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Aims: Transition of paediatric patients is challenging. This study aimed to assess the transition pathway for patients who underwent an ACE procedure as a child and to understand ongoing support requirements., Methods: A retrospective review was conducted of all patients on the Pelvic Floor Clinical Specialist Nurse's (PFCNS) database from a tertiary adult hospital. Patients receiving their ACE as an adult or patients who did not attend any outpatient appointments (OPAs) were excluded. Data was gathered on complications, additional procedures and outcomes., Results: Sixty-three patients met the inclusion criteria. The median age at referral to an appropriate team was 18 years but the median age of referral to the PFCNS was 23 years. Only 7(11 %) were referred to the PFCNS by Paediatric Services. Patients experienced a variety of problems including change in equipment (n = 38, 60 %), change in washout regime (n = 28, 44 %), ACE leakage (n = 15, 24 %), stenosis (n = 15, 24 %) and ineffective washouts (n = 11, 17 %). Of those where data was available, there was a median of 7 PFCNS and 2.5 Colorectal Consultant (CC) OPAs per patient. Surgical intervention was common including procedures to the ACE (n = 8, 13 %), excision of ACE (n = 5, 7.9 %) manual evacuation (n = 5, 7.9 %) and formation of a stoma (n = 1%). 35 (56 %) were still using their ACE with a median time since transition of 11 years., Conclusion: Patients with an ACE need considerable ongoing support yet few are appropriately transitioned. There needs to be a clear transition pathway for these patients to the PFCNS and if appropriate a CC., (Crown Copyright © 2024. Published by Elsevier Inc. All rights reserved.)

The Kimberley region of Western Australia is one of the largest and most diverse rock art provenances in the world, with a complex stylistic sequence spanning at least 16 ka, culminating in the modern art-making of the Wunumbal people. The Gunu Site Complex, in the remote Mitchell River region of the northwest Kimberley, is one of many local expressions of the Kimberley rock art sequence. Here we report excavations at two sites in this complex: Gunu Rock, a sand sheet adjacent to rock art panels; and Gunu Cave, a floor deposit within an extensive rockshelter. Excavations at Gunu Rock provide evidence for two phases of occupation, the first from 7-8 to 2.7 ka, and the second from 1064 cal BP. Excavations at Gunu Rock provide evidence for occupation from the end of the second phase to the recent past. Stone for tools in the early phase were procured from a variety of sources, but quartz crystal reduction dominated the second occupation phase. Small quartz crystals were reduced by freehand percussion to provide small flake tools and blanks for manufacturing small points called nguni by the Wunambal people today. Quartz crystals were prominent in historic ritual practices associated with the Wanjina belief system. Complex methods of making bifacially-thinned and pressure flaked quartzite projectile points emerged after 2.7 ka. Ochre pigments were common in both occupation phases, but evidence for occupation contemporaneous with the putative age of the oldest rock art styles was not discovered in the excavations. Our results show that developing a complete understanding of rock art production and local occupation patterns requires paired excavations inside and outside of the rockshelters that dominate the Kimberley., Competing Interests: The authors have the following interests: The Kandiwal Aboriginal Corporation, an incorporated body encompassing members of the Kandiwal community (about 45 people) provided support during field work and knowledge about sites in their country, under a research agreement with the ARC (as a Linkage Partner). Slingair and Heliwork Pty Ltd provided a discount on air travel across the northwest Kimberley under a research agreement with the ARC (as a Linkage Partner). There are no patents, products in development or marketed products to declare. This does not alter our adherence to all the PLoS One policies on sharing data and materials, as detailed online in the guide for authors.

[This corrects the article DOI: 10.1371/journal.pone.0193025.].

This paper presents a reassessment of the archaeological record at Leang Burung 2, a key early human occupation site in the Late Pleistocene of Southeast Asia. Excavated originally by Ian Glover in 1975, this limestone rock-shelter in the Maros karsts of Sulawesi, Indonesia, has long held significance in our understanding of early human dispersals into 'Wallacea', the vast zone of oceanic islands between continental Asia and Australia. We present new stratigraphic information and dating evidence from Leang Burung 2 collected during the course of our excavations at this site in 2007 and 2011-13. Our findings suggest that the classic Late Pleistocene modern human occupation sequence identified previously at Leang Burung 2, and proposed to span around 31,000 to 19,000 conventional 14C years BP (~35-24 ka cal BP), may actually represent an amalgam of reworked archaeological materials. Sources for cultural materials of mixed ages comprise breccias from the rear wall of the rock-shelter-remnants of older, eroded deposits dated to 35-23 ka cal BP-and cultural remains of early Holocene antiquity. Below the upper levels affected by the mass loss of Late Pleistocene deposits, our deep-trench excavations uncovered evidence for an earlier hominin presence at the site. These findings include fossils of now-extinct proboscideans and other 'megafauna' in stratified context, as well as a cobble-based stone artifact technology comparable to that produced by late Middle Pleistocene hominins elsewhere on Sulawesi.

Wallacea, the zone of oceanic islands separating the continental regions of Southeast Asia and Australia, has yielded sparse evidence for the symbolic culture of early modern humans. Here we report evidence for symbolic activity 30,000-22,000 y ago at Leang Bulu Bettue, a cave and rock-shelter site on the Wallacean island of Sulawesi. We describe hitherto undocumented practices of personal ornamentation and portable art, alongside evidence for pigment processing and use in deposits that are the same age as dated rock art in the surrounding karst region. Previously, assemblages of multiple and diverse types of Pleistocene "symbolic" artifacts were entirely unknown from this region. The Leang Bulu Bettue assemblage provides insight into the complexity and diversification of modern human culture during a key period in the global dispersal of our species. It also shows that early inhabitants of Sulawesi fashioned ornaments from body parts of endemic animals, suggesting modern humans integrated exotic faunas and other novel resources into their symbolic world as they colonized the biogeographically unique regions southeast of continental Eurasia., Competing Interests: The authors declare no conflict of interest.

Background: To identify the emotional, social and psychological consequences and recovery process of anal incontinence (AI) following obstetric anal sphincter injuries (OASIS) and explore if this can be identified as a recognisable syndrome with visual representation., Methods: A qualitative approach was adopted for this study. Data derived from case studies (n = 81) and interviews (n = 14) with women with AI after OASIS was used to identify the emotional, social and psychological consequences of AI after OASIS. Keywords and synonyms were extracted and the power of these statements displayed as a 'word picture'. The validity and authenticity of the word picture was then assessed by: a questionnaire sent to a group of mothers who had experienced this condition (n = 16); a focus group attended by mothers (n = 14) and supported by health professionals (n = 6) and via interviews with health professionals (n = 12) who were involved with helping mothers with AI following OASIS., Results: Women with AI resulting from OASIS have a specific syndrome - the 'OASIS Syndrome' - which we have uniquely visualised as a 'word picture'. They feel unclean which results in dignity loss, psychosexual morbidity, isolation, embarrassment, guilt, fear, grief, feeling low, anxiety, loss of confidence, a feeling of having been mutilated and a compromised role as a mother. Coping relies on repetitive washing (which may become a ritual), planning daily activities around toiletry needs, sharing, family support, employment if possible and attention to the baby. Recovery and healing is through care of the child and hope generated by love within the family., Conclusions: This study has identified a previously unrecognised 'OASIS Syndrome' and, by way of a new and unique 'word picture', revealed a hidden condition. There should be greater awareness by the public and profession about the 'OASIS Syndrome' and a mechanism for early identification of the condition and referral for management. This, if successful, would overcome the barrier of silence which surrounds this currently unspoken taboo.

Stone-flaking technology is the most enduring evidence for the evolving cognitive abilities of our early ancestors. Flake-making was mastered by African hominins ~3.3 ma, followed by the appearance of handaxes ~1.75 ma and complex stone reduction strategies by ~1.6 ma. Handaxes are stones flaked on two opposed faces ('bifacially'), creating a robust, sharp-edged tool, and complex reduction strategies are reflected in strategic prior flaking to prepare or 'predetermine' the nature of a later flake removal that served as a tool blank. These technologies are interpreted as major milestones in hominin evolution that reflect the development of higher-order cognitive abilities, and the presence and nature of these technologies are used to track movements of early hominin species or 'cultures' in the archaeological record. However, the warranting argument that certain variations in stone tool morphologies are caused by differences in cognitive abilities relies on analogy with technical replications by skilled modern stoneworkers, and this raises the possibility that researchers are projecting modern approaches to technical problems onto our non-modern hominin ancestors. Here we present the results of novel experiments that randomise flake removal and disrupt the modern stoneworker's inclination to use higher-order reasoning to guide the stone reduction process. Although our protocols prevented goal-directed replication of stone tool types, the experimental assemblage is morphologically standardised and includes handaxe-like 'protobifaces' and cores with apparently 'predetermined' flake removals. This shows that the geometrical constraints of fracture mechanics can give rise to what appear to be highly-designed stoneworking products and techniques when multiple flakes are removed randomly from a stone core.

A trephined stoma allows a quick postoperative recovery when a concomitant laparotomy is not necessary. However, both colostomies and ileostomies are associated with a significant short- and long-term complication rate. Review of 25 conventional trephine colostomies showed a complication rate of 20% over 5 years (three hernias and three prolapses in five patients). A laparoscopically assisted method for trephine stoma formation is described that overcomes the disadvantages of the conventional trephine technique; namely the tendency to enlarge the trephine to mobilize the mesentery, leading to prolapse; tension on an inadequately mobilized mesentery, leading to retraction; and difficulties in the orientation of an end stoma. This method was used to fashion six colostomies and one ileostomy with no complications. There was a shorter convalescence and initial stoma care was easier. This procedure is preferred for temporary or permanent stoma formation when a laparotomy is not necessary because it allows a precise trephine mobilization of the mesentery and confirmation of orientation of the bowel.