Two Acheuleans, two humankinds. From 1.5 to 0.85 Ma at Melka Kunture (Upper Awash, Ethiopian highlands)

The Acheulean is the longest-lasting human cultural record, spanning approximately 1.5 Ma and three continents. The most comprehensive sequences are found in East Africa, where, in large-scale syntheses, the Lower Pleistocene Acheulean (LPA) has often been considered a uniform cultural entity. Furthermore, the emergence and development of Acheulean technology are seen as linked to the emergence and evolution of Homo ergaster/erectus. The criterion for grouping together different lithic assemblages scattered over space and time is the presence of large cutting tools (LCTs), more than of any other component. Their degree of refinement has been used, in turn, as a parameter for evaluating Acheulean development and variability. But was the East African LPA really uniform as regards all components involved in lithic productions? The aim of this paper is to evaluate the techno-economic similarities and differences among LPA productions in a specific micro-regional and environmental context, i.e. at Melka Kunture, in the Ethiopian highlands, and in a specific period of time: between ~1.5 Ma, when some of the earliest Acheulean complexes appeared, and 1.0-0.85 Ma, when LCTs productions became intensive and widespread. Our detailed comparative analyses investigate all aspects and phases of the chaînes opératoires. Since hominin fossil remains were discovered at some of the analyzed sites, we also discuss differences among lithic productions in relation to the changing paleoanthropological record. Our studies show that at Melka Kunture the LPA techno-complexes cannot be grouped into a single uniform entity. The assembled evidence points instead to “two Acheuleans” well-defined by a strong discontinuity in various aspects of techno-economic behaviors. This discontinuity is related to a major step in human evolution: the transition from Homo ergaster/erectus to Homo heidelbergensis

The unknown Oldowan. ~1.7-million-year-old standardized obsidian small tools from Garba IV, Melka Kunture, Ethiopia

The Oldowan Industrial Complex has long been thought to have been static, with limited internal variability, embracing techno-complexes essentially focused on small-to-medium flake production. The flakes were rarely modified by retouch to produce small tools, which do not show any standardized pattern. Usually, the manufacture of small standardized tools has been interpreted as a more complex behavior emerging with the Acheulean technology. Here we report on the ~1.7 Ma Oldowan assemblages from Garba IVE-F at Melka Kunture in the Ethiopian highland. This industry is structured by technical criteria shared by the other East African Oldowan assemblages. However, there is also evidence of a specific technical process never recorded before, i.e. the systematic production of standardized small pointed tools strictly linked to the obsidian exploitation. Standardization and raw material selection in the manufacture of small tools disappear at Melka Kunture during the Lower Pleistocene Acheulean. This proves that 1) the emergence of a certain degree of standardization in toolkits does not reflect in itself a major step in cultural evolution; and that 2) the Oldowan knappers, when driven by functional needs and supported by a highly suitable raw material, were occasionally able to develop specific technical solutions. The small tool production at ~1.7 Ma, at a time when the Acheulean was already emerging elsewhere in East Africa, adds to the growing amount of evidence of Oldowan techno-economic variability and flexibility, further challenging the view that early stone knapping was static over hundreds of thousands of years

Geomorphological processes, forms and features in the surroundings of the Melka Kunture Palaeolithic site, Ethiopia

The landscape of the surroundings of the Melka Kunture prehistoric site, Upper Awash Basin, Ethiopia, were studied intensively in the last decades. Nonetheless, the area was mainly characterized under a stratigraphic/geological and archaeological point of view. However, a detailed geomorphological map is still lacking. Hence, in this study, we identify, map and visualize geomorphological forms and processes. The morphology of the forms, as well as the related processes, were remotely sensed with available high-resolution airborne and satellite sources and calibrated and validated through extensive field work conducted in 2013 and 2014. Furthermore, we integrated multispectral satellite imagery to classify areas affected by intensive erosion processes and/or anthropic activities. The Main Map at 1:15,000 scale reveals structural landforms as well as intensive water-related degradation processes in the Upper Awash Basin. Moreover, the map is available as an interactive WebGIS application providing further information and detail (www.roceeh.net/ethiopia_ geomorphological_map/)

Paleoenvironmental insights by stable isotopes and phytoliths at Simbiro III Monumental Section (~1.2-1.3 Ma) (Melka Kunture, Upper Awash, Ethiopia) (Abstract)

Depto. de Prehistoria, Historia Antigua y ArqueologíaFac. de Geografía e HistoriaTRUEpu

Melka Kunture (alto Awash, Etiopía) entre 2.000.000 y 5.000 años

Melka Kunture es un clúster de yacimientos prehistóricos situados en el altiplano etíope, a 2.000-2.200 m sobre el nivel del mar, en la cuenca alta del río Awash. El clima es más bien fresco (temperatura media anual de 17° C) y lluvioso. Los resultados palinológicos demuestran que la vegetación durante el Pleistoceno era de tipo afromontano y, por lo tanto, diferente a la de sabana que se desarrolla en cotas más bajas. Tras casi 60 años de excavaciones en 20 yacimientos y en unos 60 niveles arqueológicos distintos, la secuencia arqueológica identificada incluye el Olduvayense, Achelense, Middle Stone Age y Late Stone Age. También se han descubierto fósiles de homininos en asociación directa con industrias líticas de diferentes tecnocomplejos. Además, se conocen niveles icnológicos, que proporcionan información sobre la vida y el comportamiento de homininos y fauna. La investigación sobre la adaptación de los homininos al clima y al entorno de las tierras altas es relevante para entender cómo y cuándo se produjo el primer poblamiento de Europa

Ichnological and archaeological evidence from Gombore II OAM, Melka Kunture, Ethiopia: An integrated approach to reconstruct local environments and biological presences between 1.2 and 0.85 Ma

New ichnological data are available at the prehistoric site of Melka Kunture, Upper Awash Valley in Ethiopia. Excavation of new test pits enabled us to explore the volcanic and fluvio-lacustrine sequence at the Gombore II Open Air Museum archaeological site (ca. 0.85 Ma). This has allowed a detailed reconstruction of the palaeoenvironment and of the fauna present in the time interval between 1.2 and 0.85 Ma. Various-sized mammals, birds, molluscs as well as hominins left tracks throughout the sequence, and document a varied fauna and associated behaviours. Most of the hominin tracks were made by young individuals on the basis of size and are some of the earlier child tracks to be reported. The mollusc traces document the presence and orientation of water streams which, according to the associated vertebrate traces, were visited by hominins, mammals and birds. Most of these traces were found within levels traditionally considered barren for archaeology, yet they all document life activity and are always in situ. This confirms the potential of the ichnological research as an important complementary tool for archaeological investigations

Beta-Blocker Use in Older Hospitalized Patients Affected by Heart Failure and Chronic Obstructive Pulmonary Disease: An Italian Survey From the REPOSI Register

Beta (β)-blockers (BB) are useful in reducing morbidity and mortality in patients with heart failure (HF) and concomitant chronic obstructive pulmonary disease (COPD). Nevertheless, the use of BBs could induce bronchoconstriction due to β2-blockade. For this reason, both the ESC and GOLD guidelines strongly suggest the use of selective β1-BB in patients with HF and COPD. However, low adherence to guidelines was observed in multiple clinical settings. The aim of the study was to investigate the BBs use in older patients affected by HF and COPD, recorded in the REPOSI register. Of 942 patients affected by HF, 47.1% were treated with BBs. The use of BBs was significantly lower in patients with HF and COPD than in patients affected by HF alone, both at admission and at discharge (admission, 36.9% vs. 51.3%; discharge, 38.0% vs. 51.7%). In addition, no further BB users were found at discharge. The probability to being treated with a BB was significantly lower in patients with HF also affected by COPD (adj. OR, 95% CI: 0.50, 0.37-0.67), while the diagnosis of COPD was not associated with the choice of selective β1-BB (adj. OR, 95% CI: 1.33, 0.76-2.34). Despite clear recommendations by clinical guidelines, a significant underuse of BBs was also observed after hospital discharge. In COPD affected patients, physicians unreasonably reject BBs use, rather than choosing a β1-BB. The expected improvement of the BB prescriptions after hospitalization was not observed. A multidisciplinary approach among hospital physicians, general practitioners, and pharmacologists should be carried out for better drug management and adherence to guideline recommendations

The “Diabetes Comorbidome”: A Different Way for Health Professionals to Approach the Comorbidity Burden of Diabetes

(1) Background: The disease burden related to diabetes is increasing greatly, particularly in older subjects. A more comprehensive approach towards the assessment and management of diabetes’ comorbidities is necessary. The aim of this study was to implement our previous data identifying and representing the prevalence of the comorbidities, their association with mortality, and the strength of their relationship in hospitalized elderly patients with diabetes, developing, at the same time, a new graphic representation model of the comorbidome called “Diabetes Comorbidome”. (2) Methods: Data were collected from the RePoSi register. Comorbidities, socio-demographic data, severity and comorbidity indexes (Cumulative Illness rating Scale CIRS-SI and CIRS-CI), and functional status (Barthel Index), were recorded. Mortality rates were assessed in hospital and 3 and 12 months after discharge. (3) Results: Of the 4714 hospitalized elderly patients, 1378 had diabetes. The comorbidities distribution showed that arterial hypertension (57.1%), ischemic heart disease (31.4%), chronic renal failure (28.8%), atrial fibrillation (25.6%), and COPD (22.7%), were the more frequent in subjects with diabetes. The graphic comorbidome showed that the strongest predictors of death at in hospital and at the 3-month follow-up were dementia and cancer. At the 1-year follow-up, cancer was the first comorbidity independently associated with mortality. (4) Conclusions: The “Diabetes Comorbidome” represents the perfect instrument for determining the prevalence of comorbidities and the strength of their relationship with risk of death, as well as the need for an effective treatment for improving clinical outcomes

Antidiabetic Drug Prescription Pattern in Hospitalized Older Patients with Diabetes

Objective: To describe the prescription pattern of antidiabetic and cardiovascular drugs in a cohort of hospitalized older patients with diabetes. Methods: Patients with diabetes aged 65 years or older hospitalized in internal medicine and/or geriatric wards throughout Italy and enrolled in the REPOSI (REgistro POliterapuie SIMI—Società Italiana di Medicina Interna) registry from 2010 to 2019 and discharged alive were included. Results: Among 1703 patients with diabetes, 1433 (84.2%) were on treatment with at least one antidiabetic drug at hospital admission, mainly prescribed as monotherapy with insulin (28.3%) or metformin (19.2%). The proportion of treated patients decreased at discharge (N = 1309, 76.9%), with a significant reduction over time. Among those prescribed, the proportion of those with insulin alone increased over time (p = 0.0066), while the proportion of those prescribed sulfonylureas decreased (p < 0.0001). Among patients receiving antidiabetic therapy at discharge, 1063 (81.2%) were also prescribed cardiovascular drugs, mainly with an antihypertensive drug alone or in combination (N = 777, 73.1%). Conclusion: The management of older patients with diabetes in a hospital setting is often sub-optimal, as shown by the increasing trend in insulin at discharge, even if an overall improvement has been highlighted by the prevalent decrease in sulfonylureas prescription

Clinical features and outcomes of elderly hospitalised patients with chronic obstructive pulmonary disease, heart failure or both

Background and objective: Chronic obstructive pulmonary disease (COPD) and heart failure (HF) mutually increase the risk of being present in the same patient, especially if older. Whether or not this coexistence may be associated with a worse prognosis is debated. Therefore, employing data derived from the REPOSI register, we evaluated the clinical features and outcomes in a population of elderly patients admitted to internal medicine wards and having COPD, HF or COPD + HF. Methods: We measured socio-demographic and anthropometric characteristics, severity and prevalence of comorbidities, clinical and laboratory features during hospitalization, mood disorders, functional independence, drug prescriptions and discharge destination. The primary study outcome was the risk of death. Results: We considered 2,343 elderly hospitalized patients (median age 81 years), of whom 1,154 (49%) had COPD, 813 (35%) HF, and 376 (16%) COPD + HF. Patients with COPD + HF had different characteristics than those with COPD or HF, such as a higher prevalence of previous hospitalizations, comorbidities (especially chronic kidney disease), higher respiratory rate at admission and number of prescribed drugs. Patients with COPD + HF (hazard ratio HR 1.74, 95% confidence intervals CI 1.16-2.61) and patients with dementia (HR 1.75, 95% CI 1.06-2.90) had a higher risk of death at one year. The Kaplan-Meier curves showed a higher mortality risk in the group of patients with COPD + HF for all causes (p = 0.010), respiratory causes (p = 0.006), cardiovascular causes (p = 0.046) and respiratory plus cardiovascular causes (p = 0.009). Conclusion: In this real-life cohort of hospitalized elderly patients, the coexistence of COPD and HF significantly worsened prognosis at one year. This finding may help to better define the care needs of this population