Adaptive capacity and flexibility of the Neanderthals at Heidenschmiede (Swabian Jura) with regard to core reduction strategies.

The branched reduction system at the Heidenschmiede described here is hitherto exceptional for the Middle Paleolithic of the Swabian Jura. By means of refits and supporting objects, we are able to describe a superordinate reduction system that combines several individual reduction concepts, such as Levallois and blade production, within one volume. In the Middle Paleolithic of the Swabian Jura, blade technology has thus far played a rather minor role. On the one hand, it is possible to split a selected volume (nodule) into three parts, which are reduced separately according to individual concepts. On the other hand, it is also possible to reduce parts of a volume with one concept first and then with another. The hypothetical reduction system can be branched or linear, thus emphasizing the technological flexibility in core reduction, which requires a high degree of cognitive skills of three-dimensional imagination.

Extended roles in primary care when physiotherapist-initiated referral to X-ray can save time and reduce costs.

OBJECTIVE: The objective of this study was to evaluate an extended role for the physiotherapist in primary care in referring patients to plain X-ray. METHODS: This prospective cohort study was set in a single region in Sweden. It included 20 physiotherapists who were educated in a 1-day training in performing referral to X-ray, along with 107 patients with musculoskeletal disorders who were referred to X-ray. We evaluated referral quality and patient and physiotherapist satisfaction and calculated healthcare and patient costs. RESULTS: All referrals fulfilled the basic requirements of quality, and 78% were classified as good, fulfilling all criteria. Both patients and physiotherapists were satisfied with the extended role for the physiotherapist that decreased the waiting time to diagnosis and to adequate treatment. Costs were reduced for patients (by €53/patient) and healthcare (by €6286.2/107 patients). The cost to visit a physician was twice that of a physiotherapist visit. CONCLUSIONS: An extended role for physiotherapists in primary care in referring patients to X-ray was effective and safe for patients and reduced costs for patients and for healthcare. Physiotherapists in primary care were able to refer patients to X-ray after a 1 day of training, and the extended role freed up 45 min of physician time for each patient with a musculoskeletal disorder in need of an X-ray.

Acute necrotizing encephalopathy with SARS-CoV-2 RNA confirmed in cerebrospinal fluid.

Here, we report a case of COVID-19-related acute necrotizing encephalopathy where SARS-CoV-2 RNA was found in CSF 19 days after symptom onset after testing negative twice. Although monocytes and protein levels in CSF were only marginally increased, and our patient never experienced a hyperinflammatory state, her neurologic function deteriorated into coma. MRI of the brain showed pathologic signal symmetrically in central thalami, subinsular regions, medial temporal lobes, and brain stem. Extremely high concentrations of the neuronal injury markers neurofilament light and tau, as well as an astrocytic activation marker, glial fibrillary acidic protein, were measured in CSF. Neuronal rescue proteins and other pathways were elevated in the in-depth proteomics analysis. The patient received IV immunoglobulins and plasma exchange. Her neurologic status improved, and she was extubated 4 weeks after symptom onset. This case report highlights the neurotropism of SARS-CoV-2 in selected patients and emphasizes the importance of repeated lumbar punctures and CSF analyses in patients with suspected COVID-19 and neurologic symptoms.

The performance of tranchet blows at the Late Middle Paleolithic site of Grotte de la Verpillière I (Saône-et-Loire, France).

This paper focuses on the technological characteristics of Keilmesser with a lateral tranchet blow modification on the cutting edge. It examines the underlying technological production of these bifacial objects: this implies the evaluation of their working stage succession, as well as produced forms necessary for the execution of tranchet blow performance. Furthermore, it offers a techno-morphological description of these enigmatic tools. The Keilmesser with tranchet blow and corresponding blanks of tranchet blows from Grotte de la Verpillière I in Germolles (Saône-et-Loire, France) are used as case study. The collection of Keilmesser with tranchet blow and corresponding blanks of tranchet blow has been massively expanded with new fieldwork and the review of ancient assemblages. The majority of the pieces were made on blanks from local raw material. The evaluation of the underlying production concept shows that a Keilmesser with tranchet blow, regardless of the wide range of morphologies and matrix size, always consists of specific parts that are necessary for the production sequence and the assumed function. The production of these pieces follows highly specific working stages, some of which can be interchanged in sequence. However, it is always the goal to obtain a low-angled cutting edge. The performance of a tranchet blow is not only an integral part of production, but it is rather the aim of the entire production.