defining cell fate. Following fertilisation, DNA methylation inherited from gametes must be reprogrammed to establish totipotency and enable the parental-to-zygotic transition. To accomplish this, non-mammalian vertebrates such as zebrafish and medaka subtly reprogramme maternal 5mC profiles while maintaining high methylation levels throughout embryogenesis. In contrast, eutherian mammals such as mouse and human undergo global 5mC erasure in both embryonic and extraembryonic lineages. However, while embryonic 5mC is rapidly re-established to high levels upon implantation, the trophectoderm, which gives rise to the placenta, displays sustained and conserved DNA hypomethylation, suggesting that this drastic 5mC erasure may be functionally linked to complex placentation in mammals. To clarify whether extensive post-fertilisation 5mC erasure co-evolved with placentation, we explored embryonic methylation dynamics in marsupials, a lineage of therian mammals with a short-lived placenta. We produced a near complete telomere-to-telomere (T2T) genome and generated detailed epigenome maps of embryonic development for an Australian marsupial, the fat-tailed dunnart (Sminthopsis crassicaudata). We found the dunnart embryo exhibits genome wide DNA demethylation at the blastocyst stage, but these changes occur in the trophectoderm only, suggesting that 5mC erasure in the placenta is an ancestral state in therian mammals. Furthermore, the T2T-level dunnart genome assembly enabled identification of sex chromosomes, uncovering extensive hypomethylation of the paternally-inherited inactive X chromosome in females and revealing the previously unannotated master regulator of X chromosome inactivation, lncRNA RSX. Our data indicate that while the use of genome-wide 5mC erasure differs between eutherian and marsupial lineages, 5mC erasure in extraembryonic tissue is ancestral to therian mammals and may be necessary to support placental development.
Diet is a modifiable determinant of gut microbiome composition, yet the impact of contrasting whole-dietary patterns on microbial metabolic capacity and coordinated host metabolic signatures remains incompletely characterized. In a randomized crossover feeding trial, 34 Australian adults were provided with a Healthy Australian Diet (HAD), aligned with national dietary guidelines, and a Typical Australian Diet (TAD), reflecting average population intake for two weeks each, separated by a two-week washout. Fecal microbiome composition and function were assessed using shotgun metagenomics, plasma and urine metabolites by untargeted metabolomics, with cardiometabolic markers including blood pressure, plasma lipids, and glucose quantified. HAD was associated with reduced taxonomic and functional alpha diversity relative to baseline, with no change following TAD. Species-level responses were modest, 105 functional pathways differed between diets, with 99 increasing following HAD, predominantly related to amino acid and nucleotide biosynthesis and vitamin/cofactor metabolism. Multi-omic integration using DIABLO achieved strong discrimination of dietary responses (held-out accuracy 91.7%; permutation p = 0.005). In total, 77 individual omic feature-cardiometabolic outcome associations survived FDR correction (q < 0.05), spanning microbial gene functions, plasma metabolites, and urinary metabolites linked to cholesterol, blood pressure, and triglyceride responses. These exploratory findings suggest that integrated microbiome-metabolome profiling may capture inter-individual variation in dietary cardiometabolic responses, though replication in larger, independent, robustly designed studies is needed before translational personalized nutrition strategies can be assessed.
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Ageism is a public health emergency affecting both the health outcomes of older people and the global economy. Emergency Departments are environments where emergency clinicians often face increased cognitive load and are more susceptible to cognitive bias, which can influence patient outcomes. With an ageing population, sustainable healthcare requires a multifaceted approach that includes awareness of the extensive harms of ageism. The language and words used by healthcare providers both directly and indirectly impact patient experience and health outcomes. Consciously transitioning to age-positive language is one strategy emergency clinicians can use to combat ageism and improve healthcare experiences and outcomes for older persons presenting for emergency care.
Soils have been proposed as a tool to reduce atmospheric carbon dioxide (CO2). However, sparse field data and soil databases that do not account for geomorphic controls on soil properties hinder accurate quantification of soil organic carbon (SOC) dynamics at the watershed scale. In mountainous terrain, relict landslide deposits are common and feature thick (>5 m), weathered profiles with substantial SOC below the typically measured top 30 cm of soil. We generated a SOC-age relationship using a landslide chronosequence in Western Oregon where these landforms are abundant. We applied our relationships to an inventory of nearly 10,000 previously dated landslides and show that deep SOC stocks constitute ~70% of the total stock for landslides >41.8 thousand years. Our findings also show that SOC stocks associated with deep-seated landslides are >2× larger than estimates from a global model that does not account for geomorphic controls. These results suggest that geomorphology can improve our ability to quantify SOC stocks and could inform watershed management.
This article, as originally published, contained a mis-compiled tabulation of the notified measles clusters within Australia for the period 2014-2024, inadvertently misrepresenting the distribution of measles clusters across the country during this period. The revised text passages and the revised table presented on the following pages correct these errors. Australia has maintained endemic measles elimination since verification was first achieved in 2014. To support sustained elimination, and strengthen national preparedness, we conducted a ten-year review of measles epidemiology from 1 January 2014 to 31 December 2024. Measles notifications to the National Notifiable Disease Surveillance System were analysed by sex, age, seasonality, state/territory, country of acquisition, vaccination status, genotype, and cluster characteristics.
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Acute kidney injury (AKI) is a common and serious complication after cardiac arrest, affecting more than 30% of initially successfully resuscitated patients, with around 10% receiving Kidney Replacement Therapy (KRT). Currently, treatment options to prevent renal complications are limited. In this predefined sub-study of the Sedation, TEmperature and Pressure after Cardiac Arrest and REsuscitation (STEPCARE) trial, we evaluate the effects of sedation depth, fever management strategies, and mean arterial pressure (MAP) targets on the risk of major adverse kidney events (MAKE) in post-cardiac arrest patients. STEPCARE-MAKE is a predefined prospective sub-study of the international, randomized clinical STEPCARE trial. The main trial will enroll 3500 patients and employs a 2 × 2 × 2 factorial design, randomizing participants across three interventions: (1) deep sedation for 36 h or minimal sedation, (2) fever management with or without a feedback-controlled device, and (3) MAP target ≥ 65 mmHg or ≥ 85 mmHg. The primary outcome is the composite outcome MAKE, which includes death from any cause by day 30, initiation of KRT, or persistent renal dysfunction, defined as the final creatinine value ≥ 200% of the baseline at the time of discharge from the primary hospital or at day 30, whichever occurs first. Differences between baseline and the highest in-hospital creatinine, baseline and the last measured in-hospital creatinine, baseline and 72-h creatinine, and baseline and the highest creatinine within 72 h will be reported as secondary outcomes. The findings of this sub-study will provide new evidence on the renal effects of the STEPCARE trial interventions and may inform the future of individualized kidney-protective treatment approaches.
Variability in aging rates can be quantified with a frailty index (FI) based on the accumulation of clinically evident health deficits in aging mice. Deficit accumulation characteristics have been investigated in longitudinal studies of male but not female mice. We investigated frailty longitudinally in aging female C57BL/6N mice (n = 79; 6-29 months) and determined whether high frailty scores predicted mortality and abnormalities in blood-based biomarkers. Female mice exhibited a gradual rate of deficit accumulation (slope=0.025) as previously observed in males. High FI scores (>0.20 at 18 months) predicted mortality during follow-up at 24 months and older (p = 0.015). The range of FI scores broadened with age, with a submaximal limit to frailty of 0.55, similar to values in males. Few correlations were significant between blood-based biomarkers and chronological age in female mice, with only urea (r = 0.39; p = 0.006) and creatinine (r = 0.35; p = 0.01) levels exhibiting positive correlations with age. By contrast, many biomarkers were closely graded by the degree of frailty in females. Urea (r = 0.46, p = 0.001), creatinine (r = 0.35; p = 0.01) and chloride (r = 0.49; p = 0.001) were all positively associated with FI scores whereas glucose (r=-0.63; p = 0.001), hematocrit (r=-0.53; p = 0.001) and hemoglobin (r=-0.45; p = 0.002) were negatively correlated. Interestingly, in a small cohort of aging male mice (n = 15; aged 13-27 months), no biomarkers significantly correlated with age, despite many being correlated with frailty. Characteristic features of deficit accumulation are present in female mice. High FI scores based on the accumulation of clinically evident health deficits forecast early mortality and predict abnormalities in blood-based biomarkers better than chronological age.
Family carers have a key role in supporting malnourished older adults; yet, intervention evidence is lacking in the rehabilitation setting. This study aimed to explore the preliminary effects and acceptability of a family-centred, telehealth-enhanced dietary counselling intervention for treating protein-energy malnutrition (PEM) in rural-living older adults transitioning from rehabilitation to home, compared with usual care, in matched patient-carer dyads. A pragmatic, historically controlled, prospective, two-arm non-randomised controlled trial was conducted as a pilot study. Fifteen malnourished older adults admitted to rural rehabilitation units in New South Wales, Australia, and their family carers, were recruited and matched to 15 historical controls. The Patient-Generated Subjective Global Assessment (PG-SGA) was the primary outcome for nutrition status assessed at rehabilitation admission, discharge, and 3 months post-discharge. Quality of life, physical function, length of stay, discharge location, institutionalisation, mortality, carer burden, and service satisfaction were secondary outcomes. The historical control group received usual care. The intervention group received a telehealth-enhanced dietary counselling intervention developed with co-design principles, which engaged the family carer as a partner in the nutrition care team, delivered during the rehabilitation admission and for 3 months post-discharge. The difference in PG-SGA score from baseline to 3 months post-discharge between the two groups was 3.46 (95%CI: -2.07, 9.01; p = 0.238). The intervention group had a higher proportion of patients who were well-nourished at 3 months post-discharge compared to controls (60% vs 13%). At 3 months post-discharge, the intervention group had lower odds of being rated malnourished or with more severe malnutrition (i.e., moderate vs. well-nourished, severe vs. moderate) on the PG-SGA (OR 0.01, 95%CI: 0.00, 0.27; p = 0.005). There was a trend towards the intervention group having reduced odds of being discharged to a location other than home (OR 0.18, 95%CI: 0.03, 1.07; p = 0.06). The intervention was perceived as acceptable to patients and family carers. There were no differences between groups in other outcomes. Compared with usual care, the family-centred telehealth-enhanced dietary counselling intervention for the treatment of PEM in rural-living older adults transitioning from rehabilitation to home demonstrated preliminary efficacy and was acceptable to both patients and family carers. Future research aiming to improve PEM should meaningfully engage family carers as partners in the nutrition care team.