High-resolution Bayesian chronology of the earliest evidence of domesticated animals in the Dutch wetlands (Hardinxveld-Giessendam archaeological sites).

The archaeological sites of Hardinxveld-Giessendam de Bruin and Polderweg, situated in the Rhine-Meuse delta, are the best-preserved Mesolithic sites in the Netherlands. Due to the early appearance of domesticated animals in their faunal assemblage, they are also integral to the research of the emergence of animal husbandry in the region. This study focuses on the precise chronology of the sites, using radiocarbon dating and Bayesian modelling of both newly acquired and legacy radiocarbon dates. To mitigate the risk of erroneous dates, we dated the bone collagen of 26 herbivorous and one aquatic mammals from clear archaeological contexts and discovered that the most recent occupational phases at both sites are several centuries younger than previously thought. This is consistent with material evidence of lifestyle changes in the final phase at Hardinxveld-Giessendam de Bruin, which is now, according to our chronology, contemporaneous with the similar patterns produced in the region.

Intra-individual comparison of gadolinium-enhanced MRI using pseudo-golden-angle radial acquisition with gadoxetic acid-enhanced MRI for diagnosis of HCCs using LI-RADS.

OBJECTIVES: To determine the usefulness of extracellular contrast agent (ECA)-enhanced multiphasic liver magnetic resonance imaging (MRI) using a pseudo-golden-angle radial acquisition scheme by intra-individual comparison with gadoxetic acid-MRI (EOB-MRI) with regard to image quality and the diagnosis of hepatocellular carcinoma (HCC). MATERIALS AND METHODS: This prospective study enrolled 15 patients with 18 HCCs who underwent EOB-MRI using a Cartesian approach and ECA-MRI using the pseudo-golden-angle radial acquisition scheme (free-breathing continuous data acquisition for 64 s following ECA injection, generating six images). Two reviewers evaluated the arterial and portal phases of each MRI for artifacts, organ sharpness, and conspicuity of intrahepatic vessels and the hepatic tumors. A Liver Imaging Reporting and Data System category was also assigned to each lesion. RESULTS: There were no differences in the subjective image quality analysis between the arterial phases of two MRIs (p > 0.05). However, ghosting artifact was seen only in EOB-MRI (N = 3). Six HCCs showed different signal intensities in the arterial phase or portal phase between the two MRIs; five HCCs showed arterial hyperenhancement on ECA-MRI, but not on EOB-MRI. The capsule was observed in 15 HCCs on ECA-MRI and 6 HCCs on EOB-MRI. Five and one HCC were assigned as LR-5 and LR-4 with ECA-MRI and LR-4 and LR-3 with EOB-MRI, respectively. CONCLUSION: Free-breathing ECA-enhanced multiphasic liver MRI using a pseudo-golden-angle radial acquisition was more sensitive in detecting arterial hyperenhancement of HCC than conventional EOB-MRI, and the image quality was acceptable. KEY POINTS: • The pseudo-golden-angle radial acquisition scheme can be applied to perform free-breathing multiphasic dynamic liver MRI. • Adopting the pseudo-golden-angle radial acquisition scheme can improve the detection of arterial enhancement of HCC. • The pseudo-golden-angle radial acquisition scheme enables motion-free liver MRI.

Remarkable diversity of tick or mammalian-associated Borreliae in the metropolitan San Francisco Bay Area, California.

The diversity of Lyme disease (LD) and relapsing fever (RF)-group spirochetes in the metropolitan San Francisco Bay area in northern California is poorly understood. We tested Ixodes pacificus, I. spinipalpis, and small mammals for presence of borreliae in Alameda County in the eastern portion of San Francisco Bay between 2009 and 2012. Analyses of 218 Borrelia burgdorferi sensu lato (Bb sl) culture or DNA isolates recovered from host-seeking I. pacificus ticks revealed that the human pathogen Bb sensu stricto (hereinafter, B. burgdorferi) had the broadest habitat distribution followed by B. bissettii. Three other North American Bb sl spirochetes, B. americana, B. californiensis and B. genomospecies 2, also were detected at lower prevalence. OspC genotyping of the resultant 167 B. burgdorferi isolates revealed six ospC alleles (A, D, E3, F, H and K) in I. pacificus. A novel spirochete belonging to the Eurasian Bb sl complex, designated CA690, was found in a questing I. spinipalpis nymph. Borrelia miyamotoi, a relapsing-fever (RF) group spirochete recently implicated as a human pathogen, was detected in 24 I. pacificus. Three rodent species were infected with Bb sl: the fox squirrel (Sciurus niger) with B. burgdorferi, and the dusky-footed wood rat (Neotoma fuscipes) and roof rat (Rattus rattus) with B. bissettii. Another spirochete that clustered phylogenetically with the Spanish R57 Borrelia sp. in a clade distinct from both the LD and RF groups infected some of the roof rats. Together, eight borrelial genospecies were detected in ticks or small mammals from a single Californian county, two of which were related phylogenetically to European spirochetes.

What role do traditional beliefs play in treatment seeking and delay for Buruli ulcer disease?--insights from a mixed methods study in Cameroon.

BACKGROUND: Victims of Buruli ulcer disease (BUD) frequently report to specialized units at a late stage of the disease. This delay has been associated with local beliefs and a preference for traditional healing linked to a reportedly mystical origin of the disease. We assessed the role beliefs play in determining BUD sufferers' choice between traditional and biomedical treatments. METHODS: Anthropological fieldwork was conducted in community and clinical settings in the region of Ayos and Akonolinga in Central Cameroon. The research design consisted of a mixed methods study, triangulating a qualitative strand based on ethnographic research and quantitative data obtained through a survey presented to all patients at the Ayos and Akonolinga hospitals (N = 79) at the time of study and in four endemic communities (N = 73) belonging to the hospitals' catchment area. RESULTS: The analysis of BUD sufferers' health-seeking behaviour showed extremely complex therapeutic itineraries, including various attempts and failures both in the biomedical and traditional fields. Contrary to expectations, nearly half of all hospital patients attributed their illness to mystical causes, while traditional healers admitted patients they perceived to be infected by natural causes. Moreover, both patients in hospitals and in communities often combined elements of both types of treatments. Ultimately, perceptions regarding the effectiveness of the treatment, the option for local treatment as a cost prevention strategy and the characteristics of the doctor-patient relationship were more determinant for treatment choice than beliefs. DISCUSSION: The ascription of delay and treatment choice to beliefs constitutes an over-simplification of BUD health-seeking behaviour and places the responsibility directly on the shoulders of BUD sufferers while potentially neglecting other structural elements. While more efficacious treatment in the biomedical sector is likely to reduce perceived mystical involvement in the disease, additional decentralization could constitute a key element to reduce delay and increase adherence to biomedical treatment.

"It is me who endures but my family that suffers": social isolation as a consequence of the household cost burden of Buruli ulcer free of charge hospital treatment.

Despite free of charge biomedical treatment, the cost burden of Buruli ulcer disease (Bu) hospitalisation in Central Cameroon accounts for 25% of households' yearly earnings, surpassing the threshold of 10%, which is generally considered catastrophic for the household economy, and calling into question the sustainability of current Bu programmes. The high non-medical costs and productivity loss for Bu patients and their households make household involvement in the healing process unsustainable. 63% of households cease providing social and financial support for patients as a coping strategy, resulting in the patient's isolation at the hospital. Social isolation itself was cited by in-patients as the principal cause for abandonment of biomedical treatment. These findings demonstrate that further research and investment in Bu are urgently needed to evaluate new intervention strategies that are socially acceptable and appropriate in the local context.