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Concept: Northern Europe


Almost 150 years after the first identification of Neandertal skeletal material, the cognitive and symbolic abilities of these populations remain a subject of intense debate. We present 99 new Neandertal remains from the Troisième caverne of Goyet (Belgium) dated to 40,500-45,500 calBP. The remains were identified through a multidisciplinary study that combines morphometrics, taphonomy, stable isotopes, radiocarbon dating and genetic analyses. The Goyet Neandertal bones show distinctive anthropogenic modifications, which provides clear evidence for butchery activities as well as four bones having been used for retouching stone tools. In addition to being the first site to have yielded multiple Neandertal bones used as retouchers, Goyet not only provides the first unambiguous evidence of Neandertal cannibalism in Northern Europe, but also highlights considerable diversity in mortuary behaviour among the region’s late Neandertal population in the period immediately preceding their disappearance.

Concepts: Belgium, Northern Europe, Neanderthal, Carbon-14, Psychology, Critical thinking, Radiocarbon dating, Isotope


Investigations at Happisburgh, UK, have revealed the oldest known hominin footprint surface outside Africa at between ca. 1 million and 0.78 million years ago. The site has long been recognised for the preservation of sediments containing Early Pleistocene fauna and flora, but since 2005 has also yielded humanly made flint artefacts, extending the record of human occupation of northern Europe by at least 350,000 years. The sediments consist of sands, gravels and laminated silts laid down by a large river within the upper reaches of its estuary. In May 2013 extensive areas of the laminated sediments were exposed on the foreshore. On the surface of one of the laminated silt horizons a series of hollows was revealed in an area of ca. 12 m(2). The surface was recorded using multi-image photogrammetry which showed that the hollows are distinctly elongated and the majority fall within the range of juvenile to adult hominin foot sizes. In many cases the arch and front/back of the foot can be identified and in one case the impression of toes can be seen. Using foot length to stature ratios, the hominins are estimated to have been between ca. 0.93 and 1.73 m in height, suggestive of a group of mixed ages. The orientation of the prints indicates movement in a southerly direction on mud-flats along the river edge. Early Pleistocene human fossils are extremely rare in Europe, with no evidence from the UK. The only known species in western Europe of a similar age is Homo antecessor, whose fossil remains have been found at Atapuerca, Spain. The foot sizes and estimated stature of the hominins from Happisburgh fall within the range derived from the fossil evidence of Homo antecessor.

Concepts: Netherlands, Northern Europe, Europe, Foot, Western Europe, Human evolution, United Kingdom, Human


The human settlement of Europe during Pleistocene times was sporadic and several stages have been recognized, both from paleaoanthropological and archaeological records. If the first phase of hominin occupation (as early as 1.4 Ma) seems mainly restricted to the southern part of the continent, the second phase, characterized by specific lithic tools (handaxes), is linked to Acheulean settlements and to the emergence of Homo heidelbergensis, the ancestor of Neanderthals. This phase reached northwestern Europe and is documented in numerous sites in Germany, Great Britain and northern France, generally after 600 ka. At la Noira (Brinay, Central France), the Middle Pleistocene alluvial formation of the Cher River covers an archaeological level associated with a slope deposit (diamicton). The lithic assemblage from this level includes Large Cutting Tools (LCTs), flakes and cores, associated with numerous millstone slabs. The lithic series is classified as Acheulean on the basis of both technological and typological analyses. Cryoturbation features indicate that the slope deposits and associated archaeological level were strongly frozen and disturbed after hominin occupation and before fluvial deposition. Eight sediment samples were dated by the electron spin resonance (ESR) method and the weighted average age obtained for the fluvial sands overlying the slope deposits is 665±55 ka. This age is older than previous chronological data placing the first European Acheulean assemblages north of 45(th) parallel north at around 500 ka and modifies our current vision of the initial peopling of northern Europe. Acheulean settlements are older than previously assumed and the oldest evidences are not only located in southern Europe. La Noira is the oldest evidence of Acheulean presence in north-western Europe and attests to the possibility of pioneering phases of Acheulean settlement which would have taken place on a Mode 1-type substratum as early as 700 ka. The lithic assemblage from la Noira thus provides behavioral and technological data on early Acheulean occupation in Europe and contributes to our understanding of the diffusion of this tradition.

Concepts: France, Northern Europe, United Kingdom, Acheulean, Europe, Archaeology, Great Britain, Western Europe


Radiotherapy is used for cure or palliation in around half of patients with cancer. We analysed data on radiotherapy equipment in 33 European countries registered in the Directory of Radiotherapy Centres (DIRAC) database, managed by the International Atomic Energy Agency. As of July, 2012, Europe had 1286 active radiotherapy centres. The average number of teletherapy machines per radiotherapy centre ranged from 1·2 to 7·0 in different countries. Nordic countries, the UK, the Netherlands, and Slovenia all have large centres with four to ten teletherapy machines. Most western and southern European countries have several small centres with one or two machines, with few larger centres. The fragmentation in radiotherapy services that prevails in many European countries might affect the economic burden of radiotherapy and its quality. Eastern and southeastern European countries need to expand and modernise their radiotherapy equipment.

Concepts: NATO, Slovenia, European Union, Eastern Europe, Netherlands, Northern Europe, Europe, International Atomic Energy Agency


Previous guidelines on consent for anaesthesia were issued by the Association of Anaesthetists of Great Britain and Ireland in 1999 and revised in 2006. The following guidelines have been produced in response to the changing ethical and legal background against which anaesthetists, and also intensivists and pain specialists, currently work, while retaining the key principles of respect for patients' autonomy and the need to provide adequate information. The main points of difference between the relevant legal frameworks in England and Wales and Scotland, Northern Ireland and the Republic of Ireland are also highlighted.

Concepts: Ireland, Wales, Republic of Ireland, Northern Europe, England, Scotland, United Kingdom of Great Britain and Ireland, United Kingdom


Objectives. We compared cycling injury risks of 14 route types and other route infrastructure features. Methods. We recruited 690 city residents injured while cycling in Toronto or Vancouver, Canada. A case-crossover design compared route infrastructure at each injury site to that of a randomly selected control site from the same trip. Results. Of 14 route types, cycle tracks had the lowest risk (adjusted odds ratio [OR] = 0.11; 95% confidence interval [CI] = 0.02, 0.54), about one ninth the risk of the reference: major streets with parked cars and no bike infrastructure. Risks on major streets were lower without parked cars (adjusted OR = 0.63; 95% CI = 0.41, 0.96) and with bike lanes (adjusted OR = 0.54; 95% CI = 0.29, 1.01). Local streets also had lower risks (adjusted OR = 0.51; 95% CI = 0.31, 0.84). Other infrastructure characteristics were associated with increased risks: streetcar or train tracks (adjusted OR = 3.0; 95% CI = 1.8, 5.1), downhill grades (adjusted OR = 2.3; 95% CI = 1.7, 3.1), and construction (adjusted OR = 1.9; 95% CI = 1.3, 2.9). Conclusions. The lower risks on quiet streets and with bike-specific infrastructure along busy streets support the route-design approach used in many northern European countries. Transportation infrastructure with lower bicycling injury risks merits public health support to reduce injuries and promote cycling.

Concepts: Automobile, Northern Europe, Segregated cycle facilities, Physical trauma, Injury, Sustainable transport, Bicycle, Cycling


The Mesolithic-to-Neolithic transition marked the time when a hunter-gatherer economy gave way to agriculture, coinciding with rising sea levels. Bouldnor Cliff, is a submarine archaeological site off the Isle of Wight in the United Kingdom that has a well-preserved Mesolithic paleosol dated to 8000 years before the present. We analyzed a core obtained from sealed sediments, combining evidence from microgeomorphology and microfossils with sedimentary ancient DNA (sedaDNA) analyses to reconstruct floral and faunal changes during the occupation of this site, before it was submerged. In agreement with palynological analyses, the sedaDNA sequences suggest a mixed habitat of oak forest and herbaceous plants. However, they also provide evidence of wheat 2000 years earlier than mainland Britain and 400 years earlier than proximate European sites. These results suggest that sophisticated social networks linked the Neolithic front in southern Europe to the Mesolithic peoples of northern Europe.

Concepts: Northern Europe, English Channel, British people, England, British Isles, Isle of Man, Europe, United Kingdom


In the current mass migration to central and northern Europe, Munich has seen Germany’s largest influx of refugees - as many as 20,000 over a single weekend. The way in which their medical needs have been handled offers insight into the main challenges and their solutions.

Concepts: Czechoslovakia, Northern Europe, Frankfurt am Main, Eastern Europe, Western Europe, Central Europe, Germany, Europe


Reductions in Arctic sea ice may promote the negative phase of the North Atlantic Oscillation (NAO-). It has been argued that NAO-related variability can be used an as analogue to predict the effects of Arctic sea ice loss on mid-latitude weather. As NAO- events are associated with colder winters over Northern Europe, a negatively shifted NAO has been proposed as a dynamical pathway for Arctic sea ice loss to cause Northern European cooling. This study uses large-ensemble atmospheric simulations with prescribed ocean surface conditions to examine how seasonal-scale NAO- events are affected by Arctic sea ice loss. Despite an intensification of NAO- events, reflected by more prevalent easterly flow, sea ice loss does not lead to Northern European winter cooling and daily cold extremes actually decrease. The dynamical cooling from the changed NAO is ‘missing’, because it is offset (or exceeded) by a thermodynamical effect owing to advection of warmer air masses.

Concepts: Northern Europe, United Kingdom, Europe, Ocean, Eastern Europe, Norway, Atlantic Ocean, Arctic Ocean


European guidelines recommend the routine offer of an HIV test in patients with a number of AIDS-defining and non-AIDS conditions believed to share an association with HIV; so called indicator conditions (IC). Adherence with this guidance across Europe is not known. We audited HIV testing behaviour in patients accessing care for a number of ICs. Participating centres reviewed the case notes of either 100 patients or of all consecutive patients in one year, presenting for each of the following ICs: tuberculosis, non-Hodgkins lymphoma, anal and cervical cancer, hepatitis B and C and oesophageal candidiasis. Observed HIV-positive rates were applied by region and IC to estimate the number of HIV diagnoses potentially missed. Outcomes examined were: HIV test rate (% of total patients with IC), HIV test accepted (% of tests performed/% of tests offered) and new HIV diagnosis rate (%). There were 49 audits from 23 centres, representing 7037 patients. The median test rate across audits was 72% (IQR 32-97), lowest in Northern Europe (median 44%, IQR 22-68%) and highest in Eastern Europe (median 99%, IQR 86-100). Uptake of testing was close to 100% in all regions. The median HIV+ rate was 0.9% (IQR 0.0-4.9), with 29 audits (60.4%) having an HIV+ rate >0.1%. After adjustment, there were no differences between regions of Europe in the proportion with >0.1% testing positive (global p = 0.14). A total of 113 patients tested HIV+. Applying the observed rates of testing HIV+ within individual ICs and regions to all persons presenting with an IC suggested that 105 diagnoses were potentially missed. Testing rates in well-established HIV ICs remained low across Europe, despite high prevalence rates, reflecting missed opportunities for earlier HIV diagnosis and care. Significant numbers may have had an opportunity for HIV diagnosis if all persons included in IC audits had been tested.

Concepts: Lymphoma, Cervical cancer, Northern Europe, Central Europe, Viral load, HIV, Western Europe, Eastern Europe