Taphonomy and differential preservation of human bone remains from northern Neuquén province (República Argentina)

Se presentan los resultados de los análisis tafonómicos realizados a dos conjuntos de restos óseos humanos de los sitios arqueológicos Aquihuecó y Hermanos Lazcano (departamento Chos Malal, provincia del Neuquén). Ambos se caracterizan por su similitud cronológica (comienzos del Holoceno tardío >3.500 años), posición geográfica y material asociado, pero el estado de preservación resulta desigual. Aquihuecó presenta un conjunto muy bien preservado con ejemplares óseos escasamente fragmentados. De forma contraria, Hermanos Lazcano se caracteriza por numerosos elementos óseos fragmentados. A los efectos de explicar esta preservación diferencial se realizó el análisis tafonómico y geoquímico en ambos sitios. Los resultados indicaron la presencia de una matriz sedimentaria favorable para la preservación de restos óseos para ambos sitios. A nivel tafonómico se registró un alto contenido de carbonato de calcio sobre los restos de Aquihuecó. Interpretamos que los depósitos de carbonato cálcico son responsables de su mejor estado de preservación, mientras que en Hermanos Lazcano la disolución ósea es el principal proceso de deterioro. Se destaca la necesidad de profundizar el rol del carbonato de calcio en la preservación ósea como también en los análisis geoquímicos y geoambientales a los efectos de aportar nuevas explicaciones a la historia tafonómica de los individuos.In this study we analyze taphonomic effects in two samples of human burials from archaeological sites: Aquihuecó and Hermanos Lazcano, placed in the Department of Chos Malal, Neuquén Province. The sites are close to each other (20 km.) and have similar age (early late Holocene, >3.500 BP). Even when both samples were deposited in similar environmental conditions, have similar ages and show similar burial practices, the bones preservation is markedly different. In order to understand this differential preservation, we evaluated the taphonomic signatures of bones and soil chemistry variables of both sites. Our results show that soil chemistry is adequate for a good preservation of bones in both sites. Aquihuecó sample has abundant calcium carbonate deposits on the bones. We interpret that the high content of calcium carbonate is probably responsible for the good preservation of Aquihuecó sample. More work is needed to improve the knowledge about the role of calcium carbonate in the preservation of human bones in burial contexts.Fil: Vazquez, Romina Clara. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Patagonia Norte. Instituto de Investigación en Paleobiología y Geología; Argentina. Universidad Nacional de Río Negro. Sede Alto Valle. Instituto de Investigaciones en Paleobiología y Geología; Argentin

Chemical and microscopic analysis on sediments and human remains of the juncal lagoon (Valle del Río Negro, Norpatagonia)

Se presenta un estudio multi enfoque basado en entierroshumanos provenientes de Laguna del Juncal, depositados en forma de bochones en las colecciones de dos museosregionales del Alto Valle del Río Negro desde la década de 1970. Los restospresentan la característica coloración oscura que ha dado lugar a numerosasmenciones a lo largo de la historia de la arqueología del río Negro. Elobjetivo de este trabajo es estudiar la coloración de los restos (natural vs.antrópica) y evaluar su cronología. Para ello se presenta una caracterizaciónbioarqueológica, cronológica y tafonómica de los individuos y sus matricessedimentarias, utilizando análisis químicos y microscópicos. Se excavaron dosindividuos, un adulto y otro subadulto, ambos con escaso material culturalasociado y fueron datados en 720 ± 24 y 754 ± 24 años AP respectivamente. Lapreservación del adulto es entre regular y buena, mientras que el subadultopresentó peor preservación.  Mediantemicroanálisis químicos (MEB) se registró alto contenido de manganeso y hierroen los sedimentos, así como en el material óseo, lo cual explicaría sucoloración oscura. Se discuten los resultados en el marco de los conocimientosactuales de los entierros del noreste de Patagonia.We present a multi-focus study based on human burials from Laguna del Juncal, deposited in a plaster wrap in the collections of two regional Museums of the Río Negro Upper Valley since the 1970s. The remains present the characteristic dark coloration that has been frequently mentioned throughout the history of the archaeology of the Negro river, Argentinian Patagonia. The aim of this work is to study the coloration of the remains (natural vs. anthropic) and evaluate their chronology. To achieve this, a bioarchaeological, chronological and taphonomic characterization of the individuals and their sedimentary matrices is presented, using chemical and microscopic analyzes. Two individuals were excavated, an adult and a subadult, both with little associated cultural material, that were dated 720 ± 24 and 754 ± 24 years BP respectively. The preservation of the adult is fair to good, while the subadult presents worse preservation. By means of chemical microanalysis (SEM), high content of Mn and Fe was recorded in the sediments, as well as in the bone material, which would explain its dark coloration. The results are discussed within the framework of current knowledge of the burials of Northeast Patagonia.Fil: Beguelin, Marien. Universidad Nacional de La Plata. Facultad de Ciencias Naturales y Museo. División Antropología; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata; ArgentinaFil: Vazquez, Romina Clara. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Patagonia Norte. Instituto de Investigación en Paleobiología y Geología; ArgentinaFil: Serna, Alejandro. University of Utah; Estados Unidos. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata; Argentin

Protocol for thin section preparation of non decalcified human bone tissue

La obtención de cortes delgados de restos óseos correspondiente tanto a materiales fósiles como arqueológicos suele ser una tarea poco sencilla, lo cual conlleva generalmente un elevado costo y tiempos prolongados. Por otra parte, la formación de un laboratorio con las características necesarias para la realización de protocolos ya establecidos es sumamente costosa. En este trabajo se presenta un protocolo alternativo para la obtención de cortes delgados de muestras óseas humanas de sitios arqueológicos con el objetivo de aplicarlo al análisis microestructural. Los procedimientos de obtención de cortes delgados que aquí se detallan están al alcance de laboratorios de reciente formación. En primer lugar, se midió y se registró con imágenes digitales un fémur, una tibia y una primera costilla de un individuo adulto procedente de un cementerio contemporáneo. Luego se extrajeron fragmentos de 1 cm de hueso. Con el material se confeccionaron réplicas y por último se obtuvieron los cortes delgados. Los resultados obtenidos fueron óptimos para la observación de las características microestructurales del hueso. Con los ajustes adecuados (tiempo de fraguado, granulometría del abrasivo de acuerdo a la dureza del material, impregnación, etc.) este protocolo podría ser utilizado para diversos tipos de muestras actuales, arqueológicas e incluso fósiles.Making thin sections from fossil and archaeological materials is usually a highly time consuming and expensive task. Also, the creation of a laboratory with necessary characteristics for the development of established protocols is also expensive. This paper presents an alternative protocol for obtaining thin sections of human bone samples from archaeological sites with the aim of applying it to microstructural analysis. The procedures for obtaining thin cuts that are detailed here are within the reach of newly formed laboratories. In the first place a femur, a tibia and a first rib n adult individual from a contemporary cemetery was measured and recorded with digital images. Fragments of 1 cm of bone were them extracted. Molds and casts of the extracted samples were prepared before thin section preparation. The obtained results were optimal for the observation of the microstructural bone features. With the appropriate modifications (set time, abrasive grading according to the hardness of the material, impregnation, etc.) this protocol could be useful for several kinds of samples (extant, archaeological and even fossil ones).Fil: Navarro, Tamara Giselle. Universidad Nacional de Rosario. Facultad de Ciencias exactas, Ingeniería y Agrimensura. Museo "Florentino y Carlos Ameghino"; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Patagonia Norte. Instituto de Investigación en Paleobiología y Geología; ArgentinaFil: Janello, Marcos. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Mendoza. Instituto Argentino de Nivología, Glaciología y Ciencias Ambientales. Museo de Historia Natural de San Rafael - Ianigla | Provincia de Mendoza. Instituto Argentino de Nivología, Glaciología y Ciencias Ambientales. Museo de Historia Natural de San Rafael - Ianigla | Universidad Nacional de Cuyo. Instituto Argentino de Nivología, Glaciología y Ciencias Ambientales. Museo de Historia Natural de San Rafael - Ianigla; ArgentinaFil: Cerda, Ignacio Alejandro. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Mendoza. Instituto Argentino de Nivología, Glaciología y Ciencias Ambientales. Museo de Historia Natural de San Rafael - Ianigla | Provincia de Mendoza. Instituto Argentino de Nivología, Glaciología y Ciencias Ambientales. Museo de Historia Natural de San Rafael - Ianigla | Universidad Nacional de Cuyo. Instituto Argentino de Nivología, Glaciología y Ciencias Ambientales. Museo de Historia Natural de San Rafael - Ianigla; Argentina. Universidad Nacional de Río Negro. Sede Alto Valle. Instituto de Investigaciones en Paleobiología y Geología; Argentina. Universidad Nacional de Rosario. Facultad de Ciencias exactas, Ingeniería y Agrimensura. Museo "Florentino y Carlos Ameghino"; ArgentinaFil: Beguelin, Marien. Universidad Nacional de Río Negro. Sede Alto Valle. Instituto de Investigaciones en Paleobiología y Geología; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Patagonia Norte; ArgentinaFil: Vazquez, Romina Clara. Universidad Nacional de Río Negro. Sede Alto Valle. Instituto de Investigaciones en Paleobiología y Geología; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Patagonia Norte; Argentin

Spatial structure and temporal dynamics of the human occupation of Neuquén (Argentinian Patagonia) during the late Pleistocene-Holocene

Se generó una base de datos conformada por 184 fechados georeferenciados procedentes de sitios arqueológicos de la provincia del Neuquén. Doce de estos fechados -realizados a partir de restos óseos humanos y faunísticos- son originales y corresponden, algunos de ellos, a áreas geográficas para las que aún no se contaba con datos. Se efectuaron análisis cuantitativos temporo-espaciales. Los resultados obtenidos sobre la base de datos cronológicos y geográficos permiten caracterizar el proceso de ocupación humana de Neuquén como temprano, mayormente continuo a lo largo del tiempo y espacialmente discontinuo. La profundidad temporal del poblamiento alcanza ca. 12.000 años calibrados AP y la ocupación del espacio se incrementa significativamente hacia el Holoceno tardío. La distribución espacial de los sitios es discontinua y muestra concentraciones en áreas particulares cercanas a los cursos de agua permanente, mayoritariamente peri-cordilleranas, en tanto que en los espacios intermedios -las amplias planicies del este- no se registró una señal arqueológica marcada.A database was generated consisting of 184 georeferenced dates from archaeological sites in Neuquén Province. Twelve of these dates −taken from human and faunal bone remains− are original, and some correspond to geographical areas for which data were not previously available. Quantitative spatial-temporal analyzes were carried out. The results obtained on the basis of chronological and geographical data allow Neuquén’s human occupation process to be characterized as early, mostly continuous over time, and spatially discontinuous. The temporal depth of the settlement reaches ca. 12,000 years BP calibrated, with spacial occupation increasing significantly towards the late Holocene. The spatial distribution of the sites is discontinuous and shows concentrations in particular areas near the permanent water courses, mostly near the Andes, while in the intermediate spaces −the wide plains of the east− a marked archaeological signal was not recorded.Fil: Gordón, Florencia. Universidad Nacional de La Plata. Facultad de Ciencias Naturales y Museo. División Antropología; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata; ArgentinaFil: Beguelin, Marien. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Patagonia Norte. Instituto de Investigación en Paleobiología y Geología; ArgentinaFil: Rindel, Diego Damián. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Secretaría de Cultura de la Nación. Dirección Nacional de Cultura y Museos. Instituto Nacional de Antropología y Pensamiento Latinoamericano; ArgentinaFil: Della Negra, Claudia Eugenia. No especifíca;Fil: Hajduk, Adam. Administración de Parques Nacionales. Museo de la Patagonia "Francisco Perito Moreno"; ArgentinaFil: Vazquez, Romina Clara. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Patagonia Norte. Instituto de Investigación en Paleobiología y Geología; ArgentinaFil: Cobos, Virginia Agustina. Universidad Nacional de La Plata. Facultad de Ciencias Naturales y Museo. Departamento Científico de Antropología; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata; ArgentinaFil: Perez, Sergio Ivan. Universidad Nacional de La Plata. Facultad de Ciencias Naturales y Museo. Departamento Científico de Antropología; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata; ArgentinaFil: Bernal, Valeria. Universidad Nacional de La Plata. Facultad de Ciencias Naturales y Museo. Departamento Científico de Antropología; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata; Argentin

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

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

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

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

Tafonomía y preservación diferencial de restos óseos humanos del norte de la provincia del Neuquén (República Argentina)

In this study we analyze taphonomic effects in two samples of human burials from archaeological sites: Aquihuecó and Hermanos Lazcano, placed in the Department of Chos Malal, Neuquén Province. The sites are close to each other (20 km.) and have similar age (early late Holocene, >3.500 BP). Even when both samples were deposited in similar environmental conditions, have similar ages and show similar burial practices, the bones preservation is markedly different. In order to understand this differential preservation, we evaluated the taphonomic signatures of bones and soil chemistry variables of both sites. Our results show that soil chemistry is adequate for a good preservation of bones in both sites. Aquihuecó sample has abundant calcium carbonate deposits on the bones. We interpret that the high content of calcium carbonate is probably responsible for the good preservation of Aquihuecó sample. More work is needed to improve the knowledge about the role of calcium carbonate in the preservation of human bones in burial contexts.Se presentan los resultados de los análisis tafonómicos realizados a dos conjuntos de restos óseos humanos de los sitios arqueológicos Aquihuecó y Hermanos Lazcano (departamento Chos Malal, provincia del Neuquén). Ambos se caracterizan por su similitud cronológica (comienzos del Holoceno tardío >3.500 años), posición geográfica y material asociado, pero el estado de preservación resulta desigual. Aquihuecó presenta un conjunto muy bien preservado con ejemplares óseos escasamente fragmentados. De forma contraria, Hermanos Lazcano se caracteriza por numerosos elementos óseos fragmentados. A los efectos de explicar esta preservación diferencial se realizó el análisis tafonómico y geoquímico en ambos sitios. Los resultados indicaron la presencia de una matriz sedimentaria favorable para la preservación de restos óseos para ambos sitios. A nivel tafonómico se registró un alto contenido de carbonato de calcio sobre los restos de Aquihuecó. Interpretamos que los depósitos de carbonato cálcico son responsables de su mejor estado de preservación, mientras que en Hermanos Lazcano la disolución ósea es el principal proceso de deterioro. Se destaca la necesidad de profundizar el rol del carbonato de calcio en la preservación ósea como también en los análisis geoquímicos y geoambientales a los efectos de aportar nuevas explicaciones a la historia tafonómica de los individuos