Search

The archaeological record of Africa provides the earliest evidence for the emergence of the complex symbolic and technological behaviours that characterize Homo sapiens1–7. The coastal setting of many archaeological sites of the Late Pleistocene epoch, and the abundant shellfish remains recovered from them, has led to a dominant narrative in which modern human origins in southern Africa are intrinsically tied to the coast and marine resources8–12, and behavioural innovations in the interior lag behind. However, stratified Late Pleistocene sites with good preservation and robust chronologies are rare in the interior of southern Africa, and the coastal hypothesis therefore remains untested. Here we show that early human innovations that are similar to those dated to around 105 thousand years ago (ka) in coastal southern Africa existed at around the same time among humans who lived over 600 km inland. We report evidence for the intentional collection of non-utilitarian objects (calcite crystals) and ostrich eggshell from excavations of a stratified rockshelter deposit in the southern Kalahari Basin, which we date by optically stimulated luminescence to around 105 ka. Uranium–thorium dating of relict tufa deposits indicates sporadic periods of substantial volumes of fresh, flowing water; the oldest of these episodes is dated to between 110 and 100 ka and is coeval with the archaeological deposit. Our results suggest that behavioural innovations among humans in the interior of southern Africa did not lag behind those of populations near the coast, and that these innovations may have developed within a wet savannah environment. Models that tie the emergence of behavioural innovations to the exploitation of coastal resources by our species may therefore require revision. Human populations in the southern Africa interior were collecting non-utilitarian objects at around 105,000 years ago, suggesting that the development of this innovative behaviour did not depend on exploiting coastal resources.

Background: Despite advances in medical care, pediatric deaths are still an unfortunate reality. Most of these deaths occur within a hospital setting. End-of-life care is an important part of medical care for children with serious illnesses. Despite the importance, pediatric providers report a lack of comfort surrounding end-of-life care. Objective: To assess categorical pediatric residents’ perceptions and participation in providing end-of-life care to dying children and their families. Study Design: This is a survey-based, descriptive, mixed-methods study. Survey was sent to categorical pediatric residents at Indiana University School of Medicine in June 2018 to obtain both quantitative and qualitative information on resident perception and participation in end-of-life care. Surveys were sent to 100 residents with a response rate of 68%. Setting/Participants: Pediatric residents at Indiana University School of Medicine. Results: The comfort and participation in end-of-life care are limited in all levels of pediatric training. Residents do not feel comfortable with 19 of 22 questions related to end-of-life care. Only 32% of residents felt their education prepared them to participate in end-of-life care. Almost one-fifth (19.5%) of residents report participating in zero aspect of end-of-life care. Themes discussed by residents include education, experience, communication, social norms, emotions, self-care, comfort, and family. Conclusion: More formalized education and training is needed to increase resident comfort with and participation in end-of-life care. Such future interventions should focus on communication surrounding difficult conversations and providing guidance for families.

Over the last few decades, investigations of the southern African Late Pleistocene archeological record have transformed our understanding of Homo sapiens origins and evolution. However, the intensity of research on coastal and near-coastal records has surpassed that in the deep interior. One reason for the geographic bias is the rarity of well-preserved, datable rockshelter sites outside the more mountainous and karstic regions of South Africa. Here, we report stratified Middle Stone Age and Later Stone Age deposits at Ga-Mohana Hill North Rockshelter (GHN), near Kuruman, in the Northern Cape, South Africa. Contrary to a previous report, we show that the archeological deposits are in good context with minimal disturbance based on a detailed fabric analysis of plotted finds. Three dating methods, single-grain optically stimulated luminescence, radiocarbon, and uranium-thorium, indicate that the artifact-bearing deposits date to ~ 105 ka, ~ 31 ka, and ~ 15 ka. Thus, Ga-Mohana Hill North Rockshelter provides an important opportunity to investigate early human adaptation in this semiarid region of southern Africa.

Introduction: Pancreatic cancer (PC) has a dismal prognosis, with identified disparities in survival outcomes based on demographic characteristics. These disparities may be ameliorated by equitable access to treatments and health services. This systematic review identifies patient and service-level characteristics associated with PC health service utilisation (HSU). Methods: Medline, Embase, CINAHL, PsycINFO and Scopus were systematically searched between 1(st) January, 2010 and 17 May, 2021 for population-based, PC studies which conducted univariable and/or multivariable regression analyses to identify patient and/or service-level characteristics associated with use of a treatment or health service. Direction of effect sizes were reported in an aggregate manner. Results: Sixty-two eligible studies were identified. Most (48/62) explored the predictors of surgery (n=25) and chemotherapy (n=23), and in populations predominantly based in the United States of America (n=50). Decreased HSU was observed among people belonging to older age groups, non-Caucasian ethnicities, lower socioeconomic status (SES) and lower education status. Non-metropolitan location of residence predicted decreased use of certain treatments, and was associated with reduced hospitalisations. People with comorbidities were less likely to use treatments and services, including specialist consultations and palliative care but were more likely to be hospitalised. A more recent year of diagnosis/year of death was generally associated with increased HSU. Academically affiliated and high-volume centres predicted increased treatment use and hospital readmissions. Conclusion: Findings of this review may assist identification of vulnerable patient groups experiencing disparities in accessing and using treatments and therapies.

Ostrich eggshell (OES) beads from southern African archaeological contexts shed light on past traditions of personal ornamentation, and they are also argued to provide a proxy for understanding past social networks. However, OES beads are often understudied and not reported on in detail. In particular, there has been little research on OES bead variation during Marine Isotope Stage 2 (29,000–12,000 years ago) which includes the Last Glacial Maximum when changing climatic conditions are hypothesized to have significant impact on forager social networks. Here, we present the first technological analysis of terminal Pleistocene OES beads and fragments in the Kalahari from the ~15 ka levels at Ga-Mohana Hill North Rockshelter. We contextualise these findings through comparison with coeval OES bead assemblages across southern Africa during MIS 2. Results indicate that OES beads were manufactured at Ga-Mohana Hill North during the terminal Pleistocene occupation, based on the presence of most stages of bead manufacture. The review shows that OES beads were present across southern Africa through MIS 2, suggesting that culturing of the body was an embodied and persistent practice during that time. While the importance of OES beads as decorative objects was shared by populations across southern Africa, variation in bead diameters indicate that there was stylistic variation.

Whilst some of the diversity in management of women with ductal carcinoma in situ (DCIS) may be explained by tumour characteristics, the role of patient preference and the factors underlying those preferences have been less frequently examined. We have used a descriptive qualitative study to explore treatment decisions for a group of Australian women diagnosed with DCIS through mammographic screening. Semi-structured telephone interviews were performed with 16 women diagnosed with DCIS between January 2012 and December 2018, recruited through the LifePool dataset (a subset of BreastScreen participants who have agreed to participate in research). Content analysis using deductive coding identified three themes: participants did not have a clear understanding of their diagnosis or prognosis; reported involvement in decision making about management varied; specific factors including the psychosexual impact of mastectomy and perceptions of radiotherapy, could act as barriers or facilitators to specific decisions about treatment. The treatment the women received was not simply determined by the characteristics of their disease. Interaction with the managing clinician was pivotal, however many other factors played a part in individual decisions. Recognising that decisions are not purely a function of disease characteristics is important for both women with DCIS and the clinicians who care for them., Highlights • Factors other than the characteristics of the DCIS were involved in decisions about management. • There was a lack of understanding about diagnosis and prognosis. •There was inconsistent involvement by women in decision making about management. • Factors such as perception of mastectomy and radiotherapy could act as barriers or facilitators in decision making.

The archaeological record of Africa provides the earliest evidence for the emergence of the complex symbolic and technological behaviours that characterize Homo sapiens

The purpose of this study was to describe differences and identify education gaps in the perception of palliative care (PC) between neonatal care providers in a Level IV Neonatal intensive care unit. This is a descriptive survey mixed methods study. Email surveys were sent to social workers, pharmacists, dieticians, nurses, respiratory therapists, fellows and faculty in November of 2018. Total number of respondents was 181 with a response rate of 56%. Statistically significant differences between faculty and non-faculty were found in regards to benefits of early PC consults, need for automatic consults for certain diagnosis and the frequency of PC consults. The perception of PC differs greatly between faculty and non-faculty. Educational initiatives surrounding PC and communication along with instituting automatic consults for certain diagnosis could help bridge this difference in perception and educational gap.

Early archaeological evidence for symbolically-mediated behaviour, which is our ability to create and share coded information between and within groups, comes from the African Middle Stone Age. Nassarius kraussianus shell beads, discovered in the Late Pleistocene, Still Bay archaeological deposits at Blombos Cave, Western Cape, South Africa, are some of the worlds earliest personal ornaments and their discovery significantly pushed back the origins of complex human symbolling. Further analyses of these beads led to the hypothesis that stringing arrangements at Blombos Cave changed through time, with important implications for the development and maintenance of social norms and style in early human populations. This hypothesis was supported by qualitative comparisons of archaeological and experimental wear distributions. Here, we present the results of a quantitative approach, applying a modified edge damage distribution method and statistical modelling to published diagrams ( Vanhaeren et al. 2013 , Journal of Human Evolution 64, 500–517) of wear on N. kraussianus shell beads. Our results support the original findings that different beading arrangements result in different wear distributions, and that the wear distributions on Blombos Cave beads exhibit temporal variability. However, our results vary with respect to which stringing arrangements best match the archaeological samples. Furthermore, we conclude that a combination of multiple processes may best explain the archaeological wear distributions, a finding more congruent with a long and complicated life history of curated objects like beads. These findings add to a growing record of early human social behaviours, and contribute methodologically to use-wear analyses of personal ornaments recovered from the archaeological record.