The Exploitation of Toxic Fish from the Terminal Pleistocene in Maritime Southeast Asia: A Case Study from the Mindoro Archaeological Sites, Philippines

Representatives of the Diodontidae family (porcupinefish) are known to have been fished by prehistoric Indo-Pacific populations; however, the antiquity of the use of this family is thus far unknown. We report here on the presence of Diodontidae in the archaeological sites of Bubog I, II, and Bilat in Mindoro, Philippines, dating back to c. 13,000 BP (Before Present). This evidence demonstrates the early exploitation by islanders of poisonous fish. Every part of porcupinefish can be toxic, but the toxicity is mostly concentrated in some organs, while other parts are edible. The continuous presence of Diodontidae remains throughout the stratigraphic record of these Philippines shell middens suggests that porcupinefish were prepared by human inhabitants of the sites to render them safe for consumption, indicating an advanced cultural knowledge of the preparation needed to separate the toxic principle from the edible parts. This constitutes one of the rare examples of poison processing by humans, aside from the contentious wooden stick poison applicator from Border Cave (South Africa)

Human foraging responses to climate change; Here Sorot Entapa rockshelter on Kisar Island

This study explores prehistoric human subsistence adaptations within the context of changing marine and terrestrial environments on the tiny Island of Kisar, beginning during the Pleistocene-Holocene transition around 15,000 years ago (ka). We use zooarchaeological data on faunal remains (vertebrates and invertebrates) recovered from Here Sorot Entapa rockshelter (HSE) in temporal relationship to climate data from Flores to document prehistoric human responses to regional sea-level, temperature, and associated habitat changes that occurred after the Last Glacial Maximum (LGM). Human settlement intensity peaked during the colder drier conditions of the Bølling-Allerød period at 14.4-13 ka, and the site was abandoned during a period of unstable sea levels and coastal habitats between 9.4-5 ka. Holocene climate change coincides with increased reefal subsistence, and an increase in crab exploitation over sea urchin use. Rodent abundance increases in the early Holocene, possibly in response to expanding forests during warmer wetter conditions, with a significant increase in the late Holocene as a result of the human introduction of exotic species to the island.</p

Metal-Age maritime culture at Jareng Bori rockshelter, Pantar Island, eastern Indonesia

The archaeological record of Wallacea remains exceptionally fragmentary. This is especially the case for late Holocene human occupation of the region when lifestyle and culture in marginal island environments is relatively unknown. Here we report on the archaeology of Jareng Bori rockshelter, a Metal-Age site spanning c. 1800 cal. BP up to the late historic period and situated on the eastern coast of Pantar Island in the Lesser Sunda Islands of eastern Indonesia. We use osteoarchaeological (human and vertebrate remains), invertebrate zooarchaeological (crustacean and molluscan remains), technological (lithics, shell, and pottery) and chemical sourcing (obsidian and metal) datasets to discuss networking, migration, and human subsistence strategies during this recent period of history. While some communities were no doubt living in open village settlements where they were producing pottery, the data indicate that aspects of maritime life-ways continued much as in earlier Pleistocene settlements, with people using rockshelters like Jareng Bori to pursue a range of subsistence activities focused on the shoreline. Shellfishing of rocky and reef intertidal species and fishing for mostly small herbivorous and omnivorous fishes was practised, while domestic animals only appear in the late historic period. Wider regional cultural interactions and networking are epitomized by obsidian exchange, dental modification practices, and pottery decorations, while lithic analyses indicates continuity of stone tool technology up until recent times

Oldest human occupation of Wallacea at Laili Cave, Timor-Leste, shows broad-spectrum foraging responses to late Pleistocene environments

The Wallacea Archipelago provides an extraordinary laboratory for the study of human colonisation and adaptation, yet few detailed archaeological studies have been conducted in the region that span the earliest phase of human settlement. Laili Cave, in northern Timor-Leste, preserves the oldest human occupation in this insular region with a cultural sequence spanning 11,200 to 44,600 cal BP. Small-bodied vertebrates and invertebrates were recovered to the lowest excavated levels, associated with highly concentrated stone artefacts. We report on human behavioural adaptations within the context of Pleistocene environments and changing landscapes using zooarchaeological, stone artefact, bathymetric, and experimental isotopic analyses. Results indicate that Pleistocene humans used the abundant local chert liberally and engaged in mobile broad-spectrum exploitation of invertebrates and fishes from marine, estuarine, and freshwater environments within close proximity of Laili Cave. The faunal assemblage indicates heterogeneous but relatively stable environments during the late Pleistocene. Variability in subsistence strategies over time appears to be a response to changing landscapes and concomitant local resources. This record contrasts with marine specialisations evident from other sites in Timor-Leste and within the broader Wallacean regionThe excavation and dating of Laili was funded by ARC Discovery Grant DP0878543 and analyses by ARC Laureate Project FL120100156

Forty-thousand years of maritime subsistence near a changing shoreline on Alor Island (Indonesia)

We report archaeological findings from a significant new cave site on Alor Island, Indonesia, with an in situ basal date of 40,208-38,454 cal BP. Twenty thousand years older than the earliest Pleistocene site previously known from this island, Makpan retains dense midden deposits of marine shell, fish bone, urchin and crab remains, but few terrestrial species; demonstrating that protein requirements over this time were met almost exclusively from the sea. The dates for initial occupation at Makpan indicate that once Homo sapiens moved into southern Wallacea, settlement of the larger islands in the archipelago occurred rapidly. However, the Makpan sequence also suggests that the use of the cave following initial human arrival was sporadic prior to the terminal Pleistocene about 14,000 years ago, when occupation became intensive, culminating in the formation of a midden. Like the coastal sites on the larger neighbouring island of Timor, the Makpan assemblage shows that maritime technology in the Pleistocene was highly developed in this region. The Makpan assemblage also contains a range of distinctive personal ornaments made on Nautilus shell, which are shared with sites located on Timor and Kisar supporting connectivity between islands from at least the terminal Pleistocene. Makpan's early inhabitants responded to sea-level change by altering the way they used both the site and local resources. Marine food exploitation shows an initial emphasis on sea-urchins, followed by a subsistence switch to molluscs, barnacles, and fish in the dense middle part of the sequence, with crabs well represented in the later occupation. This new record provides further insights into early modern human movements and patterns of occupation between the islands of eastern Nusa Tenggara from ca. 40 ka.The fieldwork and dating for this project was funded by an Australian Research Council Laureate Fellowship to O’Connor (FL120100156) and analysis by the ARC Centre of Excellence for Australian Biodiversity and Heritage (CE170100015)

Early mobilisation in critically ill COVID-19 patients: a subanalysis of the ESICM-initiated UNITE-COVID observational study

Background Early mobilisation (EM) is an intervention that may improve the outcome of critically ill patients. There is limited data on EM in COVID-19 patients and its use during the first pandemic wave. Methods This is a pre-planned subanalysis of the ESICM UNITE-COVID, an international multicenter observational study involving critically ill COVID-19 patients in the ICU between February 15th and May 15th, 2020. We analysed variables associated with the initiation of EM (within 72 h of ICU admission) and explored the impact of EM on mortality, ICU and hospital length of stay, as well as discharge location. Statistical analyses were done using (generalised) linear mixed-effect models and ANOVAs. Results Mobilisation data from 4190 patients from 280 ICUs in 45 countries were analysed. 1114 (26.6%) of these patients received mobilisation within 72 h after ICU admission; 3076 (73.4%) did not. In our analysis of factors associated with EM, mechanical ventilation at admission (OR 0.29; 95% CI 0.25, 0.35; p = 0.001), higher age (OR 0.99; 95% CI 0.98, 1.00; p ≤ 0.001), pre-existing asthma (OR 0.84; 95% CI 0.73, 0.98; p = 0.028), and pre-existing kidney disease (OR 0.84; 95% CI 0.71, 0.99; p = 0.036) were negatively associated with the initiation of EM. EM was associated with a higher chance of being discharged home (OR 1.31; 95% CI 1.08, 1.58; p = 0.007) but was not associated with length of stay in ICU (adj. difference 0.91 days; 95% CI − 0.47, 1.37, p = 0.34) and hospital (adj. difference 1.4 days; 95% CI − 0.62, 2.35, p = 0.24) or mortality (OR 0.88; 95% CI 0.7, 1.09, p = 0.24) when adjusted for covariates. Conclusions Our findings demonstrate that a quarter of COVID-19 patients received EM. There was no association found between EM in COVID-19 patients' ICU and hospital length of stay or mortality. However, EM in COVID-19 patients was associated with increased odds of being discharged home rather than to a care facility. Trial registration ClinicalTrials.gov: NCT04836065 (retrospectively registered April 8th 2021)

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake