Paget’s disease of bone (PDB) is a chronic skeletal disorder that can affect one or several bones in individuals older than 55 y of age. PDB-like changes have been reported in archaeological remains ...as old as Roman, although accurate diagnosis and natural history of the disease is lacking. Six skeletons from a collection of 130 excavated at Norton Priory in the North West of England, which dates to medieval times, show atypical and extensive pathological changes resembling contemporary PDB affecting as many as 75% of individual skeletons. Disease prevalence in the remaining collection is high, at least 16% of adults, with age at death estimations as low as 35 y. Despite these atypical features, paleoproteomic analysis identified sequestosome 1 (SQSTM1) or p62, a protein central to the pathological milieu of PDB, as one of the few noncollagenous human sequences preserved in skeletal samples. Targeted proteomic analysis detected >60% of the ancient p62 primary sequence, with Western blotting indicating p62 abnormalities, including in dentition. Direct sequencing of ancient DNA excluded contemporary PDB-associated SQSTM1 mutations. Our observations indicate that the ancient p62 protein is likely modified within its C-terminal ubiquitin-associated domain. Ancient miRNAs were remarkably preserved in an osteosarcoma from a skeleton with extensive disease, with miR-16 expression consistent with that reported in contemporary PDB-associated bone tumors. Our work displays the use of proteomics to inform diagnosis of ancient diseases such as atypical PDB, which has unusual features presumably potentiated by yet-unidentified environmental or genetic factors.
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Paget's disease of bone (PDB) is a chronic, metabolic disease disrupting normal bone turnover and is reported as one of the most common bone diseases after osteoporosis. PDB is characterised by ...excessive bone remodelling resulting in bone enlargement, fragility, deformity and additional complications. Typically, PDB affects one or a few bones of the axial skeleton and is commonly recorded in older individuals (over 55 years of age) affecting more males than females. Although PDB has been reported worldwide, there is a high concentration of reported cases in the UK, with a regional hotspot in the northwest of England. This study reviews an adult male (SK463) and female (SK750) with skeletal lesions of PDB from Poulton Chapel, Cheshire. Full macroscopic and radiographic analysis has identified the skeletal distribution of PDB, with up to 75% of both skeletons affected. SK463 presents noticeable anterior bowing to both tibiae, likely the result of PDB. AMS radiocarbon dating and stable isotope analysis performed on teeth samples confirmed that both individuals' dates were medieval, had a mixed/varied diet and were local to the northwest of England. This research adds to the emerging paleopathological literature on PDB, while providing additional support for the identification of a geographical hotspot observed in contemporary populations.
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Excavations at the medieval cemetery of Poulton Chapel, Cheshire, have uncovered over 900 articulated human skeletal remains, with numbers predicted to reach as high as 1500 as excavations continue. ...The demographics of this archaeological site is typical of a medieval rural assemblage. However, SK535 provides a glimpse into some of the traumatic aspects of medieval life. The excavation of SK535 revealed a middle‐aged adult male around 168 cm in stature. His position of burial was typical of Christian burials with an east‐west orientation, but the positioning of his arms identified that this was not a typical burial. His right arm was flexed at the elbow crossing the thorax, whereas the left arm was in the extended position. This is different from the other arm positions observed at Poulton Chapel. A metal object, identified here as a Type M7 bodkin arrowhead, was recovered from underneath the right arm, from within the thorax. This arrowhead was potentially armour piercing, and the type was commonly used during the 12th–13th century. Radiocarbon dates obtained for SK535 coincide with the time of the use of this arrowhead. Following the initial assessment, the only other instance of trauma identified in SK535 was a healed transverse fracture to the right distal ulna. Due to the location of Poulton Chapel in Cheshire, SK535 could have been wounded by an arrow carrying the M7 bodkin during English‐Welsh border skirmishes, which occurred frequently during this time period. The demographic profile of this individual indicates a possible professional fighter of the medieval period; however, no firm skeletal evidence of occupation could be provided. Nonetheless, this case study not only highlights the violence experienced during the medieval period but also indicates the ability for the survival of some traumas.
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An accurate assessment of an individual’s age at death is an important life history parameter in both archaeology and forensic anthropology. When working with non-adult archaeological skeletal ...remains, the most reliable methods for age at death estimations are derived from dental development studies (Ubelaker, 1999; Cardoso, 2006; AlQahtani et al., 2010). However, a common issue when working with archaeological material is the preservation and completeness of non-adult skeletal remains. This provides a means for researchers to evaluate the remaining crania and postcranial material in order to estimate age at death. Some consider the use of epiphyseal union and fusion of
Colleges and universities cannot ignore the increasingly diverse student population in their classrooms, and how a focus on equity, diversity, and inclusion across disciplines trains students in the ...intercultural awareness they will need in competitive job markets. Yet while faculty may be aware of a need to understand EDI goals in relationship to their disciplines, and institutions may support EDI in theory, the onus of pedagogical training in EDI often falls on individual faculty. This book was written by faculty and administrators for educators who value the goals of EDI, and seek an intellectual community to help them develop their practice. Important to this book is an honest discussion of common challenges faculty may face when they engage in this difficult work, and effective strategies for addressing those challenges. The chapters are grouped according to six different themes: respect for divergent learning styles; inclusion and exclusion; technology and social action; affective considerations; reflection for critical consciousness; and safe spaces and resistance. The chapters include: (1) Placing (dis)Ability Front and Center in EDI Studies (Hyun Uk Kim); (2) Not Just Accommodating: Pedagogy Beyond the Archetypical (Rory E. Kraft Jr. and Kevin Hermberg); (3) Teaching Indigenous Sovereignty in Multicultural America (Danica Sterud Miller); (4) The Paradox of Inclusion and Exclusion (Samira Y. Garcia, Tabitha L. McCoy, and Hoa N. Nguyen); (5) From Awareness to Action: Creating PSAs to Promote EDI (Stephanie Burrell Storms, Jay Rozgonyi, and Kathi Rainville); (6) Disturbing Voices: Literacy in the Archive and the Community (Betsy Bowen); (7) Awakening to Shame's Role in Privilege and Oppression (Kyle Forrest and Peter Thompson); (8) Know Thyself: Implicit Bias and Mindfulness (Paula Gill-Lopez); (9) Transforming Fear into Courage: EDI and Compassion-Based Learning (Josephine Pui-Hing Wong and Carla T. Hilario); (10) Tools for Raising a Critical Consciousness (Amy Bergstrom); (11) A Person-Centered Approach to Facilitate Students' Social Advocacy (Stephaney Morrison); (12) Anticipating Resistances and Leveraging a Response (Kim Barber); and (13) Curricular 'Safe Spaces': Clarifying Potential Misconceptions (Chris Adamo). Foreword by Betty Overton.
Objective To determine the effectiveness of intensive structured care to optimise blood pressure control based on individual absolute risk targets in primary care.Design Pragmatic multicentre ...randomised controlled trial.Setting General practices throughout Australia, except Northern Territory, 2009-11.Participants Of 2185 patients from 119 general practices who were eligible for drug treatment for hypertension according to national guidelines 416 (19.0%) achieved their individual blood pressure target during a 28 day run-in period of monotherapy. After exclusions, 1562 participants not at target blood pressure (systolic 150 (SD 17) mm Hg, diastolic 88 (SD 11) mm Hg) were randomised (1:2 ratio) to usual care (n=524) or the intervention (n=1038).Intervention Computer assisted clinical profiling and risk target setting (all participants) with intensified follow-up and stepwise drug titration (initial angiotensin receptor blocker monotherapy or two forms of combination therapy using angiotensin receptor blockers) for those randomised to the intervention. The control group received usual care.Main outcome measures The primary outcome was individual blood pressure target achieved at 26 weeks. Secondary outcomes were change in mean sitting systolic and diastolic blood pressure, absolute risk for cardiovascular disease within five years based on the Framingham risk score, and proportion and rate of adverse events.Results On an intention to treat basis, there was an 8.8% absolute difference in individual blood pressure target achieved at 26 weeks in favour of the intervention group compared with usual care group (358/988 (36.2%) v 138/504 (27.4%)): adjusted relative risk 1.28 (95% confidence interval 1.10 to 1.49, P=0.0013). There was also a 9.5% absolute difference in favour of the intervention group for achieving the classic blood pressure target of ≤140/90 mm Hg (627/988 (63.5%) v 272/504 (54.0%)): adjusted relative risk 1.18 (1.07 to 1.29, P<0.001). The intervention group achieved a mean adjusted reduction in systolic blood pressure of 13.2 mm Hg (95% confidence interval −12.3 to −14.2 mm Hg) and diastolic blood pressure of 7.7 mm Hg (−7.1 to −8.3 mm Hg) v 10.1 mm Hg (−8.8 to 11.3 mm Hg) and 5.5 mm Hg (−4.7 to −6.2 mm Hg) in the usual care group (P<0.001). Among 1141 participants in whom five year absolute cardiovascular risk scores were calculated from baseline to the 26 week follow-up, the reduction in risk scores was greater in the intervention group than usual care group (14.7% (SD 9.3%) to 10.9% (SD 8.0%); difference −3.7% (SD 4.5%) and 15.0% (SD 10.1%) to 12.4% (SD 9.4%); −2.6% (SD 4.5%): adjusted mean difference −1.13% (95% confidence interval −0.69% to −1.63%; P<0.001). Owing to adverse events 82 (7.9%) participants in the intervention group and 10 (1.9%) in the usual care group had their drug treatment modified.Conclusions In a primary care setting intensive structured care resulted in higher levels of blood pressure control, with clinically lower blood pressure and absolute risk of future cardiovascular events overall and with more people achieving their target blood pressure. An important gap in treatment remains though and applying intensive management and achieving currently advocated risk based blood pressure targets is challenging.
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OBJECTIVE:To examine protocol adherence to structured intensive management in the Valsartan Intensified Primary carE Reduction of Blood Pressure (VIPER-BP) study involving 119 primary care clinics ...and 1562 randomized participants.
METHODS:Prospective criteria for assessing adherence to treatment prescription, uptitration, and visit attendance at 6, 10, 14, and 18 weeks postrandomization were applied to 1038 intervention participants. Protocol adherence scores of 1–5 (least to most adherent) were compared to blood pressure (BP) control during 26 weeks of follow-up.
RESULTS:Mean age was 59.3 ± 12.0 years, 963 (62%) were men, and 1045 (67%) had longstanding hypertension. Clinic attendance dropped from 91 (week 6) to 83% (week 26) and pharmacological instructions were followed for 93% (baseline) to 61% at week 14 (uptitration failures commonly representing protocol deviations). Overall, 26-week BP levels and BP target attainment ranged from 132 ± 14/79 ± 9 and 51% to 141 ± 15/83 ± 11 mmHg and 19% in those participants subject to the highest (n = 270, 26%) versus least (n = 148, 14%) per protocol adherence, respectively; adjusted relative risk (RR) 1.22 per unit protocol adherence score, 95% confidence interval (CI) 1.15–1.31; for achieving BP target (P < 0.001). Participants with a per protocol score of 4 or 5 (512/1038, 49.3%) were 1.54-fold (95% CI 1.31–1.81; P < 0.001) more likely to achieve their individual BP target compared with usual care. Clinics equipped with a practice nurse significantly influenced protocol adherence (adjusted RR 1.20, 95% CI 1.06–1.37; P = 0.004) and individual BP control (RR 1.21, 95% CI 1.04–1.41; P = 0.015).
CONCLUSION:There is considerable potential for structured care management to improve BP control in primary care, especially when optimally applied.
The colonial legacy of herbaria Park, Daniel S; Feng, Xiao; Akiyama, Shinobu ...
Nature human behaviour,
07/2023, Volume:
7, Issue:
7
Journal Article
Peer reviewed
Open access
Herbarium collections shape our understanding of Earth's flora and are crucial for addressing global change issues. Their formation, however, is not free from sociopolitical issues of immediate ...relevance. Despite increasing efforts addressing issues of representation and colonialism in natural history collections, herbaria have received comparatively less attention. While it has been noted that the majority of plant specimens are housed in the Global North, the extent and magnitude of this disparity have not been quantified. Here we examine the colonial legacy of botanical collections, analysing 85,621,930 specimen records and assessing survey responses from 92 herbarium collections across 39 countries. We find an inverse relationship between where plant diversity exists in nature and where it is housed in herbaria. Such disparities persist across physical and digital realms despite overt colonialism ending over half a century ago. We emphasize the need for acknowledging the colonial history of herbarium collections and implementing a more equitable global paradigm for their collection, curation and use.
Background:
Blood pressure targets in individuals treated for hypertension in primary care remain difficult to attain.
Aims:
To assess the role of practice nurses in facilitating intensive and ...structured management to achieve ideal BP levels.
Methods:
We analysed outcome data from the Valsartan Intensified Primary carE Reduction of Blood Pressure Study. Patients were randomly allocated (2:1) to the study intervention or usual care. Within both groups, a practice nurse mediated the management of blood pressure for 439 patients with endpoint blood pressure data (n=1492). Patient management was categorised as: standard usual care (n=348, 23.3%); practice nurse-mediated usual care (n=156, 10.5%); standard intervention (n=705, 47.3%) and practice nurse-mediated intervention (n=283, 19.0%). Blood pressure goal attainment at 26-week follow-up was then compared.
Results:
Mean age was 59.3±12.0 years and 62% were men. Baseline blood pressure was similar in practice nurse-mediated (usual care or intervention) and standard care management patients (150 ± 16/88 ± 11 vs. 150 ± 17/89 ± 11 mmHg, respectively). Practice nurse-mediated patients had a stricter blood pressure goal of ⩽125/75 mmHg (33.7% vs. 27.3%, p=0.026). Practice nurse-mediated intervention patients achieved the greatest blood pressure falls and the highest level of blood pressure goal attainment (39.2%) compared with standard intervention (35.0%), practice nurse-mediated usual care (32.1%) and standard usual care (25.3%; p<0.001). Practice nurse-mediated intervention patients were almost two-fold more likely to achieve their blood pressure goal compared with standard usual care patients (adjusted odds ratio 1.92, 95% confidence interval 1.32 to 2.78; p=0.001).
Conclusion:
There is greater potential to achieve blood pressure targets in primary care with practice nurse-mediated hypertension management.
This study sought to identify the determinants of early blood pressure (BP) control associated with monotherapy in hypertensive individuals being managed in the primary care setting. The Valsartan ...Intensified Primary Care Reduction of Blood Pressure (VIPER‐BP) study, was a multicenter, randomized controlled trial of an intensive approach to BP management. During a standardized run‐in, 2185 participants commenced monotherapy (valsartan 80 mg/d) for 14 to 28 days. A total of 1978 participants aged 59±12 years (60% men) completed the run‐in phase. Of these, 15.1%, 43.5%, and 41.4% participants had an initial BP target of ≤125/75, 130/80, and 140/90 mm Hg, respectively. A total of 416 of 2185 participants (19.0%) subsequently achieved their individual BP target during run‐in with a mean BP change of −22.6±12.1/−12.9±8.2 mm Hg vs −4.2±16.2/−3.0±9.6 mm Hg for the rest (P<.001). These early responders were more likely to be women (adjusted odds ratio, 1.41; 95% confidence interval, 1.10–1.80), had lower BP at baseline, were less likely to have been treated previously (or for less time), and had a less stringent BP target. An initial period of monotherapy achieved BP control in a high proportion of hypertensive individuals with key groups (including women and de novo cases) more likely to show an early BP response.
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