Highly specific σ2R/TMEM97 ligand FEM-1689 alleviates neuropathic pain and inhibits the integrated stress response.

The sigma 2 receptor (σ2R) was described pharmacologically more than three decades ago, but its molecular identity remained obscure until recently when it was identified as transmembrane protein 97 (TMEM97). We and others have shown that σ2R/TMEM97 ligands alleviate mechanical hypersensitivity in mouse neuropathic pain models with a time course wherein maximal antinociceptive effect is approximately 24 h following dosing. We sought to understand this unique antineuropathic pain effect by addressing two key questions: do these σ2R/TMEM97 compounds act selectively via the receptor, and what is their downstream mechanism on nociceptive neurons? Using male and female conventional knockout mice for Tmem97, we find that a σ2R/TMEM97 binding compound, FEM-1689, requires the presence of the gene to produce antinociception in the spared nerve injury model in mice. Using primary mouse dorsal root ganglion neurons, we demonstrate that FEM-1689 inhibits the integrated stress response (ISR) and promotes neurite outgrowth via a σ2R/TMEM97-specific action. We extend the clinical translational value of these findings by showing that FEM-1689 reduces ISR and p-eIF2α levels in human sensory neurons and that it alleviates the pathogenic engagement of ISR by methylglyoxal. We also demonstrate that σ2R/TMEM97 is expressed in human nociceptors and satellite glial cells. These results validate σ2R/TMEM97 as a promising target for further development for the treatment of neuropathic pain.

Highly specific σ2R/TMEM97 ligand alleviates neuropathic pain and inhibits the integrated stress response.

The Sigma 2 receptor (σ2R) was described pharmacologically more than three decades ago, but its molecular identity remained obscure until recently when it was identified as transmembrane protein 97 (TMEM97). We and others have shown that σ2R/TMEM97 ligands alleviate mechanical hypersensitivity in mouse neuropathic pain models with a time course wherein maximal anti-nociceptive effect is approximately 24 hours following dosing. We sought to understand this unique anti-neuropathic pain effect by addressing two key questions: do these σ2R/TMEM97 compounds act selectively via the receptor, and what is their downstream mechanism on nociceptive neurons? Using male and female conventional knockout (KO) mice for Tmem97, we find that a new σ2R/TMEM97 binding compound, FEM-1689, requires the presence of the gene to produce anti-nociception in the spared nerve injury model in mice. Using primary mouse dorsal root ganglion (DRG) neurons, we demonstrate that FEM-1689 inhibits the integrated stress response (ISR) and promotes neurite outgrowth via a σ2R/TMEM97-specific action. We extend the clinical translational value of these findings by showing that FEM-1689 reduces ISR and p-eIF2α levels in human sensory neurons and that it alleviates the pathogenic engagement of ISR by methylglyoxal. We also demonstrate that σ2R/TMEM97 is expressed in human nociceptors and satellite glial cells. These results validate σ2R/TMEM97 as a promising target for further development for the treatment of neuropathic pain.

Essential anatomy for core clerkships: A clinical perspective.

Clerkships are defining experiences for medical students in which students integrate basic science knowledge with clinical information as they gain experience in diagnosing and treating patients in a variety of clinical settings. Among the basic sciences, there is broad agreement that anatomy is foundational for medical practice. Unfortunately, there are longstanding concerns that student knowledge of anatomy is below the expectations of clerkship directors and clinical faculty. Most allopathic medical schools require eight "core" clerkships: internal medicine (IM), pediatrics (PD), general surgery (GS), obstetrics and gynecology (OB), psychiatry (PS), family medicine (FM), neurology (NU), and emergency medicine (EM). A targeted needs assessment was conducted to determine the anatomy considered important for each core clerkship based on the perspective of clinicians teaching in those clerkships. A total of 525 clinical faculty were surveyed at 24 United States allopathic medical schools. Participants rated 97 anatomical structure groups across all body regions on a 1-4 Likert-type scale (1 = not important, 4 = essential). Non-parametric ANOVAs determined if differences existed between clerkships. Combining all responses, 91% of anatomical structure groups were classified as essential or more important. Clinicians in FM, EM, and GS rated anatomical structures in most body regions significantly higher than at least one other clerkship (p = 0.006). This study provides an evidence-base of anatomy content that should be considered important for each core clerkship and may assist in the development and/or revision of preclinical curricula to support the clinical training of medical students.

Diroximel fumarate acts through Nrf2 to attenuate methylglyoxal-induced nociception in mice and decreases ISR activation in DRG neurons.

Diabetic neuropathic pain is associated with elevated plasma levels of methylglyoxal (MGO). MGO is a metabolite of glycolysis that causes mechanical hypersensitivity in mice by inducing the integrated stress response (ISR), which is characterized by phosphorylation of eukaryotic initiation factor 2α (p-eIF2α). Nuclear factor erythroid 2-related factor 2 (Nrf2) is a transcription factor that regulates the expression of antioxidant proteins that neutralize MGO. We hypothesized that activating Nrf2 using diroximel fumarate (DRF) would alleviate MGO-induced pain hypersensitivity. We pretreated male and female C57BL/6 mice daily with oral DRF prior to intraplantar injection of MGO (20 ng). DRF (100 mg/kg) treated animals were protected from developing MGO-induced mechanical and cold hypersensitivity. Using Nrf2 knockout mice we demonstrate that Nrf2 is necessary for the anti-nociceptive effects of DRF. In cultured mouse and human dorsal root ganglion (DRG) sensory neurons, we found that MGO induced elevated levels of p-eIF2α. Co-treatment of MGO (1 µM) with monomethyl fumarate (MMF, 10, 20, 50 µM), the active metabolite of DRF, reduced p-eIF2α levels and prevented aberrant neurite outgrowth in human DRG neurons. Our data show that targeting the Nrf2 antioxidant system with DRF is a strategy to potentially alleviate pain associated with elevated MGO levels.

Social Media Guidelines for Anatomists.

Social Media has changed the way that individuals interact with each other - it has brought considerable benefits, yet also some challenges. Social media in anatomy has enabled anatomists all over the world to engage, interact and form new collaborations that otherwise would not have been possible. In a relatively small discipline where individuals may be working as the only anatomist in an institution, having such a virtual community can be important. Social media is also being used as a means for anatomists to communicate with the current generation of students as well as members of the public. Posting appropriate content is one of the challenges raised by social media use in anatomy. Human cadaveric material is frequently shared on social media and there is divided opinion among anatomists on whether or not such content is appropriate. This article explores the uses and challenges of social media use in the field of anatomy and outlines guidelines on how social media can be used by anatomists globally, while maintaining professional and ethical standards. Creating global guidelines has shown to be difficult due to the differences in international law for the use of human tissue and also the irregularities in acquiring informed consent for capturing and sharing cadaveric images. These nuances may explain why cadaveric images are frequently shared on social media. This article proposes that as standard practice, anatomists obtain informed consent from donors before sharing images of cadaveric material on social media and ensure posts include a statement stating the same.

"Bedside Anatomy": A Tool to Contextualize Learning and Introduce Surgical Careers.

BACKGROUND: Many medical students cite an unwelcoming culture in surgery and perceive surgeons as arrogant or unfriendly. These perceptions have been reported as factors discouraging medical students from applying to surgical residency programs. This highlights an opportunity early in medical education to address these negative stereotypes and create opportunities for positive interactions with surgeons. We hypothesize that positive experiences with surgical residents and introduction to representative surgical cases early in the medical school curriculum can provide a real-world context for learning anatomy and encourage students to consider a surgical career. METHODS: We developed and implemented a series of structured, one-hour, cadaver-based sessions cofacilitated by anatomists and surgical residents for medical students during their anatomy didactics. Sessions included common surgical cases and focused on critical thinking and problem-solving skills, while offering opportunities to review cadaver anatomy. Students completed a postcourse survey. RESULTS: Nine sessions were implemented with involvement of eight surgical residents and 185 students; 83 students completed a postcourse survey (response rate of 45%). A majority of students rated the sessions "very helpful" in terms of highlighting the importance of anatomy in medical education (n = 52, 63%) and providing clinical context (n = 59, 71%). 54% (n = 45) indicated interest in a surgical career and 64% (n = 53) agreed that session participation had increased their interest in surgery. CONCLUSIONS: Overall, students agreed that sessions provided clinical context for their learning and increased interest in a surgical career. Surgical faculty and residents should engage in preclinical medical education to bridge the basic science and clinical years and introduce positive surgical role models early during medical training.

Integrating a Cadaver Review Session into the Existing Regional Anesthesia Training for Anesthesiology Residents: An Initial Experience.

The Department of Anesthesiology's Acute Pain Service (APS) places ultrasound-guided peripheral nerve blocks (PNBs) to manage acute peri-operative pain. PNB success is dependent on detailed anatomical knowledge which residents may not have formally reviewed since medical school. This study describes the integration of a cadaver review session (CRS) that reintroduces PNB-related anatomy into the existing APS rotation. During each CRS, an anatomist reviewed the major nerve and surrounding structures, while an APS attending integrated the anatomy with PNB techniques. During the pilot, 1st- and 3rd-year clinical anesthesia (CA) residents (9 CA1s, 7 CA3s) completed pre- and post-session surveys and rated the CRS's perceived value and impact on self-confidence with anatomical knowledge. Following the pilot, an additional 17 CA1s and 9 CA3s participated in the CRS and completed post-session surveys. Descriptive statistics were used to summarize responses and unpaired t tests were used to compare pre- and post-session responses and responses between cohorts. All participants were overwhelmingly positive about the CRS and its value to the APS rotation, with 98% agreeing they recommend the CRS and found it accessible. Residents believed participation would improve board exam (average = 4.83 ± 0.66) and clinical performance (average = 4.86 ± 0.65), and self-reported increases in confidence with anatomical knowledge. Residents in the pilot group reported significantly greater confidence (p < 0.01) in their perceived anatomical knowledge after the CRS. The CRS positively impacted resident confidence in their anatomical knowledge and perceived ability to identify anatomical structures. Residents reported the CRS was a highly valued addition to regional anesthesia training.

The Current State of Physics Plan Review Training in Medical Physics Residency Programs in North America.

PURPOSE: This study aimed to identify the current state of residency training in physics plan reviews. METHODS AND MATERIALS: A voluntary, anonymous survey was sent to all program directors of accredited therapeutic medical physics residency programs in North America. Survey questions were developed to determine whether and how residents are trained in physics plan reviews. Survey questions were developed using expert validation and cognitive pretesting. RESULTS: Using a prospectively approved study (COMIRB 18-1073), responses were collected from 70 program directors, representing a 70% response rate. All respondents (100%) designated patient safety to be the purpose of physics plan reviews. Of the respondents, 94% indicated that physicists should first receive training in physics plan reviews while in a residency program. The vast majority of respondents (99%) provide training to residents in physics plan reviews. Although 57 programs (81% of respondents) have residents perform physics plan reviews as part of clinical practice (with varying levels of independence), 13 programs (19% of respondents) do not. The majority of respondents use the following training methods: observe staff physicists (96%), perform supervised reviews on actual patients for training or clinical practice (93%), use a checklist (80%), and read reference materials (62%). Although simulation plans with embedded errors would be implemented by 71% of respondents, they are currently used in only 19% of programs. CONCLUSIONS: The present study is the first to characterize chart-check teaching practices in medical physics residency programs. The vast majority of programs currently train residents in physics plan reviews. The most common teaching methods are observing and performing physics plan reviews, but there is variability in the level of resident involvement in clinical practice for physics plan reviews. There is room for the field to consider advancing current training methods, which is especially important given the critical roles that physics plan reviews have with regard to patient safety.

Seeing with Sound: How Ultrasound Is Changing the Way We Look at Anatomy.

Ultrasound uses high frequency sound waves and their rebounding echoes to capture live images of the structures beneath the skin. Thanks to recent technological advances, contemporary ultrasound machines offer excellent image resolution packaged in smaller, highly portable devices, which has allowed ultrasound to expand into new areas, both within the hospital as well as across non-traditional settings. Ultrasound is an incredibly powerful visualization tool in medicine, allowing physicians to safely see and interrogate the most relevant parts of their patient's internal anatomy instantly. Point-of-care ultrasound, a focused ultrasound evaluation performed at the patient's bedside, is now common across medical specialties, encompassing a vast array of diagnostic, procedural and screening applications. The impressive expansion of point-of-care ultrasound has resulted in an increased demand for ultrasound training earlier during medical school. As a non-invasive and non-destructive way to see inside the living body, ultrasound is an ideal tool to teach anatomy. It allows both medical and non-medical students the ability to improve their understanding and retention of anatomical form and function. The widespread and still expanding use of ultrasound in healthcare today, as well as its adoption into the anatomy classroom, is a testament to the power of ultrasound for achieving real-time visualization of the hidden aspects of our bodies.

Improved medical student perception of ultrasound using a paired anatomy teaching assistant and clinician teaching model.

This study describes a new teaching model for ultrasound (US) training, and evaluates its effect on medical student attitudes toward US. First year medical students participated in hands-on US during human gross anatomy (2014 N = 183; 2015 N = 182). The sessions were facilitated by clinicians alone in 2014, and by anatomy teaching assistant (TA)-clinician pairs in 2015. Both cohorts completed course evaluations which included five US-related items on a four-point scale; cohort responses were compared using Mann-Whitney U tests with significance threshold set at 0.05. The 2015 survey also evaluated the TAs (three items, five-point scale). With the adoption of the TA-clinician teaching model, student ratings increased significantly for four out of five US-items: "US advanced my ability to learn anatomy" increased from 2.91 ± 0.77 to 3.35 ± 0.68 (P < 0.0001), "Incorporating US increased my interest in anatomy" from 3.05 ± 0.84 to 3.50 ± 0.71 (P < 0.0001), "US is relevant to my current educational needs" from 3.36 ± 0.63 to 3.54 ± 0.53 (P = 0.015), and "US training should start in Phase I" from 3.36 ± 0.71 to 3.56 ± 0.59 (P = 0.010). Moreover, more than 84% of students reported that TAs enhanced their understanding of anatomy (mean 4.18 ± 0.86), were a valuable part of US training (mean 4.23 ± 0.89), and deemed the TAs proficient in US (mean 4.24 ± 0.86). By using an anatomy TA-clinician teaching team, this study demonstrated significant improvements in student perceptions of the impact of US on anatomy education and the relevancy of US training to the early stages of medical education. Anat Sci Educ 11: 175-184. © 2017 American Association of Anatomists.

Use and perceptions of plastination among medical anatomy educators in the United States.

Traditionally, medical schools have maintained collections of tissues/organs to engage students in anatomy. Such collections are often stored in volatile and toxic preservatives. Plastination is an alternative tissue preservation technique in which polymers replace water and lipids resulting in benign, dry, and anatomically authentic specimens. Plastination is used in medical education internationally; however, its use within U.S. medical schools is not widely discussed in the anatomical literature. This study aimed to determine the knowledge, use, and perceptions of plastination as a teaching tool among U.S. anatomy medical educators. A total of 98 medical anatomy educators who fit inclusion criteria and teach allopathic (MD) students and/or osteopathic (DO) students in the United States completed a national survey, representing 77 medical schools across 37 states. Of these, 100% had heard of plastination, 57% correctly defined plastination, but only 39% currently utilize plastinates for anatomy education. The most frequent explanation for nonuse of plastinates was a preference for the dissection experience, followed by lack of resources and negative past experiences related to durability and quality. A majority (75%) of U.S. medical anatomy educators perceived plastination as a good supplement to, but not a replacement for, cadaveric dissection, 19% indicated no curiosity to use plastination or considered it not useful, and 14% expressed ethical concerns. These findings suggest plastinates are more widely used in the United States than reflected by the literature; however, perceptions regarding their utility indicate a dominant theme for their use to supplement, not replace, cadaveric dissection. Clin. Anat, 2017. © 2017 Wiley Periodicals, Inc.

@AACAnatomy twitter account goes live: A sustainable social media model for professional societies.

Social media, with its capabilities of fast, global information sharing, provides a useful medium for professional development, connecting and collaborating with peers, and outreach. The goals of this study were to describe a new, sustainable model for Twitter use by professional societies, and analyze its impact on @AACAnatomy, the Twitter account of the American Association of Clinical Anatomists. Under supervision of an Association committee member, an anatomy graduate student developed a protocol for publishing daily tweets for @AACAnatomy. Five tweet categories were used: Research, Announcements, Replies, Engagement, and Community. Analytics from the 6-month pilot phase were used to assess the impact of the new model. @AACAnatomy had a steady average growth of 33 new followers per month, with less than 10% likely representing Association members. Research tweets, based on Clinical Anatomy articles with an abstract link, were the most shared, averaging 5,451 impressions, 31 link clicks, and nine #ClinAnat hashtag clicks per month. However, tweets from non-Research categories accounted for the highest impression and engagement metrics in four out of six months. For all tweet categories, monthly averages show consistent interaction of followers with the account. Daily tweet publication resulted in a 103% follower increase. An active Twitter account successfully facilitated regular engagement with @AACAnatomy followers and the promotion of clinical anatomy topics within a broad community. This Twitter model has the potential for implementation by other societies as a sustainable medium for outreach, networking, collaboration, and member engagement. Clin. Anat. 31:566-575, 2018. © 2017 Wiley Periodicals, Inc.

The Omo-Kibish I pelvis.

Omo-Kibish I (Omo I) from southern Ethiopia is the oldest anatomically modern Homo sapiens skeleton currently known (196 ± 5 ka). A partial hipbone (os coxae) of Omo I was recovered more than 30 years after the first portion of the skeleton was recovered, a find which is significant because human pelves can be informative about an individual's sex, age-at-death, body size, obstetrics and parturition, and trunk morphology. Recent human pelves are distinct from earlier Pleistocene Homo spp. pelves because they are mediolaterally narrower in bispinous breadth, have more vertically oriented ilia, lack a well-developed iliac pillar, and have distinct pubic morphology. The pelvis of Omo I provides an opportunity to test whether the earliest modern humans had the pelvic morphology characteristic of modern humans today and to shed light onto the paleobiology of the earliest humans. Here, we formally describe the preservation and morphology of the Omo I hipbone, and quantitatively and qualitatively compare the hipbone to recent humans and relevant fossil Homo. The Omo I hipbone is modern human in appearance, displaying a moderate iliac tubercle (suggesting a reduced iliac pillar) and an ilium that is not as laterally flaring as earlier Homo. Among those examined in this study, the Omo I ischium is most similar in shape to (but substantially larger than) that of recent Sudanese people. Omo I has features that suggest this skeleton belonged to a female. The stature estimates in this study were derived from multiple bones from the upper and lower part of the body, and suggest that there may be differences in the upper and lower limb proportions of the earliest modern humans compared to recent humans. The large size and robusticity of the Omo I pelvis is in agreement with other studies that have found that modern human reduction in postcranial robusticity occurred later in our evolutionary history.

Evaluation of an innovative hands-on anatomy-centered ultrasound curriculum to supplement graduate gross anatomy education.

Ultrasound (US) can enhance anatomy education, yet is incorporated into few non-medical anatomy programs. This study is the first to evaluate the impact of US training in gross anatomy for non-medical students in the United States. All 32 master's students enrolled in gross anatomy with the anatomy-centered ultrasound (ACUS) curriculum were recruited. Mean Likert ratings on pre- and post-course surveys (100% response rates) were compared to evaluate the effectiveness of the ACUS curriculum in developing US confidence, and gauge its impact on views of US. Post-course, students reported significantly higher (P < 0.001) mean confidence ratings in five US skills (pre-course versus post-course mean): obtaining scans (3.13 ±1.04 versus 4.03 ±0.78), optimizing images (2.78 ±1.07 versus 3.75 ±0.92), recognizing artifacts (2.94 ±0.95 versus 3.97 ±0.69), distinguishing tissue types (2.88 ±0.98 versus 4.09 ±0.69), and identifying structures (2.97 ±0.86 versus 4.03 ±0.59), demonstrating the success of the ACUS curriculum in students with limited prior experience. Views on the value of US to anatomy education and to students' future careers remained positive after the course. End-of-semester quiz performance (91% response rate) provided data on educational outcomes. The average score was 79%, with a 90% average on questions about distinguishing tissues/artifacts, demonstrating positive learning outcomes and retention. The anatomy-centered ultrasound curriculum significantly increased confidence with and knowledge of US among non-medical anatomy students with limited prior training. Non-medical students greatly value the contributions that US makes to anatomy education and to their future careers. It is feasible to enhance anatomy education outside of medical training by incorporating US. Anat Sci Educ 10: 348-362. © 2016 American Association of Anatomists.

The role of ultrasound in graduate anatomy education: Current state of integration in the United States and faculty perceptions.

Ultrasound (US) is increasingly taught in medical schools, where it has been shown to be a valuable adjunct to anatomy training. To determine the extent of US training in nonmedical anatomy programs, and evaluate anatomists' perceptions on the role of US in anatomy education, an online survey was distributed to faculty in anatomy Master's and Doctoral programs. Survey results sampled 71% of anatomy graduate degree programs nationally. Of the faculty surveyed, 65% report little to no experience with US. Thirty-six percent of programs surveyed incorporate exposure to US, while only 15% provide hands-on US training. Opportunities for anatomy trainees to teach with US were found in 12% of programs. Likert responses indicated that anatomists hold overwhelmingly positive views on the contributions of US to anatomy education: 91% agreed US reinforces anatomical concepts (average 4.33 ± 0.68), 95% agreed it reinforces clinical correlates (average 4.43 ± 0.65). Anatomists hold moderately positive views on the value of US to the future careers of anatomy graduates: 69% agreed US increases competitiveness on the job market (average 3.91 ± 0.90), 85% agreed US is a useful skill for a medical school teaching career (average 4.24 ± 0.75), and 41% agreed that US should be required for a medical education career (average 3.34 ± 1.09). With continued improvements in technology and the widespread adoption of US into diverse areas of clinical practice, medical education is on the cusp of a paradigm shift with regards to US. Anatomists must decide whether US is an essential skills for the modern anatomist. Anat Sci Educ 9: 453-467. © 2016 American Association of Anatomists.

Size variation in early human mandibles and molars from Klasies River, South Africa: comparison with other middle and late Pleistocene assemblages and with modern humans.

Previous studies of the Middle Stone Age human remains from Klasies River have concluded that they exhibited more sexual dimorphism than extant populations, but these claims have not been assessed statistically. We evaluate these claims by comparing size variation in the best-represented elements at the site, namely the mandibular corpora and M(2)s, to that in samples from three recent human populations using resampling methods. We also examine size variation in these same elements from seven additional middle and late Pleistocene sites: Skhul, Dolní Vestonice, Sima de los Huesos, Arago, Krapina, Shanidar, and Vindija. Our results demonstrate that size variation in the Klasies assemblage was greater than in recent humans, consistent with arguments that the Klasies people were more dimorphic than living humans. Variation in the Skhul, Dolní Vestonice, and Sima de los Huesos mandibular samples is also higher than in the recent human samples, indicating that the Klasies sample was not unusual among middle and late Pleistocene hominins. In contrast, the Neandertal samples (Krapina, Shanidar, and Vindija) do not evince relatively high mandibular and molar variation, which may indicate that the level of dimorphism in Neandertals was similar to that observed in extant humans. These results suggest that the reduced levels of dimorphism in Neandertals and living humans may have developed independently, though larger fossil samples are needed to test this hypothesis.

A description of the Omo I postcranial skeleton, including newly discovered fossils.

Recent fieldwork in the Kibish Formation has expanded our knowledge of the geological, archaeological, and faunal context of the Omo I skeleton, the earliest known anatomically modern human. In the course of this fieldwork, several additional fragments of the skeleton were recovered: a middle manual phalanx, a distal manual phalanx, a right talus, a large and a small fragment of the left os coxae, a portion of the distal diaphysis of the right femur that conjoins with the distal epiphysis recovered in 1967, and a costal fragment. Some researchers have described the original postcranial fragments of Omo I as anatomically modern but have noted that a variety of aspects of the specimen's morphology depart from the usual anatomy of many recent populations. Reanalysis confirms this conclusion. Some of the unusual features in Omo I--a medially facing radial tuberosity, a laterally flaring facet on the talus for the lateral malleolus, and reduced dorsovolar curvature of the base of metacarpal I--are shared with Neandertals, some early modern humans from Skhul and Qafzeh, and some individuals from the European Gravettian, raising the possibility that Eurasian early modern humans inherited these features from an African predecessor rather than Neandertals. The fragment of the os coxae does not unambiguously diagnose Omo I's sex: the greater sciatic notch is intermediate in form, the acetabulum is large (male?), and a preauricular sulcus is present (female?). The preserved portion of the left humerus suggests that Omo I was quite tall, perhaps 178-182 cm, but the first metatarsal suggests a shorter stature of 162-173 cm. The morphology of the auricular surface of the os coxae suggests a young adult age.

Further new hominin fossils from the Kibish Formation, southwestern Ethiopia.

In addition to the new fragments of the Omo I skeleton, renewed fieldwork in the Kibish Formation along the lower reaches of the Omo River in southwestern Ethiopia has yielded new hominin finds from the Kibish Formation. The new finds include four heavily mineralized specimens: a partial left tibia and a fragment of a distal fibular diaphysis from Awoke's Hominid Site (AHS), a parietal fragment, and a portion of a juvenile occipital bone. The AHS tibia and fibula derive from Member I and are contemporaneous with Omo I and II. The other specimens derive from Chad's Hominid Site (CHS), and derive from either Member III or IV, which constrains their age between approximately 8.6 and approximately 104 ka.