OBJECTIVES/GOALS: Older adults in rural communities are at an elevated risk of falling. Perturbation-Based Balance Training (PBT) is a highly effective fall prevention paradigm but its feasibility in the community is unknown. The purpose of this study was to determine the feasibility and acceptability of PBT to older adults and local clinicians in rural communities. METHODS/STUDY POPULATION: 19 older adults (60+ years) were recruited from communities in rural Montana to take part in a PBT program. The PBT program was implemented using a bespoke portable PBT treadmill developed by our research team and validated against commercial PBT treadmills. To increase ecological validity, the program was implemented by local clinicians. The PBT program lasted 6 weeks, with 1 session per week, participants received up to 35 trip perturbations per session. The feasibility and acceptability of PBT to participants and clinicians was assessed within the Theoretical Framework of Acceptability, prospectively and retrospectively via interviews and surveys, and concurrently via field notes. RESULTS/ANTICIPATED RESULTS: Data analysis is ongoing and will be complete by the time of presentation. Preliminary results suggest the portable PBT program was generally acceptable to older adults and local clinicians. Perceived effectiveness was generally positive and increased balance awareness and low burden are emerging as common themes. Local clinicians indicated the burden of implementing PBT was low, PBT fit within their views on fall prevention, and had a high level of perceived effectiveness. There appear to be a few limitations to feasibility, which are primarily related to the weight and transportation of the treadmill. We are currently working to refine the treadmill and lower its weight and are developing a grant with local clinicians and extension agents that would facilitate transportation to a broader network of communities. DISCUSSION/SIGNIFICANCE: Our preliminary findings suggest PBT is feasible in rural communities and accepted by older adults. Increased balance and fall awareness and low burden are emerging as important factors in the feasibility and acceptability of PBT. This study provides a foundation for future studies to translate other PBT modalities from the lab to the community.

Thirty years after the discovery of an Early Neolithic timber hall at Balbridie in Scotland was reported in Antiquity, new analysis of the site's archaeobotanical assemblage, featuring 20 000 cereal grains preserved when the building burnt down in the early fourth millennium BC, provides new insights into early farming practices. The results of stable isotope analyses of cereals from Balbridie, alongside archaeobotanical and stable isotope results from three other sites, indicate that while cereals were successfully cultivated in well-established plots without manuring at Balbridie, a variety of manuring strategies was implemented at the other sites. These differences reinforce the picture of variability in cultivation practices across Neolithic North-west Europe.

Informal care-givers play an important role, with health-care systems relying on the billions of hours of care they provide. Care-givers experience high levels of psychological distress and isolation; however, the efficacy of what support is the best for care-givers is unclear. The primary aim of this systematic review is to determine the effect of group creative arts interventions on informal care-givers of adults. The secondary aim is to understand the impact of group type, the primary outcomes and how they are measured. Given the heterogeneous nature of the included studies, a narrative synthesis approach was taken. Database searches identified 2,587 studies, 25 of which met the full inclusion criteria. Studies included group creative arts interventions for either care-givers only (N = 8) or for care-giver/cared-for dyads (N = 17). The majority of the participants in the studies were older Caucasian females. Group creative arts interventions are beneficial for care-givers and for the person being cared for; however, benefits differ depending on whether the group is for care-givers only or for care-giver/cared-for dyads. Future research will benefit from care-givers being involved in the design of the creative arts intervention to provide input regarding group type and relevant outcome measures. Future research should consider targeting their intervention to care-givers with a low baseline score to increase the ability of the study to demonstrate a significant difference.

The introduction of agriculture is a key defining element of the Neolithic, yet considerable debate persists concerning the nature and significance of early farming practices in north-west Europe. This paper reviews archaeobotanical evidence from 95 Neolithic sites (c. 4000–2200 cal bc) in Wales, focusing on wild plant exploitation, the range of crops present, and the significance of cereals in subsistence practices. Cereal cultivation practices in Early Neolithic Wales are also examined using cereal grain stable carbon (δ13C) and nitrogen (δ15N) isotope analysis. The Early Neolithic period witnessed the widespread uptake of cereals alongside considerable evidence for continued wild plant exploitation, notably hazelnuts and wild fruits. The possibility that wild plants and woodlands were deliberately managed or altered to promote the growth of certain plants is outlined. Small cereal grain assemblages, with little evidence for chaff and weed seeds, are common in the Early Neolithic, whereas cereal-rich sites are rare. Emmer wheat was the dominant crop in the Early Neolithic, while other cereal types were recorded in small quantities. Cereal nitrogen isotope (δ15N) values from Early Neolithic sites provided little evidence for intensive manuring. We suggest that cultivation conditions may have been less intensive when compared to other areas of Britain and Europe. In the later Neolithic period, there is evidence for a decline in the importance of cereals. Finally, the archaeobotanical and crop isotope data from this study are considered within a wider European context.

The Coneybury ‘Anomaly’ is an Early Neolithic pit located just south-east of Stonehenge, Wiltshire. Excavations recovered a faunal assemblage unique in its composition, consisting of both wild and domestic species, as well as large quantities of ceramics and stone tools, including a substantial proportion of blades/bladelets. We present a suite of new isotope analyses of the faunal material, together with ancient DNA sex determination, and reconsider the published faunal data to ask: What took place at Coneybury, and who was involved? We argue on the basis of multiple lines of evidence that Coneybury represents the material remains of a gathering organised by a regional community, with participants coming from different areas. One group of attendees provided deer instead of, or in addition to, cattle. We conclude that the most likely scenario is that this group comprised local hunter-gatherers who survived alongside local farmers.

Introduction: Online medical education resources are widely used in emergency medicine (EM), but strategies to assess quality remain elusive. We previously derived the Medical Education Translational Resources: Impact and Quality (METRIQ) 8 instrument to evaluate quality in medical education blog posts. Methods: As part of a subsequent validation study (The METRIQ Blog Study), a mixed-methods usability analysis was performed to obtain user feedback on the quality assessment instrument in order to improve its clarity and reliability. Participants in the METRIQ Study were first asked to rate five blog posts using the METRIQ-8 Score. They then evaluated the METRIQ-8 instruments ease of use and likelihood of being recommended to others using a 7-point Likert scale and free text comments. Participants were also asked to flag and comment on items within the score that they felt were unclear. Global usability ratings were summarized using median scores or percent rated unclear. We used ANOVA to test associations between ease of use and demographic factors. A thematic analysis was performed on the comments. Results: 309 EM medical students, residents, and attendings completed the survey. Global ratings were generally very favorable (median 2 [IQR 2-3], with 7 being the lowest score) for ease of use and likelihood of recommendation, and did not vary by participants country of origin, frequency of blog use, or learner level. Participants stated that the score was structured, systematic, and straightforward. They found it useful for junior learners and for guiding blog creation. Four questions in the score (questions 2, 4, 5, and 7) were identified by 10% of subjects to be unclear. Thematic analysis of comments identified suggested four main themes for improving the score: adding clearer definitions with marking rubrics; shortening the 7-point scale; adding items evaluating blog post presentation and utility; and, rephrasing the wording of certain questions for clarity. Conclusion: A mixed methods usability analysis of the METRIQ-8 instrument for assessing blog quality was globally well received by EM medical students, residents, and attendings. Qualitative analyses revealed multiple areas to improve the instruments clarity and usability. The METRIQ score is a promising instrument for evaluating the quality of blogs; further development and testing is needed to improve its utility.

Ecomorphological and biogeochemical (trace element, and carbon, nitrogen, and oxygen isotope ratios) analyses have been used for determining the dietary niches and habitat preferences of large mammals from lower Pleistocene deposits at Venta Micena (Guadix-Baza Basin, Spain). The combination of these two approaches takes advantage of the strengths and overcome the weakness of both approaches. The range of δ13Ccollagen values for ungulate species indicates that C3 plants were dominant in the diet of these mammals. δ13Ccollagen values vary among ungulates: perissodactyls have the lowest values and bovids the highest ones, with cervids showing intermediate values. The hypsodonty index measured in lower molar teeth and the relative length of the lower premolar tooth row indicate that the horse, Equus altidens, was a grazing species, whereas the rhino, Stephanorhinus etruscus, was a mixed feeder in open habitats. The similar δ13Ccollagen values shown in both perissodactyls does not reflect differences in feeding behavior with other ungulates, but rather a lower isotope enrichment factor in these monogastric herbivores than in ruminants, owing to their lower metabolic efficiency. The cervids Eucladoceros giulii and Dama sp. show low hypsodonty values, indicating that they were mixed feeders or browsers from forested habitats, an ecomorphologically based conclusion corroborated in the former by its low δ15Ncollagen content (canopy effect). Bovid species (Bovini aff. Leptobos, Soergelia minor, and Hemitragus albus) presumably inhabited open environments, according to their comparatively high hypsodonty and δ15Ncollagen values. Carnivore species (Homotherium latidens, Megantereon whitei, Pachycrocuta brevirostris, Canis falconeri, and Canis etruscus) exhibit higher δ15Ncollagen values than ungulates. These results record the isotopic enrichment expected with an increase in trophic level and are also supported by low bone Sr.Zn ratios. The elevated δ15Ncollagen value for a sample of Mammuthus meridionalis, which came from an individual with unfused epiphyses, confirms that it was a suckling animal. The δ15Ncollagen value of the scimitar-cat H. latidens is well above that obtained for the young individual of Mammuthus, which indicates that juvenile elephants were an important part of its diet. The hippo, Hippopotamus antiquus, yielded unexpectedly high δ15Ncollagen values, which suggest feeding on aquatic, non-N2-fixing plants. The high δ18Ohydroxyl values of bovids Hemitragus and Soergelia and of cervid Dama indicate that these ungulates obtained most of their water requirements from the vegetation. The megaherbivores and Eucladoceros exhibit the lowest δ18Ohydroxyl values, which suggest increased water dependence for them. Paleosynecological analysis was based on the relative abundance of species of large mammals from different ecological categories, determined by feeding behavior and locomotion types. The comparison of the frequencies of such categories in Venta Micena with those found in modern African communities indicates that the composition of the paleocommunity closely resembles those of savannas with tall grass and shrubs. The net above-ground primary productivity estimated for the on-crop biomass of the mammalian species preserved in the fossil assemblage also yields a figure congruent with that expected for an open environment.

A coastal exposure at Wine Haven, Robin Hood's Bay (North Yorkshire, UK) fulfils the criteria for definition as the Global Stratotype Section and Point (GSSP) for the base of the Pliensbachian Stage (Lower Jurassic). This marine sequence was deposited during a long-term transgression and is relatively expanded stratigraphically. A rich fauna of ammonites above and below the boundary interval allows recognition of the Leptechioceras gr. meigeini, Paltechioceras aureolum and Paltechioceras tardecrescens horizons of latest Sinemurian age, and the Bifericeras donovani, and Apoderoceras gr. aculeatum horizons of earliest Pliensbachian age. A suitable level for the boundary is characterized by the faunal association of Bifericeras donovani Dommergues & Meister and Apoderoceras sp. Strontium-isotope stratigraphy, based on analysis of belemnites, yields a calcite 87Sr/86Sr ratio for the suggested boundary level of 0.707425±0.000021 (combined uncertainties based on line fit to stratigraphic dataset (±0.000004) and measurement of the standard (±0.000017)). Alternative uncertainties of ∼±0.000008 are associated with the most extreme interpretation of sedimentation-rate history allowed by the strontium-isotope data (that is, abrupt changes in sedimentation rate at precisely the boundary level); however, sedimentological considerations, and measured strontium-isotope values at the boundary, support condensation rather than hiatus. Belemnite oxygen-isotope data suggest a significant temperature drop (∼5 °C) across the boundary at this locality.