Adquisición y aprovechamiento de los recursos líticos en la Cueva de la Flecha (Cantabria)

La industria lítica musteriense de la cueva de La Flecha está elaborada principalmente sobre pequeños cantos rodados de cuarcita obtenidos en un depósito conglomerático a pocos kilómetros. Su reducido tamaño hace poco rentable un desbastado previo, de manera que se ha aplicado una talla directa, fundamentalme unidireccional, sobre los mismos que da como resultado la proliferación de lascas corticales, algunas de las cuales han sido seleccionadas como soporte para las raederas. Nos encontramos así ante un ejemplo de adaptación a los condicionantes que impone este recurso y que, además, constituye un método óptimo de economizar materia prima

Surroundings of Altamira, an archaeological site around the cave of Altamira (Santillana del Mar, Cantabria)

RESUMEN: este artículo presenta la situación actual de la investigación sobre el yacimiento de Alrededores de Altamira a través de la revisión de los estudios publicados hasta la fecha y de los resultados obtenidos en la primera fase de investigación en el marco del proyecto de Altamira Prospecta desarrollado por el Museo Nacional y Centro de Investigación de Altamira. El estudio de Alrededores de Altamira permite profundizar en el conocimiento de los primeros pobladores de la zona circundante a la cueva de Altamira, así como conocer las estrategias que estas sociedades han desarrollado en este entorno a lo largo de una dilatada cronología, a lo largo de todo el Paleolítico.ABSTRACT: this paper presents the current situation of research on the Surroundings of Altamira site through the review of studies published to date and results obtained in the first phase of research within the framework of the Altamira Prospecta project, developed by the Museo Nacional y Centro de Investigación de Altamira. The study of Surroundings of Altamira allows us to deepen the knowledge of first settlers of the area surrounding the cave of Altamira, as well as to get a better understanding of the strategies that these societies have developed in this environment throughout a wide chronology, throughout the Palaeolithic

La cueva sepulcral calcolítica del Cubío del Escalón (Matienzo, Cantabria) y el modelo de las pequeñas cuevas sepulcrales en Cantabria

El Cubío del Escalón es una pequeña cueva localizada en Matienzo, Cantabria, donde en el año 2009 se hallaron algunos restos humanos. Una intervención arqueológica cuatro años más tarde documentó los restos de un mínimo de seis individuos, cinco adultos y un niño. Prácticamente todos los huesos se encontraban en mal estado de conservación, debido a las remociones que el yacimiento había sufrido. Junto con los restos óseos, se recogieron unas pocas piezas de sílex, cerámica y fauna. Este sitio se encaja dentro de cierto modelo de cueva sepulcral que se usaba con frecuencia en el Calcolítico y la Edad del Bronce. El estudio de los yacimientos funerarios de ese periodo en Cantabria ha determinado que 55% de los mismos poseen una boca de menos de 2,5 m de ancho y su anchura media es inferior a los 3,5 m. Sin embargo, dentro de una diversidad de prácticas sepulcrales, en el mismo periodo también se utilizaban cavidades grandes, aunque las inhumaciones en cueva conocidas seguramente corresponderían a una parte pequeña de la población, por lo que podrían existir otros ritos

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research