| 1. |
- Khatri, C, et al.
(författare)
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Outcomes after perioperative SARS-CoV-2 infection in patients with proximal femoral fractures: an international cohort study
- 2021
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Ingår i: BMJ open. - : BMJ. - 2044-6055. ; 11:11, s. e050830-
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Tidskriftsartikel (refereegranskat)abstract
- Studies have demonstrated high rates of mortality in people with proximal femoral fracture and SARS-CoV-2, but there is limited published data on the factors that influence mortality for clinicians to make informed treatment decisions. This study aims to report the 30-day mortality associated with perioperative infection of patients undergoing surgery for proximal femoral fractures and to examine the factors that influence mortality in a multivariate analysis.SettingProspective, international, multicentre, observational cohort study.ParticipantsPatients undergoing any operation for a proximal femoral fracture from 1 February to 30 April 2020 and with perioperative SARS-CoV-2 infection (either 7 days prior or 30-day postoperative).Primary outcome30-day mortality. Multivariate modelling was performed to identify factors associated with 30-day mortality.ResultsThis study reports included 1063 patients from 174 hospitals in 19 countries. Overall 30-day mortality was 29.4% (313/1063). In an adjusted model, 30-day mortality was associated with male gender (OR 2.29, 95% CI 1.68 to 3.13, p<0.001), age >80 years (OR 1.60, 95% CI 1.1 to 2.31, p=0.013), preoperative diagnosis of dementia (OR 1.57, 95% CI 1.15 to 2.16, p=0.005), kidney disease (OR 1.73, 95% CI 1.18 to 2.55, p=0.005) and congestive heart failure (OR 1.62, 95% CI 1.06 to 2.48, p=0.025). Mortality at 30 days was lower in patients with a preoperative diagnosis of SARS-CoV-2 (OR 0.6, 95% CI 0.6 (0.42 to 0.85), p=0.004). There was no difference in mortality in patients with an increase to delay in surgery (p=0.220) or type of anaesthetic given (p=0.787).ConclusionsPatients undergoing surgery for a proximal femoral fracture with a perioperative infection of SARS-CoV-2 have a high rate of mortality. This study would support the need for providing these patients with individualised medical and anaesthetic care, including medical optimisation before theatre. Careful preoperative counselling is needed for those with a proximal femoral fracture and SARS-CoV-2, especially those in the highest risk groups.Trial registration numberNCT04323644
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| 2. |
- Dominguez-Rodrigo, M., et al.
(författare)
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Earliest Acheulian paleolandscape reveals a 1.7 million-year-old megasite at Olduvai Gorge (Tanzania)
- 2023
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Ingår i: Quaternary Science Reviews. - 0277-3791 .- 1873-457X. ; 316
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Tidskriftsartikel (refereegranskat)abstract
- FLK West (Bed II, Olduvai Gorge) contains the oldest association of Acheulian stone tools and exploitation of fauna (including megafauna) by hominins in the Pleistocene. Recently, the FLK West paleolandscape has been intensively studied, unveiling a spatial association between archaeological materials and hydrothermal resources. A new type of landscape use by hominins has also been documented around the area where the penecontemporaneous FLK West and HWK site complex were formed, resulting in an array of habitats spanning thousands of square meters covered with large amounts of lithic artefacts. Here, we show how the intensive use of certain environments by hominins resulted in these megasites, in which hominins engaged in a variety of activities, complementary to those performed at discrete archaeological clusters like FLK West. Despite using these habitats redundantly as quarries, hominins performed extensive core reduction of several types of raw materials indicating a dexterity and careful planning undocumented in earlier periods. Here, we also show how palaeoecological reconstructions must be based on fine-scale geological analyses, given the palimpsestic nature of both geological and anthropogenic processes. The research reported here also uncovered an additional unknown source of metamorphic rocks for hominins at Olduvai, which questions a large part of previous modeling based on hominin provisioning exclusively at Naibor Soit. We also show that the manufacture of handaxes was slightly older than documented at FLK West and that they occur in isolation on the landscape in addition to being clustered at sites. This implies that at the beginning of the Acheulian, hominins were not only using and discarding handaxes at specific loci, but they also transported these tools for various activities across the landscape as part of their strategized adaptation to those environments. The occurrence of these intensively-used megasites hints at some territorial behaviors by early Acheulian hominins.
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| 3. |
- Pizarro-Monzo, M., et al.
(författare)
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Determining the diagenetic paths of archaeofaunal assemblages and their palaeoecology through artificial intelligence : an application to Oldowan sites from Olduvai Gorge (Tanzania)
- 2022
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Ingår i: Journal of Quaternary Science. - : Wiley. - 0267-8179 .- 1099-1417. ; 37:3, s. 543-557
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Tidskriftsartikel (refereegranskat)abstract
- The implementation of deep-learning methods to the taphonomic analysis of the microscopic modification of bone-surface modifications exposed to different chemical diagenetic pathways can effectively discriminate between acidic and alkaline soil properties, indirectly reflecting different ecological conditions. Here we use this novel method to assess the sedimentary conditions of two of the oldest Oldowan archaeofaunal records (DS and PTK, Bed I) from Olduvai Gorge Bed I in Tanzania. We show how the results support different diagenetic conditions for both penecontemporaneous sites, which are appropriate for their respective locations on the palaeolandscape to which they belonged. We also show how geochemical analyses of the clay deposit that embedded both sites indicate a similar soil pH divergence. PTK was formed on an alluvial sloping surface affected by rills but draining efficiently, which resulted in alkaline soil conditions, that optimised bone-surface preservation. DS occurred in a more depressed area that underwent intermittent flooding, affecting soil chemistry by creating more acidic conditions. This impacted on bone surfaces by dynamically modifying mark morphology. This deep-learning approach has relevance for the interpretation of the local palaeoecological conditions of both assemblages and their respective depositional loci. The results presented here open a new window to the incremental information gain through the use of artificial intelligence methods in taphonomic and palaeoecological research.
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