The effectiveness of using carbonate isotope measurements of body tissues to infer diet in human evolution: Evidence from wild western chimpanzees (Pan troglodytes verus)*

Changes in diet throughout hominin evolution have been linked with important evolutionary changes. Stable carbon isotope analysis of inorganic apatite carbonate is the main isotopic method used to reconstruct fossil hominin diets; to test its effectiveness as a paleodietary indicator we present bone and enamel carbonate carbon isotope data from a well-studied population of modern wild western chimpanzees (Pan troglodytes verus) of known sex and age from Taï, Cote d'Ivoire.We found a significant effect of age class on bone carbonate values, with adult chimpanzees being more 13C- and 18O-depleted compared to juveniles. Further, to investigate habitat effects, we compared our data to existing apatite data on eastern chimpanzees (P. troglodytes schweinfurthii) and found that the Taï chimpanzees are significantly more depleted in enamel d13Cap and d18Oap compared to their eastern counterparts. Our data are the first to present a range of tissue-specific isotope data from the same group of wild western chimpanzees and, as such, add new data to the growing number of modern non-human primate comparative isotope datasets providing valuable information for the interpretation of diet throughout hominin evolution. By comparing our data to published isotope data on fossil hominins we found that our modern chimpanzee bone and enamel data support hypotheses that the trend towards increased consumption of C4 foods after 4 Ma (millions of years ago) is unique to hominins

Diet and disease in Tomar, Portugal: comparing stable carbon and nitrogen isotope ratios between skeletons with and without signs of infectious disease

Objectives: This study explored the correspondence between stable isotope ratios and indicators of non-specific (periostitis and/or osteomyelitis) and specific (venereal syphilis) disease in a sample of human skeletons from a Portuguese archaeological collection. Additionally, this study examined stable carbon (δ13C) and nitrogen (δ15N) isotope ratios between individuals at different disease stages. Materials and Methods: δ13C and δ15N data from previously analysed skeletons without signs of infectious disease or physiological stress (n=32) were compared to new data from skeletons with active (n=6), healed (n=7) or a combination of both lesions (n=10). Skeletons with lesions (n=23) were also grouped as having only healed tibial periostitis (n=7), generalised non-specific (n=5) and generalised specific infections (n=2). The skeletons with lesions that did not fit into these groups (n=9) were not used in this analysis. Results: The δ15N from skeletons with non-specific generalised infections in several bones differed significantly when compared to skeletons that had either only healed tibial periostitis or were without lesions. Skeletons with venereal syphilis had similar mean δ13C and δ15N to either skeletons without signs of disease or those with only healed tibial periostitis. Discussion: These results suggest different diets may be linked into an individual’s susceptibility to these pathogens. Diet influences resistance to infectious disease, while infections decrease nutrient availability, increase malabsorption and resting energy expenditure. Potentially therefore, combining isotopic evidence of diet with pathology may contribute to a new understanding of health and lifestyle in the past

Bone deep: variation in stable isotope ratios and histomorphometric measurements of bone remodelling within adult humans

Stable carbon (?13C) and nitrogen (?15N) isotope studies of ancient human diet increasingly sample several skeletal elements within an individual. Such studies draw upon differences in bone turnover rates to reconstruct diet during different periods of time within an individual’s lifetime. Rib and femoral bone, with their respectively fast and slow remodeling rates, are the bones most often sampled to reconstruct shorter and longer term signals of diet prior to death. It is poorly understood if ?13C and ?15N vary between bone types within a single individual, or if this variation corresponds with bone turnover rate (BTR). Here, we determined ?13C and ?15N for ten different bones from ten adult human skeletons (n=5 males; n=5 females). Isotope values were compared to the rate that each bone remodeled, calculated from osteon population (OPD) density. Results reveal that isotope ratios varied within each skeleton (?13C: max= -1.58‰; ?1542 N: max= 3.05‰). Humeri, metacarpals, and ribs had the highest rate of bone remodelling; the occipital bone had the lowest. A regression analyses revealed that higher rates of bone remodeling are significantly and negatively correlated with lower ?15N. Our results suggest that the occipital bone, with its slow rate of bone renewal, may prove useful for isotopic studies that reconstruct diet over longer periods of time within an individual’s lifetime. Isotope studies that compare individual skeletal elements between populations should standardize their methodology to bones with either a slow or fast turnover rate

Did military orders influence the general population diet? Stable isotopes analysis from Medieval Tomar, Portugal

This study integrates bone collagen stable isotope data (carbon, nitrogen and sulphur) from 33 human adult tibiae (15 females; 18 males) and 13 faunal remains from Tomar, while it was under the Military Orders domain (eleventh–seventeenth centuries). Historical literature indicates that the amount of meat consumption amongst Templars was lower than in individuals with similar social status. In Medieval times, these Military Orders had total control of towns and angling and fishing rights, but their influence on the general population diet remains unknown. While no statistically significant differences (p > 0.05) were found between sexes, social status, or for bone collagen δ13C and δ34Sbetween age groups, δ15N did differ significantly with age, which may be related to tooth loss in old individuals. Additionally, the human samples have higher stable isotope differences, in comparison with faunal samples, than would be expected within the food web, particularly for δ13C. This human bone collagen δ13C enrichment may reflect a diet rich in aquatic protein intake, which is also supported by δ34S archived in human and faunal samples, and the presence of oysters and cockles shells at the excavation. The religious diet restrictions might have led to a higher intake of aquatic protein when meat consumption was not allowed

Transitioning to home and beyond following stroke: a prospective cohort study of outcomes and needs

Introduction: Understanding of the needs of people with stroke at hospital discharge and in the first six-months is limited. This study aim was to profile and document the needs of people with stroke at hospital discharge to home and thereafter. Methods: A prospective cohort study recruiting individuals with stroke, from three hospitals, who transitioned home, either directly, through rehabilitation, or with early supported discharge teams. Their outcomes (global-health, cognition, function, quality of life, needs) were described using validated questionnaires and a needs survey, at 7–10 days, and at 3-, and 6-months, post-discharge. Results: 72 patients were available at hospital discharge; mean age 70 (SD 13); 61% female; median NIHSS score of 4 (IQR 0–20). 62 (86%), 54 (75%), and 45 (63%) individuals were available respectively at each data collection time-point. Perceived disability was considerable at hospital discharge (51% with mRS ≥ 3), and while it improved at 3-months, it increased thereafter (35% with mRS ≥ 3 at 6-months). Mean physical health and social functioning were “fair” at hospital discharge and ongoing; while HR-QOL, although improved over time, remained impaired at 6-months (0.69+/-0.28). At 6-months cognitive impairment was present in 40%. Unmet needs included involvement in transition planning and care decisions, with ongoing rehabilitation, information, and support needs. The median number of unmet needs at discharge to home was four (range:1–9), and three (range:1–7) at 6-months. Conclusion: Stroke community reintegration is challenging for people with stroke and their families, with high levels of unmet need. Profiling outcomes and unmet needs for people with stroke at hospital-to-home transition and onwards are crucial for shaping the development of effective support interventions to be delivered at this juncture

A protocol to evaluate the impact of embedding Public and Patient Involvement in a structured PhD program for stroke care

BackgroundEmbedding Public and Patient Involvement (PPI) in postgraduate research has been recognized as an important component of post-graduate training, providing research scholars with an awareness and a skillset in an area which prepares them for future roles as healthcare researchers. Improving Pathways for Acute STroke And Rehabilitation (iPASTAR) is a structured PhD training program [Collaborative Doctoral Award (CDA)] which aims to design a person-centered stroke pathway throughout the trajectory of stroke care, to optimize post-stroke health and wellbeing. PPI is embedded at all stages.PurposeThe iPASTAR research programme was strongly informed by a round-table PPI consultation process with individuals who experienced stroke and who provided broad representation across ages, gender, geographical locations (urban and rural) and the PhD themed areas of acute care, early supported discharge and lifestyle-based interventions after stroke. Four PhD scholars taking part in the CDA-iPASTAR now work collaboratively with four stroke champions, supported by a wider PPI advisory panel.MethodsThis study will evaluate the process and impact of embedding PPI during a PhD program. We will conduct a longitudinal mixed-methods evaluation, conducting focus groups at 24, 36, and 48 months to explore the experiences of the key stakeholders involved. The participants will include PhD scholars, PPI partners (PPI Advisory Group and PPI Champions), PhD supervisors and a PPI manager. An independent researcher will conduct the evaluation. We will include focus groups, individual interviews and participant reflections. Qualitative data will be analyzed using thematic and content analysis, quantitative data will be analyzed using descriptive statistics.DiscussionPPI and patient voice initiatives bring together researchers, family, and people with health care issues into meaningful dialogue and allow the development of a patient-voice learning network. Embedding PPI training within a PhD program can build meaningful capacity in PPI partnerships in stroke research

Comparative Isotope Ecology of African Great Apes

The isotope ecology of great apes is a useful reference for palaeodietary reconstructions in fossil hominins. As extant apes live in C3 dominated habitats, variation in isotope signatures is assumed to be low compared to hominoids also exploiting C4-plant resources. However, isotopic differences between sites and between and within individuals were poorly understood due to the lack of vegetation baseline data. In this comparative study we included all species of free-ranging African great apes (Pan troglodytes, Pan paniscus, Gorilla gorilla gorilla and Gorilla beringeri beringei). We explore differences in isotope baselines across different habitats and how isotopic signatures in apes can be related to feeding niches (faunivory and folivory). Secondly, we illustrate how stable isotopic variation within African ape populations compares to other primates, including hominins from the fossil record, and discuss possible implications for dietary flexibility. Using 815 carbon and nitrogen isotope data from 155 sectioned hair samples and an additional collection of 189 fruit samples we compare six different great ape sites. We investigate the relationship between vegetation baselines and climatic variables, and subsequently correct great ape isotope data to a standardized plant baseline from the respective sites. We gained temporal isotopic profiles of individual animals by sectioning hair along its growth trajectory. Isotopic signatures of great apes differed between sites, mainly as vegetation isotope baselines were correlated with site-specific climatic conditions. We show that controlling for plant isotopic characteristics at a given site is essential for data interpretation. When controlling for plant baseline effects, we found distinct isotopic profiles for each great ape population. Based on evidence from habituated groups and sympatric great ape species these differences could be related to faunivory and folivory. Dietary flexibility in extant apes varies between species and populations, but temporal isotopic variation was overall lower than in species shifting from C3 to C4-resources, including fossil hominins and extant primates

COVID-19 symptoms at hospital admission vary with age and sex: results from the ISARIC prospective multinational observational study

Background: The ISARIC prospective multinational observational study is the largest cohort of hospitalized patients with COVID-19. We present relationships of age, sex, and nationality to presenting symptoms. Methods: International, prospective observational study of 60 109 hospitalized symptomatic patients with laboratory-confirmed COVID-19 recruited from 43 countries between 30 January and 3 August 2020. Logistic regression was performed to evaluate relationships of age and sex to published COVID-19 case definitions and the most commonly reported symptoms. Results: ‘Typical’ symptoms of fever (69%), cough (68%) and shortness of breath (66%) were the most commonly reported. 92% of patients experienced at least one of these. Prevalence of typical symptoms was greatest in 30- to 60-year-olds (respectively 80, 79, 69%; at least one 95%). They were reported less frequently in children (≤ 18 years: 69, 48, 23; 85%), older adults (≥ 70 years: 61, 62, 65; 90%), and women (66, 66, 64; 90%; vs. men 71, 70, 67; 93%, each P < 0.001). The most common atypical presentations under 60 years of age were nausea and vomiting and abdominal pain, and over 60 years was confusion. Regression models showed significant differences in symptoms with sex, age and country. Interpretation: This international collaboration has allowed us to report reliable symptom data from the largest cohort of patients admitted to hospital with COVID-19. Adults over 60 and children admitted to hospital with COVID-19 are less likely to present with typical symptoms. Nausea and vomiting are common atypical presentations under 30 years. Confusion is a frequent atypical presentation of COVID-19 in adults over 60 years. Women are less likely to experience typical symptoms than men

Bone deep: Variation in stable isotope ratios and histomorphometric measurements of bone remodelling within adult humans

Stable carbon (δ13C) and nitrogen (δ15N) isotope studies of ancient human diet increasingly sample several skeletal elements within an individual. Such studies draw upon differences in bone turnover rates to reconstruct diet during different periods of time within an individual's lifetime. Rib and femoral bone, with their respectively fast and slow remodelling rates, are the bones most often sampled to reconstruct shorter and longer term signals of diet prior to death. It is poorly understood if δ13C and δ15N vary between bone types within a single individual, or if this variation corresponds with bone turnover rate (BTR). Here, we determined δ13C and δ15N for ten different bones from ten adult human skeletons (n = 5 males; n = 5 females). Isotope values were compared to the rate that each bone remodeled, calculated from osteon population (OPD) density. Results reveal that isotope ratios varied within each skeleton (δ13C: max = −1.58‰; δ15N: max = 3.05‰). Humeri, metacarpals, and ribs had the highest rate of bone remodelling; the occipital bone had the lowest. A regression analyses revealed that higher rates of bone remodelling are significantly and negatively correlated with lower δ15N. Our results suggest that the occipital bone, with its slow rate of bone renewal, may prove useful for isotopic studies that reconstruct diet over longer periods of time within an individual's lifetime. Isotope studies that compare individual skeletal elements between populations should standardize their methodology to bones with either a slow or fast turnover rate.This project was funded by a University of Kent, School of Anthropology & Conservation Small Research Gran