Climate change, human health, and resilience in the Holocene.

Climate change is an indisputable threat to human health, especially for societies already confronted with rising social inequality, political and economic uncertainty, and a cascade of concurrent environmental challenges. Archaeological data about past climate and environment provide an important source of evidence about the potential challenges humans face and the long-term outcomes of alternative short-term adaptive strategies. Evidence from well-dated archaeological human skeletons and mummified remains speaks directly to patterns of human health over time through changing circumstances. Here, we describe variation in human epidemiological patterns in the context of past rapid climate change (RCC) events and other periods of past environmental change. Case studies confirm that human communities responded to environmental changes in diverse ways depending on historical, sociocultural, and biological contingencies. Certain factors, such as social inequality and disproportionate access to resources in large, complex societies may influence the probability of major sociopolitical disruptions and reorganizations-commonly known as "collapse." This survey of Holocene human-environmental relations demonstrates how flexibility, variation, and maintenance of Indigenous knowledge can be mitigating factors in the face of environmental challenges. Although contemporary climate change is more rapid and of greater magnitude than the RCC events and other environmental changes we discuss here, these lessons from the past provide clarity about potential priorities for equitable, sustainable development and the constraints of modernity we must address.

Dental health in Roman dogs: A pilot study using standardized examination methods.

OBJECTIVE: To utilize standardized clinical veterinary methods to analyze dental health in a series of Roman dog maxillae and mandibles and to compare results to modern clinical data. MATERIALS: 28 skulls of juvenile and adult dogs from three archaeological sites in Switzerland and Germany dating to the Roman period. METHODS: Standardized examination was carried out, which included metric radiographic assessment to diagnose oral pathology and estimate age at death. In one case, CT analysis was undertaken. RESULTS: The estimated average age at death was between three and four years old. Tooth fracture, periodontal disease, the presence of non-vital teeth, and brachycephalic skull form were found in the sample. Tooth resorption was unexpectedly noted. CONCLUSION: The study provides valuable insights into the dental health of dogs in the Roman era. Compared to modern dogs, Roman dogs examined in this study appear to have a shorter lifespan but display a high rate of pathological dental disease, while disease patterns were very similar to those of modern dogs. Dogs with pronounced brachycephalic features were found. SIGNIFICANCE: This pilot study is the first to use standardized clinical examination and recording techniques to assess dental health in dogs from archaeological contexts. It provides insight into the dental health of Roman era dogs and offers data upon which cross-populational studies can be initiated. LIMITATIONS: The sample size and geographic location of the archaeological sites were limited. SUGGESTIONS FOR FURTHER RESEARCH: Subsequent standardized studies, preferably in as many different Roman Empire regions as possible, are recommended.

Impact of early telemedicine follow-up on 30-Day hospital readmissions.

INTRODUCTION: Telemedicine is increasing in popularity but the impact of this shift on patient outcomes has not been well described. Prior data has shown that early post-discharge office visits can reduce readmissions. However, it is unknown if routine use of telemedicine visits for this purpose is similarly beneficial. MATERIALS AND METHODS: We conducted a retrospective observational study using electronic health records data to assess if the rate of 30-day hospital readmissions differed between modality of visit for primary care or cardiology post-discharge follow-up visits. RESULTS: Compared to discharges with completed in-person follow-up visits, the adjusted odds of readmission for those with telemedicine follow-up visits was not significantly different (odds ratio [OR] 0.96, 95% confidence interval [CI] 0.61 to 1.51, P = 0.86). CONCLUSIONS: Our study showed that 30-day readmission rate did not differ significantly according to the modality of visit. These results provide reassurance that telemedicine visits are a safe and viable alternative for primary care or cardiology post-hospitalization follow-up.

Examining medication ordering errors using AHRQ network of patient safety databases.

BACKGROUND: Studies examining the effects of computerized order entry (CPOE) on medication ordering errors demonstrate that CPOE does not consistently prevent these errors as intended. We used the Agency for Healthcare Research and Quality (AHRQ) Network of Patient Safety Databases (NPSD) to investigate the frequency and degree of harm of reported events that occurred at the ordering stage, characterized by error type. MATERIALS AND METHODS: This was a retrospective observational study of safety events reported by healthcare systems in participating patient safety organizations from 6/2010 through 12/2020. All medication and other substance ordering errors reported to NPSD via common format v1.2 between 6/2010 through 12/2020 were analyzed. We aggregated and categorized the frequency of reported medication ordering errors by error type, degree of harm, and demographic characteristics. RESULTS: A total of 12 830 errors were reported during the study period. Incorrect dose accounted for 3812 errors (29.7%), followed by incorrect medication 2086 (16.3%), and incorrect duration 765 (6.0%). Of 5282 events that reached the patient and had a known level of severity, 12 resulted in death, 4 resulted in severe harm, 45 resulted in moderate harm, 341 resulted in mild harm, and 4880 resulted in no harm. CONCLUSION: Incorrect dose and incorrect drug orders were the most commonly reported and harmful types of medication ordering errors. Future studies should aim to develop and test interventions focused on CPOE to prevent medication ordering errors, prioritizing wrong-dose and wrong-drug errors.

Forensic anthropology casework at the Cook County Illinois Medical Examiner's Office, Chicago, IL, 2012-2022.

Forensic anthropology has grown in recent years with increased methodological standardization, technical advancements, and increasing numbers of academic institutions offering coursework and programs at the undergraduate and graduate levels. However, few practicing forensic anthropologists publish the composition of their casework, resulting in limited understanding of the true mechanics of the field by academics and forensic professionals. This study reports on forensic anthropology casework at the Cook County Medical Examiner's Office between March 2012 and February 2022. A total of 132 cases were evaluated. Results indicate that peak months of discovery were June (n = 19) and September (n = 17), with the fewest in January (n = 5). Most discovery contexts were outdoor surface recoveries (n = 55) and were fully skeletonized (n = 47). The majority of consultation requests consisted of biological profile estimation (n = 99). An average of 77.1 days elapsed from discovery to anthropology consult, 60.3 days from consultation to anthropological analysis, and 14.1 days from analysis to report submission. Assessment of the data indicates that the impact of seasonal variation, changing Medical Examiner personnel, as well as the complexity of cases influence forensic anthropology casework in Cook County. Report and discussion of forensic anthropologists' casework strengthens our understanding of the field, allows for the formulation of best practices, and serves as data upon which decisions regarding protocol, funding, resources, and need can be based. With additional practitioners collecting and sharing their data, a clearer understanding of the scope and utility of the field will be appreciated by colleagues and the greater forensic scientific community.

The Impact of Telemedicine Visits on the Controlling High Blood Pressure Quality Measure During the COVID-19 Pandemic: Retrospective Cohort Study.

BACKGROUND: Telemedicine visit use vastly expanded during the COVID-19 pandemic, and this has had an uncertain impact on cardiovascular care quality. OBJECTIVE: We sought to examine the association between telemedicine visits and the failure to meet the Controlling High Blood Pressure (BP) quality measure from the Centers for Medicare & Medicaid Services. METHODS: This was a retrospective cohort study of 32,727 adult patients with hypertension who were seen in primary care and cardiology clinics at an urban, academic medical center from February to December 2020. The primary outcome was a failure to meet the Controlling High Blood Pressure quality measure, which was defined as having no BP recorded or having a last recorded BP of ≥140/90 mm Hg (ie, poor BP control). Multivariable logistic regression was used to assess the association between telemedicine visit use during the study period (none, 1 telemedicine visit, or ≥2 telemedicine visits) and poor BP control; we adjusted for demographic and clinical characteristics. RESULTS: During the study period, no BP was recorded for 2.3% (486/20,745) of patients with in-person visits only, 27.1% (1863/6878) of patients with 1 telemedicine visit, and 25% (1277/5104) of patients with ≥2 telemedicine visits. After adjustment, telemedicine use was associated with poor BP control (1 telemedicine visit: odds ratio [OR] 2.06, 95% CI 1.94-2.18; P<.001; ≥2 telemedicine visits: OR 2.49, 95% CI 2.31-2.68; P<.001; reference: in-person visits only). This effect disappeared when the analysis was restricted to patients with at least 1 recorded BP (1 telemedicine visit: OR 0.89, 95% CI 0.83-0.95; P=.001; ≥2 telemedicine visits: OR 0.91, 95% CI 0.83-0.99; P=.03). CONCLUSIONS: Increased telemedicine visit use is associated with poorer performance on the Controlling High Blood Pressure quality measure. However, telemedicine visit use may not negatively impact BP control when BP is recorded.

Indication alerts to improve problem list documentation.

BACKGROUND: Problem lists represent an integral component of high-quality care. However, they are often inaccurate and incomplete. We studied the effects of alerts integrated into the inpatient and outpatient computerized provider order entry systems to assist in adding problems to the problem list when ordering medications that lacked a corresponding indication. METHODS: We analyzed medication orders from 2 healthcare systems that used an innovative indication alert. We collected data at site 1 between December 2018 and January 2020, and at site 2 between May and June 2021. We reviewed random samples of 100 charts from each site that had problems added in response to the alert. Outcomes were: (1) alert yield, the proportion of triggered alerts that led to a problem added and (2) problem accuracy, the proportion of problems placed that were accurate by chart review. RESULTS: Alerts were triggered 131 134, and 6178 times at sites 1 and 2, respectively, resulting in a yield of 109 055 (83.2%) and 2874 (46.5%), P< .001. Orders were abandoned, for example, not completed, in 11.1% and 9.6% of orders, respectively, P<.001. Of the 100 sample problems, reviewers deemed 88% ± 3% and 91% ± 3% to be accurate, respectively, P = .65, with a mean of 90% ± 2%. CONCLUSIONS: Indication alerts triggered by medication orders initiated in the absence of a justifying diagnosis were useful for populating problem lists, with yields of 83.2% and 46.5% at 2 healthcare systems. Problems were placed with a reasonable level of accuracy, with 90% ± 2% of problems deemed accurate based on chart review.

Twenty-first century bioarchaeology: Taking stock and moving forward.

This article presents outcomes from a Workshop entitled "Bioarchaeology: Taking Stock and Moving Forward," which was held at Arizona State University (ASU) on March 6-8, 2020. Funded by the National Science Foundation (NSF), the School of Human Evolution and Social Change (ASU), and the Center for Bioarchaeological Research (CBR, ASU), the Workshop's overall goal was to explore reasons why research proposals submitted by bioarchaeologists, both graduate students and established scholars, fared disproportionately poorly within recent NSF Anthropology Program competitions and to offer advice for increasing success. Therefore, this Workshop comprised 43 international scholars and four advanced graduate students with a history of successful grant acquisition, primarily from the United States. Ultimately, we focused on two related aims: (1) best practices for improving research designs and training and (2) evaluating topics of contemporary significance that reverberate through history and beyond as promising trajectories for bioarchaeological research. Among the former were contextual grounding, research question/hypothesis generation, statistical procedures appropriate for small samples and mixed qualitative/quantitative data, the salience of Bayesian methods, and training program content. Topical foci included ethics, social inequality, identity (including intersectionality), climate change, migration, violence, epidemic disease, adaptability/plasticity, the osteological paradox, and the developmental origins of health and disease. Given the profound changes required globally to address decolonization in the 21st century, this concern also entered many formal and informal discussions.

No stone unturned: The presence of kidney stones in a skeleton from 19th century Peoria, Illinois.

During the excavation of the 19th century Peoria City Cemetery (Peoria, Illinois), a skeleton of a female, aged 20-30 years old, was found with large, bilateral calcified masses in the abdominal region. The masses were analyzed by Fourier transform infrared (FTIR) spectroscopy, and the results compared to published clinical data in an effort to determine the etiology of the stones. The calcified masses were determined to be staghorn struvite uroliths, which commonly result from chronic urinary tract infection and likely impacted the overall health of this individual.