The Magdalenian (∼23.5–∼13.5 kBP) is one of the two major technocomplexes identified in Europe during the late Upper Palaeolithic and is notable for its complex worked bone and lithic industries, and ...both artistic and ritualistic behaviours. Magdalenian funerary behaviours, however, remain enigmatic, with human assemblages often represented by scattered and fragmented remains showing evidence of post-mortem manipulation that has been associated with cannibalism. To best clarify any patterns of funerary behaviour during the Magdalenian, an exhaustive literature review was performed to identify Magdalenian sites that have delivered human remains. Of the 59 sites identified, it was possible to ascertain funerary behaviour at 25 sites, with 10 deposits attributed to primary burial, 13 showing evidence of anthropic modification indicative of cannibalism, and two sites combining both behaviours. Given the similarities of the anthropic modifications observed on the cutmarked and cannibalised human remains across sites, the high frequency and geographic distribution of this practice, and the association, in some of the sites, of cannibalism with the ritualistic manipulation of human remains, it is proposed that cannibalism during the Magdalenian was practiced as a form of funerary behaviour rather than for necessity or as gastronomic cannibalism. Funerary cannibalism appears in greater abundance during the Middle Magdalenian whilst primary burials are more common during the Upper and terminal Magdalenian. Further, although genetic data are limited, we identify a relationship between funerary behaviour and genetic ancestry, with all cannibalised individuals showing ancestry associated with the GoyetQ2 cluster, indicative of Magdalenian human groups, whilst sequenced individuals found in a primary burial context show a genetic affinity with the Epigravettian (Villabruna associated ancestry), the other major technocomplex of the period. We hypothesise that cannibalism is a funerary behaviour indicative of GoyetQ2 associated Magdalenian populations, and that differences in funerary behaviours during the Magdalenian reflect distinct genetic ancestries indicative of known population movements during the terminal Upper Palaeolithic. This interpretation must be tempered however given that limited taphonomic or genetic study has been performed at the majority of Magdalenian sites, and thus to fully clarify the funerary behaviours of Magdalenian groups additional focus on understudied Magdalenian assemblages needs to be established.
•Primary burial and funerary cannibalism are identified as the mortuary practices of the Magdalenian Upper Palaeolithic culture.•It is proposed that funerary cannibalism was a widespread funerary behaviour of the culture, given its recurrent appearance across sites and close association with the ritualistic manipulation of human remains with the shaping of skull-cups and engravings.•An association between funerary behaviour and genetic ancestry is identified, with individuals showing GoyetQ2 ancestry (associated with the Magdalenian) found solely in a funerary cannibalism context, and those carrying a Villabruna ancestry component (associated with the Epigravettian) found in a primary burial context.•When considered alongside prior studies that have identified widespread replacement of Magdalenian groups by Epigravettian groups during the late Upper Palaeolithic, results intimate that the shift from cannibalism to primary burial behaviour may be further indication of widespread population turnover in late Upper Palaeolithic Europe.•Further taphonomic and genetic study on as yet unstudied Magdalenian and Epigravettian human skeletal assemblages is required to fully clarify these relationships.
The inference of biological relations between individuals is fundamental to understanding past human societies. Caregiving, resource sharing and sexual behaviours are often mediated by biological ...kinship and yet the identification and interpretation of kin relationships in prehistoric human groups is difficult. In recent years, the advent of archaeogenetic techniques have offered a fresh approach, and when combined with more traditional osteological and interpretive archaeological methods, allows for improved interpretation of the burial practices, cultural behaviours, and societal stratification in ancient societies. Although archaeogenetic techniques are developing at pace, questions remain as to their accuracy, particularly when applied to the low coverage datasets that results from the sequencing of DNA derived from highly degraded ancient material.
The performance of six of the most commonly used kinship identifcation software methods was explored at a range of low and ultra low genome coverages. An asymmetrical response was observed across packages, with decreased genome coverage resulting in differences in both direction and degree of change of calculated kinship scores and thus pairwise relatedness estimates are dependant on both package used and genome coverage. Methods reliant upon genotype likelihoods methods (lcMLkin, NGSrelate and NGSremix) show a decreased level of prediction at coverage below 1x, although were consistent in the particular relationships identified at these coverages when compared to the pseudohaploid reliant methods tested (READ, the Kennett 2017 method and TKGWV2.0). The three pseudohaploid methods show predictive potential at coverages as low as 0.05x, although the accuracy of the relationships identified is questionable given the increase in the number of relationships identifIed at the low coverage (type I errors).
Two pseudohaploid methods (READ and Kennett 2017) show relatively consistent inference of kin relationships at low coverage (0.5x), with READ only showing a significant performance drop off at ultralow coverages (< 0.2x). More generally, our results reveal asymmetrical kinship classifications in some software packages even at high coverages, highlighting the importance of applying multiple methods to authenticate kin relationships in ancient material, along with the continuing need to develop laboratory methods that maximise data output for downstream analyses.
Background. Previous studies have suggested that asymptomatic carriers of toxigenic Clostridium difficile are a source of hospital-associated (HA) infections. Multilocus variable number of tandem ...repeats analysis (MLVA) is a highly discriminatory molecular subtyping tool that helps to determine possible transmission sources. Methods. Clostridium difficile isolates were recovered from perirectal swabs collected for vancomycin-resistant Enterococcus (VRE) surveillance as well as from clinical C. difficile toxin–positive stool samples from July to November 2009 at the University of Pittsburgh Medical Center Presbyterian (UPMC). MLVA was performed to determine the genetic relationships between isolates from asymptomatic carriers and patients with HA C. difficile infection (HA-CDI). Asymptomatic carriage and HA-CDI isolates were considered to be associated if the carriage isolate was collected before the HA-CDI isolate and if the MLVA genotypes had a summed tandem-repeat difference of ≤2. Results. Of 3006 patients screened, 314 (10.4%) were positive for toxigenic C. difficile, of whom 226 (7.5%) were detected only by VRE surveillance cultures. Of 56 incident cases of CDI classified as HA at UPMC during the study with available isolates, 17 (30%) cases were associated with CDI patients, whereas 16 (29%) cases were associated with carriers. Transmission events from prior bed occupants with CDI (n = 2) or carriers (n = 2) were identified in 4 of 56 cases. Conclusions. In our hospital with an established infection control program designed to contain transmission from symptomatic CDI patients, asymptomatic carriers appear to have played an important role in transmission. Identification and isolation of carriers may be necessary to further reduce transmission of C. difficile in such settings.
Increased incidence of infections due to Klebsiella pneumoniae carbapenemase (KPC)-producing Klebsiella pneumoniae (KPC-Kp) was noted among patients undergoing endoscopic retrograde ...cholangiopancreatography (ERCP) at a single hospital. An epidemiologic investigation identified KPC-Kp and non-KPC-producing, extended-spectrum β-lactamase (ESBL)-producing Kp in cultures from 2 endoscopes. Genotyping was performed on patient and endoscope isolates to characterize the microbial genomics of the outbreak. Genetic similarity of 51 Kp isolates from 37 patients and 3 endoscopes was assessed by pulsed-field gel electrophoresis (PFGE) and multi-locus sequence typing (MLST). Five patient and 2 endoscope isolates underwent whole genome sequencing (WGS). Two KPC-encoding plasmids were characterized by single molecule, real-time sequencing. Plasmid diversity was assessed by endonuclease digestion. Genomic and epidemiologic data were used in conjunction to investigate the outbreak source. Two clusters of Kp patient isolates were genetically related to endoscope isolates by PFGE. A subset of patient isolates were collected post-ERCP, suggesting ERCP endoscopes as a possible source. A phylogeny of 7 Kp genomes from patient and endoscope isolates supported ERCP as a potential source of transmission. Differences in gene content defined 5 ST258 subclades and identified 2 of the subclades as outbreak-associated. A novel KPC-encoding plasmid, pKp28 helped define and track one endoscope-associated ST258 subclade. WGS demonstrated high genetic relatedness of patient and ERCP endoscope isolates suggesting ERCP-associated transmission of ST258 KPC-Kp. Gene and plasmid content discriminated the outbreak from endemic ST258 populations and assisted with the molecular epidemiologic investigation of an extended KPC-Kp outbreak.
Abstract Background The goal of this systematic literature review was to enhance understanding of substance use, service use, and treatment among Latino subgroups to improve access to care and ...treatment outcomes in an era of health care reform. Methods The authors used 13 electronic databases and manually searched the literature from January 1, 1978, to May 30, 2013. One hundred (69%) of 145 primary research articles met the inclusion criteria. Two blinded, independent reviewers scored each article. Consensus discussions and a content expert reconciled discrepancies. Results Current rates of alcohol and substance abuse among Latinos are comparable to or surpass other U.S. ethnic groups. Disparities in access and quality of care are evident between Latinos and other ethnic groups. As a heterogeneous group, Latinos vary by geographic region in terms of substance of choice and their cultural identity takes precedence over general ethnic identity as a likely determinant of substance abuse behaviors. There is growing research interest in systems influencing treatment access and adherence among racial/ethnic and gender minority groups. However, studies on Latinos’ service use and immediate treatment outcomes have been both limited in number and inconsistent in findings. Conclusions This review identified human capital, quality of care, and access to culturally responsive care as key strategies to eliminate disparities in health and treatment quality. Implications are discussed, including the need for effectiveness studies on Latinos served by systems of care that, under health care reform, are seeking to maximize resources, improve outcomes, and reduce variation in quality of care.
Maximum individual body size in pseudosuchian archosaurs is not well constrained in the fossil record, but it may be influenced by a variety of factors including basal metabolic rate, evolutionary ...relationships, and environmental conditions. Body size varies among the Aetosauria in which estimated total length ranges between 1 m (e.g., Coahomasuchus kahleorum) and 5 m (e.g., Desmatosuchus spurensis). A new, very large specimen of the aetosaurian Typothorax coccinarum from Petrified Forest National Park in northeastern Arizona is nearly twice the size of all other known specimens of Typothorax and is the largest aetosaur specimen currently known worldwide. The specimen lacks co‐ossified neurocentral sutures in the trunk vertebrae which may suggest that the individual had not yet reached skeletal maturity, yet smaller specimens of T. coccinarum exhibit partially or fully co‐ossified neurocentral sutures in the same region. If body size correlates with skeletal maturity in aetosaurs, this discrepancy warns that timing of neurocentral suture co‐ossification in aetosaurs may not be a reliable indicator of ontogenetic stage. Osteohistological observations of a trunk rib demonstrate that although PEFO 42506 shows a large body size, the specimen did not deposit an external fundamental system despite depositing as many as 19 growth lines, further indicating that it had not yet reached skeletal maturity. Thus, at least within Aetosauria, neurocentral suture co‐ossification and skeletal maturity may correlate, whereas body size can be incongruent in comparison. Furthermore, this specimen indicates that non‐desmatosuchin aetosaurs could exhibit large body sizes and suggests that some aetosaurs may have experienced indeterminate growth.
Carbapenem-resistant
(CRKP) strains belonging to sequence type 258 (ST258) are frequent causes of hospital-associated outbreaks and are a major contributor to the spread of carbapenemases. This ...genetic lineage emerged several decades ago and remains a major global health care challenge. In this study, genomic epidemiology was used to investigate the emergence, evolution, and persistence of ST258 carbapenem-resistant
outbreak-causing lineages at a large tertiary care hospital over 8 years. A time-based phylogenetic analysis of 136 ST258 isolates demonstrated the succession of multiple genetically distinct ST258 sublineages over the 8-year period. Ongoing genomic surveillance identified the emergence and persistence of several distinct clonal ST258 populations. Patterns of multidrug resistance determinants and plasmid replicons were consistent with continued evolution and persistence of these populations. Five ST258 outbreaks were documented, including three that were caused by the same clonal lineage. Mutations in genes encoding effectors of biofilm production and iron acquisition were identified among persistent clones. Two emergent lineages bearing
integrative conjugative element 10 (ICE
) and harboring yersiniabactin and colibactin virulence factors were identified. The results show how distinct ST258 subpopulations have evolved and persisted within the same hospital over nearly a decade.
The carbapenem class of antibiotics is invaluable for the treatment of selected multidrug-resistant Gram-negative pathogens. The continued transmission of carbapenem-resistant bacteria such as ST258
is of serious global public health concern, as treatment options for these infections are limited. This genomic epidemiologic investigation traced the natural history of ST258
in a single health care setting over nearly a decade. We found that distinct ST258 subpopulations have caused both device-associated and ward-associated outbreaks, and some of these populations remain endemic within our hospital to the present day. The finding of virulence determinants among emergent ST258 clones supports the idea of convergent evolution of drug-resistant and virulent CRKP strains and highlights the need for continued surveillance, prevention, and control efforts to address emergent and evolving ST258 populations in the health care setting.
Background Identifying pregnancy-associated risk factors before the development of major cardiovascular disease events could provide opportunities for prevention. The objective of this study was to ...determine the association between outcomes in first pregnancies and subsequent cardiovascular health. Methods and Results The Nulliparous Pregnancy Outcomes Study Monitoring Mothers-to-be Heart Health Study is a prospective observational cohort that followed 4484 women 2 to 7 years (mean 3.2 years) after their first pregnancy. Adverse pregnancy outcomes (defined as hypertensive disorders of pregnancy, small-for-gestational-age birth, preterm birth, and stillbirth) were identified prospectively in 1017 of the women (22.7%) during this pregnancy. The primary outcome was incident hypertension (HTN). Women without adverse pregnancy outcomes served as controls. Risk ratios (RR) and 95% CIs were adjusted for age, smoking, body mass index, insurance type, and race/ethnicity at enrollment during pregnancy. The overall incidence of HTN was 5.4% (95% CI 4.7% to 6.1%). Women with adverse pregnancy outcomes had higher adjusted risk of HTN at follow-up compared with controls (RR 2.4, 95% CI 1.8-3.1). The association held for individual adverse pregnancy outcomes: any hypertensive disorders of pregnancy (RR 2.7, 95% CI 2.0-3.6), preeclampsia (RR 2.8, 95% CI 2.0-4.0), and preterm birth (RR 2.7, 95% CI 1.9-3.8). Women who had an indicated preterm birth and hypertensive disorders of pregnancy had the highest risk of HTN (RR 4.3, 95% CI 2.7-6.7). Conclusions Several pregnancy complications in the first pregnancy are associated with development of HTN 2 to 7 years later. Preventive care for women should include a detailed pregnancy history to aid in counseling about HTN risk. Clinical Trial Registration URL: http://www.clinicaltrials.gov Unique identifier: NCT02231398.
Background. Rifampin is used as adjunctive therapy for Clostridium difficile–associated disease, and the drug's derivative, rifaximin, has emerged as an attractive antimicrobial for treatment of C. ...difficile–associated disease. Rifampin resistance in C. difficile strains has been reported to be uncommon. Methods. We examined the prevalence of rifampin resistance among 470 C. difficile isolates (51.1% during 2001–2002 and 48.9% during 2005) from a large teaching hospital. Rifampin sensitivity was performed using E-test. The epidemic BI/NAP1 C. difficile clone was identified by tcdC genotyping and multilocus variable number of tandem repeats analysis. A 200–base pair fragment of the rpoB gene was sequenced for 102 isolates. Data on rifamycin exposures were obtained for all patients. Results. Rifampin resistance was observed in 173 (36.8%) of 470 recovered isolates and 167 (81.5%) of 205 of epidemic clone isolates (P<.001). Six rpoB genotypes were associated with rifampin resistance. Of 8 patients exposed to rifamycins, 7 had rifampin-resistant C. difficile, compared with 166 of 462 unexposed patients (relative risk, 2.4; 95% confidence interval, 1.8–3.3). Conclusions. Rifampin resistance is common among epidemic clone C. difficile isolates at our institution. Exposure to rifamycins before the development of C. difficile–associated disease was a risk factor for rifampin-resistant C. difficile infection. The use of rifaximin may be limited for treatment of C. difficile–associated disease at our institution.
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