The expression of asymmetry in hand bones from the medieval cemetery at Écija, Spain

The unique nature of ‘handedness’ in modern humans poses questions about the development of this trait in both extinct hominid species and archaeological populations. An examination of the expression of hand preference in skeletal material is required to answer such questions. The main focus of previous research on asymmetry and hand preference has been on the bones of the upper limb, rather than those of the hand. This study addresses this issue by exploring the expression of asymmetry in the metacarpals and phalanges in 65 adult skeletons from the Medieval Muslim cemetery in Écija, Spain. From comparisons of metric properties of the bones and muscle marker development, varying patterns of asymmetry distribution were found. Sex was found to have a highly significant effect on metric properties, but not on asymmetry scores or muscle development. Age was not found to be significant in any of the analyses. These results suggest that the expression of hand preference varies throughout the hand, and is influenced by the method with which it is assessed. The bones of the hand have an important contribution to make to handedness research, as long as care is paid to associated methodological issue

The expression of bilateral asymmetry in the hands and humeri: a methodological comparison

The population-level preference for the use of the right hand is one of the defining characteristics of Homo sapiens and as such, its evolutionary origins within the human genus remain a topic of interest. Identifying hand preference in extinct hominin species is complicated by the difficulty in distinguishing markers of laterality in the bones of the upper limb. These difficulties are further compounded by the range of osteological methods available to study asymmetry and the under-representation of the bones of the hand in such studies.To better understand the evolution of handedness within the hominin lineage, the effect of methodology on asymmetry expression must first be clarified, as this in turn influences our notions of handedness in individuals and groups. The current study took an inclusive approach to the measurement of upper limb asymmetry in both modern human and non-human primate samples. To assess the contribution that the bones of the hand can make to asymmetry research, data from the metacarpals and phalanges were compared with that from the humerus, a more commonly-studied region of the upper limb. Both metric and musculoskeletal stress marker (MSM) data were collected and compared in order to assess the comparability of asymmetry profiles generated by contrasting methodological approaches. Asymmetry was determined for a sample of modern human skeletons and a non-human primate sample comprising Pan troglodytes schweinfurthii and Gorilla gorilla gorilla.Two key findings emerge from these analyses: 1) The expression of asymmetry differs, in terms of both direction and magnitude, between the bones of the hand and the humerus. Differences are also apparent between the metacarpals and phalanges. 2) Metric and MSM methods differ in the asymmetry profiles they generate, with the MSM method generally underestimating the magnitude of asymmetry present in a sample, relative to that identified by a metric approach. In addition, the various skeletal samples studied exhibit variation in their relative asymmetry profiles which can be attributed to potential differences in functional recruitment patterns in the upper limbs of these individuals.Together, these findings clearly highlight the care that must be taken in analyses of asymmetry, due to the level of methodological variation present in currently inter-changeable approaches. The relatively neglected region of the hand has an important contribution to make to our understanding of asymmetry in the upper limb. The results of this study recommend the adoption of a more inclusive approach to the study of upper limb bilateral asymmetry, particular when inferences are to be made regarding handedness. By combining methodological approaches and incorporating data from across the upper limb, a more accurate picture of asymmetry expression will emerge and allow us to better understand the evolutionary development of this trait in our hominin ancestors

The Aboriginal Population Health Training Initiative: a NSW Health program established to strengthen the Aboriginal public health workforce

Objectives: Increasing the representation of Aboriginal people in the health workforce can contribute to improving Aboriginal people’s health and wellbeing by supporting the provision of more culturally appropriate health programs and services. The Aboriginal Population Health Training Initiative aims to strengthen the Aboriginal public health workforce in New South Wales (NSW), with the long-term goal of improving the health of Aboriginal people. Type of program or service: The program provides comprehensive, competency-based public health training for Aboriginal people. Methods: Participants undertake a series of work placements in public health, and complete a Master of Public Health degree. Results: A 2014 evaluation demonstrated that the program makes an important contribution to strengthening the NSW Aboriginal public health workforce. Trainees reported a high level of satisfaction with the quality of their work placements, the flexibility of the program to support their work and study, and efforts made to ensure the program’s cultural safety. The program has a high trainee retention rate (17 of 18 trainees), and all graduates have successfully gained employment within the NSW health system. Lessons learnt: Three key factors contribute to the success of the program: trainees undertake their training within their communities; the structure promotes the direct application of learning through simultaneous work and study; and the NSW Government shows strong leadership and support

Postoperative continuous positive airway pressure to prevent pneumonia, re-intubation, and death after major abdominal surgery (PRISM): a multicentre, open-label, randomised, phase 3 trial

Background: Respiratory complications are an important cause of postoperative morbidity. We aimed to investigate whether continuous positive airway pressure (CPAP) administered immediately after major abdominal surgery could prevent postoperative morbidity. Methods: PRISM was an open-label, randomised, phase 3 trial done at 70 hospitals across six countries. Patients aged 50 years or older who were undergoing elective major open abdominal surgery were randomly assigned (1:1) to receive CPAP within 4 h of the end of surgery or usual postoperative care. Patients were randomly assigned using a computer-generated minimisation algorithm with inbuilt concealment. The primary outcome was a composite of pneumonia, endotracheal re-intubation, or death within 30 days after randomisation, assessed in the intention-to-treat population. Safety was assessed in all patients who received CPAP. The trial is registered with the ISRCTN registry, ISRCTN56012545. Findings: Between Feb 8, 2016, and Nov 11, 2019, 4806 patients were randomly assigned (2405 to the CPAP group and 2401 to the usual care group), of whom 4793 were included in the primary analysis (2396 in the CPAP group and 2397 in the usual care group). 195 (8\ub71%) of 2396 patients in the CPAP group and 197 (8\ub72%) of 2397 patients in the usual care group met the composite primary outcome (adjusted odds ratio 1\ub701 [95% CI 0\ub781-1\ub724]; p=0\ub795). 200 (8\ub79%) of 2241 patients in the CPAP group had adverse events. The most common adverse events were claustrophobia (78 [3\ub75%] of 2241 patients), oronasal dryness (43 [1\ub79%]), excessive air leak (36 [1\ub76%]), vomiting (26 [1\ub72%]), and pain (24 [1\ub71%]). There were two serious adverse events: one patient had significant hearing loss and one patient had obstruction of their venous catheter caused by a CPAP hood, which resulted in transient haemodynamic instability. Interpretation: In this large clinical effectiveness trial, CPAP did not reduce the incidence of pneumonia, endotracheal re-intubation, or death after major abdominal surgery. Although CPAP has an important role in the treatment of respiratory failure after surgery, routine use of prophylactic post-operative CPAP is not recommended