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BACKGROUND: The benefits and timing of percutaneous dilatational tracheostomy (PDT) in Intensive Care Unit (ICU) COVID-19 patients are still controversial. PDT is considered a high-risk procedure for the transmission of SARS-CoV-2 to healthcare workers (HCWs). The present study analyzed the optimal timing of PDT, the clinical outcomes of patients undergoing PDT, and the safety of HCWs performing PDT. METHODS: Of the 133 COVID-19 patients who underwent PDT in our ICU from 1 April 2020 to 31 March 2021, 13 patients were excluded, and 120 patients were enrolled. A trained medical team was dedicated to the PDT procedure. Demographic, clinical history, and outcome data were collected. Patients who underwent PDT were stratified into two groups: an early group (PDT ≤ 12 days after orotracheal intubation (OTI) and a late group (>12 days after OTI). An HCW surveillance program was also performed. RESULTS: The early group included 61 patients and the late group included 59 patients. The early group patients had a shorter ICU length of stay and fewer days of mechanical ventilation than the late group (p < 0.001). On day 7 after tracheostomy, early group patients required fewer intravenous anesthetic drugs and experienced an improvement of the ventilation parameters PaO2/FiO2 ratio, PEEP, and FiO2 (p < 0.001). No difference in the case fatality ratio between the two groups was observed. No SARS-CoV-2 infections were reported in the HCWs performing the PDTs. CONCLUSIONS: PDT was safe and effective for COVID-19 patients since it improved respiratory support parameters, reduced ICU length of stay and duration of mechanical ventilation, and optimized the weaning process. The procedure was safe for all HCWs involved in the dedicated medical team. The development of standardized early PDT protocols should be implemented, and PDT could be considered a first-line approach in ICU COVID-19 patients requiring prolonged mechanical ventilation.
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Notarchirico (Southern Italy) has yielded the earliest evidence of Acheulean settlement in Italy and four older occupation levels have recently been unearthed, including one with bifaces, extending the roots of the Acheulean in Italy even further back in time. New 40Ar/39Ar on tephras and ESR dates on bleached quartz securely and accurately place these occupations between 695 and 670 ka (MIS 17), penecontemporaneous with the Moulin-Quignon and la Noira sites (France). These new data demonstrate a very rapid expansion of shared traditions over Western Europe during a period of highly variable climatic conditions, including interglacial and glacial episodes, between 670 and 650 (i.e., MIS17/MIS16 transition). The diversity of tools and activities observed in these three sites shows that Western Europe was populated by adaptable hominins during this time. These conclusions question the existence of refuge areas during intense glacial stages and raise questions concerning understudied migration pathways, such as the Sicilian route.
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[This corrects the article DOI: 10.1371/journal.pone.0218591.].
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For the past decade, debates on the earliest evidence of bifacial shaping in Western Europe have focused on several key issues, such as its origin (i.e., local or introduced), or on what should define the Acheulean culture. Whatever hypotheses are proposed for its origin, the onset and technological strategies for making Large Cutting Tools (LCTs), including biface production, are key issues and are often associated with other behavioural changes, such as increased core technology complexity. Current archaeological patterns do not support the existence of transitional industries. Rather, the scant evidence suggests that biface production associated with the management of bifacial volume was widespread around 700 ka. Among the earliest sites, the site of Notarchirico in Southern Italy stands out as one of the most significant examples. 40Ar/39Ar ages and ESR dates recently provided a revised chronology for the whole sedimentary sequence and constrained the archaeological levels between ca. 610 and 670 ka. Five archaeosurfaces (A, A1, B, D and F) yielded LCTs, including bifaces, during Marcello Piperno's excavations from 1980 to 1995. In light of this new chronological framework, which is much shorter than previously thought, we propose in this contribution a revision of the bifaces by applying the "chaine opératoire" method for the first time (analysis of reduction processes). Our goals are to assess biface production in this early Western European locality and to characterize the strategies applied at the site throughout the sequence. A corpus of 32 tools was selected from the A-A1, B, D and F archaeosurfaces. The technological analysis shows that hominins had the capacity to manage bifacial volumes, when raw material quality was adequate. Clear differences do not emerge between the different levels in terms of shaping modes or final forms. However, we demonstrate that the oldest level (level F), with the richest corpus, lacks flint and displays a higher diversity of bifaces. This ability to manage bifacial and bilateral equilibrium, as well as the diversity of the morphological results, is observed in a few penecontemporaneous sites (700-600 ka), both in the north-western and southern parts of Western Europe. These patterns suggest that hominins mastered well-controlled and diversified biface production, combining intense shaping and minimal shaping, and shared a common technological background regardless of the geographical area, and applied this technology regardless of the available raw materials. The degree of skill complexity of hominins in Western Europe between 700 and 600 ka, the current lack of evidence suggesting "gradual industries" between core-and-flake series and Acheulean techno-complexes, raise numerous questions on the origin of new behaviours in Western Europe, their mode of diffusion, and their association with Homo heidelbergensis or other Middle Pleistocene populations.
