Bone artifacts from roman cremation burials: methods, results and conclusions - The example of the cemetery of Kaiseraugst-im Sager (Ch)

En las sepulturas de incineración romanas de mediados del siglo I en adelante, tan solo unos pocos artefactos han sido documentados hasta la fecha. En el presente artículo se presenta la discusión sobre los problemas metodológicos que llevaron a este resultado y cómo sus efectos pueden ser minimizados en trabajos futuros. De esa forma, podemos mostrar los tipos de hueso trabajado procedentes del cementerio de Kaiseraugst-Im Sager son considerablemente distintos de hallazgos contemporáneos documentados en la ciudad de Augusta Rurica.In the Roman cremation graves from the middle of the 1st century onwards only a few bone artifacts have been found to date. In this article we discuss the methodological problems that lead to this result and how their effects can be minimized in future work. In this way we can show that the types of worked bone from the cemetery of Kaiseraugst-Im Sager differ considerably from the contemporaneous finds from the town of Augusta Raurica

Research Assistants: Invisible but Indispensable in Ethnographic Research

Until recently, anthropological literature on the collaboration between the researcher and his/her assistant(s) was rather scarce – although these helpers in the field are highly involved in our knowledge production. In PhD theses, where sole authorship is required for academic degrees, the work with assistants is mentioned briefly in the methodology parts, but then disappears again in the published books. Working with research assistants raises questions of author- ship, authority and ethical considerations in general (Galizia and Schneider 2005: 8, Gupta 2014). In this contribution we argue that collaborations with research assistants strongly influence our data, its analysis and finally our ethnographic texts. Hence, we promote an ethnographic writing that thoroughly reflects working with research assistants and makes this collaboration more explicit

„stercus ex latrinis" - Die unappetitliche Nachnutzung von Schacht MR6/MR 32 in der Region 17C der Unterstadt von Augusta Raurica

Im vorliegenden Aufsatz werden die Ergebnisse der interdisziplinären Auswertung der Verfüllung von Schacht MR 6/MR 32 vorgestellt, der anlässlich der Lehrgrabung «Kaiseraugst-Auf der Wacht» (2011–2013. 001) in der westlichen Unterstadt von Augusta Raurica (Region 17C) entdeckt wurde. Der rund 4,2 m tiefe, trocken gemauerte Schacht MR 6/MR 32, dessen primäre Verwendung (cella promptuaria? fossa nivalis?) nicht hinreichend geklärt ist, wurde wahrscheinlich in flavischer Zeit errichtet und bereits zu Beginn des 2. Jahrhunderts wieder aufgegeben und verfüllt (vgl. Schneider/Schwarz 2017 [in diesem Band]). Die archäologischen und mikromorphologischen Analysen haben gezeigt, dass es sich bei den unteren Füllschichten (Schichtpaket A) unter anderem um stercus, also um Fäkalien handelt, die wahrscheinlich in kurzem zeitlichem Abstand nacheinander eingebracht worden sind. Die Latrinensedimente sind nicht in situ entstanden, sondern stam-men aus ausgeschöpften Latrinengruben, die sich vermutlich in der näheren Umgebung von Schacht MR 6/MR 32 befanden. Zu einem geringeren Teil fanden sich in Schichtpaket A auch gewöhnliche Haus-haltabfälle, wobei ungeklärt bleibt, ob sich darin separate Entsorgungsvorgänge widerspiegeln oder ob diese zusammen mit den Latrinensedimenten in den Schacht gelangt sind. Das Fundmaterial aus den unteren Füllschichten (Ensemble A) datiert nach Aussage der Keramik, der Kleinfunde sowie der Fundmünzen in die Zeit zwischen 70/80 und 120/140 n. Chr. Ensemble A um-fasst folglich Fundmaterial, das während der ersten (ältesten) zivilen Siedlungsphase der Unterstadt von Augusta Raurica in der Region 17C in den Boden gekommen ist. Wichtigstes Ergebnis ist die Feststellung, dass sich die von der älteren Forschung vertretene Unterscheidung in eine «reiche» Oberstadtund eine «arme» Unterstadt im archäo(bio)logischen Fundmaterial aus Schacht MR 6/MR 32 nicht widerspiegelt. Im Gegenteil: Die Analyse des keramischen Fundmaterials, der Klein- und Grosstierknochen sowie der botanischen Makroreste hat gezeigt, dass die in der Umgebung von Schacht MR 6/MR 32 lebende Bevölkerung weitgehend romanisiert war und sich auch relativ vielseitig ernährt hat. Für eine gehobene Ernährung sprechen unter anderem die hohen Anteile von Schwein und Huhn bzw. von Jungtieren sowie die nachgewiesenen Fischarten und die botanischen Makroreste. Unter letztgenannten fanden sich zahlreiche in Augusta Raurica auch sonst belegte Gemüse-, Obst- und Gewürzarten. Besonders hervorzuheben sind im vorliegenden Fall die eher seltenen Nachweise von Gurke, Gartenkresse und Schwarzkümmel. Dass zwei «klassische Luxusindikatoren» – Austern und Mittelmeermakrelen – in Ensemble A fehlen, ist zwar erstaunlich, spricht aber nicht gegen eine Interpretation der Latrinensedimente als Relikte einer sozial gut gestellten Bevölkerung. Konkrete und weiterführende Hinweise zum Gesundheitszustand der in der Region 17C lebenden Bevölkerung lieferte eine aus Schichtpaket A entnommene Sedimentprobe. Darin fanden sich zahlreiche Eier sowohl des Peitschen- als auch des Spulwurms; diese Würmer verursachen unter anderem chronische Durchfallerkrankungen, die in der römischen Epoche weit verbreitet waren, und zwar – wie das vorliegende Beispiel zeigt – offensichtlich auch bei sozial besser gestellten Bevölkerungsschichten

Association of age and disease duration with comorbidities and disability: A study of the Swiss Multiple Sclerosis Registry.

BACKGROUND While comorbidities increase with age, duration of multiple sclerosis (MS) leads to disability accumulation in persons with MS. The influence of ageing vis-a-vis MS duration remains largely unexplored. We studied the independent associations of ageing and MS duration with disability and comorbidities in the Swiss MS Registry participants. METHODS Self-reported data was cross-sectionally analyzed using confounder-adjusted logistic regression models for 6 outcomes: cancer, type 2 diabetes (T2D), hypertension, cardiac diseases, depression, and having at least moderate or severe gait disability. Using cubic splines, we explored non-linear changes in risk shapes. RESULTS Among 1615 participants age was associated with cardiac diseases (OR 1.05, 95% CI [1.02, 2.08]), hypertension (OR 1.08, 95% CI [1.06, 2.10]), T2D (OR 1.10, 95%CI [1.05, 1.16]) and cancer (OR 1.04, 95% CI [1.01, 1.07]). MS duration was not associated with comorbidities, except for cardiac diseases (OR 1.03, 95% CI [1.00, 1.06]). MS duration and age were independently associated with having at least moderate gait disability (OR 1.06, 95% CI [1.04, 1.07]; OR 1.04, 95% CI [1.02, 1.05], respectively), and MS duration was associated with severe gait disability (OR 1.05, 95% CI [1.03, 1.08]). The spline analysis suggested a non-linear increase of having at least moderate gait disability with age. CONCLUSIONS Presence of comorbidities was largely associated with age only. Having at least moderate gait disability was associated with both age and MS duration, while having severe gait disabity was associated with MS duration only

Efficacy of antibiotic prophylaxis in patients with cancer and hematopoietic stem cell transplantation recipients : A systematic review of randomized trials

PURPOSE: To determine the efficacy and safety of different prophylactic systemic antibiotics in adult and pediatric patients receiving chemotherapy or undergoing hematopoietic stem cell transplantation (HSCT). METHODS: We conducted a systematic review and performed searches of Ovid MEDLINE, MEDLINE in-process and Embase; and Cochrane Central Register of Controlled Trials. Studies were included if patients had cancer or were HSCT recipients with anticipated neutropenia, and the intervention was systemic antibacterial prophylaxis. Strategies synthesized included fluoroquinolone vs no antibiotic/nonabsorbable antibiotic; fluoroquinolone vs trimethoprim-sulfamethoxazole; trimethoprim-sulfamethoxazole vs no antibiotic; and cephalosporin vs. no antibiotic. Fluoroquinolone vs cephalosporin and levofloxacin vs ciprofloxacin were compared by network meta-analysis. Primary outcome was bacteremia. RESULTS: Of 20 984 citations screened, 113 studies comparing prophylactic antibiotic to control were included. The following were effective in reducing bacteremia: fluoroquinolone vs no antibiotic/nonabsorbable antibiotic (risk ratio (RR) 0.56, 95% confidence interval (CI) 0.41-0.76), trimethoprim-sulfamethoxazole vs no antibiotic (RR 0.59, 95% CI 0.41-0.85) and cephalosporin vs no antibiotic (RR 0.30, 95% CI 0.16-0.58). Fluoroquinolone was not significantly associated with increased Clostridium difficile infection (RR 0.62, 95% CI 0.31-1.24) or invasive fungal disease (RR 1.28, 95% CI 0.79-2.08) but did increase resistance to fluoroquinolone among bacteremia isolates (RR 3.35, 95% CI 1.12 to 10.03). Heterogeneity in fluoroquinolone effect on bacteremia was not explained by evaluated study, population, or methodological factors. Network meta-analysis revealed no direct comparisons for pre-specified analyses; superior regimens were not identified. CONCLUSIONS: Fluoroquinolone, trimethoprim-sulfamethoxazole, and cephalosporin prophylaxis reduced bacteremia. A clinical practice guideline to facilitate prophylactic antibiotic decision-making is required

Effective Immunological Guidance of Genetic Analyses Including Exome Sequencing in Patients Evaluated for Hemophagocytic Lymphohistiocytosis

We report our experience in using flow cytometry-based immunological screening prospectively as a decision tool for the use of genetic studies in the diagnostic approach to patients with hemophagocytic lymphohistiocytosis (HLH). We restricted genetic analysis largely to patients with abnormal immunological screening, but included whole exome sequencing (WES) for those with normal findings upon Sanger sequencing. Among 290 children with suspected HLH analyzed between 2010 and 2014 (including 17 affected, but asymptomatic siblings), 87/162 patients with "full" HLH and 79/111 patients with "incomplete/atypical" HLH had normal immunological screening results. In 10 patients, degranulation could not be tested. Among the 166 patients with normal screening, genetic analysis was not performed in 107 (all with uneventful follow-up), while 154 single gene tests by Sanger sequencing in the remaining 59 patients only identified a single atypical CHS patient. Flow cytometry correctly predicted all 29 patients with FHL-2, XLP1 or 2. Among 85 patients with defective NK degranulation (including 13 asymptomatic siblings), 70 were Sanger sequenced resulting in a genetic diagnosis in 55 (79%). Eight patients underwent WES, revealing mutations in two known and one unknown cytotoxicity genes and one metabolic disease. FHL3 was the most frequent genetic diagnosis. Immunological screening provided an excellent decision tool for the need and depth of genetic analysis of HLH patients and provided functionally relevant information for rapid patient classification, contributing to a significant reduction in the time from diagnosis to transplantation in recent years

Guideline for the management of clostridium difficile infection in children and adolescents with cancer and pediatric hematopoietic stem-cell transplantation recipients

Purpose The aim of this work was to develop a clinical practice guideline for the prevention and treatment of Clostridium difficile infection (CDI) in children and adolescents with cancer and pediatric hematopoietic stem-cell transplantation (HSCT) patients. Methods An international multidisciplinary panel of experts in pediatric oncology and infectious diseases with patient advocate representation was convened. We performed systematic reviews of randomized controlled trials for the prevention or treatment of CDI in any population and considered the directness of the evidence to children with cancer and pediatric HSCT patients. We used the Grading of Recommendations Assessment, Development, and Evaluation approach to generate recommendations. Results The panel made strong recommendations to administer either oral metronidazole or oral vancomycin for the initial treatment of nonsevere CDI and oral vancomycin for the initial treatment of severe CDI. Fidaxomicin may be considered in the setting of recurrent CDI. The panel suggested that probiotics not be routinely used for the prevention of CDI, and that monoclonal antibodies and probiotics not be routinely used for the treatment of CDI. A strong recommendation to not use fecal microbiota transplantation was made in this population. We identified key knowledge gaps and suggested directions for future research. Conclusion We present a guideline for the prevention and treatment of CDI in children and adolescents with cancer and pediatric HSCT patients. Future research should include randomized controlled trials that involve children with cancer and pediatric HSCT patients to improve the management of CDI in this population

Clinical and Immunological Phenotype of Patients With Primary Immunodeficiency Due to Damaging Mutations in NFKB2

Non-canonical NF-κB-pathway signaling is integral in immunoregulation. Heterozygous mutations in NFKB2 have recently been established as a molecular cause of common variable immunodeficiency (CVID) and DAVID-syndrome, a rare condition combining deficiency of anterior pituitary hormone with CVID. Here, we investigate 15 previously unreported patients with primary immunodeficiency (PID) from eleven unrelated families with heterozygous NFKB2-mutations including eight patients with the common p.Arg853* nonsense mutation and five patients harboring unique novel C-terminal truncating mutations. In addition, we describe the clinical phenotype of two patients with proximal truncating mutations. Cohort analysis extended to all 35 previously published NFKB2-cases revealed occurrence of early-onset PID in 46/50 patients (mean age of onset 5.9 years, median 4.0 years). ACTH-deficiency occurred in 44%. Three mutation carriers have deceased, four developed malignancies. Only two mutation carriers were clinically asymptomatic. In contrast to typical CVID, most patients suffered from early-onset and severe disease manifestations, including clinical signs of T cell dysfunction e.g., chronic-viral or opportunistic infections. In addition, 80% of patients suffered from (predominately T cell mediated) autoimmune (AI) phenomena (alopecia > various lymphocytic organ-infiltration > diarrhea > arthritis > AI-cytopenia). Unlike in other forms of CVID, auto-antibodies or lymphoproliferation were not common hallmarks of disease. Immunophenotyping showed largely normal or even increased quantities of naïve and memory CD4+ or CD8+ T-cells and normal T-cell proliferation. NK-cell number and function were also normal. In contrast, impaired B-cell differentiation and hypogammaglobinemia were consistent features of NFKB2-associated disease. In addition, an array of lymphocyte subpopulations, such as regulatory T cell, Th17-, cTFH-, NKT-, and MAIT-cell numbers were decreased. We conclude that heterozygous damaging mutations in NFKB2 represent a distinct PID entity exceeding the usual clinical spectrum of CVID. Impairment of the non-canonical NF-κB pathways affects function and differentiation of numerous lymphocyte-subpopulations and thus causes a heterogeneous, more severe form of PID phenotype with early-onset. Further characteristic features are multifaceted, primarily T cell-mediated autoimmunity, such as alopecia, lymphocytic organ infiltration, and in addition frequently ACTH-deficiency