Animal bones and human society in the late younger stone age of arctic Norway

In recent decades anthropologists and archaeologists have divided hunter-gatherer groups into two types; "simple" and "complex". However, many documented foraging communities display traits associated with both types, and the placement of past and present hunter-gatherers into either category is problematic. The substantial house remains of the late Younger Stone Age hunter-gatherers of Varangerfjord, North Norway, have been connected by many archaeologists with sedentism and, by extension, with "complexity" and permanent social hierarchies. This analysis takes a more direct approach social organisation, using faunal remains to better define the social relationships between households within this community. The large mammal remains from a series of houses are compared to determine whether all households had equal access to prey species and to different parts of large mammal carcasses. Towards this end, the climate and available resources are established for North Norway during the Younger Stone Age. Previous interpretations of the archaeology of the period, including the argument for "complexity" are then discussed. The study sites and associated faunal assemblages are presented. Seal hunting patterns are compared between households in terms of both the choice of species and the age breakdown of each hunted seal population. Local differences in the numbers of ringed seal are attributed to the preference of ringed seal for certain types of coastline. Strong similarities are noted between all sites in terms of both the season of seal hunting activity and the selection of adult versus juvenile harp seal and ringed seal. Distribution of seal and reindeer body parts are also compared between and within houses. Again, there are more similarities than differences between households. Seals were returned whole to all houses and reindeer body part representation appears to be mediated by the utility of each part for artefact manufacture. The implication of these results are discussed in terms of the structure of social relationships, symbolic behaviour and territoriality. The utility of this approach in a broader context is also considered

Maize Provisioning of Ontario Late Woodland Turkeys: Isotopic Evidence of Seasonal, Cultural, Spatial and Temporal Variation

The isotopic composition (δ13C, δ15N) of bone collagen from Ontario Late Woodland archaeological turkeys was compared with that of modern Ontario wild turkeys, and archaeological turkeys from American Southwestern, Mexican and other Woodland sites to determine whether Late Woodland Ontario peoples managed wild turkeys by provisioning them with maize, the only isotopically distinct horticultural plant at that time. Despite the fact that humans from Late Woodland Western Basin and Iroquoian traditions consumed equal amounts of maize, wild turkeys utilized by the two groups exhibit different diets. Western Basin turkeys reflect a C3-only diet, whereas Iroquoian turkeys were consuming significant quantities of maize (a C4 plant). Both groups of archaeological turkey consumed less maize than modern wild turkeys with access to waste left in fields by mechanized agriculture, but because ancient crop yields were much lower, we suggest that Iroquoian turkeys must have been provisioned, probably to create a reliable and nearby hunting niche (Linares 1976). Archaeological and isotopic evidence supports ethnohistoric accounts that turkeys were hunted after the fall harvest. Iroquoian archaeological turkey diets, in general, reflect the seasonal consumption of maize that would have been created by cold weather maize provisioning, with the major exception of one turkey from an Attawandaron (Neutral) site that appears to have been fed maize year round. Motivations for provisioning by Middle Ontario Iroquoian people likely included climate change and ritual/ceremonial activity as well as a reliable food supply. Because Iroquoian women controlled the harvest, it is likely that they were instrumental in altering this human/animal interaction, creating a position on the wild/domesticated continuum that is unique in the North American archaeological literature

C-STICH2: emergency cervical cerclage to prevent miscarriage and preterm birth—study protocol for a randomised controlled trial

Abstract Background Cervical cerclage is a recognised treatment to prevent late miscarriage and pre-term birth (PTB). Emergency cervical cerclage (ECC) for cervical dilatation with exposed unruptured membranes is less common and the potential benefits of cerclage are less certain. A randomised control trial is needed to accurately assess the effectiveness of ECC in preventing pregnancy loss compared to an expectant approach. Methods C-STICH2 is a multicentre randomised controlled trial in which women presenting with cervical dilatation and unruptured exposed membranes at 16 + 0 to 27 + 6 weeks gestation are randomised to ECC or expectant management. Trial design includes 18 month internal pilot with embedded qualitative process evaluation, minimal data set and a within-trial health economic analysis. Inclusion criteria are ≥16 years, singleton pregnancy, exposed membranes at the external os, gestation 16 + 0–27 + 6 weeks, and informed consent. Exclusion criteria are contraindication to cerclage, cerclage in situ or previous cerclage in this pregnancy. Randomisation occurs via an online service in a 1:1 ratio, using a minimisation algorithm to reduce chance imbalances in key prognostic variables (site, gestation and dilatation). Primary outcome is pregnancy loss; a composite including miscarriage, termination of pregnancy and perinatal mortality defined as stillbirth and neonatal death in the first week of life. Secondary outcomes include all core outcomes for PTB. Two-year development outcomes will be assessed using general health and Parent Report of Children’s Abilities-Revised (PARCA-R) questionnaires. Intended sample size is 260 participants (130 each arm) based on 60% rate of pregnancy loss in the expectant management arm and 40% in the ECC arm, with 90% power and alpha 0.05. Analysis will be by intention-to-treat. Discussion To date there has been one small trial of ECC in 23 participants which included twin and singleton pregnancies. This small trial along with the largest observational study (n = 161) found ECC to prolong pregnancy duration and reduce deliveries before 34 weeks gestation. It is important to generate high quality evidence on the effectiveness of ECC in preventing pregnancy loss, and improve understanding of the prevalence of the condition and frequency of complications associated with ECC. An adequately powered RCT will provide the highest quality evidence regarding optimum care for these women and their babies. Trial registration ISRCTN Registry ISRCTN12981869 . Registered on 13th June 2018

Abandoned Acid? Understanding Adherence to Bisphosphonate Medications for the Prevention of Osteoporosis among Older Women: A Qualitative Longitudinal Study

Background There is significant morbidity and mortality caused by the complications of osteoporosis, for which ageing is the greatest epidemiological risk factor. Preventive medications to delay osteoporosis are available, but little is known about motivators to adhere to these in the context of a symptomless condition with evidence based on screening results. Aim To describe key perceptions that influence older women's adherence and persistence with prescribed medication when identified to be at a higher than average risk of fracture. Design of Study A longitudinal qualitative study embedded within a multi-centre trial exploring the effectiveness of screening for prevention of fractures. Setting Primary care, Norfolk. United Kingdom Methods Thirty older women aged 70–85 years of age who were offered preventive medication for osteoporosis and agreed to undertake two interviews at 6 and 24 months post-first prescription. Results There were no overall predictors of adherence which varied markedly over time. Participants' perceptions and motivations to persist with medication were influenced by six core themes: understanding adherence and non-adherence, motivations and self-care, appraising and prioritising risk, anticipating and managing side effects, problems of understanding, and decision making around medication. Those engaged with supportive professionals could better tolerate and overcome barriers such as side-effects. Conclusions Many issues are raised following screening in a cohort of women who have not previously sought advice about their bone health. Adherence to preventive medication for osteoporosis is complex and multifaceted. Individual participant understanding, choice, risk and perceived need all interact to produce unpredictable patterns of usage and acceptability. There are clear implications for practice and health professionals should not assume adherence in any older women prescribed medication for the prevention of osteoporosis. The beliefs and motivations of participants and their healthcare providers regarding the need to establish acceptable medication regimes is key to promoting and sustaining adherence

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

« Vous nous aidez à raconter notre histoire » : Restituer les histoires de vie des Inuvialuit en mode numérique et en temps réel

Inuvialuit have always created culture through our/their living and land-based practices. For us, making culture means doing, practicing, and sharing activities and songs and country food, on the land and in town, together with our families and communities. These layers of history are embedded in the landscape of Inuvialuit Nunangat, our homeland, and in the voices of Elders past and present speaking about their knowledges and experiences. In this paper, we describe how Inuvialuit communities are practicing our living traditions today and capturing them using digital methods to produce a new Inuvialuit Living History website that celebrates the past, present, and future of our communities.Les Inuvialuit ont toujours créé leur culture à travers nos/leurs pratiques de vie ancrées dans le territoire. Pour nous, « faire la culture » signifie réaliser, pratiquer et partager des activités, des chants et de la nourriture locale, dans la nature et dans les villages, ensemble avec nos familles et nos communautés. Ces niveaux d’histoire sont inscrits dans le paysage inuvialuit de langue nunangat, notre pays, et dans les voix des Aînés du passé et du présent qui parlent de leur savoir et de leur expérience. Dans cet article, nous décrivons la façon dont les communautés inuvialuit vivent en pratique encore aujourd’hui leurs traditions et les enregistrent au moyen de méthodes numériques pour élaborer un nouveau site Internet d’Histoire vivante des Inuvialuit qui rende hommage au passé, au présent et à l’avenir de nos communautés.Inuvialuit taima idjuhiit pitquhiliuqhimaaqpakhimayut inuudtjuhingmikut ubluq tamaat atuqtatik ukualut nunami hulilukaarutitik. Uvaptingni ima ittuq pitquhiliungniq, hulilukarutivut atuqhimaaqhugit, hulilukaaqtavut avanmut aituqhugit, pihiitigutlu, niqainangnilu niriplutik, aavaqhunilu nunami, Igluqarviptingniitutalu hulilukaangniq, Ilagiivaluvut ilagiplugit hulilukaqatigiplugit nunalaatlu aallat. Inuvialuit Nunagani tahapkuat Pitquhiraluavut nunami naunaitut, nunagiyaptingnilu, innakhat ublumi inuuyuni tahpkuatlu huiqhimayunilu uqauhiini tuhangnaqtut ilihimayamingnik imaalu atuqpaktakhimayamingniklu inuuniarutimingni. Uvani titiqami, uqariyaqut qanuq ublumi Inuvialuit Nunalaat qanuq tahapkut pitquhivut huli ublu aulapkaininganik atuqhimaqhugit atdjiliuqhugitlu qaritauyangmut iliyukhanik, tigumiaqtanutlu, nutaanik Inuvialuit Qangaraaluk Inuuniarutainik Pitquhiiniklu qaritauyakut takuuriliuqhutik qarauluk pitquhingit aliahuutigiplugit, ublumilu atuqtainik, kiguvaapta nunalaani pihimayakhainik.Inuvialuit nunalu silalu niryutillu malirullugit pitqusiruaqpaktuat. Uvaptingni, inuusiqput immana ittuq nunamilu inuuniarvingnilu: anguniluklutik, savangnilukluta, nigaaqtuqluta, ikayuqtigiikluta atuutitigun niqitigunlu, tamarmik inuuqatigiit. Taapkuat pitqusit ilurriliqtauyut Inuvialuit Nunangani nayuqtaptingni. Inirnirillu ingilraan qangmagaluaq quliaqtuarivagait pitqusitik. Uvani makpiraami, quliaqtuariyavut qanuq Inuvialuit inuuniarvingni piqusingit itilaangitigun qangma. Nutaamik Inuvialuit Pitqusingit Ingilraan quliaqtuat qaritauyanun ililugit inuuniarviit takuyaksangit.Inuvialuit inuuniaruhimiktigun inuuniarutiktingni aturaat inuuniaqhuting aulaaqturvingmingni nuami unuuniaqhuting atr̂amik niqiqaqhuting nunahinamin. Uvaptingnun inuuniarniq itnaittuq inuuniarniq aturnaqtuq uuturarnaqtuq, avanmun aviktuarnaqtuq inuuniarnit niqinik,aulaaqturvingmingni inaur̂amillu. Ukuat qaligiiktuat inuuniarningi aipaarnihat nalunaingutchirait inuuniarvikting Inuvialuit nunangat. Aimavikput nunakput, utuqhanaat nipingat aipaarnihat pangmanikun ilihimakaminiklu inuur̂amingniglu,Uumani maqpiraami, ilitchuripkair̂ugut qanuqinupiat inuuniaruhinginik inar̂ani utiqtitchiniaqtuat inuuniaruhomingnik pangmapak,pikachaliuqługit tuquqtaqr̂ugit qanuq inuuniarningigun Inupiat aipaani qaqhaur̂anunlu ilivlugit tautuakr̂anginik qviahuutikr̂anginik tautuktuarumihigi,pangma aipaanihat inar̂ani

“You Help Us Tell our Story”: Making Inuvialuit Living Histories in Digital and Real Time

Inuvialuit have always created culture through our/their living and land-based practices. For us, making culture means doing, practicing, and sharing activities and songs and country food, on the land and in town, together with our families and communities. These layers of history are embedded in the landscape of Inuvialuit Nunangat, our homeland, and in the voices of Elders past and present speaking about their knowledges and experiences. In this paper, we describe how Inuvialuit communities are practicing our living traditions today and capturing them using digital methods to produce a new Inuvialuit Living History website that celebrates the past, present, and future of our communities.Les Inuvialuit ont toujours créé leur culture à travers nos/leurs pratiques de vie ancrées dans le territoire. Pour nous, « faire la culture » signifie réaliser, pratiquer et partager des activités, des chants et de la nourriture locale, dans la nature et dans les villages, ensemble avec nos familles et nos communautés. Ces niveaux d’histoire sont inscrits dans le paysage inuvialuit de langue nunangat, notre pays, et dans les voix des Aînés du passé et du présent qui parlent de leur savoir et de leur expérience. Dans cet article, nous décrivons la façon dont les communautés inuvialuit vivent en pratique encore aujourd’hui leurs traditions et les enregistrent au moyen de méthodes numériques pour élaborer un nouveau site Internet d’Histoire vivante des Inuvialuit qui rende hommage au passé, au présent et à l’avenir de nos communautés.Inuvialuit taima idjuhiit pitquhiliuqhimaaqpakhimayut inuudtjuhingmikut ubluq tamaat atuqtatik ukualut nunami hulilukaarutitik. Uvaptingni ima ittuq pitquhiliungniq, hulilukarutivut atuqhimaaqhugit, hulilukaaqtavut avanmut aituqhugit, pihiitigutlu, niqainangnilu niriplutik, aavaqhunilu nunami, Igluqarviptingniitutalu hulilukaangniq, Ilagiivaluvut ilagiplugit hulilukaqatigiplugit nunalaatlu aallat. Inuvialuit Nunagani tahapkuat Pitquhiraluavut nunami naunaitut, nunagiyaptingnilu, innakhat ublumi inuuyuni tahpkuatlu huiqhimayunilu uqauhiini tuhangnaqtut ilihimayamingnik imaalu atuqpaktakhimayamingniklu inuuniarutimingni. Uvani titiqami, uqariyaqut qanuq ublumi Inuvialuit Nunalaat qanuq tahapkut pitquhivut huli ublu aulapkaininganik atuqhimaqhugit atdjiliuqhugitlu qaritauyangmut iliyukhanik, tigumiaqtanutlu, nutaanik Inuvialuit Qangaraaluk Inuuniarutainik Pitquhiiniklu qaritauyakut takuuriliuqhutik qarauluk pitquhingit aliahuutigiplugit, ublumilu atuqtainik, kiguvaapta nunalaani pihimayakhainik.Inuvialuit nunalu silalu niryutillu malirullugit pitqusiruaqpaktuat. Uvaptingni, inuusiqput immana ittuq nunamilu inuuniarvingnilu: anguniluklutik, savangnilukluta, nigaaqtuqluta, ikayuqtigiikluta atuutitigun niqitigunlu, tamarmik inuuqatigiit. Taapkuat pitqusit ilurriliqtauyut Inuvialuit Nunangani nayuqtaptingni. Inirnirillu ingilraan qangmagaluaq quliaqtuarivagait pitqusitik. Uvani makpiraami, quliaqtuariyavut qanuq Inuvialuit inuuniarvingni piqusingit itilaangitigun qangma. Nutaamik Inuvialuit Pitqusingit Ingilraan quliaqtuat qaritauyanun ililugit inuuniarviit takuyaksangit.Inuvialuit inuuniaruhimiktigun inuuniarutiktingni aturaat inuuniaqhuting aulaaqturvingmingni nuami unuuniaqhuting atr̂amik niqiqaqhuting nunahinamin. Uvaptingnun inuuniarniq itnaittuq inuuniarniq aturnaqtuq uuturarnaqtuq, avanmun aviktuarnaqtuq inuuniarnit niqinik,aulaaqturvingmingni inaur̂amillu. Ukuat qaligiiktuat inuuniarningi aipaarnihat nalunaingutchirait inuuniarvikting Inuvialuit nunangat. Aimavikput nunakput, utuqhanaat nipingat aipaarnihat pangmanikun ilihimakaminiklu inuur̂amingniglu,Uumani maqpiraami, ilitchuripkair̂ugut qanuqinupiat inuuniaruhinginik inar̂ani utiqtitchiniaqtuat inuuniaruhomingnik pangmapak,pikachaliuqługit tuquqtaqr̂ugit qanuq inuuniarningigun Inupiat aipaani qaqhaur̂anunlu ilivlugit tautuakr̂anginik qviahuutikr̂anginik tautuktuarumihigi,pangma aipaanihat inar̂ani