Stone axes throw new light on Baltic stone age mortuary rites.

Despite their ubiquity, Mesolithic lithic tools given as funerary offerings have rarely been studied in detail. Whereas personal ornaments (e.g. beads, pendants) are commonly interpreted as markers of social identity and status, archaeologists have struggled to understand the stone tools, commonly regarded as "utilitarian" items. As a result, this class of grave goods has not received the same level of attention, leaving a significant gap in our understanding of Mesolithic mortuary behaviours. Our research challenges long-lasting perceptions of lithic tools as strictly utilitarian objects and draws on studies of one of the most substantial stone axe funerary collections from one of the largest Stone Age cemeteries in Europe-Zvejnieki, Latvia. Evidence suggests the selection of unused axes as grave offerings, while unusual wear traces on an axe found in a female grave (no 57) raises questions about its use in the burial rites. Using a multi-proxy approach, we compare life histories of axes placed in burials to those recovered from contemporary, nearby settlement contexts. Finally, a strong correlation between axes and women and children at Zvejnieki challenges gendered stereotypes of stone tools, historically regarded as possessions of the adult male members of Stone Age societies.

Chronology and social significance of the "princely" barrow cemetery in Leki Male and the Central European Early Bronze Age.

The "princely" barrows of Leki Male, Greater Poland are the oldest such monuments within the distribution area of Únetice societies in Central Europe. While in the Circum-Harz group and in Silesia similar rich furnished graves under mounds have appeared as single monuments as early as 1950 BC, Leki Male represents a chain of barrows constructed between 2150 BC and 1800 BC. Of the original 14 mounds, only four were preserved well enough that their complex biographies can now be reconstructed. They included ritual activities (before, during, and after the funeral), and also subsequent incursions, including robberies. The long lasting barrow cemetery at Leki Male can be linked to a nearby fortified site, Bruszczewo. Together, Leki Male and Bruszczewo represent a stable, socially differentiated society that existed for no less than 350-400 years. Therefore, it can be argued that the Early Bronze Age societies of Greater Poland were extremely sustainable in comparison to those of other Únetice regions.

Insights into medieval rural lives: A paleo-odontological investigation of two central European communities.

OBJECTIVE: Oral status is an important indicator of past lifestyles. Determining the presence and extent of oral pathologies helps reconstruct average oral health, paramasticatory activities and diet of ancient and historical populations. DESIGN: In this study, the dental remains from the early medieval cemetery of Früebergstrasse in Baar (Canton of Zug, Switzerland) and the high medieval Dalheim cemetery (North Rhine-Westphalia, Germany) were analyzed. Caries, periodontal condition, periapical lesions, antemortem tooth loss, and enamel hypoplasia were assessed in 654 teeth (993 observable loci) from 68 individuals (Baar: n = 36; Dalheim: n = 32). RESULTS: The oral status of both populations was affected by age with higher values of tooth wear in advanced age individuals. High tooth wear values in both populations point towards the consumption of abrasive foods. Pronounced anterior tooth wear in Baar may also be due to non-masticatory tooth usage. Finally, possible nutritional deficiencies were hypothesized for the Baar population. A higher caries prevalence was observed in the Baar group, probably due to differences in carbohydrate intake. The oral conditions observed in the two studied populations exhibited several analogies, suggesting comparable lifestyles despite their separation in space and time. The only differences observed are related to the use of teeth as "tools" and are thus determined by behavioral choices rather than diverse socioeconomic factors. CONCLUSIONS: Using multiple dental parameters to examine the oral health of premodern individuals can provide useful insights into the interactions between humans and their environment, from dietary patterns to paramasticatory activities.

Unravelling social status in the first medieval military order of the Iberian Peninsula using isotope analysis.

Medieval Iberia witnessed the complex negotiation of religious, social, and economic identities, including the formation of religious orders that played a major role in border disputes and conflicts. While archival records provide insights into the compositions of these orders, there have been few direct dietary or osteoarchaeological studies to date. Here, we analysed 25 individuals discovered at the Zorita de los Canes Castle church cemetery, Guadalajara, Spain, where members of one of the first religious orders, the Order of Calatrava knights, were buried between the 12th to 15th centuries CE. Stable carbon (δ13C) and nitrogen (δ15N) isotope analyses of bone collagen reveal dietary patterns typical of the Medieval social elite, with the Bayesian R model, 'Simmr' suggesting a diet rich in poultry and marine fish in this inland population. Social comparisons and statistical analyses further support the idea that the order predominantly comprised the lower nobility and urban elite in agreement with historical sources. Our study suggests that while the cemetery primarily served the order's elite, the presence of individuals with diverse dietary patterns may indicate complexities of temporal use or wider social interaction of the medieval military order.

Two cases of smallpox from 1540 CE circum-contact (early colonial) Northern Coastal Peru.

OBJECTIVE: This project seeks to create a differential diagnosis for lesions found on the skeletal remains of two children as a means to explore the presence of viral disease in 16th- century Peru. MATERIALS: Extremely well-preserved human remains of two children who died between the ages of 1-2 years old, recovered from the circum-contact (∼1540 CE) cemetery in Huanchaco, Peru. METHODS: Macroscopic and radiographic analysis. RESULTS: Both individuals present with cortical thickening, symmetrical destructive lesions, metaphyseal expansion, perforations, exposure of the medullary cavity, resorption of metaphyseal ends and necrosis of the long bones, and deposited reactive new bone. These features are consistent with osteomyelitis variolosa and bacterial osteomyelitis. CONCLUSIONS: Three features of Individuals IG-124 and IG-493 suggest a highly consistent diagnosis of osteomyelitis variolosa: multiple skeletal lesions, the historical context of the area, and the high mortality rate of non-adults in the circum-contact cemetery. SIGNIFICANCE: Although viral infections are ubiquitous and well documented historically, their etiologies are often difficult to determine in archaeological populations. Orthopoxvirus variola (smallpox) is one of the many viruses whose archaeological impact is still under explored in skeletal remains. LIMITATIONS: The absence of smallpox in other children from the Huanchaco cemetery creates difficulty in ascertaining true prevalence rates or information on potential outbreaks. SUGGESTIONS FOR FURTHER RESEARCH: Further research analyzing aDNA from calculus and/or residues using a DIP-GC-MS method might create a better understanding of how smallpox spread through the region.

Mosquitoes in urban green spaces and cemeteries in northern Spain.

BACKGROUND: Mosquitoes inhabiting urban green spaces and cemeteries in Europe represent a crucial facet of public health concern and contribute to the ecological balance. As urbanization intensifies, these areas increasingly serve as vital habitats for various mosquito species, fostering breeding grounds and increasing the risk of disease transmission. METHODS: A study was conducted in the three main cities (inland, coastal, and estuarine) of the Basque Country, northern Spain, to investigate the species composition, abundance, dynamic populations, larval habitats, and host preferences of mosquitoes in urban green spaces and cemeteries. CDC traps and dipping were used to collect mosquitoes for 2 years (2019-2020). RESULTS: A total of 21 mosquito species were identified, with Culex pipiens s.l. being the most abundant and widespread. The three ecological forms of Cx. pipiens were found, and Cx. pipiens pipiens was the most common in both green areas and cemeteries. Morphological identification together with molecular tools identified 65 COI sequences with high homology. The highest species richness was found in the inland city, followed by the coastal city and the estuarine city. Mosquito abundance was significantly higher in green areas compared to cemeteries and in the coastal and estuarine cities compared to the inland city. The investigation of larval breeding sites highlighted the dominance of Cx. pipiens s.l., particularly in semi-artificial ponds, diverse water-holding containers (tyres and buckets) and drainage systems in green areas; in cemeteries, most of the larvae were found in flowerpots and funerary urns. Seasonal activity exhibited variable peaks in mosquito abundance in the different cities, with a notable increase in July or August. Additionally, blood meal analysis revealed that Cx. pipiens s.l. fed on several common urban avian species. CONCLUSIONS: Studies on mosquitoes are essential to understand their role in disease transmission and to design targeted and sustainable management strategies to mitigate the associated risks.

Network of large pedigrees reveals social practices of Avar communities.

From AD 567-568, at the onset of the Avar period, populations from the Eurasian Steppe settled in the Carpathian Basin for approximately 250 years1. Extensive sampling for archaeogenomics (424 individuals) and isotopes, combined with archaeological, anthropological and historical contextualization of four Avar-period cemeteries, allowed for a detailed description of the genomic structure of these communities and their kinship and social practices. We present a set of large pedigrees, reconstructed using ancient DNA, spanning nine generations and comprising around 300 individuals. We uncover a strict patrilineal kinship system, in which patrilocality and female exogamy were the norm and multiple reproductive partnering and levirate unions were common. The absence of consanguinity indicates that this society maintained a detailed memory of ancestry over generations. These kinship practices correspond with previous evidence from historical sources and anthropological research on Eurasian Steppe societies2. Network analyses of identity-by-descent DNA connections suggest that social cohesion between communities was maintained via female exogamy. Finally, despite the absence of major ancestry shifts, the level of resolution of our analyses allowed us to detect genetic discontinuity caused by the replacement of a community at one of the sites. This was paralleled with changes in the archaeological record and was probably a result of local political realignment.

The Impact on Environmental Health from Cemetery Waste in Middle Tennessee.

The burial of caskets with arsenic-treated wood and formaldehyde-based embalming fluids can harm the environment and health. Arsenic (As) can leach into water, affecting aquatic life and the food chain. Formaldehyde can contaminate groundwater, risking drinking water and causing health problems. The purpose of this study was to investigate the prevalence of As and formaldehyde in cemetery plots of different ages. For this, we evaluated whether there is a potential for formaldehyde and As from cemetery caskets to contaminate waterways, which could impact livestock and allow transmission to individuals. There were six soil samples (n = 6), collected at 2 m depth, close to the buried caskets, as well as two (n = 2) groundwater samples (soil + groundwater) collected from a cemetery in Middle Tennessee. The soil was analyzed by an environmental lab using EPA 8315A for formaldehyde and EPA 3050B for As. All samples were below the limit of detection (

Compromised health: Examining growth and health in a late antique Roman infant and child cemetery.

OBJECTIVES: Combining research from infant and child development, public health, anthropology, and history, this research examines the relationship between growth, growth disruption, and skeletal indicators of chronic and/or episodic physiological stress (stress) among juvenile individuals (n = 60) interred at the late antique infant and child cemetery at Poggio Gramignano (PG) (ca. 5th century CE), associated with a rural agricultural community. MATERIALS AND METHODS: Growth disruption-evidenced by decreased long bone length compared to dental age-and stress experience-evidenced by skeletal stress indicators-within these individuals are compared to those within juveniles from a comparative sample (n = 66) from two urban Roman-era cemeteries, Villa Rustica (VR) (0-250 CE) and Tragurium City Necropolis (TCN) (0-700 CE). RESULTS: Results indicate that individuals from PG had significantly smaller femoral lengths-for-age than those from VR and TCN; however, the frequency of skeletal stress indicators was higher among juveniles from VR and TCN. DISCUSSION: These differences in growth and stress experience are likely related to the different biosocial and ecological environments present in these two regions. For the community at PG, internal and external violent conflicts, as well as social, political, and economic turmoil, and subsistence shortages, endemic and epidemic infectious disease, nutritional deficiencies, and inherited or acquired anemia may have synergized to create chronically and/or episodically deleterious conditions for its juveniles.

The spleen is the graveyard of CD4+ cells in patients with immunological failure of visceral leishmaniasis and AIDS.

BACKGROUND: Visceral leishmaniasis (VL), or kala-azar, is a common comorbidity in patients with AIDS in endemic areas. Many patients continue to experiences relapses of VL despite virological control, but with immunological failure. These patients remain chronically symptomatic with hypersplenism, for example with anemia, leukopenia, and thrombocytopenia, and are at risk of severe co-infection due to low CD4+ count. Therefore, in this study, splenectomized patients with VL and HIV infection were investigated to understand why the CD4+ count fails to recover in these patients, evaluating the importance of spleen mass for hypersplenism and immunological failure. METHODS: From a retrospective open cohort of 13 patients who had previously undergone splenectomy as salvage therapy for relapsing VL, 11 patients with HIV infection were investigated. This study compared the patients' complete blood cell count (CBC) and CD4+ and CD8+ cell counts before and after splenectomy with respect to spleen weight. RESULTS: CBC was substantially improved after splenectomy, indicating hypersplenism. However, to the best of our knowledge, this is the first study to show that spleen mass is strongly and negatively correlated with CD4+ cell count (ρ = -0.71, P = 0.015). CONCLUSIONS: This finding was unexpected, as the spleen is the most extensive lymphoid tissue and T-lymphocyte source. After reviewing the literature and reasoning, we hypothesized that the immunological failure was secondary to CD4+ loss initially by apoptosis in the spleen induced by productive HIV infection and, subsequently, by pyroptosis sustained by parasitic infection in spleen macrophages.

Female biased adult sex ratio in the Bronze Age cemetery of Shahr-i Sokhta (Iran) as an indicator of long distance trade and matrilocality.

OBJECTIVES: This paper starts from the unusual observation of the overrepresentation of females among adults in the cemetery of Bronze Age Shahr-i Sokhta (Seistan, Iran) and explores the post marital residence pattern. By integrating taphonomical (skeletal preservation), anthropological (sex ratio [SR], sexual dimorphism, stress indicators, age at death), archeological (long distance trade indicators, habitation floor area, social role of women), and ancient DNA (heterozygosity levels in X chromosomes) data we test the hypothesis of post marital matrilocality in the site. METHODS: We computed the SR (pelvis-based sex determination) in a random unpublished adult sample from the cemetery of Shahr-i Sokhta and in two samples previously published by other authors. We used comparative data on SR from: a large Supra Regional multi-chronological sample of sites, n = 47, with 8808 adult sexed individuals, from Southern Europe, Egypt, Middle East, Southern Russia; a Regional Bronze Age sample of sites (n = 10) from Bactria Margiana and Indus Valley with 1324 adult sexed individuals. We estimated the heterozygosity levels in X chromosomes compared with the rest of the autosomes on the assumption that in a matrilocal society females should show lower variability than men. RESULTS: Adult SR in a sample (n = 549) from Shahr-i Sokhta is 70.5, the overrepresentation of females is shared with Regional Bronze Age sites from Bactria Margiana (SR = 72.09) and Indus Valley (SR = 67.54). On the contrary, in a larger Supra Regional multi-chronological sample of sites, mean SR ranges between 112.7 (Bronze Age) and 163.1 (Middle Ages). Taphonomical and anthropological indicators do not explain the overrepresentation of female skeletons. Archeological indicators suggest a high social status of women and that the society was devoted to long range trade activities. heterozygosity levels in X chromosomes are in agreement with a matrilocal society. CONCLUSIONS: Indicators suggest that Bronze Age Shahr-ì Sokhta was a matrilocal society and that long distance trade was an important economic factor producing an overrepresentation of adult female skeletons in the cemetery.

Tombstone cost and longevity: The San Pedro Cemetery Museum in Medellín in Colombia.

BACKGROUND: Studies in the West suggest that tombstone cost is associated with longevity. The objective of this observational study was to investigate the association between tombstone cost and longevity in a large cemetery in Latin America. METHODS: Age at death was obtained from 2,273 consecutive death certificates held at the San Pedro Cemetery Museum in Medellín in Colombia. Subjects died in 2022, 2021, or 2020. Tombs are arranged in galleries in the cemetery and tombstone cost was based on the material from which the tombstone was made, its position in the gallery, and its ornamentation. Analysis of variance was used and the assumption of equal variance was not violated. RESULTS: Approximately 77% of tombstones were of low cost, 21% of medium cost, and 2% of high cost. Data from 1,751 subjects were used to investigate differences in longevity according to tombstone cost while adjusting for sex, civil status, violent death, and year of death. Longevity was similar in the low-cost group and medium-cost group: 64.3 years (63.2, 65.3) versus 63.3 years (61.3, 65.3) [estimated mean (95% confidence interval)]. Longevity was lower in the high-cost group: 47.0 years (40.1, 53.9). CONCLUSIONS: The inverse association between tombstone cost and longevity would suggest that people in Medellín are inclined to spend more on tombstones when commemorating the tragic death of a young person.

Age-related changes in the bottom view area of ancient children's skulls from the Zaghunluq Cemetery in Xinjiang, China.

This study examined forty skull samples of ancient children, aged 2-15 years, excavated from the Zaghunluq cemetery in Xinjiang, China. The purpose of the study was to analyze the patterns of age-related physiological development and growth spurts in the skulls of these ancient children by comparing the projected areas of the bottom view of the skull, the occipital bone, and the maxilla among different age groups. The analysis of variance (ANOVA) revealed significant differences in the projected areas of the skull's bottom view, occipital bone, and maxilla among five age groups (2 years old, 3-5 years old, 6-8 years old, 9-11 years old, and 12-15 years old). The growth spurts in the projected area of the occipital bone occurred at ages 3-5 years and 6-8 years. As for the maxilla, the growth spurts took place at ages 6-8 years and 12-15 years. Meanwhile, the projected area of the skull's bottom view exhibited a continuous increase without any periods of rapid growth. These findings may reflect the patterns of age-related growth in the skulls of ancient children in Xinjiang, China.

"Heal the sick": Health status and caregiving during the 17th-18th century in Northern Italy (St. Biagio cemetery, Ravenna).

OBJECTIVE: The study of health-related care provision in archeology gives important indications on the culture and community organization of past populations. This study aims to assess the health status of the skeletal assemblage recovered from the burial site of St. Biagio (Ravenna, 17th-18th Centuries); next, we identified likely instances of need for and receipt of caregiving in response to the condition, to examine evidence of community attitudes toward disease and disability. MATERIALS AND METHODS: The skeletal assemblage is composed of 133 individuals in a generally good state of preservation. Sex and age-at-death were estimated through classical anthropological methods. Health status was inferred through the biological index of frailty (BIF) and paleopathological analysis was performed through macroscopic and radiographic investigations. The "bioarcheology of care" approach was applied to individuals who showed evidence of impairment and disability. RESULTS: The skeletal assemblage of St. Biagio was equally represented by males and females (50% males), with a higher percentage of adults (83.4%) than subadults (10.5%), and this is reflected in the high life expectancy at birth (40.3 years). No significant differences in health status emerged between age groups and sexes, with a generally high percentage of joint diseases, antemortem trauma, and infectious diseases. Evidence of care and compassion was found in some individuals with a high degree of impairment or disability, as in the case of probable Angelman syndrome. DISCUSSION: This study provided important insights into the biological and social aspects of an Early Modern population in Northern Italy, showing that people with functional and/or visible abnormalities were probably cared for in life and were presumably considered full members of the society.

Elongated styloid process of an autopsied skull from the Cemetery of Santa Maria Maggiore in Vercelli, 18th-19th century (Piedmont, northern Italy).

We discuss the coexistence of a postmortem cut and a pathological alteration, recorded on a skeleton belonging to an adult man that was discovered during the archaeological investigations of the cemetery of the Church of Santa Maria Maggiore in Vercelli (northern Italy, 18th-19th century). The skull presents an oblique cleft, which from the top of the frontal bone bends towards the occipital, and the left styloid process is elongated compared to normal values (48 mm). The elongated styloid process is due to the ossification of the styloid ligament which has several possible causes. To increase the knowledge about this pathological condition in the past, it was necessary to compare all the data present in the literature today and consider the few cases published in the paleopathological field. In this paper, our main goals are: i) to investigate the reasons for which the craniotomy was performed; ii) to examine the possible cause of the ossification of the styloid process, described as Eagle's syndrome; iii) to enrich the archaeological literature of elongated styloid process cases and iv) to investigate the presence of a hypothetical relationship between the autopsy cut and the diagnosed Eagle's syndrome on this skull.

The Early Iron Age elite grave from the Kapiteljska njiva barrow cemetery (Novo mesto, Slovenia): an approach to dental profiling through non-invasive and minimally-invasive techniques.

Kapiteljska njiva is a prehistoric cemetery located in the town of Novo mesto in southern Slovenia. There is a long history of archaeological research at this site, as the first investigations date back to the end of the 19th century. In 2004, an Early Iron Age barrow XVI was investigated. The oldest surviving grave in the barrow is the central grave, numbered XVI/34, which according to its position and the richness of the grave goods, belongs to a woman of higher status. Most likely, she was the first member or initiator of a family that continued to bury its dead in the barrow for the next 300 years. There were no preserved skeletal elements; however, in the head part of the grave, remains of human teeth, mostly the tooth crowns and the shells of enamel from the tooth crowns, were found among the scattered amber beads of a necklace. Moreover, these tooth remains are one of the few human biological materials (mostly fragments of skull and long limb bones) unearthed in this cemetery, reflecting the influence of acidic soil from the burial site. This study aimed to create a dental profile of the deceased in a similar way as during a forensic investigation. The remains were examined macroscopically and stereo-microscopically. The morphological traits were scored following the ASUDAS protocol. Ancestry was estimated by entering these scores into a beta version of the web-based application rASUDAS. Brothwell's system was used for age at death estimation from occlusal attrition. Identification of sex was based on the analysis of sex-specific amelogenin isoforms in dental enamel by nanoflow liquid chromatography tandem mass spectrometry (nanoLC-MS/MS). The present study reveals that the dental remains from Kapiteljska njiva belong to the permanent dentition of a single individual and that only the right upper central incisor and third molar are completely absent. The remains of teeth exhibit a simple external morphology, characterised by the absence of morphological dental traits, with a notable exception of the two-rooted left lower canine. The probability of assigning this individual to the Western Eurasian ancestry group is 98%. According to the degree of dentine exposure on the occlusal surfaces of molars, the estimated age range is 17-25 years. Another line of evidence comes from the observation that the first signs of approximal attrition are present in lower third molars but absent in the only preserved upper counterpart, indicating that the age at which the lower third molars entered into occlusion represents a proxy of the individual's age at death. Data on the chronology of the lower third molar development and eruption in present-day European populations from forensic literature (Brkic et al. 2011; Olze et al. 2008; Selmanagic et al. 2013) and The London Atlas confirm the above age-range estimate. Caution is, however, needed in the interpretation of results, because reference data are not based on the population of the individual's origin. Proteomic analysis classified the individual as a female, which is in line with the archaeological evidence. No pathological lesions or indicators of systemic stress were identified; however, the absence of approximal attrition facets in upper anterior teeth indicates interdental spacing. The results of dental profiling are discussed in the context of historical background, today's clinical knowledge, and epidemiological data.

Burial leakage: A human accustomed groundwater contaminant sources and health hazards study near cemeteries in Benin City, Nigeria.

This study was carried out to assess the levels of physico-chemical parameters that could be impacted by burial leakage and associated human health risks in Benin City, Nigeria. A total of thirty groundwater samples were collected from two cemeteries and analysed for pH, alkalinity, chloride, sulphate, nitrate, phosphate, ammonia- N, calcium, sodium, potassium, BOD5, COD, Mn, Cd, Cu, Ni, Pb, Zn and Fe. The concentrations of the parameters were compared to national and international standards. The results revealed that the groundwater is highly acidic in nature. Principal component analysis (PCA) revealed that except for alkalinity, all other parameters characterised contributed significantly to various principal components (PC) with eigenvalues ≥ 1. Moreover, the significance of the PC depicted decomposition of the body corpse and associated burial materials. Water quality index (WQI), heavy metal evaluation index (HEI) and Nemerov pollution index (NI) indicated that groundwater from the study area is of poor quality, and highly contaminated by heavy metals. We determined the Chronic health risk through exposure by calculating the hazard quotient (HQ) and hazard index (HI), for both children and adults. For the oral exposure, approximately 33% of samples suggest the high category of chronic risk for children while the medium category was indicated for adults. We found that oral exposure showed relatively higher risk than dermal exposure, and chronic risk for children and adults ranged from low to negligible. However, the carcinogenic risk of Ni and Pb via oral exposure route suggests, very high risk for Ni and medium risk for Pb. In consideration that long term exposure to low concentrations of some heavy metals (including Pb, Cd, and Ni) could result in different manifestations of cancer, we recommend that residents of these areas should find an alternative source of water for drinking and other domestic uses.

Avoid equipment graveyards: rigorous process to improve identification and procurement of effective, affordable, and usable newborn devices in low-resource hospital settings.

BACKGROUND: Millions of newborns die annually from preventable causes, with the highest rates occurring in Africa. Reducing neonatal mortality requires investment to scale hospital care, which includes providing hospitals with appropriate technology to care for small and sick newborns. Expensive medical devices designed for high-resource settings often fail to withstand conditions in low-resource hospitals, including humidity, dust, frequent user turnover, complex maintenance, lack of stable power, or difficulty sourcing expensive consumables. Rigorous evaluation protocols are needed to identify effective, affordable, rugged, and easy-to-use medical devices appropriate for quality hospital-based newborn care in low-resource hospitals. METHODS: We developed an evidence-based technology review process to identify medical devices suitable for small and sick newborn care in low-resource hospitals. The eight-step process consists of: identifying devices needed for effective newborn care; defining Target Product Profiles (TPPs); identifying commercially-available products that may meet TPPs; conducting desk research to evaluate technologies against TPPs; performing technical performance verification testing under laboratory conditions; verifying technical performance after exposure to heat, humidity, dust, and power loss; performing usability evaluations with nurses, and qualifying devices that pass all steps. Devices were purchased, installed, and monitored in newborn wards across Kenya, Malawi, Nigeria, and Tanzania. RESULTS: Of 271 devices considered, only 45 (16.6%) met corresponding TPPs based on desk research. Thirty-nine were purchased and evaluated in the laboratory; five (12.8%) failed to meet TPPs. Thirty-four products passing laboratory evaluation underwent short-term environmental testing; only one (2.9%) device failed. Thirty-seven products underwent usability testing with 127 clinicians; surprisingly, 14 (37.8%) failed to meet TPPs. Twenty-three products passed all evaluations, and 2457 devices were installed across 65 newborn wards in Kenya, Malawi, Nigeria, and Tanzania. Continuous device monitoring reported minimal device failures, with failed devices typically returned to service within two days, resulting in an average uptime (service days divided by days installed) of 99%. CONCLUSION: An evidence-based device selection process can improve procurement of effective, affordable, rugged, usable newborn care devices for low-resource hospitals, and feedback to manufacturers can improve device quality. Similar processes could be adapted beyond newborn care to identify medical devices suitable for implementation in any low-resource setting.

"Tuberculosis on the spot" - Discussion of a probable sternal tuberculosis from a late medieval cemetery from Hungary.

Investigations of non-adult remains are particularly suitable for finding epidemic periods in past populations. This study presents a probable unique example of osseous manifestation of tuberculosis on a child's skeletal remains from medieval Hungary. Between 2009 and 2011 the Field Service for Cultural Heritage excavated the exceptional cemetery of Perkáta - Nyúli-dulo in Hungary, with around 5000+ graves. The analysed skeleton (SNR 948) was located in the medieval (10-16th century) part of the cemetery. Besides the standard macroscopic pathological observation, we also performed radiographic analysis. The remains of the child (13-14 year-old) showed numerous skeletal lesions: the ribs have proliferative lesions (dense nodules) on the visceral surface of the shaft, lytic lesions with rounded edges occurred on the thoracic and lumbar vertebral bodies, and on the facies auricularis of the left ilium we can see pitting and new bone formation. What makes this pathological case exceptional is the significant change in the manubrium. It shows extensive osteolytic lesions, probably due to tuberculous osteomyelitis, which is a unique phenomenon in an archaeological context. This rare type of extra-spinal tuberculous osteomyelitis appears in less than 1% of cases with skeletal TB, and even less in case of children, according to modern medical literature. Although some cases of slight lesions on the manubrium have been described from an archaeological context, no such cases showing advanced lesions have been published so far. In the future, biomolecular analyses should be conducted as well, in order to confirm the presence of TB in this individual.