Evaluating landscape knowledge and lithic resource selection at the French Middle Paleolithic site of the Bau de l'Aubesier.

We report on the application of a novel approach to exploring the degree of landscape knowledge, wayfinding abilities, and the nature of decision-making processes reflected in the utilization of stone resources in the French Middle Paleolithic. Specifically, we use data from the site of the Bau de l'Aubesier to explore the reasons why a majority of the 350 raw material sources cataloged in the surrounding region appear not to have been utilized, including several located near the site and yielding high-quality lithic materials. To this end, we focus on the spatial relationships between sources as an explanatory variable, operationalized in terms of minimum travel times. Using geographic information system software and a generalized linear model of resource selection derived from the Bau assemblages, we compute source utilization probabilities from the perspective of hominins located off-site. We do so under three optimization scenarios, factoring in the intrinsic characteristics (e.g., quality) and time required to reach each source on the way to the Bau. More generally, we find that in slightly more than 50% of cases, seemingly viable sources may have been ignored simply because the minimum cost path leading back to the Bau passes through or requires only minimal deviations to reach, higher quality options. More generally, we found that throughout the entire region, a cost/benefit analysis of competing sources favors those from source areas known to have been utilized. Virtually all the available information on lithic procurement at the Bau is consistent with a model of landscape utilization premised on detailed knowledge of a very large area, an ability to accurately estimate travel times between locations, and a pragmatic strategy of stone resource exploitation based on minimizing costs (travel and search times) and maximizing utility.

Change in raw material selection and subsistence behaviour through time at a Middle Palaeolithic site in southern France.

We apply a resource selection model to the lithic assemblages from 11 archaeological layers at a Middle Palaeolithic site in southern France, the Bau de l'Aubesier. The model calculates how to weight each of 10 variables in order to best match the proportions of raw materials from various potential sources in the lithic assemblages. We then combine the variables into two sets of five each, those related to the characteristics of the raw materials themselves, and those related to the sources and the terrain around them. Running the model with each subset shows that the terrain variables always provide a better match to raw material use than do the raw material variables taken by themselves, but the best model is always the overall (10-variable) model. This means that terrain is most important in every case, but raw material properties also matter. Comparing the percentage contributions of each subset within the overall model, however, shows a clear change in emphasis in the upper layers versus the lower layers of the site. In the lower six layers, the percent contribution of the terrain variables is always greater than that of the raw material variables, but in the upper five layers the reverse is true: terrain still matters, but raw material becomes more important. We also look at faunal and basic tool typological data, which show a progressive change through time, as smaller prey become more important (and large prey less so), and tools and cores proportionally less abundant in the assemblages in the upper layers. We suggest that these results reflect a change in subsistence strategies at the time of a particularly harsh climate near the end of the Middle Pleistocene, and that hominin groups using this site continued to use this new approach throughout the rest of the Pleistocene.

Resource selection of lithic raw materials in the Middle Palaeolithic in southern France.

The work reported here uses several approaches to examine the costs and benefits associated with exploiting potential sources of lithic raw material in the Vaucluse, southern France, and then tests the results against the proportions of raw materials from various sources found in the lithic assemblage of a Middle Palaeolithic site, the Bau de l'Aubesier. A previously published equation designed to quantify the attractiveness of each source proves to be significantly correlated with source use, but the results show that it can be improved. We then individually test the components of the attractiveness equation (raw material quality, source extent, terrain difficulty, and the size and abundance of raw material pieces at the source) and additional variables (Calories expended to get from the source to the site using a straight-line route, Calories expended using a least-cost path, surface distance of the source from the site, and distance to the closest used source) using generalized linear models. Since very similar raw materials can be found at more than one source, we combine such similar sources into source areas, and test the area of the source area (AOSA) and the total area of sources within the source area (AOSISA), as two additional independent variables. The best model shows that raw material quality, source extent, abundance of large and very large rocks, and AOSISA, are positively correlated with use of sources, while terrain difficulty, abundance of small and medium rocks, Calories, and AOSA, are negatively correlated with source use. This shows that the hominins at the Bau de l'Aubesier optimized their raw material procurement to get the most good quality material that they could, while minimizing the time and energy spent getting and using it.

Implementation of a Standardized Approach to Improve the Pediatric Discharge Medication Process.

BACKGROUND AND OBJECTIVES: The pediatric inpatient discharge medication process is complicated, and caregivers have difficulty managing instructions. Authors of few studies evaluate systematic processes for ensuring quality in these care transitions. We aimed to improve caregiver medication management and understanding of discharge medications by standardizing the discharge medication process. METHODS: An interprofessional team at an urban, tertiary care children's hospital trialed interventions to improve caregiver medication management and understanding. These included mnemonics to aid in complete medication counseling, electronic medical record enhancements to standardize medication documentation and simplify dose rounding, and housestaff education. The primary outcome measure was the proportion of discharge medication-related failures in each 4-week period. Failure was defined as an incorrect response on ≥1 survey questions. Statistical process control was used to analyze improvement over time. Process measures related to medication documentation and dose rounding were compared by using the χ2 test and process control. RESULTS: Special cause variation occurred in the mean discharge medication-related failure rate, which decreased from 70.1% to 36.1% and was sustained. There were significantly more complete after-visit summaries (21.0% vs 85.1%; P < .001) and more patients with simplified dosing (75.2% vs 95.6%; P < .001) in the intervention period. Special cause variation also occurred for these measures. CONCLUSIONS: A systematic approach to standardizing the discharge medication process led to improved caregiver medication management and understanding after pediatric inpatient discharge. These changes could be adapted by other hospitals to enhance the quality of this care transition.

Caregiver Medication Management and Understanding After Pediatric Hospital Discharge.

OBJECTIVES: Caregivers frequently make mistakes when following instructions on discharge medications, and these instructions often contain discrepancies. Minimal literature reflects inpatient discharges. Our objective was to describe failures in caregiver management and understanding of inpatient discharge medications and to test the association of documentation discrepancies and sociodemographic factors with medication-related failures after an inpatient hospitalization. METHODS: This study took place in an urban tertiary care children's hospital that serves a low-income, minority population. English-speaking caregivers of children discharged on an oral prescription medication were surveyed about discharge medication knowledge 48 to 96 hours after discharge. The primary outcome was the proportion of caregivers who failed questions on a 10-item questionnaire (analyzed as individual question responses and as a composite outcome of any discharge medication-related failure). Bivariate tests were used to compare documentation errors, complex dosing, and sociodemographic factors to having any discharge medication-related failure. RESULTS: Of 157 caregivers surveyed, 70% had a discharge medication-related failure, most commonly because of lack of knowledge about side effects (52%), wrong duration (17%), and wrong start time (16%). Additionally, 80% of discharge instructions provided to caregivers lacked integral medication information, such as duration or when the next dose after discharge was due. Twenty five percent of prescriptions contained numerically complex doses. In bivariate testing, only race and/or ethnicity was significantly associated with having any failure (P = .03). CONCLUSIONS: The majority of caregivers had a medication-related failure after discharge, and most discharge instructions lacked key medication information. Future work to optimize the discharge process to support caregiver management and understanding of medications is needed.