Surgical amputation of a limb 31,000 years ago in Borneo.

The prevailing view regarding the evolution of medicine is that the emergence of settled agricultural societies around 10,000 years ago (the Neolithic Revolution) gave rise to a host of health problems that had previously been unknown among non-sedentary foraging populations, stimulating the first major innovations in prehistoric medical practices1,2. Such changes included the development of more advanced surgical procedures, with the oldest known indication of an 'operation' formerly thought to have consisted of the skeletal remains of a European Neolithic farmer (found in Buthiers-Boulancourt, France) whose left forearm had been surgically removed and then partially healed3. Dating to around 7,000 years ago, this accepted case of amputation would have required comprehensive knowledge of human anatomy and considerable technical skill, and has thus been viewed as the earliest evidence of a complex medical act3. Here, however, we report the discovery of skeletal remains of a young individual from Borneo who had the distal third of their left lower leg surgically amputated, probably as a child, at least 31,000 years ago. The individual survived the procedure and lived for another 6-9 years, before their remains were intentionally buried in Liang Tebo cave, which is located in East Kalimantan, Indonesian Borneo, in a limestone karst area that contains some of the world's earliest dated rock art4. This unexpectedly early evidence of a successful limb amputation suggests that at least some modern human foraging groups in tropical Asia had developed sophisticated medical knowledge and skills long before the Neolithic farming transition.

Black-White Differences in Child Maltreatment Reports and Foster Care Placements: A Statistical Decomposition Using Linked Administrative Data.

Introduction Official statistics have confirmed that relative to their presence in the population and relative to white children, black children have consistently higher rates of contact with child protective services (CPS). We used linked administrative data and statistical decomposition techniques to generate new insights into black and white differences in child maltreatment reports and foster care placements. Methods Birth records for all children born in Allegheny County, Pennsylvania, between 2008 and 2010 were linked to administrative service records originating in multiple county data systems. Differences in rates of involvement with child protective services between black and white children by age 4 were decomposed using nonlinear regression techniques. Results Black children had rates of CPS involvement that were 3 times higher than white children. Racial differences were explained solely by parental marital status (i.e., being unmarried) and age at birth (i.e., predominantly teenage mothers). Adding other covariates did not capture any further racial differences in maltreatment reporting or foster care placement rates, they simply shifted differences already explained by marital status and age to these other variables. Discussion Racial differences in rates of maltreatment reports and foster care placements can be explained by a basic model that adjusts only for parental marital status and age at the time of birth. Increasing access to early prevention services for vulnerable families may reduce disparities in child protective service involvement. Using birth records linked to other administrative data sources provides an important means to developing population-based research.

Earliest known funerary rites in Wallacea after the last glacial maximum.

The insular region of Wallacea has become a focal point for studying Pleistocene human ecological and cultural adaptations in island environments, however, little is understood about early burial traditions during the Pleistocene. Here we investigate maritime interactions and burial practices at Ratu Mali 2, an elevated coastal cave site on the small island of Kisar in the Lesser Sunda Islands of eastern Indonesia dated to 15,500-3700 cal. BP. This multidisciplinary study demonstrates extreme marine dietary adaptations, engagement with an extensive exchange network across open seas, and early mortuary practices. A flexed male and a female, interred in a single grave with abundant shellfish and obsidian at Ratu Mali 2 by 14.7 ka are the oldest known human burials in Wallacea with established funerary rites. These findings highlight the impressive flexibility of our species in marginal environments and provide insight into the earliest known ritualised treatment of the dead in Wallacea.

Adverse childhood experiences and school readiness outcomes: results from the Growing Up in New Zealand study.

AIM: The Center for Disease Control's (CDC) Adverse Childhood Experiences (ACEs) have been associated with adverse health consequences in adults and children, but less is known about any association between ACE and early learning skills. We investigated the relationship between ACEs and objective preschool measures of skills using the Growing up In New Zealand (GUiNZ) cohort study (n=5,562; 2009-2015). METHODS: We mapped standard ACE definitions to GUiNZ to determine the prevalence of ACEs. We performed regression analysis to investigate the association between ACEs and a range of outcome measures, including counting up to 10, counting down from 10, letter recognition, affective knowledge, name writing, number writing and delayed gratification. RESULTS: Before entering primary school, 52.8% of GUiNZ children experienced at least one ACE. We found a dose-response relationship with seven of the eight tests. For example, after statistically adjusting for multiple potential confounders, for each one additional ACE, children were 1.12 times more likely to be unable to count up from 1-10 (95% Confidence Interval 1.04-1.19). CONCLUSIONS: Awareness of the negative impact of ACEs on school readiness should aid in the development and prioritisation of prevention strategies to reduce the occurrence and impact of ACEs in children.

Children in the public benefit system at risk of maltreatment: identification via predictive modeling.

A growing body of research links child abuse and neglect to a range of negative short- and long-term health outcomes. Determining a child's risk of maltreatment at or shortly after birth provides an opportunity for the delivery of targeted prevention services. This study presents findings from a predictive risk model (PRM) developed to estimate the likelihood of substantiated maltreatment among children enrolled in New Zealand's public benefit system. The objective was to explore the potential use of administrative data for targeting prevention and early intervention services to children and families. A data set of integrated public benefit and child protection records for children born in New Zealand between January 1, 2003, and June 1, 2006, was used to develop a risk algorithm using stepwise probit modeling. Data were analyzed in 2012. The final model included 132 variables and produced an area under the receiver operating characteristic curve of 76%. Among children in the top decile of risk, 47.8% had been substantiated for maltreatment by age 5 years. Of all children substantiated for maltreatment by age 5 years, 83% had been enrolled in the public benefit system before age 2 years. This analysis demonstrates that PRMs can be used to generate risk scores for substantiated maltreatment. Although a PRM cannot replace more-comprehensive clinical assessments of abuse and neglect risk, this approach provides a simple and cost-effective method of targeting early prevention services.